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Abstract
CONTEXT - The identification of precursor or dysplastic lesions in the thyroid is difficult. Pathology of the C cell has been extensively studied, and the preneoplastic nature of C-cell hyperplasia in the setting of familial medullary thyroid carcinomas is well established. However, the distinction between neoplastic and physiologic/reactive C-cell hyperplasia remains a challenge. Unlike C cells, the existence of a precursor lesion of follicular cell-derived tumors is less well established, and a dysplastic or preneoplastic follicular lesion has not been well defined. OBJECTIVE - To discuss putative precursor lesions in the thyroid arising from C cells and follicular epithelial cells. DATA SOURCES - Data were obtained from a review of the pertinent peer-reviewed literature. CONCLUSIONS - Although the preneoplastic nature of C-cell hyperplasia in the setting of familial medullary thyroid carcinoma is well recognized, the preneoplastic nature/malignant potential of reactive/physiologic C-cell hyperplasia and its role in the development of sporadic, medullary thyroid carcinoma is still unclear. Current data suggest that benign follicular lesions may have malignant potential, and there may be a multifocal progression from benign to malignant. Atypical follicular lesions in the background of chronic lymphocytic thyroiditis may represent dysplastic or premalignant lesions.
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Karkuzhali P, Yogambal M, Kumar M. An Indian Tertiary Care Hospital Scenario of Papillary Carcinoma of Thyroid. J Clin Diagn Res 2017; 11:EC26-EC29. [PMID: 28764174 DOI: 10.7860/jcdr/2017/27673.10095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/17/2017] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Thyroid carcinoma is the most common endocrine malignancy and its Papillary Histotype {Papillary Carcinoma of Thyroid (PTC)} is the most common type of Thyroid cancer. The clinicopathological features of PTC vary with geographical location. AIM To describe the clinicopathological profile of PTC in a Tertiary Care Hospital located in Chennai, Tamil Nadu, India. MATERIALS AND METHODS Data on age, sex, centricity of the tumour, presence of calcifications, infiltration, metastasis, associated non malignant conditions and frequency of histological subtypes of all cases of PTC diagnosed in Department of Pathology, Madras Medical College Chennai, Tamil Nadu, India between January 2007 and December 2011 were obtained from clinicopathological documents and analysed statistically. RESULTS Statistically significant correlations were found between age and sex, age and metastasis, sex and centricity, sex and metastasis, size of lesion and sex, size of lesion and age, size and presence of calcifications and presence of calcifications and metastasis. CONCLUSION Scenario of PTC in our tertiary care setup which warrants attention is male preponderance of multicentric lesions. Further, a high association with colloid nodular goitre, while low incidence of tall cell variant is notable clinico pathological scenarios in this study.
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Affiliation(s)
- Ponnuswamy Karkuzhali
- Former Director, Department of Pathology, Madras Medical College, Chennai, Tamilnadu, India
| | - Muthureddy Yogambal
- Assistant Professor, Department of Pathology, Stanley Medical College, Chennai, Tamilnadu, India
| | - Manoj Kumar
- Clinical Research Scholar, Department of Division of Pulmonary and Critical Care Medicine, Emory University, School of Medicine, Atlanta, GA, USA
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Resende de Paiva C, Grønhøj C, Feldt-Rasmussen U, von Buchwald C. Association between Hashimoto's Thyroiditis and Thyroid Cancer in 64,628 Patients. Front Oncol 2017; 7:53. [PMID: 28443243 PMCID: PMC5385456 DOI: 10.3389/fonc.2017.00053] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/13/2017] [Indexed: 11/22/2022] Open
Abstract
Background The incidence of thyroid cancer (TC) is increasing although explanatory causes are lacking. A link between cancer and inflammation is well documented but unclear for autoimmune thyroid diseases and TC. We aimed to systematically review the association between Hashimoto’s thyroiditis (HT) and papillary, follicular, medullary, anaplastic thyroid carcinoma, and thyroid lymphoma (TL). Methods PubMed, OVID Medline, Google Scholar, and the Cochrane Library were searched from 1955 to 2016. The inclusion criteria were age >18 years, ≥20 cases of HT or TC. We collectively examined the incidence of HT in TC and of TC in HT. Results We identified 36 studies (64,628 subjects) published between 1955 and 2016 from 13 countries. We found a relative risk (RR) of HT among papillary thyroid cancer (PTC) of 2.36 [95% confidence intervals (CIs) 1.55–3.29, p < 0.001], an RR of PTC among HT of 1.40 (95% CI 1.07–1.85, p = 0.016), and an RR of TL among HT of 9.74 (95% CI 3.93–24.13, p < 0.001). Conclusion We report an association between HT and PTC and between HT and TL. No association was found between HT and follicular, medullary, or anaplastic thyroid cancer.
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Affiliation(s)
- Christina Resende de Paiva
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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54
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Gao L, Ma B, Zhou L, Wang Y, Yang S, Qu N, Gao Y, Ji Q. The impact of presence of Hashimoto's thyroiditis on diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy in subcentimeter thyroid nodules: A retrospective study from FUSCC. Cancer Med 2017; 6:1014-1022. [PMID: 28382784 PMCID: PMC5430084 DOI: 10.1002/cam4.997] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/19/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
The incidence of PTMC has been increasing in the recent years. This study aimed to investigate the diagnostic value of US-FNA in thyroid nodules ≤1 cm and whether the presence of Hashimoto's thyroiditis (HT) in thyroid could influence the accuracy. The patients who accepted US-FNA at FUSCC from December 2012 to November 2015 and followed our criteria were enrolled in this study. We extracted the cytological, pathological, and follow-up US/US-FNA data of patients with subcentimeter nodules. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false-negative rate (FNR), false-positive rate (FPR), and AUC were calculated to define FNA diagnostic performance in patients. The association of HT with cytological results was analyzed in univariate and multivariate logistic regression analysis. In total, 754 patients with 817 subcentimeter nodules were collected to comprise the FUSCC cohort. Of the 817 nodules, the cytological results were ND/UNS in 80 nodules (9.8%), benign in 74 (9.1%), AUS/FLUS in 80 (9.8%), FN/SFN in 6 (0.7%), suspicious for malignancy (SM) in 222 (27.2%), and malignant in 355 (43.5%). The sensitivity, specificity, PPV, NPV, and AUC of US-FNA for the subcentimeter nodules were 98.8%, 90.5%, 98.8%, 90.5%, and 94.7%, respectively. In comparison with HT-positive subcentimeter nodules, the diagnostic value of US-FNA for HT-negative nodules was significantly higher (HT-positive: AUC = 91.6%, HT-negative: AUC = 95.9%, P = 0.028). The coexistent HT was found to increase the risk of the FNR and indeterminate cytological results. US-FNA demonstrated an effective method for diagnosis of subcentimeter thyroid nodules with a low nondiagnostic rate in our study. The presence of HT in thyroid could be a risk factor for the increased FNR and indeterminate cytological results during US-FNA.
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Affiliation(s)
- Lili Gao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ben Ma
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li Zhou
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yu Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Shuwen Yang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ning Qu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yi Gao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qinghai Ji
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
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Ieni A, Vita R, Magliolo E, Santarpia M, Di Bari F, Benvenga S, Tuccari G. One-third of an Archivial Series of Papillary Thyroid Cancer (Years 2007-2015) Has Coexistent Chronic Lymphocytic Thyroiditis, Which Is Associated with a More Favorable Tumor-Node-Metastasis Staging. Front Endocrinol (Lausanne) 2017; 8:337. [PMID: 29250033 PMCID: PMC5716977 DOI: 10.3389/fendo.2017.00337] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/15/2017] [Indexed: 11/13/2022] Open
Abstract
The significance and impact of the coexistence of chronic lymphocytic thyroiditis (CLT) with thyroid cancer is still debated. To verify the influence of CLT on papillary thyroid cancer (PTC), we retrospectively collected 505 PTC cases and analyzed age at diagnosis, sex, size, lymph node status, and staging. We found that CLT was present in 168 PTC (33.3%). Compared with the 337 patients without CLT (non-CLT), CLT patients were younger (44.42 ± 13.72 vs. 47.21 ± 13.76 years, P = 0.03), had smaller tumors (9.39 ± 6.10 vs. 12 ± 9.71 mm, P = 0.002), and lower rate of lymph node metastases (12.5 vs. 21.96%, P = 0.01, OR = 0.508). Tumor-node-metastasis (TNM) staging (T1a through T4) was more favorable for the CLT group compared to the non-CLT group (for instance, T1a = 65.5 vs. 49.8%, T3 = 4.8 vs. 23.4%). This study shows that one in three patients with PTC harbors CLT, which is associated with a more favorable TNM staging, consistently with a favorable outlook of PTC.
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Affiliation(s)
- Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age “Gaetano Barresi”—Section of Pathological Anatomy, University of Messina, Messina, Italy
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- *Correspondence: Roberto Vita,
| | | | - Mariacarmela Santarpia
- Department of Human Pathology of Adult and Evolutive Age “Gaetano Barresi”—Section of Oncology, University of Messina, Messina, Italy
| | - Flavia Di Bari
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- Master Program on Childhood, Adolescent and Women’s Endocrine Health, University of Messina, Messina, Italy
- Interdepartmental Program of Molecular & Clinical Endocrinology and Women’s Endocrine Health, University Hospital, Azienda Ospedaliera Universitaria Policlinico G. Martino, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age “Gaetano Barresi”—Section of Pathological Anatomy, University of Messina, Messina, Italy
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56
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Lee IS, Hsieh AT, Lee TW, Lee TI, Chien YM. The Association of Thyrotropin and Autoimmune Thyroid Disease in Developing Papillary Thyroid Cancer. Int J Endocrinol 2017; 2017:5940367. [PMID: 28951739 PMCID: PMC5603117 DOI: 10.1155/2017/5940367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/18/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common type of malignant thyroid neoplasm. However, the incidence of PTC with autoimmune thyroid disease (AITD) varies between studies. This study aims to investigate whether patients with AITD have increased incidence of PTC. We also analyzed the relationship of serum thyroid-stimulating hormone (TSH) levels and PTC in relation to AITD based on histopathological data. METHODS A total of 533 participants who underwent thyroidectomy were enrolled in this retrospective study based on clinicohistopathological data and known thyroid autoantibodies. Patients were divided into PTC and benign groups according to histopathologic diagnosis. Age, gender, body mass index, and serum TSH level before thyroidectomy were recorded. RESULTS Of the 533 enrolled patients, 159 (29.8%) were diagnosed with PTC, of which 38 (35.5%) had Hashimoto's thyroiditis (HT). More patients with HT were female, and patients with HT, Graves' disease, and thyroid nodules with higher TSH level had a higher incidence of PTC. CONCLUSIONS A high proportion of the patients with PTC had HT. There was a trend that a higher serum TSH level was associated with a greater risk of thyroid cancer.
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Affiliation(s)
- I-Shuan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - An-Tsz Hsieh
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ting-Wei Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ting-I Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Ting-I Lee: and
| | - Yu-Mei Chien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- *Yu-Mei Chien:
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57
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Malaguarnera R, Vella V, Nicolosi ML, Belfiore A. Insulin Resistance: Any Role in the Changing Epidemiology of Thyroid Cancer? Front Endocrinol (Lausanne) 2017; 8:314. [PMID: 29184536 PMCID: PMC5694441 DOI: 10.3389/fendo.2017.00314] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022] Open
Abstract
In the past few decades, the incidence of thyroid cancer (TC), namely of its papillary hystotype (PTC), has shown a steady increase worldwide, which has been attributed at least in part to the increasing diagnosis of early stage tumors. However, some evidence suggests that environmental and lifestyle factors can also play a role. Among the potential risk factors involved in the changing epidemiology of TC, particular attention has been drawn to insulin-resistance and related metabolic disorders, such as obesity, type 2 diabetes, and metabolic syndrome, which have been also rapidly increasing worldwide due to widespread dietary and lifestyle changes. In accordance with this possibility, various epidemiological studies have indeed gathered substantial evidence that insulin resistance-related metabolic disorders might be associated with an increased TC risk either through hyperinsulinemia or by affecting other TC risk factors including iodine deficiency, elevated thyroid stimulating hormone, estrogen-dependent signaling, chronic autoimmune thyroiditis, and others. This review summarizes the current literature evaluating the relationship between metabolic disorders characterized by insulin resistance and the risk for TC as well as the possible underlying mechanisms. The potential implications of such association in TC prevention and therapy are discussed.
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Affiliation(s)
- Roberta Malaguarnera
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Veronica Vella
- School of Human and Social Sciences, “Kore” University of Enna, Enna, Italy
- *Correspondence: Veronica Vella, ; Antonino Belfiore,
| | - Maria Luisa Nicolosi
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonino Belfiore
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- *Correspondence: Veronica Vella, ; Antonino Belfiore,
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58
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DİRİKOÇ A, FAKI S, BAŞER H, ÖZDEMİR D, AYDIN C, ERSOY R, KILIÇ M, KILIÇARSLAN A, ÇAKIR B. Thyroid malignancy risk in different clinical thyroid diseases. Turk J Med Sci 2017; 47:1509-1519. [DOI: 10.3906/sag-1611-67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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59
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Thyroid autoimmunity: is really associated with papillary thyroid carcinoma? Eur Arch Otorhinolaryngol 2016; 274:1677-1681. [DOI: 10.1007/s00405-016-4414-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/29/2016] [Indexed: 11/26/2022]
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60
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Farrell E, Heffron C, Murphy M, O'Leary G, Sheahan P. Impact of lymphocytic thyroiditis on incidence of pathological incidental thyroid carcinoma. Head Neck 2016; 39:122-127. [DOI: 10.1002/hed.24544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/30/2016] [Accepted: 06/22/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Eric Farrell
- School of Medicine; University College Cork; Cork Ireland United Kingdom
| | - Cynthia Heffron
- Department of Pathology; Cork University Hospital; Cork Ireland United Kingdom
| | - Matthew Murphy
- Department of Endocrinology; South Infirmary Victoria University Hospital, Cork; Cork Ireland United Kingdom
| | - Gerard O'Leary
- Department of Otolaryngology - Head and Neck Surgery; South Infirmary Victoria University Hospital, Cork; Cork Ireland United Kingdom
| | - Patrick Sheahan
- Department of Otolaryngology - Head and Neck Surgery; South Infirmary Victoria University Hospital, Cork; Cork Ireland United Kingdom
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61
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Gao X, Zhang X, Zhang Y, Hua W, Maimaiti Y, Gao Z. Is papillary thyroid microcarcinoma an indolent tumor?: A retrospective study on 280 cases treated with radioiodine. Medicine (Baltimore) 2016; 95:e5067. [PMID: 27749574 PMCID: PMC5059077 DOI: 10.1097/md.0000000000005067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The increasing detection of papillary thyroid microcarcinoma (PTMC) has created management dilemmas. To clarify the clinical significance of postsurgery stimulated thyroglobulin (ps-Tg) in PTMC who undergo thyroidectomy and radioactive iodine (RAI), we retrospectively reviewed the 358 PTMC patients who were treated with RAI and followed up in our hospital. Those with an excessive anti-Tg antibody, ultrasound-detected residual were excluded, thereby resulting in the inclusion of 280 cases. Their clinical and histopathological information and clinical outcomes were collected and summarized. Tumor stages were classified according to the tumor, node, metastasis (TNM) staging system and the consensus of the European Thyroid Association (ETA) risk stratification system, respectively. Kaplan-Meier curves were constructed to compare the disease-free survival (DFS) rates of different risk-staging systems. By the end of follow-up, none of the patients died of the disease or relapsed. The 8-year DFS rate was 76.9%. Kaplan-Meier curves showed different DFS rates in TNM stages I versus IV, III versus IV, very low risk versus high risk, low risk versus high risk, respectively (P < 0.05), while they were not significantly different in stage I versus stage III, very low risk versus low risk (P > 0.05). Finally, 40 (14.3%) cases got a persistent disease. Five variables (male sex, nonconcurrent benign pathology, initial tumor size >5 mm, lymph node metastasis, and ps-Tg ≥ 10 μg/L) were associated with disease persistence by univariate regression analysis. Ps-Tg ≥ 10 μg/L was the only independent prognostic variable that predicted disease persistence by multivariate regression analysis (odds ratio: 36.057, P = 0.000). Therefore, PTMC with a small size of ≤1 cm does not always act as an indolent tumor. In conclusion, ps-Tg ≥ 10 μg/L is associated with increased odds of disease persistence. ETA risk stratification is more effective in predicting disease persistence than the TNM classification system.
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Affiliation(s)
| | | | | | | | - Yusufu Maimaiti
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zairong Gao
- Department of Nuclear Medicine
- Correspondence: Zairong Gao, Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277, Jiefang Road, Wuhan 430022, China (e-mail: )
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Yang SW, Kang SH, Kim KR, Choi IH, Chang HS, Oh YL, Hong SW. Do Helper T Cell Subtypes in Lymphocytic Thyroiditis Play a Role in the Antitumor Effect? J Pathol Transl Med 2016; 50:377-84. [PMID: 27681413 PMCID: PMC5042902 DOI: 10.4132/jptm.2016.07.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/08/2016] [Accepted: 07/25/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is frequently accompanied by lymphocytic thyroiditis (LT). Some reports claim that Hashimoto's thyroiditis (the clinical form of LT) enhances the likelihood of PTC; however, others suggest that LT has antitumor activity. This study was aimed to find out the relationship between the patterns of helper T cell (Th) cytokines in thyroid tissue of PTC with or without LT and the clinicopathological manifestation of PTC. METHODS Fresh surgical samples of PTC with (13 cases) or without (10 cases) LT were used. The prognostic parameters (tumor size, extra-thyroidal extension of PTC, and lymph node metastasis) were analyzed. The mRNA levels of two subtypes of Th cytokines, Th1 (tumor necrosis factor α [TNF-α], interferon γ [IFN-γ ], and interleukin [IL] 2) and Th2 (IL-4 and IL-10), were analyzed. Because most PTC cases were microcarcinomas and recent cases without clinical follow-up, negative or faint p27 immunoreactivity was used as a surrogate marker for lymph node metastasis. RESULTS PTC with LT cases showed significantly higher expression of TNF-α (p = .043), IFN-γ (p < .010), IL-4 (p = .015) than those without LT cases. Although the data were not statistically significant, all analyzed cytokines (except for IL-4) were highly expressed in the cases with higher expression of p27 surrogate marker. CONCLUSIONS These results indicate that mixed Th1 (TNF-α, IFN-γ , and IL-2) and Th2 (IL-10) immunity might play a role in the antitumor effect in terms of lymph node metastasis.
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Affiliation(s)
- Seok Woo Yang
- Department of Medicine, Yonsei University Graduate School, Seoul, Korea
| | - Seong-Ho Kang
- Department of Laboratory Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Kyung Rae Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - In Hong Choi
- Department of Microbiology, Yonsei University College of Medicine, Seoul, Korea
| | - Hang Seok Chang
- Department of General Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Soon Won Hong
- Department of Pathology, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
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Konturek A, Barczyński M, Stopa M, Nowak W. Trends in Prevalence of Thyroid Cancer Over Three Decades: A Retrospective Cohort Study of 17,526 Surgical Patients. World J Surg 2016; 40:538-44. [PMID: 26560150 PMCID: PMC4746222 DOI: 10.1007/s00268-015-3322-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Thyroid cancer (TC) incidence has been increasing in recent years. The aim of this study was to investigate our institution-based estimates of operative volumes for TC over the last three decades. Materials and methods This was a retrospective cohort study of patients undergoing thyroid surgery at our institution. Patient characteristics were reviewed in three subgroups: Group I (treated in 1981–1986), Group II (treated in 1987–2002), and Group III (treated in 2003–2012). Results TC was diagnosed in 1578/17,526 (9.0 %) thyroid operations. Incidence of TC increased from 3.7 % in Group I to 10.4 % in Group III (p < 0.001). Incidence of papillary TC increased form 40.6 % in Group I to 81.3 % in Group III (p < 0.001). In the latter group, 23.5 % of all papillary TCs were diagnosed in patients with Hashimoto’s disease. Meanwhile, incidence of anaplastic TC decreased from 16.2 % in Group I to 2.1 % in Group III patients (p < 0.001). pT1 tumors were diagnosed in 8.1 % Group I and 54.8 % Group III (p < 0.001), whereas pT4 tumors were identified in 40.5 % Group I, 2.4 % Group II, and 0.84 % Group III subjects (p < 0.001). pT3 tumors were found in 51.6 % Group I, whereas multifocal papillary TCs were found in 15.7 % Group III patients, the latter with a higher prevalence of pN1 stage (p < 0.001). Conclusions The following trends in surgical volume for TC were identified throughout the study period: a fivefold increase of thyroid operations for TC, a threefold increase in incidence of papillary TC, and an eightfold decrease in incidence of anaplastic TC. It is of interest that a significant increase in incidence of multifocal papillary TC in young female patients with Hashimoto’s disease was found over time.
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Affiliation(s)
- Aleksander Konturek
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Krakow, Poland.
| | - Marcin Barczyński
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Krakow, Poland
| | - Małgorzata Stopa
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Krakow, Poland
| | - Wojciech Nowak
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Krakow, Poland
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A Modified Thyroid Imaging Reporting and Data System (mTI-RADS) For Thyroid Nodules in Coexisting Hashimoto's Thyroiditis. Sci Rep 2016; 6:26410. [PMID: 27194206 PMCID: PMC4872201 DOI: 10.1038/srep26410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/03/2016] [Indexed: 11/29/2022] Open
Abstract
To develop a conventional ultrasound (US) modified Thyroid Imaging Reporting and Data System (mTI-RADS) to stratify the malignancy risk of thyroid nodule in coexisting Hashimoto’s thyroiditis (HT). The study included 138 malignant and 292 benign thyroid nodules confirmed by cytological or histopathological results. The risk score (RS) for each significant US feature was estimated by multiplying corresponding regression coefficient and the total score for each nodule was defined as the sum of these individual scores. The mTI-RADS was established according to the total RS and divided into category 3, 4a, 4b, 4c and 5. Marked hypoechogenicity, taller-than-wide shape, poorly-defined margin, microcalcification or macrocalcification and halo sign absence were statistically significant US features in prediction of thyroid malignancy (all p < 0.05). The total RS for each nodule was defined as following: RS = 2.1× (if marked hypoechogenicity) + 1.2× (if taller-than-wide shape) + 1.7× (if no halo sign) + 0.6× (if poorly-defined margin) + 1.2× (if microcalcification or macrocalcification). The malignancy rates in mTI-RADS category 3, 4a, 4b, 4c and 5 nodules were 3.7%, 19.3%, 38.1%, 62.7% and 94.1%, respectively, with significant differences among different categories (P < 0.001). The mTI-RADS category may facilitate subsequent treatment management in HT patients.
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Karatzas T, Vasileiadis I, Zapanti E, Charitoudis G, Karakostas E, Boutzios G. Thyroglobulin antibodies as a potential predictive marker of papillary thyroid carcinoma in patients with indeterminate cytology. Am J Surg 2016; 212:946-952. [PMID: 27324384 DOI: 10.1016/j.amjsurg.2015.12.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/14/2015] [Accepted: 12/02/2015] [Indexed: 10/21/2022]
Abstract
BACKROUND We investigated the efficacy of thyroglobulin antibodies (TgAb) in detecting malignancy in indeterminate thyroid nodules and evaluated the possible association between TgAb and autoimmunity in papillary thyroid carcinoma (PTC). METHODS This retrospective, nonrandomized study included 1,646 patients who had undergone preoperative fine-needle aspiration biopsy to evaluate their thyroid nodules, and then standard total thyroidectomy. Of 194 patients (11.8%) with indeterminate nodules, 61 (31.4%) had PTC and 133 (68.6%) had benign nodules at the final histologic examination. RESULTS Univariate analysis showed that multifocality (P = .002), bilaterality (P = .003), lymph-node metastasis (P = .030), and capsule penetration (P = .003) were significantly associated with positive TgAb in patients with indeterminate cytology and histopathologic diagnosis of PTC. The multivariate analysis showed that TgAb positivity (P < .001) and preoperative thyroid-stimulating hormone levels (P = .022) were independent predictive factor for PTC diagnosis in patients with indeterminate cytology. CONCLUSIONS Preoperative TgAb could be a marker for PTC in patients with indeterminate thyroid nodules, increasing diagnostic accuracy. TgAb positivity could also influence the clinical assessment and subsequent selection of total thyroidectomy.
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Affiliation(s)
- Theodore Karatzas
- Second Department of Propedeutic Surgery, Medical School, University of Athens, Laikon General Hospital, Athens, Greece
| | - Ioannis Vasileiadis
- Department of Otolaryngology/Head and Neck Surgery, Venizeleio - Pananeio General Hospital, Herakleion, Greece; Department of Otolaryngology - Head and Neck Surgery, Royal London Hospital, Barts and the London Trust, London, UK.
| | - Evangelia Zapanti
- Endocrine Unit, First Department of Internal Medicine, Medical School, University of Athens, Laikon General Hospital, Athens, Greece
| | - Georgios Charitoudis
- Department of Otolaryngology/Head and Neck Surgery, Venizeleio - Pananeio General Hospital, Herakleion, Greece
| | - Efthimios Karakostas
- Department of Otolaryngology/Head and Neck Surgery, Venizeleio - Pananeio General Hospital, Herakleion, Greece
| | - Georgios Boutzios
- Endocrine Unit, Department of Pathophysiology, Medical School, University of Athens, Laikon General Hospital, Athens, Greece
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Coexistence of chronic lymphocytic thyroiditis and papillary thyroid carcinoma. Impact on presentation, management, and outcome. Int J Surg 2016; 28 Suppl 1:S70-4. [DOI: 10.1016/j.ijsu.2015.12.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/13/2015] [Accepted: 05/22/2015] [Indexed: 11/23/2022]
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Okani CO, Otene B, Nyaga T, Ngbea J, Eke A, Edegbe F, Anyiam D. Report of a case of papillary thyroid carcinoma in association with Hashimoto's thyroiditis. Niger Med J 2016; 56:433-5. [PMID: 26903704 PMCID: PMC4743296 DOI: 10.4103/0300-1652.171612] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Hashimoto thyroiditis (HT) is an autoimmune disease, known to be the most common cause of hypothyroidism in nonendemic goitrous areas. It is usually characterized by symmetric, painless, and diffused but sometimes localized swelling of the thyroid gland with features of hypothyroidism. Papillary thyroid carcinoma (PTC), on the other hand, is the most common yet less aggressive form of thyroid cancer, especially in iodine-deficient areas. The coexistence of the two diseases is possible but not common. This case study reports a 50-year-old female with a 10-year history of a huge goiter, which was essentially symptom-free until about 3 months prior to presentation when the patient started complaining of neck pain, dysphagia, productive cough, and cold intolerance. Physical examination revealed focal cystic and tender area in the multinodular swelling and associated cervical lymphadenopathy on the left side of the neck. The serum thyroid stimulating hormone was high, sub-normal T3, and the T4 was low. The fine needle aspiration cytology yielded 10 ml of aspirate of pus admixed with altered blood which on microscopy showed a few suspicious follicular epithelial cells with open nuclei admixed with mainly neutrophil polymorphs, siderophages, and foam cells in a hemorrhagic background. The patient had an incision biopsy that showed areas displaying PTC and HT.
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Affiliation(s)
| | - Benjamin Otene
- Department of Histopathology, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Terhemba Nyaga
- Department of Histopathology, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Joseph Ngbea
- Department of Histopathology, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Agaba Eke
- Department of Surgery, Benue State University Teaching Hospital, Makurdi, Benue State, Nigeria
| | - Felix Edegbe
- Department of Histopathology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Daniel Anyiam
- Department of Histopathology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Kocer D, Karakukcu C, Karaman H, Gokay F, Bayram F. May the neutrophil/lymphocyte ratio be a predictor in the differentiation of different thyroid disorders? Asian Pac J Cancer Prev 2016; 16:3875-9. [PMID: 25987053 DOI: 10.7314/apjcp.2015.16.9.3875] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The neutrophil/lymphocyte ratio (NLR) is a simple index of systemic inflammatory response, and has been shown to be a prognostic indicator in some types of cancer. Inflammation has been implicated in the initiation and progression of thyroid cancer. The aim of this study was to examine the relationship of NLR with papillary thyroid cancer (PTC) and different benign thyroid pathologies like multinodular goiter (MNG) and lymphocytic thyroiditis (LT). MATERIALS AND METHODS We retrospectively evaluated the neutrophil, lymphocyte counts and NLR calculated from these parameters of 232 patients with histologically confirmed as multinodular goiter (group MNG) (n=70), lymphocytic thyroiditis (group LT) (n=97), LT with PTC (group LT- PTC) (n=25) and PTC (group PTC) (n=40). The optimal cut-off value for NLR was determined. RESULTS NLR level was significantly higher in groups LT-PTC and PTC as compared to groups MNG and LT (p<0.05). NLR of LT subgroups according to TSH levels were not different (p>0.05). When we grouped the patients as benign and malignant according to PTC presence, the optimum NLR cut-off point obtained from ROC analysis was 1.91 (sensitivity 89.0% and specificity 54.5%). CONCLUSIONS Since NLR was significantly elevated in group LT-PTC and group PTC, NLR value may give an opinion as a potential marker in differentiation of benign and malign thyroid disorders. For this purpose a cut-off value of 1.91 for NLR may be accepted.
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Affiliation(s)
- Derya Kocer
- Clinical Biochemistry, Training and Research Hospital, Kayseri, Turkey E-mail :
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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The clinicopathologic differences of central lymph node metastasis in predicting lateral lymph node metastasis and prognosis in papillary thyroid cancer associated with or without Hashimoto’s thyroiditis. Tumour Biol 2015; 37:8037-45. [DOI: 10.1007/s13277-015-4706-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/20/2015] [Indexed: 12/28/2022] Open
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Qu N, Zhang L, Lin DZ, Ji QH, Zhu YX, Wang Y. The impact of coexistent Hashimoto's thyroiditis on lymph node metastasis and prognosis in papillary thyroid microcarcinoma. Tumour Biol 2015; 37:7685-92. [PMID: 26692097 DOI: 10.1007/s13277-015-4534-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/21/2014] [Indexed: 11/25/2022] Open
Abstract
The impact of coexistent Hashimoto's thyroiditis (HT) on lymph node metastasis (LNM) and prognosis in papillary thyroid microcarcinoma (PTMC) remains controversial. We evaluated the association of coexistent HT with clinicopathologic parameters, LNM, and prognosis by retrospectively reviewing a series of consecutive patients treated for PTMC at Fudan University Cancer Center from January 2005 to December 2010. Of all 1,250 patients with complete data for analysis, 364 (29.1 %) had coexistent HT (HT group) and 886 patients (70.9 %) had no evidence of HT (control group). The HT group had higher proportion of female (87.9 vs 70.1 %) patients, higher mean level of thyroid-stimulating hormone (TSH) (2.39 vs 2.00 mIU/L), and lower incidence of extrathyroidal extension (7.4 vs 11.7 %) than those in the control group. However, the incidence of LNM and recurrence was similar between the two groups, and HT was not associated with LNM and recurrence. A series of clinicopathologic factors identified for predicting LNM and recurrence in the control group did not show any prediction in the HT group. In summary, this study suggested that coexistent HT had insignificant protective effect on LNM and prognosis in PTMC, which was inconsistent with prior studies. Further studies aiming to determine novel predictors are recommended in PTMC patients with coexistent HT.
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Affiliation(s)
- Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ling Zhang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Dao-Zhe Lin
- Department of Oncology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Yong-Xue Zhu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
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Iliadou PK, Effraimidis G, Konstantinos M, Grigorios P, Mitsakis P, Patakiouta F, Pazaitou-Panayiotou K. Chronic lymphocytic thyroiditis is associated with invasive characteristics of differentiated thyroid carcinoma in children and adolescents. Eur J Endocrinol 2015; 173:827-33. [PMID: 26369577 DOI: 10.1530/eje-14-1046] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 09/08/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND The association between chronic lymphocytic thyroiditis (CLT) and thyroid cancer is an interesting topic. The aim of the present study was to evaluate if demographic and histological characteristics as well as the long-term outcome of thyroid cancer was different in children and adolescents with and without CLT. METHODS The medical records of children and adolescents (≤21 years old) were reviewed. The following data were recorded: gender, year and age at diagnosis, family history of thyroid cancer, history of external radiation therapy, histological type (papillary and variants, follicular and variants), tumour size, multifocality, infiltration of thyroid parenchyma or surrounding soft tissues, vascular invasion, presence of lymph node and distant metastases. Information about the presence of TgAb and TPOAb was also collected. RESULTS One hundred eight children and adolescents (median age 19.0, interquartile range 4.0 years) were diagnosed with differentiated thyroid carcinoma (DTC); 31 patients (28.7%) presented histological characteristics compatible with CLT. Infiltration of thyroid parenchyma was more frequent in patients with CLT compared to patients without (74.2% vs 48.1% respectively, P=0.024). Familial papillary thyroid carcinoma (PTC) was more frequent in patients with CLT compared to those without CLT (20.7% vs 2.8% respectively, P=0.009). There was no better outcome with respect to the presence of CLT or not. CONCLUSIONS Children and adolescents with CLT present more frequently familial PTC as well as thyroid cancer with invasive characteristics.
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Affiliation(s)
- Paschalia K Iliadou
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Grigoris Effraimidis
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Michalakis Konstantinos
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Panagiotou Grigorios
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Periklis Mitsakis
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Frideriki Patakiouta
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
| | - Kalliopi Pazaitou-Panayiotou
- Department of EndocrinologyTheagenio Cancer Hospital, 2, Al Simeonidi Street, 54007 Thessaloniki, GreeceEndocrinology SectionInternal Medicine Department, Nykobing Falster Hospital, Nykobing Falster, DenmarkDepartment of PathologyTheagenio Cancer Hospital, Thessaloniki, Greece
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Baser H, Ozdemir D, Cuhaci N, Aydin C, Ersoy R, Kilicarslan A, Cakir B. Hashimoto's Thyroiditis Does Not Affect Ultrasonographical, Cytological, and Histopathological Features in Patients with Papillary Thyroid Carcinoma. Endocr Pathol 2015; 26:356-64. [PMID: 26481630 DOI: 10.1007/s12022-015-9401-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) is controversial. In this study, we aimed to compare preoperative thyroid functions, ultrasonography (US) features, fine-needle aspiration biopsy (FNAB) results, and histopathological characteristics of PTC in patients with and without HT. Data of 919 PTC patients were reviewed retrospectively. The diagnosis of HT was based on histopathological examination and patients were grouped as HT and non-HT. There were 1321 PTC lesions in 919 patients among which 317 (34.5 %) had coexistent HT. There were no significant differences in nodule volume, longitudinal diameter, texture, echogenicity, marginal regularity, presence of microcalcification and hypoechoic halo, and peripheral vascularization in patients with and without HT (p > 0.05, for all parameters). Macrocalcification was observed more frequently in the non-HT group (p = 0.021). FNAB results were similar in the two groups (p = 0.105). Distribution of variants, capsule invasion, vascular invasion, and extrathyroidal extension were observed with similar rates in the HT and non-HT groups. Lymph node metastasis was significantly higher in patients without HT (p = 0.012). Of the carcinomas, 66.1 % (n = 874) were papillary thyroid microcarcinoma (PTMC). Tumor size was lower in PTMC lesions coexistent with HT (p = 0.026). We observed lower rates of capsule invasion, extrathyroidal extension, and lymph node metastases in PTMC with HT compared to without HT (p = 0.007, p = 0.003, and p = 0.015, respectively). This study showed that US features, FNAB results, and histopathological findings of PTC lesions are not influenced by the presence of HT. However, PTMC seems to be related with less aggressive histopathological behavior in HT.
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Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey.
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Neslihan Cuhaci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Cevdet Aydin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Aydan Kilicarslan
- Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Zivancevic-Simonovic S, Mihaljevic O, Majstorovic I, Popovic S, Markovic S, Milosevic-Djordjevic O, Jovanovic Z, Mijatovic-Teodorovic L, Mihajlovic D, Colic M. Cytokine production in patients with papillary thyroid cancer and associated autoimmune Hashimoto thyroiditis. Cancer Immunol Immunother 2015; 64:1011-9. [PMID: 25971541 PMCID: PMC11029755 DOI: 10.1007/s00262-015-1705-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/25/2015] [Indexed: 12/19/2022]
Abstract
Hashimoto thyroiditis (HT) is the most frequent thyroid autoimmune disease, while papillary thyroid cancer (PTC) is one of the most common endocrine malignancies. A few patients with HT also develop PTC. The aim of this study was to analyze cytokine profiles in patients with PTC accompanied with autoimmune HT in comparison with those in patients with PTC alone or HT alone and healthy subjects. Cytokine levels were determined in supernatants obtained from phytohemagglutinin (PHA)-stimulated whole blood cultures in vitro. The concentrations of selected cytokines: Th1-interferon gamma (IFN-γ); Th2-interleukin 4 (IL-4), interleukin 5 (IL-5), interleukin 6 (IL-6), interleukin 10 (IL-10) and interleukin 13 (IL-13); Th9-interleukin 9 (IL-9); and Th17-interleukin 17 (IL-17A) were measured using multiplex cytokine detection systems for human Th1/Th2/Th9/Th17/Th22. We found that PTC patients with HT produced significantly higher concentrations of IL-4, IL-6, IL-9, IL-13 and IFN-γ than PTC patients without HT. In conclusion, autoimmune HT affects the cytokine profile of patients with PTC by stimulating secretion of Th1/Th2/Th9 types of cytokines. Th1/Th2 cytokine ratios in PTC patients with associated autoimmune HT indicate a marked shift toward Th2 immunity.
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75
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Stanciu AE, Serdarevic N, Hurduc AE, Stanciu MM. IL-4, IL-10 and high sensitivity-CRP as potential serum biomarkers of persistent/recurrent disease in papillary thyroid carcinoma with/without Hashimoto's thyroiditis. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:539-48. [PMID: 26305420 DOI: 10.3109/00365513.2015.1057895] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the potential role of interleukin 4 (IL-4), interleukin 10 (IL-10) and high-sensitivity C-reactive protein (hs-CRP) as serum biomarkers of persistent/recurrent disease in papillary thyroid carcinoma (PTC) with/without Hashimoto's thyroiditis (HT). METHODS Eighty consecutive patients (64 F/16 M, 43.2 ± 12.7 years) with PTC and 40 (37 F/3 M, 40.6 ± 12.3 years) with papillary thyroid carcinoma associated with Hashimoto's thyroiditis (PTC + HT) were evaluated before radioiodine therapy. A control group of 20 patients with HT without thyroid cancer (18 F/2 M, 47.3 ± 2.8 years) was included in the study for the comparison of cytokine levels. RESULTS No meaningful differences were found in clinical outcomes between PTC and PTC + HT groups (47.5% vs. 45% persistent/recurrent disease). Serum IL-4, IL-10 and hs-CRP levels were higher in patients with persistent/recurrent disease compared to those without recurrence (p < 0.001). IL-4, IL-10 and hs-CRP were also found in substantially higher concentrations in PTC + HT patients with persistent/recurrent disease than in patients with HT or PTC (with or without recurrence) (p < 0.01). Positive correlations were observed between IL-4, IL-10, hs-CRP and thyroglobulin (Tg) (r between 0.48 and 0.56, p < 0.005) or antithyroglobulin antibodies (TgAb) (r between 0.63 and 0.80, p < 0.002) in PTC and PTC + HT patients with persistent/recurrent disease. CONCLUSIONS Increased levels of serum IL-4, IL-10 and hs-CRP are associated with persistent/recurrent disease in PTC and PTC + HT patients. Our results suggest that these biomarkers might be used to improve patient stratification according to the risk of recurrence, especially in patients with PTC + HT, where Tg levels are not reliable due to presence of TgAb.
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Affiliation(s)
- Adina E Stanciu
- a Department of Carcinogenesis and Molecular Biology , Institute of Oncology Bucharest , Bucharest , Romania
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Zeng RC, Jin LP, Chen ED, Dong SY, Cai YF, Huang GL, Li Q, Jin C, Zhang XH, Wang OC. Potential relationship between Hashimoto's thyroiditis and BRAF(V600E) mutation status in papillary thyroid cancer. Head Neck 2015; 38 Suppl 1:E1019-25. [PMID: 26041461 DOI: 10.1002/hed.24149] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/13/2015] [Accepted: 05/31/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the potential relationship between Hashimoto's thyroiditis and BRAF(V600E) mutation status in patients with papillary thyroid carcinoma (PTC). METHODS A total of 619 patients with PTC who underwent total thyroidectomy with lymph node dissection were enrolled in this study. Univariable and multivariate analyses were used. RESULTS Hashimoto's thyroiditis was present in 35.9% (222 of 619) of PTCs. Multivariate logistic regressions showed that BRAF(V600E) mutation, sex, extrathyroidal extension, and lymph node metastasis were independent factors for Hashimoto's thyroiditis. Female sex, more frequent extrathyroidal extension, and a higher incidence of lymph node metastasis were significantly associated with PTCs accompanied by BRAF(V600E) mutation without Hashimoto's thyroiditis compared with PTCs accompanied by BRAF(V600E) mutation with Hashimoto's thyroiditis. CONCLUSION Hashimoto's thyroiditis was negatively associated with BRAF(V600E) mutation, extrathyroidal extension, and lymph node metastasis. In addition, Hashimoto's thyroiditis was related to less lymph node metastasis and extrathyroidal extension in PTCs with BRAF(V600E) mutation. Therefore, Hashimoto's thyroiditis is a potentially protective factor in PTC. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1019-E1025, 2016.
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Affiliation(s)
- Rui-Chao Zeng
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Lang-Ping Jin
- Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - En-Dong Chen
- Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Si-Yang Dong
- Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ye-Feng Cai
- Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Guan-Li Huang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Quan Li
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chun Jin
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Xiao-Hua Zhang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Ou-Chen Wang
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
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Kim SJ, Myong JP, Jee HG, Chai YJ, Choi JY, Min HS, Lee KE, Youn YK. Combined effect of Hashimoto's thyroiditis and BRAF(V600E) mutation status on aggressiveness in papillary thyroid cancer. Head Neck 2015; 38:95-101. [PMID: 25213729 DOI: 10.1002/hed.23854] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the association between Hashimoto's thyroiditis and BRAF(V600E) mutation status in patients with papillary thyroid cancer (PTC) and to determine their combined association with tumor aggressiveness in PTC. METHODS A total of 1780 patients with PTC who underwent surgery were enrolled in this study. Simple and multiple analyses were performed to determine the association between Hashimoto's thyroiditis and the BRAF(V600E) mutation in PTC. RESULTS Hashimoto's thyroiditis was present in 11.5% of patients (204/1780) with PTC. Multiple logistic regressions showed that BRAF(V600E) (odds ratio [OR] = 0.493; 95% confidence interval [CI] = 0.360-0.678) and the female sex (OR = 7.146; 95% CI = 3.408-18.347) were independent factors associated with Hashimoto's thyroiditis in PTC. BRAF(V600E) mutation and the Hashimoto's thyroiditis-negative PTC group were associated with aggressive disease (OR = 3.069; 95% CI = 1.654-5.916). CONCLUSION Hashimoto's thyroiditis was associated less frequently with BRAF(V600E) , and frequently with the female sex in patients with PTC. Hashimoto's thyroiditis and BRAF(V600E) status may help to predict clinical outcome of PTC.
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Affiliation(s)
- Su-jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Jun Pyo Myong
- Department of Occupational and Environmental Medicine & Center for Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Gun Jee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Bundang Seoul National University Hospital, Seoul, Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
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78
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Sonographic features of primary tumor as independent predictive factors for lymph node metastasis in papillary thyroid carcinoma. Clin Transl Oncol 2015; 17:830-4. [PMID: 26041723 DOI: 10.1007/s12094-015-1313-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/26/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this research was to find the sonographic features of primary tumor as independent predictive factors for lymph node metastasis in papillary thyroid carcinoma. METHODS/PATIENTS To facilitate the research, 514 patients with papillary thyroid carcinoma were divided into solitary and multifocal groups. In solitary group, thyroid lesions were divided into several subgroups by size, border, margin, echogenicity, echohomogeneity, calcification, vascularization, location, stiffness and Hashimoto's thyroiditis (HT) conditions. Then, univariable and multivariable analyses were performed to find the sonographic features of primary tumor as independent predictive factors for lymph node metastasis in papillary thyroid carcinoma. RESULTS A significant difference of lymph node metastasis rate was found between multifocal and solitary groups (P < 0.05). In univariable analysis, size, vascularization and coexistence of HT were found to be statistically significant factors (P = 0.004, 0.118, 0.016). Multivariable analysis revealed that lymph node metastasis rate was mainly associated with size [odds ratio (OR) = 1.690, 95 % confidence interval (CI) 1.157-2.469] and coexistence of HT (OR = 0.441, 95 % CI 0.219-0.888). CONCLUSION Preoperative sonographic features of primary tumor including the number, size and coexistence of HT were independent predictive factors for the state of cervical lymph node metastasis in patients with papillary thyroid carcinoma.
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79
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Girardi FM, Barra MB, Zettler CG. Papillary thyroid carcinoma: does the association with Hashimoto's thyroiditis affect the clinicopathological characteristics of the disease? Braz J Otorhinolaryngol 2015; 81:283-7. [PMID: 25458258 PMCID: PMC9452232 DOI: 10.1016/j.bjorl.2014.04.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/12/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction Papillary carcinoma is the most common malignant thyroid neoplasm. The effect of the concurrent presence of Hashimoto's thyroiditis and papillary thyroid carcinoma remains controversial. Objective To evaluate the association between Hashimoto's thyroiditis and clinicopathological parameters in thyroid papillary carcinoma cases, based on an historical institutional cohort analysis. Methods Cross-sectional study obtained from a historical cohort, including all cases submitted to thyroidectomy for papillary thyroid carcinoma in a single institution during an 11-year period study. Results A total of 417 patients with papillary thyroid carcinoma were enrolled; 148 (35.4%) also had Hashimoto's thyroiditis. A female predominance among cases associated to Hashimoto's thyroiditis was observed. The thyroid tumor, in cases associated with Hashimoto's thyroiditis, had a smaller mean diameter, lower frequency of extra-thyroid extension, and earlier clinicopathological staging. Conclusions A high proportion of papillary thyroid carcinoma cases are associated with Hashimoto's thyroiditis. There are associations among these cases with several histopathological factors already recognized for their prognostic value, which by themselves could impact outcomes.
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Affiliation(s)
- Fábio Muradás Girardi
- Head and Neck Surgery Department, Hospital Santa Rita, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil.
| | - Marinez Bizarro Barra
- Pathology Department, Hospital Santa Rita, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | - Cláudio Galleano Zettler
- Pathology Department, Hospital Santa Rita, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
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80
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Slijepcevic N, Zivaljevic V, Marinkovic J, Sipetic S, Diklic A, Paunovic I. Retrospective evaluation of the incidental finding of 403 papillary thyroid microcarcinomas in 2466 patients undergoing thyroid surgery for presumed benign thyroid disease. BMC Cancer 2015; 15:330. [PMID: 25925164 PMCID: PMC4423135 DOI: 10.1186/s12885-015-1352-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/23/2015] [Indexed: 12/22/2022] Open
Abstract
Background The aim of our study was to investigate the incidence of papillary thyroid microcarcinoma (PTMC) in patients operated for benign thyroid diseases (BTD) and its relation to age, sex, extent of surgery and type of BTD. Methods Retrospective study of 2466 patients who underwent thyroid surgery for BTD from 2008 to 2013. To determine independent predictors for PTMC we used three separate multivariate logistic regression models (MLR). Results There were 2128 (86.3%) females and 338 (13.7%) males. PTMC was diagnosed in 345 (16.2%) females and 58 (17.2%) males. Age ranged from 14 to 85 years (mean 54 years). Sex and age were not related to the incidence of PTMC. The overall incidence of PTMC was 16.3%. The highest incidence was in Hashimoto thyroiditis (22.7%, χ2 = 10.80, p < 0.001); and in patients with total/near-total thyroidectomy (17.7%, χ2 = 7.05, p < 0.008). The lowest incidence (6.6%, χ2 = 9.96, p < 0.001) was in a solitary hyperfunctional thyroid nodule (SHTN). According to MLR, Hashimoto thyroiditis (OR 1.54, 95% CI 1.15-2.05, p < 0.003) and SHTN (OR 0.43, 95% CI 0.21-0.87, p < 0.019) are independent predictors. Since the extent of surgery was an independent predictor (OR 1.45, 95% CI 1.10-1.92, p = 0.009) for all BTD, and sex and age were not; when the MLR model was adjusted for them, Graves disease (OR 0.72, 95% CI 0.53-0.99, p < 0.041) also proved to be an independent predictor. Conclusions Sex and age are not statistically related to the incidence of PTMC in BTD. The incidence of PTMC is higher in Hashimoto thyroiditis and patients with total/near-total thyroidectomy; and lower in patients with a SHTN and Graves disease.
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Affiliation(s)
- Nikola Slijepcevic
- Centre for endocrine surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia.
| | - Vladan Zivaljevic
- Centre for endocrine surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia. .,School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Jelena Marinkovic
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia. .,Institute of Medical Statistics and Informatics, School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, Serbia.
| | - Sandra Sipetic
- School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia. .,Institute of Epidemiology, School of Medicine, University of Belgrade, Visegradska 26a, Belgrade, 11000, Serbia.
| | - Aleksandar Diklic
- Centre for endocrine surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia. .,School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
| | - Ivan Paunovic
- Centre for endocrine surgery, Clinical Centre of Serbia, Koste Todorovica 8, Belgrade, 11000, Serbia. .,School of Medicine, University of Belgrade, Dr Subotica 8, Belgrade, 11000, Serbia.
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81
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Park SH, Park CS, Kim YI, Nam-Goong IS, Kim YS, Lee JC, Choi JI, Park JW, Kim ES. Osteopontin Levels in Patients with Papillary Thyroid Cancer According to the Presence of Hashimoto's Thyroiditis. Asian Pac J Cancer Prev 2015; 16:2447-51. [DOI: 10.7314/apjcp.2015.16.6.2447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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82
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Han R, Li F, Wang Y, Ying Z, Zhang Y. Virtual touch tissue quantification (VTQ) in the diagnosis of thyroid nodules with coexistent chronic autoimmune Hashimoto's thyroiditis: A preliminary study. Eur J Radiol 2015; 84:327-31. [DOI: 10.1016/j.ejrad.2014.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/01/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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83
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Park JY, Kim DW, Park HK, Ha TK, Jung SJ, Kim DH, Bae SK. Comparison of T stage, N stage, multifocality, and bilaterality in papillary thyroid carcinoma patients according to the presence of coexisting lymphocytic thyroiditis. Endocr Res 2015; 40:151-5. [PMID: 25531396 DOI: 10.3109/07435800.2014.977911] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study aimed to assess the relationship between coexisting lymphocytic thyroiditis and T-N stages of papillary thyroid carcinoma (PTC) by histopathological analysis. MATERIALS AND METHODS The study included 653 patients who underwent thyroid surgery for PTC at our hospital. Each case was classified as either Hashimoto's thyroiditis (HT), non-Hashimoto type of lymphocytic thyroiditis (NHLT), or normal according to the histopathology of thyroid parenchyma. Patient age, gender, surgical modality, location, T stage, N stage, multifocality and bilaterality were compared according to the histopathology. RESULTS The prevalence of coexisting lymphocytic thyroiditis was 25.8% (169/653); HT (7.5%, 49/653) and NHLT (18.3%, 120/653). There were no significant differences in T stage, N stage, multifocality and bilaterality with regard to coexisting lymphocytic thyroiditis, regardless of whether HT and NHLT were considered collectively or discretely. Primary tumor size (p < 0.0001), location (p = 0.0011), N stage (p < 0.0001), multifocality (p < 0.0001) and bilaterality (p < 0.0001) differed significantly according to T stage, and gender (p = 0.0193), primary tumor size (p < 0.0001), T stage (p < 0.0001), multifocality (p < 0.0001) and bilaterality (p < 0.0001) differed significantly according to N stage. CONCLUSIONS PTC patients with coexisting lymphocytic thyroiditis did not differ from those with normal parenchyma in terms of T stage, N stage, multifocality and bilaterality.
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84
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Surgical Treatment of Hashimoto's with Thyroid Microcarcinoma. Cell Biochem Biophys 2014; 72:123-6. [PMID: 25433724 DOI: 10.1007/s12013-014-0418-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study is to explore the surgical strategies for treating Hashimoto's disease complicated with thyroid microcarcinoma. We analyzed the clinical data of 25 patients with Hashimoto's disease with thyroid microcarcinoma who were treated in our hospital from January 1995 to September 2011. The incidence of Hashimoto's disease with thyroid microcarcinoma was 9.8 % (25/256) in our hospital. Amongst them, 19 patients had papillary thyroid carcinoma and six had follicular thyroid carcinoma. There were 24 cases (96 %) confirmed by the frozen section examination and one (4 %) after surgery. One patient did not undergo remedial surgery. The surgical approaches were determined based on preoperative examinations and intraoperative frozen pathology, including thyroid lobe and isthmus resection with contralateral lobe subtotal resection in 19 cases, and bilateral subtotal thyroid lobectomy in one case. Central lymph node dissection was conducted for all patients except one who was not diagnosed until after the surgery. No recurrence occurred during the follow-up (range: 6 months to 17 years) and all patients have survived to date. The preoperative diagnosis rate of Hashimoto's disease with thyroid cancer (in particular thyroid microcarcinomas) is low. Preoperative palpation, color Doppler ultrasound, fine needle aspiration, and the frozen section examination are helpful to improve the diagnosis rate of Hashimoto's disease with thyroid microcarcinoma. Surgery procedure is the most effective approach.
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85
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Sugitani I, Fujimoto Y, Yamada K. Association between serum thyrotropin concentration and growth of asymptomatic papillary thyroid microcarcinoma. World J Surg 2014; 38:673-8. [PMID: 24233662 DOI: 10.1007/s00268-013-2335-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thyrotropin (TSH) is a known thyroid growth factor. Several studies have suggested its potential role in carcinogenesis and the progression of differentiated thyroid carcinoma. We have been conducting a prospective trial of nonsurgical observation for asymptomatic papillary thyroid microcarcinoma (PMC) since 1995. The aim of this study was to investigate whether serum TSH concentrations can be used to predict PMC growth. METHODS This study examined 415 asymptomatic PMCs.Three hundred twenty-two patients decided to undergo nonsurgical observation by ultrasonography and were followed for ≥ 2 years. RESULTS After a mean of 6.5 years of observation (range 2-22 years), 25 lesions (6 %) had increased in size, 377(91 %) showed no change and 13 (3 %) had decreased in size. Both baseline TSH and mean TSH during follow-up for PMC that increased in size did not differ significantly from those lesions that were unchanged or decreased in size. Increases in size were seen in 0 of 18 (0 %), 15 of 260(6 %), 10 of 126 (8 %), and 0 of 11 (0 %) for PMCs with baseline TSH <0.50, 0.50-1.99, 2.00-3.99, and ≥ 4.00 mIU/L, respectively. A logistic regression model analyzing the association between baseline TSH and outcome showed an odds ratio of 1.01 (95 % confidence interval [CI], 0.66-1.29). No significant correlations were apparent between mean TSH during follow-up and change in PMC volume (r = 0.019, p = 0.70). CONCLUSIONS No significant association between TSH and tumor progression was verified during the nonsurgical observation trial for PMC. TSH is not a good predictor of PMC growth.
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86
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Cordioli MICV, Cury AN, Nascimento AO, Oliveira AKD, Mello M, Saieg MA. Study of the histological profile of papillary thyroid carcinomas associated with Hashimoto's thyroiditis. ACTA ACUST UNITED AC 2014; 57:445-9. [PMID: 24030184 DOI: 10.1590/s0004-27302013000600006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/22/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the association between the histological parameters of papillary thyroid cancer (PTC) and the presence of Hashimoto's thyroiditis (HT). MATERIALS AND METHODS Histological samples from patients with PTC were reviewed by an endocrine pathologist. The following parameters were analyzed: presence of concomitant HT, multifocality, presence of nodal metastasis, tumor size, vascular invasion, perineural infiltration, histological variant, and pathological staging. Clinical data included gender and age at the time of the diagnosis. RESULTS A total of 94 cases of PTC were reviewed. There was a predominance of women (85.1% vs. 14.9%) and median age at presentation was 45.13 years. The presence of HT was significantly associated with greater occurrence of multifocal tumors (p = 0.004), early pathological stage (p = 0.02), and smaller tumor size (p = 0.025). CONCLUSIONS Patients with PTC associated with HT had significantly smaller tumors, more often multifocal and in an earlier stage than their counterparts without HT. A better understanding of the immune response involved in these tumors may be useful for future strategies on the prevention and for the development of new therapeutic approaches for this group of neoplasms.
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87
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Zhang Y, Ma XP, Deng FS, Liu ZR, Wei HQ, Wang XH, Chen H. The effect of chronic lymphocytic thyroiditis on patients with thyroid cancer. World J Surg Oncol 2014; 12:277. [PMID: 25179111 PMCID: PMC4162966 DOI: 10.1186/1477-7819-12-277] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/20/2014] [Indexed: 12/31/2022] Open
Abstract
Background The purpose of this study was to investigate the association between chronic lymphocytic thyroiditis (CLT) and malignant tumors of the thyroid. Methods A retrospective review of 647 patients who underwent thyroid surgery at the Department of Breast and Thyroid Surgery in Anhui Provincial Hospital, China in 2012 was performed. The clinicopathological characteristics of patients with thyroid malignancies and CLT were collected. CLT was diagnosed by histopathological method. Results Among 647 patients, 144 patients had thyroid malignancies and 108 patients had been diagnosed with CLT. Moreover, in total, 44 patients had thyroid malignancies coexistent with CLT: forty-one (93.2%) patients had been diagnosed with the papillary thyroid cancer (PTC); two (4.5%) patients suffered from medullary carcinoma; and one (2.3%) patient suffered from lymphoma. The morbidity of thyroid malignancies in patients with CLT was significantly higher than that in patients without CLT (40.7% versus 18.6%; P <0.001). A female preponderance was observed in the patients with CLT compared with those without CLT (P <0.001). There was no statistically significant difference in the tumor size (P = 0.073), multifocality (P = 0.0871), neck lymph node metastasis (P = 0.350), age (P = 0.316), microcarcinoma (P = 0.983) and tumor-node-metastasis (TNM) stage (P = 0.949) between the patients of thyroid malignancies with CLT and without CLT. Conclusions Female predominance was observed in patients with CLT. CLT may have no effect on the progression of thyroid malignant tumor. Nevertheless, the influences of CLT on the prognosis of the thyroid carcinoma still need to be investigated with a larger sample size.
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Affiliation(s)
- Yi Zhang
- Department of General Surgery, The Affiliated Provincial Hospital of Anhui Medical University, No,1, Tian'ehu Road, 230001 Hefei, China.
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Wu X, Lun Y, Jiang H, Gang Q, Xin S, Duan Z, Zhang J. Coexistence of thyroglobulin antibodies and thyroid peroxidase antibodies correlates with elevated thyroid-stimulating hormone level and advanced tumor stage of papillary thyroid cancer. Endocrine 2014; 46:554-60. [PMID: 24338678 DOI: 10.1007/s12020-013-0121-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/09/2013] [Indexed: 01/20/2023]
Abstract
The correlation between thyroglobulin antibodies (TgAb) or thyroid peroxidase antibodies (TPOAb) and papillary thyroid cancer (PTC) remains controversial. This histological study aimed to explore the correlation between thyroid autoantibodies (TAb), thyroid-stimulating hormone (TSH), and PTC in patients with thyroid nodules (TN). This was a retrospective study. 2,132 non-autoimmune thyroid diseases (AITD) patients who underwent thyroidectomy were subdivided into: TgAb or TPOAb single positive (TgAb+ or TPOAb+) TN group; TgAb and TPOAb double positive or negative (TAb+ or TAb-) TN group. PTC patients showed a higher rate of TAb+ TN (10.24 vs. 4.89 %; P = 0.000) and a higher TSH level (1.83 ± 0.07 vs. 1.39 ± 0.03 mIU/L; P = 0.000) than patients with benign nodules. TAb+ TN patients showed a higher TSH level and PTC frequency than those with TAb- TN (1.91 ± 0.17 vs. 1.47 ± 0.03 mIU/L; P = 0.011) (41.35 vs. 22.08 %; P = 0.000). In PTC, TAb+ TN patients showed a higher TSH level (2.57 ± 0.35 vs. 1.79 ± 0.07 mIU/L; P = 0.032), a greater frequency of lymph node metastasis (52.73 vs. 36.51 %, P = 0.026), and a lower micro-PTC frequency (16.36 vs. 39.51 %; P = 0.001) than TAb- TN patients. PTC was correlated with TgAb+ TN (OR = 1.921, CI 1.431-2.580; P = 0.000), TPOAb+ TN (OR = 1.945, CI 1.195-3.165; P = 0.007), TAb+ TN (OR = 2.393, CI 1.635-3.501; P = 0.000), and serum TSH >1.35 mIU/L (OR = 1.742, CI 1.089-2.786; P = 0.021). Serum positive TgAb or TPOAb is an independent predictor for PTC regardless of AITD. The coexistence of TgAb and TPOAb confers a greater risk for PTC than isolated positive TgAb or TPOAb, and is correlated with elevated TSH level and advanced PTC stage.
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Affiliation(s)
- Xiaoyu Wu
- Department of Vascular & Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
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89
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Anand A, Singh KR, Kushwaha JK, Hussain N, Sonkar AA. Papillary Thyroid Cancer and Hashimoto's Thyroiditis: An Association Less Understood. Indian J Surg Oncol 2014; 5:199-204. [PMID: 25419066 DOI: 10.1007/s13193-014-0325-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/16/2014] [Indexed: 01/21/2023] Open
Abstract
Hashimoto's thyroiditis (HT), part of the spectrum of autoimmune thyroid diseases is a major cause of thyroid hypofunction worldwide. Papillary thyroid carcinoma (PTC), the most prevalent of all thyroid carcinomas has been associated with HT. Literature on this association are based on preoperative FNA or post thyroidectomy histopathology reports, which are subject to potential biases. Molecular, hormonal and histopathalogical basis of this association has been hypothesized, however a definite causal association has not been proved till date. This review aims to study the basis of this association and clinical features and management of HT concurrent with PTC. There are no distinctive clinical or radiological features that categorically differentiates HT concurrent with PTC from PTC or which can pick up a nodule harboring PTC in setting of HT. Smaller nodule size and radiological features like hypoechogenecity; hyper vascularity and calcification in a clinical setting of hypothyroidism have a higher odds ratio for malignancy and merit further investigations. PTC associated with HT has been seen to be less aggressive with earlier presentation with lesser chances of extra thyroidal extension and lymph nodal metastasis. The management and follow up of PTC in HT is no different from that of PTC alone. The prognosis of PTC concurrent with HT is better compared to age and stage matched PTC in terms of lower recurrence and disease free and overall survival.
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Affiliation(s)
- Akshay Anand
- Department of Surgery, King George's Medical University, Lucknow, U.P. India 226001
| | - Kul Ranjan Singh
- Department of Surgery, King George's Medical University, Lucknow, U.P. India 226001
| | | | - Nuzhat Hussain
- RML Institute of Medical Sciences, Lucknow, U.P. India 226001
| | - Abhinav Arun Sonkar
- Department of Surgery, King George's Medical University, Lucknow, U.P. India 226001
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Kim HG, Kim EK, Han KH, Kim H, Kwak JY. Pathologic spectrum of lymphocytic infiltration and recurrence of papillary thyroid carcinoma. Yonsei Med J 2014; 55:879-85. [PMID: 24954314 PMCID: PMC4075390 DOI: 10.3349/ymj.2014.55.4.879] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the prognosis of papillary thyroid carcinoma (PTC) patients according to different pathologic grades of lymphocytic thyroiditis (LT). MATERIALS AND METHODS This study included 144 PTC patients who underwent total thyroidectomy with radioactive iodine remnant ablation therapy. Pathologic grades of LT were separated at two points, chronic lymphocytic thyroiditis (CLT) and Hashimoto thyroiditis (HT). Patients were divided into two groupings according to the presence of the diseases (Grouping 1; patients with CLT or HT and without CLT or HT, Grouping 2; patients with HT and without HT). The groupings were compared according to recurrence, clinicopathologic and ultrasound (US) characteristics, and disease free survival. RESULTS Of 144 patients, 41 had CLT and 19 had HT. There were 10 patients (6.9%) with tumor recurrence. In both groupings, the presence of calcification was more frequently associated with patients with LT (p=0.041 and 0.047, respectively). In Grouping 2, the mean age at diagnosis was older in patients without HT compared to patients with HT (p=0.032). On multivariate analysis, the presence of LT was not an independent predictor of recurrence in both groupings. For both groupings, pathologic tumor size and taller than wide shape on US were independent predictors of recurrence. The presence of LT in PTC patients did not affect recurrence. CONCLUSION There was no relationship between PTC prognosis and different grades of LT. Pathologic tumor size and taller than wide shape on ultrasound were independent predictors of PTC recurrence regardless of concurrent LT.
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Affiliation(s)
- Hyun Gi Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwa Han
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunki Kim
- Department of Pathology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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91
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Predictive role of nontumoral sodium iodide symporter activity and preoperative thyroid characteristics in remission process of thyroid cancer patients. Ann Nucl Med 2014; 28:623-31. [DOI: 10.1007/s12149-014-0854-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
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Jayaprakash K, Kishanprasad H, Hegde P, Chandrika R. Hashimotos Thyroiditis with Coexistent Papillary Carcinoma and Non-hodgkin Lymphoma-thyroid. Ann Med Health Sci Res 2014; 4:268-70. [PMID: 24761251 PMCID: PMC3991953 DOI: 10.4103/2141-9248.129061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Lymphocytic thyroiditis and hashimoto's thyroiditis (HT) are the two main forms of autoimmune thyroiditis among which the latter is most frequent. A vast majority of cases of papillary carcinoma and primary thyroid lymphoma (PTL) arise in the setting of HT. A case of 32-year-old female who presented with thyroid enlargement, post-thyroidectomy showed hashimoto's thyroiditis (HT) with coexistent papillary carcinoma and non-hodgkin lymphoma (NHL). The immunohistochemistry was positive for CD 20, CD 45, bcl 2 for lymphoma, low and high molecular cytokeratin for papillary carcinoma. The staging studies showed no evidence of metastasis. It is thus concluded that papillary carcinoma and NHL can coexist with HT. The thyroid lymphoma or papillary carcinoma has to be thought off, whenever patients presents with sudden enlargement in a known case of HT. A patient presenting with concomitant primary thyroid lymphoma and papillary thyroid carcinoma must be judiciously evaluated, since, the treatment has to prioritize the tumor with worst stage at the time of diagnosis.
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Affiliation(s)
- Ks Jayaprakash
- Department of Pathology, KS Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, Karnataka, India
| | - Hl Kishanprasad
- Department of Pathology, KS Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, Karnataka, India
| | - P Hegde
- Department of Pathology, KS Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, Karnataka, India
| | - R Chandrika
- Department of Pathology, KS Hegde Medical Academy of Nitte University, Deralakatte, Mangalore, Karnataka, India
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93
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The study of the coexistence of Hashimoto’s thyroiditis with papillary thyroid carcinoma. J Cancer Res Clin Oncol 2014; 140:1021-6. [DOI: 10.1007/s00432-014-1629-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 02/24/2014] [Indexed: 01/26/2023]
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94
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Vasileiadis I, Boutzios G, Charitoudis G, Koukoulioti E, Karatzas T. Thyroglobulin antibodies could be a potential predictive marker for papillary thyroid carcinoma. Ann Surg Oncol 2014; 21:2725-32. [PMID: 24595799 DOI: 10.1245/s10434-014-3593-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hashimoto thyroiditis (HT) is associated with an increased risk of developing papillary thyroid carcinoma (PTC). The relationship between thyroid autoimmunity and cancer remains controversial. The purpose of this study was to investigate whether the preoperative TgAb could be a potential predictor of PTC in patients with thyroid nodules and to assess whether there is an association of preoperative TgAb with lymph node metastases. METHODS This retrospective, nonrandomised study included 854 patients who underwent standard total thyroidectomy. Benign thyroid nodules were diagnosed in 447 patients, and 407 presented with malignant nodules. The examined parameters included the clinical characteristics, preoperative TSH and TgAb levels, and the histopathological characteristics of the tumour. RESULTS Tumour size >10 mm (p = 0.01), the presence of PTC (p < 0.001), elevated TSH levels (2.64 ± 1.28 μU/ml vs. 2.09 ± 0.98 μU/ml, p = 0.001), HT (p < 0.001), and lymph node metastasis (p = 0.005) were significantly associated with positive TgAb. Additionally, tumour size >10 mm (p < 0.001), preoperative TgAb positivity (p = 0.003), and elevated TSH levels (TSH > 3.4 μU/ml, p = 0.038) were independent risk factors for PTC based on the multivariate logistic regression analysis. CONCLUSIONS This study showed that TgAb positivity was an independent risk factor for PTC. A positive correlation between TgAb and PTC in patients with indeterminate nodules was existed. Additionally, a positive correlation existed between TgAb and lymph node metastases in patients with PTC. Prospective studies with a larger number of patients and long-term follow-up are needed clarify the potential role of positive serum TgAb in the prediction of PTC.
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Affiliation(s)
- Ioannis Vasileiadis
- Department of Otolaryngology/Head and Neck Surgery, Venizeleio - Pananeio General Hospital, Herakleion, Alexandroupolis, Greece,
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95
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Kwon JH, Nam ES, Shin HS, Cho SJ, Park HR, Kwon MJ. P2X7 Receptor Expression in Coexistence of Papillary Thyroid Carcinoma with Hashimoto's Thyroiditis. KOREAN JOURNAL OF PATHOLOGY 2014; 48:30-5. [PMID: 24627692 PMCID: PMC3950232 DOI: 10.4132/koreanjpathol.2014.48.1.30] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/25/2014] [Accepted: 01/27/2014] [Indexed: 11/17/2022]
Abstract
Background This study was aimed at investigating the relation of P2X7 receptor (P2X7R) expression with the clinicopathological features of papillary thyroid carcinoma (PTC) coexisting with Hashimoto's thyroiditis (HT). Methods We examined 170 patients (84, PTC with HT; 86, PTC without HT). P2X7R expression was examined by immunohistochemical methods. The staining intensity and patterns were evaluated and scored using a semi-quantitative method. Results The PTC with HT group was more likely to contain women and had less extrathyroid extension, lymph node (LN) metastasis, lymphovascular invasion, and recurrence than the PTC without HT group. Patients positive for P2X7R had significantly higher frequencies of lymphovascular invasion, extrathyroid extension, LN metastasis, and absence of HT. As shown by multivariate analysis, the expression of P2X7R was significantly higher if HT was absent and extrathyroid extension was present. In the PTC with HT group, the expression of P2X7R was significantly higher in patients with tumor multifocality, lymphovascular invasion, and extrathyroid extension. In the PTC without HT group, the expression of P2X7R was significantly higher in women and those having tumor multifocality. Conclusions Coexistence of PTC with HT is associated with good prognostic factors, and P2X7R expression in PTC was correlated with poor prognostic factors and the absence of HT.
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Affiliation(s)
- Ji Hyun Kwon
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eun Sook Nam
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyung Sik Shin
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong Jin Cho
- Department of Pathology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hye Rim Park
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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96
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Jara SM, Carson KA, Pai SI, Agrawal N, Richmon JD, Prescott JD, Dackiw A, Zeiger MA, Bishop JA, Tufano RP. The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in North American patients with papillary thyroid carcinoma. Surgery 2014; 154:1272-80; discussion 1280-2. [PMID: 24238047 DOI: 10.1016/j.surg.2013.07.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several studies have reported that concurrent chronic lymphocytic thyroiditis (CLT) with papillary thyroid carcinoma (PTC) is associated with improved prognosis of the PTC, including decreased lymph node metastasis. We sought to assess the incidence of central nodal metastasis (CNM) in patients with PTC and concurrent CLT. METHODS We studied 495 consecutive patients who underwent thyroidectomy with nodal excision for PTC. Pathology reports identified the presence of CLT and the extent of CNM. RESULTS There were 226 patients (46%) with CLT and 220 (44%) with CNM. Patients with CLT were more often female (88% vs. 71%; P < .001) and had a younger median age (43 vs. 47 years; P = .03), a lesser incidence of CNM (35% vs. 52.4%; P < .001), and a greater incidence of pT1a (40% vs. 25%; P < .001) and pT1b (38% vs. 29%; P < .001) tumors. Multivariate analysis showed that the presence of CLT was associated with a 39% decreased odds of CNM after adjusting for age, gender, tumor size, PTC histopathologic subtype, and presence of lymphovascular invasion (odds ratio, 0.61; 95% confidence interval, 0.38-0.99; P = .046). Predicted probability modeling showed that all females with CLT and no suspicious nodal findings on ultrasonography had a 9-11% risk of CNM with pT1a tumors. CONCLUSION Female patients of all ages with CLT and small PTCs have the least incidence of CNM.
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Affiliation(s)
- Sebastian M Jara
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD
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97
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Konturek A, Barczyński M, Nowak W, Wierzchowski W. Risk of lymph node metastases in multifocal papillary thyroid cancer associated with Hashimoto's thyroiditis. Langenbecks Arch Surg 2014; 399:229-36. [PMID: 24407910 PMCID: PMC3916705 DOI: 10.1007/s00423-013-1158-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 12/25/2013] [Indexed: 10/27/2022]
Abstract
AIMS The aim of this study was to evaluate the risk factors of lymph nodes metastases (LNM) in patients with papillary thyroid cancer (PTC) and coexisting Hashimoto's thyroiditis (HT). PATIENTS AND METHODS This was a retrospective cohort study of patients with PTC and HT who had undergone total thyroidectomy (TT) with central neck dissection (CND) over an 11-year period (between 2002 and 2012). Pathological reports of all eligible patients were reviewed. Multivariable analysis was performed to identify risk factors of LNM. RESULTS During the study period, PTC was diagnosed in 130 patients with HT who had undergone TT with CND (F/M ratio = 110:20; median age, 52.4 ± 12.7 years). Multifocal lesions were observed in 28 (21.5 %) patients. LNM were identified in 25 of 28 (89.3 %) patients with multifocal PTC and HT versus 69 of 102 (67.5 %) patients with a solitary focus of PTC and HT (p = 0.023). In multivariable analysis, multifocal disease was identified as an independent risk factor for LNM (odds ratio, 3.99; 95 % confidence interval, 1.12 to 14.15; p = 0.033). CONCLUSIONS Multifocal PTC in patients with HT is associated with an increased risk of LNM. Nevertheless, the clinical importance of this finding needs to be validated in well-designed prospective studies.
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Affiliation(s)
- Aleksander Konturek
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, Kraków, 31-202, Poland,
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98
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Azizi G, Keller JM, Lewis M, Piper K, Puett D, Rivenbark KM, Malchoff CD. Association of Hashimoto's thyroiditis with thyroid cancer. Endocr Relat Cancer 2014; 21:845-52. [PMID: 25217233 PMCID: PMC4187247 DOI: 10.1530/erc-14-0258] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This prospective study investigates the relationship between Hashimoto's thyroiditis (HT) and thyroid cancer (TC) in patients with thyroid nodules (TNs). We prospectively examined 2100 patients with 2753 TNs between January 5, 2010 and August 15, 2013. A total of 2023 patients with 2669 TNs met the inclusion criteria of TN ≥5 mm and age ≥18 years. Each patient had blood drawn before fine-needle aspiration biopsy (FNAB) for the following measurements: TSH, free thyroxine, free tri-iodothyronine, thyroid peroxidase antibody (TPOAb), and antithyroglobulin antibody (TgAb). Diagnosis of TC was based on pathology analysis of thyroidectomy tissue. The associations of TC with the independent variables were determined by univariate and multivariate logistic regression analysis and reported as adjusted odds ratio (OR) with 95% CI. A total of 248 malignant nodules were found in 233 patients. There was an association of TC with both increased serum TgAb concentration and age<45 years. An elevated serum TgAb concentration was found in 10.2% of patients (182 of 1790) with benign nodules as compared with 20.6% of patients (48 of 233) with malignant nodules (P≤0.0001). TgAb (OR=2.24: CI=1.57, 3.19) and TSH ≥1 μIU/ml (OR (95% CI)) OR: 1.49 (1.09, 2.03) were significant predictors of TC in multivariate analysis controlling for age and gender. TC was not associated with serum concentrations of TPOAb. In patients with TN, elevated serum concentration of TgAb and TSH ≥1 μIU/ml are independent predictors for TC. The association between HT and TC is antibody specific.
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Affiliation(s)
- G Azizi
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - J M Keller
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - M Lewis
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - K Piper
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - D Puett
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - K M Rivenbark
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
| | - C D Malchoff
- Wilmington Endocrinology1717 Shipyard Boulevard, Suite 220, Wilmington, North Carolina 28403, USAWilmington Pathology Associates1915 South 17th Street, Suite 100, Wilmington, North Carolina 28401, USAChildren's Hospital Colorado13123 East 16th Avenue, Aurora, Colorado 80045, USACarolina Arthritis1710 South 17th Street, Wilmington, North Carolina 28401, USAUniversity of Connecticut Health Center263 Farmington Avenue, Farmington, Connecticut 06030, USA
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99
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Wong SL, Grodski S, Yeung MJ, Serpell JW. Anti-thyroid antibodies as a predictor of thyroid cancer. ANZ J Surg 2013; 85:849-53. [DOI: 10.1111/ans.12453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Sze Ling Wong
- Endocrine Surgery Unit; Monash University; Alfred Hospital; Melbourne Victoria Australia
| | - Simon Grodski
- Endocrine Surgery Unit; Monash University; Alfred Hospital; Melbourne Victoria Australia
| | - Meei J. Yeung
- Endocrine Surgery Unit; Monash University; Alfred Hospital; Melbourne Victoria Australia
| | - Jonathan W. Serpell
- Endocrine Surgery Unit; Monash University; Alfred Hospital; Melbourne Victoria Australia
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100
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Park M, Park SH, Kim EK, Yoon JH, Moon HJ, Lee HS, Kwak JY. Heterogeneous echogenicity of the underlying thyroid parenchyma: how does this affect the analysis of a thyroid nodule? BMC Cancer 2013; 13:550. [PMID: 24237991 PMCID: PMC3832886 DOI: 10.1186/1471-2407-13-550] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 11/14/2013] [Indexed: 12/02/2022] Open
Abstract
Background Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Thus, the aim of this study was to evaluate the influence of underlying thyroid echogenicity on diagnosis of thyroid malignancies using US. Methods A total of 1,373 patients who underwent US-guided fine needle aspiration of 1,449 thyroid nodules from June 2009 to August 2009 were included. The diagnostic performance of US assessment for thyroid nodules was calculated and compared according to underlying thyroid echogenicity. The diagnostic performance of US assessments in the diagnosis of thyroid malignancy according to the underlying parenchymal echogenicity was compared using a logistic regression with the GEE (generalized estimating equation) method. Each US feature of malignant and benign thyroid nodules was analyzed according to underlying echogenicity to evaluate which feature affected the final diagnosis. Results Among the 1,449 nodules, 325 (22.4%) were malignant and 1,124 (77.6%) were benign. Thyroid glands with heterogeneous echogenicity showed significantly lower specificity, PPV, and accuracy compared to thyroid glands with homogeneous echogenicity, 76.3% to 83.7%, 48.7% to 60.9%, and 77.6% to 84.4%, respectively (P = 0.009, 0.02 and 0.005, respectively). In benign thyroid nodules, microlobulated or irregular margins were more frequently seen in thyroid glands with heterogeneous echogenicity than in those with homogenous echogenicity (P < 0.001). Conclusion Heterogeneous echogenicity of the thyroid gland significantly lowers the specificity, PPV, and accuracy of US in the differentiation of thyroid nodules. Therefore, caution is required during evaluation of thyroid nodules detected in thyroid parenchyma showing heterogeneous echogenicity.
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Affiliation(s)
| | | | | | | | | | | | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea.
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