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Eun NL, Kim JA, Lee Y, Youk JH, Yun HJ, Chang H, Kim SM, Lee YS, Chang HS, Yang H, Jeon S, Son EJ. Preoperative Ultrasonography Predicts Level II Lymph Node Metastasis in N1b Papillary Thyroid Carcinoma: Implications for Surgical Planning. Biomedicines 2024; 12:1588. [PMID: 39062161 PMCID: PMC11274539 DOI: 10.3390/biomedicines12071588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE To investigate whether preoperative ultrasonographic (US) features of the index cancer and metastatic lymph nodes (LNs) are associated with level II LN metastasis in N1b papillary rmfthyroid carcinoma (PTC) patients. MATERIALS AND METHODS We enrolled 517 patients (mean age, 42 [range, 6-80] years) who underwent total thyroidectomy and lateral compartment LN dissection between January 2009 and December 2015. We reviewed the clinicopathologic and US features of the index cancer and metastatic LNs in the lateral neck. Logistic regression analysis was performed to analyze features associated with level II LN metastasis. RESULTS Among the patients, 196 (37.9%) had level II metastasis on final pathology. In the preoperative model, larger tumor size (odds ratios [ORs], 1.031; 95% confidence interval [CI]: 1.011-1.051, p = 0.002), nonparallel tumor shape (OR, 1.963; 95% CI: 1.322-2.915, p = 0.001), multilevel LN involvement (OR, 1.906; 95% CI: 1.242-2.925, p = 0.003), and level III involvement (OR, 1.867; 95% CI: 1.223-2.850, p = 0.004), were independently associated with level II LN metastasis. In the postoperative model, non-conventional pathology remained a significant predictor for level II LN metastasis (OR, 1.951; 95% CI: 1.121-3.396; p = 0.018), alongside the presence of extrathyroidal extension (OR, 1.867; 95% CI: 1.060-3.331; p = 0.031), and higher LN ratio (OR, 1.057; 95% CI: 1.039-1.076; p < 0.001). CONCLUSIONS Preoperative US features of the index tumor and LN may be helpful in guiding surgery in N1b PTC. These findings could enhance preoperative planning and decision-making, potentially reducing surgical morbidities by identifying those at higher risk of level II LN metastasis and tailoring surgical approaches accordingly.
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Affiliation(s)
- Na Lae Eun
- Department of Radiology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea; (N.L.E.)
| | - Jeong-Ah Kim
- Department of Radiology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea; (N.L.E.)
| | - Yangkyu Lee
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea; (N.L.E.)
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Hojin Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Hyejin Yang
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea
| | - Eun Ju Son
- Department of Radiology, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Gangnam-gu, Seoul 06273, Republic of Korea; (N.L.E.)
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D'Agostino C, Block L, Smith A, Weintraub S, Rose S, Coletti DJ, Khamis N. Enhancing point-of-care ultrasound (POCUS) utilization in primary care: A thyroid POCUS training course for internal medicine residents. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39016344 DOI: 10.1002/jcu.23767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/20/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND POCUS is valuable in primary care, yet outpatient-specific point-of-care ultrasound (POCUS) curriculum integration into internal medicine (IM) residency is limited. We addressed this gap by developing a thyroid POCUS workshop for IM residents. AIM Develop and implement an educational curriculum to integrate thyroid POCUS into an IM residency program and evaluate the impact on resident knowledge, perceived skills, and attitudes. SETTING The study was conducted in a resident primary care clinic at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Residency Program in Internal Medicine at North Shore University Hospital and Long Island Jewish Medical Center. PARTICIPANTS All 108 IM residents (PGY1-3) in one program participated in the study during their ambulatory clinic block. PROGRAM DESCRIPTION Residents participated in a 1-hour workshop involving a didactic session and two breakout groups: one for hands-on practice and another for case-based discussions with image review. PROGRAM EVALUATION Residents completed pre- and post-session surveys assessing knowledge, perceived skills, and attitudes toward thyroid POCUS. These data showed statistically significant increases in all assessed areas. DISCUSSION Integrating thyroid POCUS into an IM residency curriculum significantly improved resident knowledge, attitudes, and perceived skills related to these exams. Residents valued this learning experience and expressed intentions to incorporate it into their future practice.
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Affiliation(s)
| | - Lauren Block
- Department of Medicine, Northwell Health, New Hyde Park, New York, USA
| | - Alexander Smith
- Department of Medicine, Northwell Health, New Hyde Park, New York, USA
| | - Spencer Weintraub
- Department of Medicine, Northwell Health, New Hyde Park, New York, USA
| | - Sage Rose
- Department of Counseling & Mental Health Professions, Hofstra University, Hempstead, New York, USA
| | - Daniel J Coletti
- Department of Medicine, Northwell Health, New Hyde Park, New York, USA
| | - Nehal Khamis
- Department of Advanced Studies in Education/Master of Education for Health Professions Program, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Population Health, Hofstra University, Hempstead, New York, USA
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203
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Xu X, Li C, Yu X, Wang G, Guo Y, Ni H, Zhao W, Wang Y, Dong B. Clinicopathological features affecting the efficacy in 131I ablation therapy of papillary thyroid carcinoma with lymph node metastasis. Front Endocrinol (Lausanne) 2024; 15:1382009. [PMID: 39086895 PMCID: PMC11288842 DOI: 10.3389/fendo.2024.1382009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Background Lymph node metastasis is the major cause of increased recurrence and death in patients with papillary thyroid carcinoma (PTC). We evaluate the clinicopathologic factors affecting excellent response (ER) in patients with PTC with lymph node metastasis following operation and 131I ablation therapy. Methods A total of 423 patients with PTC with lymph node metastasis who underwent thyroidectomy and postoperative 131I ablation therapy were enrolled. The relationship between clinicopathological factors affecting ER achievement was analyzed. Results Multivariate analysis showed that the foci diameter (≤1 cm), unifocal, combination with Hashimoto's thyroiditis (HT), lymph node metastases rate (LR) (≤40%), no postoperative lymph node metastasis, low preablative stimulated thyroglobulin (ps-Tg) level (≤3.87 ng/mL), and the time of 131I ablation therapy (one time) were positively correlated with the ER achievement [odds ratio (OR): 1.744, 3.114, 3.920, 4.018, 2.074, 9.767, and 49.491, respectively; all p < 0.05]. The receiver operating characteristic (ROC) curves showed that the cutoff values of ps-Tg and LR were 4.625 ng/mL and 50.50%, respectively. The AUC of ROC of ps-Tg and LR for predicting ER achievement was 0.821 and 0.746, respectively. The Tg and the cumulative risk of non-ER elevated with the increase of LR, especially for the high-level ps-Tg (>4.625 ng/mL) group. Conclusion The foci diameter and number, combination with HT, LR, and ps-Tg level are independent factors for ER. Ps-Tg level and LR are valid predictive factors for the efficacy of 131I therapy in patients with PTC. The predictive value of the cumulative risk of non-ER can be improved by the combination of ps-Tg and LR.
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Affiliation(s)
- Xiang Xu
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chengqian Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaolong Yu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guoqiang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanjun Guo
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Huaiwen Ni
- Department of Endocrinology, Lanling County People’s Hospital of Linyi, Linyi, China
| | - Wenjuan Zhao
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yangang Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bingzi Dong
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, China
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Liu B, Zhou H, Tan L, Siu KTH, Guan XY. Exploring treatment options in cancer: Tumor treatment strategies. Signal Transduct Target Ther 2024; 9:175. [PMID: 39013849 PMCID: PMC11252281 DOI: 10.1038/s41392-024-01856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 07/18/2024] Open
Abstract
Traditional therapeutic approaches such as chemotherapy and radiation therapy have burdened cancer patients with onerous physical and psychological challenges. Encouragingly, the landscape of tumor treatment has undergone a comprehensive and remarkable transformation. Emerging as fervently pursued modalities are small molecule targeted agents, antibody-drug conjugates (ADCs), cell-based therapies, and gene therapy. These cutting-edge treatment modalities not only afford personalized and precise tumor targeting, but also provide patients with enhanced therapeutic comfort and the potential to impede disease progression. Nonetheless, it is acknowledged that these therapeutic strategies still harbour untapped potential for further advancement. Gaining a comprehensive understanding of the merits and limitations of these treatment modalities holds the promise of offering novel perspectives for clinical practice and foundational research endeavours. In this review, we discussed the different treatment modalities, including small molecule targeted drugs, peptide drugs, antibody drugs, cell therapy, and gene therapy. It will provide a detailed explanation of each method, addressing their status of development, clinical challenges, and potential solutions. The aim is to assist clinicians and researchers in gaining a deeper understanding of these diverse treatment options, enabling them to carry out effective treatment and advance their research more efficiently.
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Affiliation(s)
- Beilei Liu
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
- State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
| | - Hongyu Zhou
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Licheng Tan
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Kin To Hugo Siu
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Xin-Yuan Guan
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China.
- State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
- Advanced Energy Science and Technology Guangdong Laboratory, Huizhou, China.
- MOE Key Laboratory of Tumor Molecular Biology, Jinan University, Guangzhou, China.
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205
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Yamazaki H, Sugimori M, Saito A. Larotrectinib efficacy for liver metastases in papillary thyroid carcinoma patient harboring SQSTM1-NTRK1 fusion. Surg Case Rep 2024; 10:171. [PMID: 39014182 PMCID: PMC11252091 DOI: 10.1186/s40792-024-01971-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Pooled data analysis from three phase I/II larotrectinib clinical trials revealed that larotrectinib demonstrated rapid and durable disease control and a favorable safety profile for patients with neurotrophic-tropomyosin receptor kinase (NTRK) fusion positive thyroid carcinoma. Herein, we report the case of a patient with papillary thyroid carcinoma (PTC) and liver metastases who demonstrated a durable response to treatment with larotrectinib. CASE PRESENTATION A 50-year-old female with PTC was referred to our hospital for postoperative observation. Computed tomography (CT) scan was performed to screen for distant metastasis, since thyroglobulin concentration increased gradually, and revealed multiple distant metastases, including multiple liver metastases. Radioactive iodine was administered at a dose of 100 mCi. However, uptake was observed only in the thyroid bed, and distant metastases had no avidity. As liver metastases progressed, lenvatinib (24 mg/day) was initiated after confirmation of liver metastases by liver biopsy 9 years and 1 month after the initial referral to our hospital. Since the multiple metastases became refractory for lenvatinib, the OncoGuide™ NCC Oncopanel System was performed, and the SQSTM1-NTRK1 gene fusion was confirmed. Larotrectinib was subsequently administered at a dose of 200 mg/day. The CT before the initiation of larotrectinib showed multiple liver metastases with a maximum diameter of 48 mm. The first CT evaluation at 1 month after the initiation of larotrectinib treatment showed that the tumor volume was reduced by 28% in the RECIST 1.1 criteria. After 3 months of larotrectinib treatment, a 38% reduction in the tumor volume was achieved as the best clinical response. The only side effect was grade 1 myalgia. At 12 months after the initiation of larotrectinib treatment, none of the lesions had progressed. CONCLUSIONS In conclusion, larotrectinib demonstrated effective antitumor activity against liver metastases of PTC, a relatively rare site of distant metastasis. Furthermore, the efficacy of larotrectinib was maintained, even though the patient had a history of multi-tyrosine kinase inhibitor treatment and a relatively infrequent fusion gene, SQSTM1-NTRK1.
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Affiliation(s)
- Haruhiko Yamazaki
- Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Makoto Sugimori
- Division of Cancer Genome Medicine, Genomics Laboratory, and Gastroenterology, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-Ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Aya Saito
- Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
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206
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Lin D, Hanna CA, Frost A, Wrenn A, Eltoum I. Oncocytic/Hürthle cell lesions have the same implied risk of neoplasm/malignancy as their follicular counterparts. Cytopathology 2024. [PMID: 39012032 DOI: 10.1111/cyt.13424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/10/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION There are conflicting results on whether the presence of oncocytes modifies the risk of neoplasm (RON) or malignancy (ROM) for thyroid fine-needle aspirates (FNAs): Atypia of undetermined significance AUS and Follicular Neoplasm, FN, or Oncocytic Neoplasm, ON. To our knowledge, the effect of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has not yet been studied. We compared RON and ROM between follicular type AUS (AUS-FT) and oncocytic type AUS (AUS-OT) and between FN and ON. MATERIALS AND METHODS We retrospectively analysed all thyroid FNAs with the diagnostic category of AUS-other or Neoplasm (2005-2015). AUS-FT had predominance of microfollicles and AUS-OT had predominance of oncocytes. Histology follow-up was then reviewed and RON, ROM was then calculated and compared (significant at p < 0.05). We repeated the search for 2018 to evaluate for NIFTP effect. RESULTS Pre-NIFTP, 859/5063 cases (17%) were AUS-FT, AUS-OT, FN, and ON. Histology follow-up was available for 297 cases (35%). RON was 83/183 (45%) for AUS-FT, 35/76 (46%) for AUS-OT, 15/25 (60%) for FN and 11/13 (85%) for ON. Post-NIFTP, RON was 11/31 (35%) for AUS-FT, 5/8 (63%) for AUS-OT, 1/2 (50%) for FN and 4/5 (80%) for ON. For both periods, RON, ROM of AUS-FT was not significantly different than AUS-OT, and no significant differences were observed comparing FN and ON. CONCLUSION The predominance of oncocytes does not modify the implied RON, ROM for categories of AUS or FN\ON, even after the adoption of NIFTP.
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Affiliation(s)
- Diana Lin
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - C Alexandra Hanna
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andra Frost
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allison Wrenn
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Isam Eltoum
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Nguyen TPX, Roytrakul S, Buranapraditkun S, Shuangshoti S, Kitkumthorn N, Keelawat S. Proteomics profile in encapsulated follicular patterned thyroid neoplasms. Sci Rep 2024; 14:16343. [PMID: 39013964 PMCID: PMC11252349 DOI: 10.1038/s41598-024-67079-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024] Open
Abstract
Diagnosing encapsulated follicular-patterned thyroid tumors like Invasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma (IEFVPTC), Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP), and Well-Differentiated Tumor of Uncertain Malignant Potential (WDT-UMP) remains challenging due to their morphological and molecular similarities. This study aimed to investigate the protein distinctions among these three thyroid tumors and discover biological tumorigenesis through proteomic analysis. We employed total shotgun proteome analysis allowing to discover the quantitative expression of over 1398 proteins from 12 normal thyroid tissues, 13 IEFVPTC, 11 NIFTP, and 10 WDT-UMP. Principal component analysis revealed a distinct separation of IEFVPTC and normal tissue samples, distinguishing them from the low-risk tumor group (NIFTP and WDT-UMP). IEFVPTC exhibited the highest number of differentially expressed proteins (DEPs) compared to the other tumors. No discriminatory proteins between NIFTP and WDT-UMP were identified. Moreover, DEPs in IEFVPTC were significantly associated with thyroid tumor progression pathways. Certain hub genes linked to the response of immune checkpoint inhibitor therapy, revealing the potential predictor of prognosis. In conclusion, the proteomic profile of IEFVPTC differs from that of low-risk tumors. These findings may provide valuable insights into tumor biology and offer a basis for developing novel therapeutic strategies for follicular-patterned thyroid neoplasms.
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Affiliation(s)
- Truong Phan-Xuan Nguyen
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Sittiruk Roytrakul
- Functional Proteomics Technology Laboratory, National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathumthani 12120, Thailand
| | - Supranee Buranapraditkun
- Division of Allergy and Clinical Immunology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Thai Red Cross Society, Bangkok, 10330, Thailand
- Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology (TPGHAI), Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Shanop Shuangshoti
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Chulalongkorn GenePRO Center, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Nakarin Kitkumthorn
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, 10330, Thailand.
| | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
- Precision Pathology of Neoplasia Research Group, Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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208
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Peng X, Zhao H, Ye L, Hou F, Yi Z, Ren Y, Lu L, Chen F, Lv J, Wang Y, Cai H, Zheng X, Yang Q, Chen T. Biomarker Identification and Risk Prediction Model Development for Differentiated Thyroid Carcinoma Lung Metastasis Based on Primary Lesion Proteomics. Clin Cancer Res 2024; 30:3059-3072. [PMID: 38723277 PMCID: PMC11247316 DOI: 10.1158/1078-0432.ccr-23-3806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/15/2024] [Accepted: 05/07/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The rising global high incidence of differentiated thyroid carcinoma (DTC) has led to a significant increase in patients presenting with lung metastasis of DTC (LMDTC). This population poses a significant challenge in clinical practice, necessitating the urgent development of effective risk stratification methods and predictive tools for lung metastasis. EXPERIMENTAL DESIGN Through proteomic analysis of large samples of primary lesion and dual validation employing parallel reaction monitoring and IHC, we identified eight hub proteins as potential biomarkers. By expanding the sample size and conducting statistical analysis on clinical features and hub protein expression, we constructed three risk prediction models. RESULTS This study identified eight hub proteins-SUCLG1/2, DLAT, IDH3B, ACSF2, ACO2, CYCS, and VDAC2-as potential biomarkers for predicting LMDTC risk. We developed and internally validated three risk prediction models incorporating both clinical characteristics and hub protein expression. Our findings demonstrated that the combined prediction model exhibited optimal predictive performance, with the highest discrimination (AUC: 0.986) and calibration (Brier score: 0.043). Application of the combined prediction model within a specific risk threshold (0-0.97) yielded maximal clinical benefit. Finally, we constructed a nomogram based on the combined prediction model. CONCLUSIONS As a large sample size study in LMDTC research, the identification of biomarkers through primary lesion proteomics and the development of risk prediction models integrating clinical features and hub protein biomarkers offer valuable insights for predicting LMDTC and establishing personalized treatment strategies.
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Affiliation(s)
- Xiaoqi Peng
- Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongbo Zhao
- Laboratory Zoology Department, Kunming Medical University, Kunming, China
| | - Lijuan Ye
- Department of Pathology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fei Hou
- Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zihan Yi
- Department of Medical Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanxin Ren
- Department of Head and Neck Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lin Lu
- Academy of Biomedical Engineering, Kunming Medical University, Kunming, China
| | - Fukun Chen
- Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Juan Lv
- Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yinghui Wang
- Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haolin Cai
- Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xihua Zheng
- Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qing Yang
- Department of Head and Neck Surgery, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ting Chen
- Department of Nuclear Medicine, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
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209
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Fawzy MS, Alenezi AA, Abu AlSel BT, Toraih EA. Long-term survival outcomes of systemic therapy in patients with isolated and mixed medullary thyroid cancer. Heliyon 2024; 10:e33654. [PMID: 39040258 PMCID: PMC11260957 DOI: 10.1016/j.heliyon.2024.e33654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/24/2024] Open
Abstract
Background Medullary thyroid carcinoma (MTC) is an uncommon thyroid cancer with limited treatment options for advanced disease. A small subset exhibits mixed MTC histology with both medullary and well-differentiated components. We investigated survival outcomes with systemic therapy in isolated versus mixed MTC using a large population-based cohort. Methods Patients diagnosed with MTC from 2000 to 2019 were identified in the National Cancer Institute's Surveillance, Epidemiology, and End Results database. The overall and thyroid cancer-specific survivals were compared between isolated (n = 1814) and mixed (n = 113) MTC cohorts. The impact of postoperative systemic therapy on survival was analyzed. Results No significant difference in 10-year overall survival was observed between isolated (77.4 %) and mixed (75.2 %) MTC in a cohort of 1927 patients. Median overall survival was similar between isolated (136.9 months) and mixed MTC (129.0 months), p = 0.81. While systemic therapy improved 10-year survival in isolated MTC (83.2 % vs. 76.9 %, p < 0.001), no benefit was seen in mixed MTC (76.4 % vs. 74.2 %, p = 0.82). Multivariate analysis confirmed survival gains with systemic therapy for isolated (HR = 0.763, 95%CI = 0.590-0.987, p = 0.040) but not mixed MTC (HR = 0.909, 95%CI = 0.268-3.079, p = 0.88). Conclusions In this large population-based study, no significant survival difference was observed between isolated and mixed MTC. Systemic therapy was associated with improved survival in isolated MTC, but not in the mixed subtype. These findings suggest a differential treatment response that warrants further investigation in prospective studies and may inform histology-tailored management strategies for mixed MTC.
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Affiliation(s)
- Manal S. Fawzy
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
- Unit of Medical Research and Postgraduate Studies, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Aziza Ali Alenezi
- University Health Center, Northern Border University, Arar, Saudi Arabia
| | - Baraah T. Abu AlSel
- Department of Pathology, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Eman A. Toraih
- Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA
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Xiong X, Huang B, Gan Z, Liu W, Xie Y, Zhong J, Zeng X. Ubiquitin-modifying enzymes in thyroid cancer:Mechanisms and functions. Heliyon 2024; 10:e34032. [PMID: 39091932 PMCID: PMC11292542 DOI: 10.1016/j.heliyon.2024.e34032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Thyroid cancer is the most common malignant tumor of the endocrine system, and evidence suggests that post-translational modifications (PTMs) and epigenetic alterations play an important role in its development. Recently, there has been increasing evidence linking dysregulation of ubiquitinating enzymes and deubiquitinases with thyroid cancer. This review aims to summarize our current understanding of the role of ubiquitination-modifying enzymes in thyroid cancer, including their regulation of oncogenic pathways and oncogenic proteins. The role of ubiquitination-modifying enzymes in thyroid cancer development and progression requires further study, which will provide new insights into thyroid cancer prevention, treatment and the development of novel agents.
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Affiliation(s)
- Xingmin Xiong
- Department of Thyroid and Hernia Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, 323 National Road, Ganzhou, 341000, Jiangxi, China
| | - BenBen Huang
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, 323 National Road, Ganzhou, 341000, Jiangxi, China
| | - Zhe Gan
- Ganzhou Key Laboratory of Thyroid Cancer, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China
| | - Weixiang Liu
- Institute of Thyroid and Parathyroid Disease, Gannan Medical University, Ganzhou, Jiangxi, 341000, China
| | - Yang Xie
- Department of Thyroid and Hernia Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China
- Ganzhou Key Laboratory of Thyroid Cancer, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China
| | - Jianing Zhong
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, 323 National Road, Ganzhou, 341000, Jiangxi, China
| | - Xiangtai Zeng
- Department of Thyroid and Hernia Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, 341000, China
- Institute of Thyroid and Parathyroid Disease, Gannan Medical University, Ganzhou, Jiangxi, 341000, China
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211
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Kostopoulou E, Koliofoti EG, Spilioti DX, Miliordos K, Skiadopoulos S, Gil APR, Fouzas S, Sinopidis X, Spiliotis BE. Diagnosis of Thyroid Nodules in Children and Adolescents with Subclinical Hypothyroidism and Their Outcomes after Early Thyroxine Treatment-A Longitudinal Study. Diagnostics (Basel) 2024; 14:1528. [PMID: 39061665 PMCID: PMC11275568 DOI: 10.3390/diagnostics14141528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/01/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
Pediatric thyroid nodules (TNs) present a higher malignancy rate compared to adults. We sought to diagnose the frequency and characteristics of TNs in children and adolescents with subclinical hypothyroidism (SH) and their outcomes after levothyroxine (LT4) therapy. A total of 256 children with TNs and SH were followed every semester from 2006 to 2018. All patients were treated with LT4. Clinical and radiologic findings, such as the size and texture of the nodules, were documented. Analysis included one-way ANOVA, Kruskal-Wallis, Chi-square, and Fisher's exact tests. After initial LT4 therapy, TNs disappeared in 85.5% and did not reappear throughout follow-up. In 14.5%, TNs remained the same or increased in size, but they decreased after subsequent LT4 administration with an increased dose. Thyroid disease family history (FHTD) was documented in 77.0%. In total, 64.5% developed a goiter, 46.0% exhibited thyroid heterogeneity on ultrasound, 23.4% had positive Anti-Tg, and 25.4% had positive anti-TPO autoantibodies. Our findings support the possible premise that early pharmacologic intervention with LT4 may be beneficial in children and adolescents with TNs and SH. The increased frequency of FHTD, goiter, thyroid heterogeneity, and Hashimoto in our patients emphasizes that thyroid ultrasounds may be warranted in children and adolescents with these characteristics in order to rule out the presence of TNs.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
| | - Eleana Georgia Koliofoti
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
| | - Diamantina X. Spilioti
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
| | - Konstantinos Miliordos
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (K.M.); (S.F.)
| | - Spyros Skiadopoulos
- Department of Medical Physics, School of Medicine, University of Patras, 26504 Patras, Greece;
| | - Andrea Paola Rojas Gil
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
- Laboratory of Basic Health Sciences, Department of Nursing, Faculty of Health Sciences, University of Peloponnese, 22100 Tripoli, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (K.M.); (S.F.)
| | - Xenophon Sinopidis
- Department of Pediatric Surgery, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Bessie E. Spiliotis
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece; (E.K.); (E.G.K.); (D.X.S.); (A.P.R.G.); (B.E.S.)
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212
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Liu B, Peng Y, Su Y, Diao C, Cheng R. Treatment and management of medullary thyroid microcarcinoma: a 10-year retrospective study from a single center. Endocrine 2024:10.1007/s12020-024-03958-2. [PMID: 39009923 DOI: 10.1007/s12020-024-03958-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/06/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE To explore individualized treatment and management methods for medullary thyroid microcarcinoma (MTMC). METHODS Clinical data of patients with medullary thyroid carcinoma with a diameter ≤1 cm admitted to the First Affiliated Hospital of Kunming Medical University from June 2013 to June 20× were collected. Combined with different treatment guidelines for medullary thyroid carcinoma, factors affecting lymph node metastasis and postoperative disease status were analyzed. RESULTS Twenty-nine patients with MTMC were included in the analysis, including 24 patients who underwent total thyroidectomy, 5 who underwent thyroid gland lobectomy, and 13 who experienced postoperative lymph node metastasis. Multifocal tumor and calcitonin (Ctn) were the influencing factors, while multifocal tumor, Ctn, lymph node metastasis, and AJCC stage affected the dynamic risk stratification of postoperative disease. CONCLUSION Calcitonin detection is an important method for detecting MTMC. A tumor diameter ≤1 cm does not indicate that the tumor is in the early stage. The presence of multifocal tumors and Ctn should be used as important indicators for preoperative evaluation. Dynamic stratified risk assessment is critical in postoperative follow-up.
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Affiliation(s)
- Bin Liu
- Thyroid Disease Diagnosis and Treatment Center, First Affiliated Hospital of Kunming Medical University, Yunnan, China
- Kunming Medical University, Yunnan, China
| | - Ying Peng
- Thyroid Disease Diagnosis and Treatment Center, First Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Yanjun Su
- Thyroid Disease Diagnosis and Treatment Center, First Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Chang Diao
- Thyroid Disease Diagnosis and Treatment Center, First Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Ruochuan Cheng
- Thyroid Disease Diagnosis and Treatment Center, First Affiliated Hospital of Kunming Medical University, Yunnan, China.
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213
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Agarwal S, Jung CK, Gaddam P, Hirokawa M, Higashiyama T, Hang JF, Lai WA, Keelawat S, Liu Z, Na HY, Park SY, Fukuoka J, Satoh S, Mussazhanova Z, Nakashima M, Kakudo K, Bychkov A. PD-L1 Expression and Its Modulating Factors in Anaplastic Thyroid Carcinoma: A Multi-institutional Study. Am J Surg Pathol 2024:00000478-990000000-00390. [PMID: 39004795 DOI: 10.1097/pas.0000000000002284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Anti-PD immunotherapy is currently under investigation in anaplastic thyroid carcinoma (ATC). Tumor cell surface PD-L1 expression is considered predictive of therapeutic response. Although papillary thyroid carcinoma has been widely studied for PD-L1 expression, there are limited data on ATC. In this retrospective multi-institutional study involving 9 centers across Asia, 179 ATCs were assessed for PD-L1 expression using the SP263 (Ventana) clone. A tumor proportion score (TPS) ≥1% was required to consider a case PD-L1-positive. PD-L1 expression was compared with the histological patterns, the type of specimen (small or large), tumor molecular profile (BRAF V600E and TERT promoter mutation status), and patient outcome. PD-L1 expression in any co-existent differentiated thyroid carcinoma (DTC) was evaluated separately and compared with ATC. Most ATCs (73.2%) were PD-L1-positive. The median TPS among positive cases was 36% (IQR 11% to 75%; range 1% to 99%). A high expression (TPS ≥ 50%) was noted in 30.7%. PD-L1-negative cases were more likely to be small specimens (P=0.01). A negative result on small samples, hence, may not preclude expression elsewhere. ATCs having epithelioid and pleomorphic histological patterns were more likely to be PD-L1-positive with higher TPS than sarcomatoid (P<0.01). DTCs were more frequently negative and had lower TPS than ATC (P<0.01). Such PD-L1 conversion from DTC-negative to ATC-positive was documented in 71% of cases with co-existent DTC. BRAF V600E, but not TERT promoter mutations, correlated significantly with PD-L1-positivity rate (P=0.039), reinforcing the potential of combining anti-PD and anti-BRAF V600E drugs. PD-L1 expression, however, did not impact the patient outcome.
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Affiliation(s)
- Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chan Kwon Jung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Pranitha Gaddam
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-An Lai
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Precision Pathology of Neoplasia Research Group, Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Zhiyan Liu
- Department of Pathology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Junya Fukuoka
- Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shinya Satoh
- Department of Endocrine Surgery, Yamashita Thyroid and Parathyroid Clinic, Fukuoka, Japan
| | - Zhanna Mussazhanova
- Department of Tumor and Diagnostic Pathology, Nagasaki University, Nagasaki, Japan
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Nagasaki University, Nagasaki, Japan
| | - Kennichi Kakudo
- Department of Pathology, Izumi City General Hospital, Izumi, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
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214
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Sun S, Zhou Q, Hu T. A model based on ultrasound and clinical factors to predict central lymph node metastasis in cN0 papillary thyroid microcarcinoma. Heliyon 2024; 10:e33891. [PMID: 39071653 PMCID: PMC11283140 DOI: 10.1016/j.heliyon.2024.e33891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Objective The prevalence of thyroid malignancies has sharply elevated in the past few years, and a large number of newly diagnosed thyroid malignancies was papillary thyroid microcarcinomas (PTMC). The efficacy of prophylactic central lymph node dissection (PCLND) in patients with clinical lymph node-negative (cN0) PTMC is still debatable. In this study, we aimed to create a predictive model to assess the likelihood of central lymph node metastasis (CLNM) in cN0 PTMC. Methods Two hundred and fifty three patients diagnosed with cN0 PTMC who received surgery in the First People's Hospital of Kunshan from October 2018 to June 2023 were enrolled. Multivariate logistic regression was employed to evaluate the patient's clinical and ultrasonographic information to determine independent factors. Two prediction models were generated and their ability to evaluate the likelihood of CLNM in cN0 PTMC was determined and compared. Results Multivariate analysis based on clinical characteristics revealed that, CLNM was markedly linked to age, tumor size, and extrathyroidal infiltration in cN0 PTMC. Multivariate analysis utilizing clinical and ultrasound features demonstrated that age, tumor size, extrathyroidal infiltration, shape, microcalcification were independent risk factors for CLNM. The analysis of the receiver operating characteristic curve demonstrated that the predictive nomogram utilizing clinical and ultrasound features was more beneficial for predicting CLNM. And decision curve demonstrates the same. The model's calibration curve exhibited strong consistency. Conclusions Age, tumor size, extrathyroidal infiltration, shape, microcalcification are significant independent factors of CLNM in cN0 PTMC. A predictive model derived from these independent clinical and ultrasound factors has a good value, but further validation is still required.
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Affiliation(s)
- Shaokun Sun
- Department of Thyroid Surgery, The First People's Hospital of Kunshan, Suzhou, Jiangsu, China
| | - Qin Zhou
- Department of Thyroid Surgery, The First People's Hospital of Kunshan, Suzhou, Jiangsu, China
| | - Tao Hu
- Department of Thyroid Surgery, The First People's Hospital of Kunshan, Suzhou, Jiangsu, China
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215
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Zhang Y, Chen Q, Niu L, Huang H, Yang Z, Liao T, Guan Q, Xiang J. Multi-omics data analysis reveals the complex roles of age in differentiated thyroid cancer. Heliyon 2024; 10:e33595. [PMID: 39044989 PMCID: PMC11263663 DOI: 10.1016/j.heliyon.2024.e33595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/25/2024] Open
Abstract
Aims Age is a major risk factor for differentiated thyroid cancer (DTC); however, the mechanisms underlying aging-regulated progression of DTC remains unclear. Methods Based on multi-omics data (transcriptional files, somatic mutation files, methylation files) derived from the TCGA database, we comprehensively investigated the genomic and biological features associated with aging in patients with DTC. Results We confirmed that age was an independent risk factor for overall survival and progression-free survival of patients with DTC, and confirmed that 55 years of age (adopted in the 8th AJCC staging system) is an appropriate cutoff for patients with DTC rather than 45 years (adopted in the 7th AJCC staging system). Using 55 years as the cutoff, we demonstrated DNA methylation-driven transcriptional regulation during aging, and identified the landscape of somatic mutations in young and old patients with DTC along with two aging-related mutations: TTN and EIF1AX. Subsequently, we investigated the infiltration of immune cells in DTC, and found that old patients exhibited decreased CD8+ T cells infiltration with lower cytotoxicity. Finally, we constructed a prognosis prediction model based on three age-related genes (PTK2B, E2F1, and GHR) that showed satisfactory performance in predicting patients prognosis. Conclusions We comprehensively investigated the complex interplay between age and biological features of DTC, which may provide new insights into the role of aging in DTC.
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Affiliation(s)
- Yu Zhang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qi Chen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Lili Niu
- Central Laboratory, First Affiliated Hospital, Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, 116021, China
- Pharmacy Department, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, 201399, China
| | - Hu Huang
- Department of Thyroid and Breast Surgery, Jiangnan University Affiliated Hospital, Wuxi, 214000, China
| | - Zhou Yang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Tian Liao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Qing Guan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jun Xiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
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216
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Gao X, Gao J, Sun Y, Zhao J, Geng L, Wang C, Qiao M, Wang J. The common pathogenesis of nodular goiter in both sexes: An exploration into gene expression and signaling pathways. Heliyon 2024; 10:e33411. [PMID: 39035545 PMCID: PMC11259846 DOI: 10.1016/j.heliyon.2024.e33411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
The past few years have witnessed an increasing incidence of nodular goiter (NG), with a well-documented higher prevalence in females than males. This gender disparity has led research to focus primarily on female subjects, potentially overlooking common pathogenic mechanisms in both sexes. In this study, we investigated the shared pathogenesis of NG in males and females. Utilizing a rat model and RNA sequencing, we identified differentially expressed genes associated with the disease. We further validated these findings in normal human thyroid cells and human papillary thyroid cancer cells. A randomized experiment was conducted with equal numbers of male and female rats divided into control and NG model groups. The NG model was established using propylthiouracil and various assessments such as thyroid ultrasonography, thyroid index, thyroid function, and thyroid histology were performed. Transcriptome analysis revealed numerous upregulated and downregulated genes in both male and female model groups. Key genes like KDR, FLT1, PDGFB, and CAV1, and pathways including PI3K-Akt, MAPK, Ras, fluid shear stress and atherosclerosis, calcium signaling, and Rap1 signaling pathways were linked with the disease. Western blot and immunofluorescence analysis confirmed these findings, which were further supported by cell-based experiments. In conclusion, our findings suggest that abnormal expression of specific genes and pathways leading to irregular cell growth, blood vessel formation, and inflammation may be common factors in the pathogenesis of NG in both males and females.
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Affiliation(s)
- Xiangju Gao
- Research and Innovation Team of Emotional Diseases and Syndromes in Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Jie Gao
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Ya Sun
- Institute of Traditional Chinese Medicine Innovation, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Jing Zhao
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Li Geng
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Changlin Wang
- Research and Innovation Team of Emotional Diseases and Syndromes in Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Mingqi Qiao
- School of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Jieqiong Wang
- Emotional Disease Syndrome Liver Storage Pharmacological Young Scientific Research Innovation Team in Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
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217
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Keshavarzi A, Alaei-Shahmiri F, Fallahi B, Emami Z, Malek M, Khamseh ME. Predictors of response to Radioactive Iodine Therapy in Intermediate and high risk patients with papillary thyroid carcinoma. BMC Endocr Disord 2024; 24:112. [PMID: 39004697 PMCID: PMC11247765 DOI: 10.1186/s12902-024-01648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Radioactive iodine (RAI) therapy is the standard treatment approach after total thyroidectomy in patients with papillary thyroid carcinoma (PTC). We aimed to identify predictive factors of response to the treatment in intermediate and high-risk patients with PTC. In addition, the impact of multiple RAI treatments was explored. METHODS In a 3-year retrospective study, data from intermediate and high-risk patients with PTC who received RAI therapy following total thyroidectomy, were analyzed by the end of year-one and year-three. Demographic data, tumor size, capsular/vascular invasion, extrathyroidal extension, local or distant metastasis, initial dose and cumulative dose of RAI, serum thyroglobulin(Tg), antithyroglobulin antibody(TgAb), and imaging findings were investigated. Patients with an excellent response to a single dose of RAI treatment, after three years of follow-up were classified as the "Responder group". Excellent response was defined as stimulated serum Tg less than 1 ng/ml, or unstimulated serum Tg less than 0.2 ng/ml in TgAb-negative patients with negative imaging scans. RESULTS 333 patient records with a complete data set were analyzed in this study. After three years of initial treatment, 271 patients were non-responders (NR) and 62 were responders (R). At baseline, the median pre-ablation serum Tg level was 5.7 ng/ml in the NR group, and 1.25 ng/ml in the R group (P < 0.001). TSH-Stimulated serum Tg greater than 15.7 ng/ml, was associated with response failure even after multiple RAI therapy, AUC: 0.717(0.660-0.774), sensitivity: 52.5%, specificity: 89.47%, P < 0.001. On the other hand, multiple RAI therapy was associated with excellent response in 16.2% of the patients. The chance of ER was decreased by 74% if initial post-operation ultrasound imaging confirmed the presence of locoregional involvement, OR 0.26, (95% CI: 0.12-0.55), P < 0.001. CONCLUSION Stimulated serum Tg and locoregional involvement after total thyroidectomy are predictive factors of non-response to RAI therapy in intermediate and high-risk patients with PTC. In addition, a minority of patients achieve excellent response after multiple RAI therapy.
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Affiliation(s)
- Azam Keshavarzi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Alaei-Shahmiri
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., Vali-asr Ave., Vali-asr Sq, Tehran, Iran
| | - Babak Fallahi
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Emami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., Vali-asr Ave., Vali-asr Sq, Tehran, Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, No. 10, Firoozeh St., Vali-asr Ave., Vali-asr Sq, Tehran, Iran.
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218
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Wang Q, Wu T, Zhao R, Li Y, Chen X, Shen S, Zhang X. Development and Validation of a Prediction Model for Thyroid Dysfunction in Patients During Immunotherapy. Endocr Pract 2024:S1530-891X(24)00604-9. [PMID: 39004306 DOI: 10.1016/j.eprac.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/24/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE This study was designed to develop and validate a predictive model for assessing the risk of thyroid toxicity following treatment with immune checkpoint inhibitors. METHODS A retrospective analysis was conducted on a cohort of 586 patients diagnosed with malignant tumors who received programmed cell death 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Logistic regression analyses were performed on the training set to identify risk factors of thyroid dysfunction, and a nomogram was developed based on these findings. Internal validation was performed using K-fold cross-validation on the validation set. The performance of the nomogram was assessed in terms of discrimination and calibration. Additionally, decision curve analysis was utilized to demonstrate the decision efficiency of the model. RESULTS Our clinical prediction model consisted of 4 independent predictors of thyroid immune-related adverse events, namely baseline thyrotropin (TSH, OR = 1.427, 95%CI:1.163-1.876), baseline thyroglobulin antibody (TgAb, OR = 1.105, 95%CI:1.035-1.180), baseline thyroid peroxidase antibody (TPOAb, OR = 1.172, 95%CI:1.110-1.237), and baseline platelet count (platelet, OR = 1.004, 95%CI:1.000-1.007). The developed nomogram achieved excellent discrimination with an area under the curve of 0.863 (95%CI: 0.817-0.909) and 0.885 (95%CI: 0.827-0.944) in the training and internal validation cohorts respectively. Calibration curves exhibited a good fit, and the decision curve indicated favorable clinical benefits. CONCLUSION The proposed nomogram serves as an effective and intuitive tool for predicting the risk of thyroid immune-related adverse events, facilitating clinicians making individualized decisions based on patient-specific information.
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Affiliation(s)
- Qian Wang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Tingting Wu
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Ru Zhao
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China; Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Yuanqin Li
- Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China; Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xuetao Chen
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Shanmei Shen
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
| | - Xiaowen Zhang
- Department of Endocrinology, Endocrine and Metabolic Disease Medical Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
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219
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Hartzband P. Thyroid nodules and cancer: The search for certainty. Cancer Cytopathol 2024. [PMID: 39003584 DOI: 10.1002/cncy.22882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Pamela Hartzband
- Division of Endocrinology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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220
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Goldner W. The Role of Age in the Risk Assessment of Differentiated Thyroid Cancers. J Clin Endocrinol Metab 2024; 109:e1673-e1674. [PMID: 38118019 DOI: 10.1210/clinem/dgad743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Whitney Goldner
- University of Nebraska Medical Center, Omaha, NE, 68198, USA
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221
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Kong X, Wang L, Sun Y, Zhu D, Yang C. Comparison of radiofrequency ablation and surgery for thyroid papillary microcarcinoma: efficacy, safety and life quality. Front Endocrinol (Lausanne) 2024; 15:1352503. [PMID: 39072279 PMCID: PMC11272987 DOI: 10.3389/fendo.2024.1352503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/24/2024] [Indexed: 07/30/2024] Open
Abstract
Objective To compare the efficacy, safety and patients' quality of life of radiofrequency ablation (RFA) and surgery in the treatment of papillary thyroid microcarcinoma (PTMC). Methods MEDLINE, EMBASE, Cochrane, CNKI and other databases were searched for studies on radiofrequency ablation versus traditional surgery for PTMC up to October 2022. RevMan5.4 software was used for Meta-analysis. Results 10 articles were selected from 392 articles, including 873 cases of radiofrequency ablation and 781 cases of open surgery. After meta-analysis, the incidence of postoperative complications in the radiofrequency ablation group was lower than that in the surgery group, and the difference was statistically significant [OR=0.24, 95%CI (0.14,0.41), P<0.001]. There were no significant differences in lymph node metastasis rate, local recurrence rate, and new tumor rate between the two groups [OR=1.6, 95%CI (0.21, 12.41), P>0.05; OR=0.85, 95%CI (0.05, 13.8), P>0.05; OR=0.12, 95%CI (0.01, 0.98), P>0.05]. The treatment time and hospital stay in the radiofrequency ablation group were shorter than those in the open surgery group [MD=-49.99, 95%CI (-62.02, -37.97), P<0.001; MD=-5.21, 95%CI(-7.19,-3.23),P<0.001], and the cost was significantly lower than that of the traditional surgery group [SMD=-14.97, 95%CI (-19.14, -10.81), P<0.001]. The quality of life of patients in the radiofrequency ablation group was higher than that in the surgery group [MD=-1.61, 95%CI (-2.06, -1.17), P<0.001]. Conclusion Compared with traditional open surgery, radiofrequency ablation for papillary thyroid microcarcinoma has the advantages of less trauma, fewer complications, faster recovery and higher quality of life. The indications need to be strictly controlled in the treatment. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022374987).
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Affiliation(s)
- Xiaoyan Kong
- Department of Endocrinology, Air Force Medical Center, Beijing, China
- Department of Graduate School, China Medical University, Shenyang, China
| | - Liangchen Wang
- Department of Endocrinology, Air Force Medical Center, Beijing, China
- Department of Graduate School, China Medical University, Shenyang, China
| | - Yuchen Sun
- Department of Endocrinology, Air Force Medical Center, Beijing, China
- Department of Graduate School, China Medical University, Shenyang, China
| | - Di Zhu
- Department of Endocrinology, Air Force Medical Center, Beijing, China
- Department of Graduate School, China Medical University, Shenyang, China
| | - Caizhe Yang
- Department of Endocrinology, Air Force Medical Center, Beijing, China
- Department of Graduate School, China Medical University, Shenyang, China
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Xu D, Sui L, Zhang C, Xiong J, Wang VY, Zhou Y, Zhu X, Chen C, Zhao Y, Xie Y, Kong W, Yao J, Xu L, Zhai Y, Wang L. The clinical value of artificial intelligence in assisting junior radiologists in thyroid ultrasound: a multicenter prospective study from real clinical practice. BMC Med 2024; 22:293. [PMID: 38992655 PMCID: PMC11241898 DOI: 10.1186/s12916-024-03510-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND This study is to propose a clinically applicable 2-echelon (2e) diagnostic criteria for the analysis of thyroid nodules such that low-risk nodules are screened off while only suspicious or indeterminate ones are further examined by histopathology, and to explore whether artificial intelligence (AI) can provide precise assistance for clinical decision-making in the real-world prospective scenario. METHODS In this prospective study, we enrolled 1036 patients with a total of 2296 thyroid nodules from three medical centers. The diagnostic performance of the AI system, radiologists with different levels of experience, and AI-assisted radiologists with different levels of experience in diagnosing thyroid nodules were evaluated against our proposed 2e diagnostic criteria, with the first being an arbitration committee consisting of 3 senior specialists and the second being cyto- or histopathology. RESULTS According to the 2e diagnostic criteria, 1543 nodules were classified by the arbitration committee, and the benign and malignant nature of 753 nodules was determined by pathological examinations. Taking pathological results as the evaluation standard, the sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) of the AI systems were 0.826, 0.815, 0.821, and 0.821. For those cases where diagnosis by the Arbitration Committee were taken as the evaluation standard, the sensitivity, specificity, accuracy, and AUC of the AI system were 0.946, 0.966, 0.964, and 0.956. Taking the global 2e diagnostic criteria as the gold standard, the sensitivity, specificity, accuracy, and AUC of the AI system were 0.868, 0.934, 0.917, and 0.901, respectively. Under different criteria, AI was comparable to the diagnostic performance of senior radiologists and outperformed junior radiologists (all P < 0.05). Furthermore, AI assistance significantly improved the performance of junior radiologists in the diagnosis of thyroid nodules, and their diagnostic performance was comparable to that of senior radiologists when pathological results were taken as the gold standard (all p > 0.05). CONCLUSIONS The proposed 2e diagnostic criteria are consistent with real-world clinical evaluations and affirm the applicability of the AI system. Under the 2e criteria, the diagnostic performance of the AI system is comparable to that of senior radiologists and significantly improves the diagnostic capabilities of junior radiologists. This has the potential to reduce unnecessary invasive diagnostic procedures in real-world clinical practice.
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Affiliation(s)
- Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Lin Sui
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Jing Xiong
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Vicky Yang Wang
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Yahan Zhou
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Xinying Zhu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
| | - Chen Chen
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Yu Zhao
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yiting Xie
- Demetics Medical Technology Co. Ltd., Hangzhou, 310022, China
| | - Weizhen Kong
- Department of Mathematics, The University of Hong Kong, Hong Kong, 999077, China
| | - Jincao Yao
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
| | - Lei Xu
- Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou, 310022, China.
- Present address: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Yuxia Zhai
- The Second Affiliated Hospital of Shantou University Medical College, Guangdong, 515041, China.
| | - Liping Wang
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China.
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China.
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Altshuler B, Bikas A, Pappa T, Marqusee E, Cho NL, Nehs MA, Liu JB, Doherty GM, Landa I, Ahmadi S, Alexander EK. Nonoperative, Active Surveillance of Larger Malignant and Suspicious Thyroid Nodules. J Clin Endocrinol Metab 2024; 109:1996-2002. [PMID: 38349208 DOI: 10.1210/clinem/dgae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
CONTEXT Active surveillance for papillary thyroid cancer (PTC) meeting criteria for surgical resection is uncommon. Which patients may prove reasonable candidates for this approach is not well defined. OBJECTIVE This work aimed to examine the feasibility and safety of active surveillance for patients with known or suspected intrathyroidal PTC up to 4 cm in diameter. METHODS A retrospective review was conducted of all consecutive patients who underwent nonoperative active surveillance of suspicious or malignant thyroid nodules over a 20-year period from 2001 to 2021. We included patients with an initial ultrasound-fine-needle aspiration confirming either (a) Bethesda 5 or 6 cytology or (b) a "suspicious" Afirma molecular test. The primary outcomes and measures included the rate of adverse oncologic outcomes (mortality and recurrence), as well as the cumulative incidence of size/volume growth. RESULTS Sixty-nine patients were followed with active surveillance for 1 year or longer (average 55 months), with 26 patients (38%) having nodules 2 cm or larger. No patients were found to develop new-incident occurrence of lymph node or distant metastasis. One patient, however, demonstrated concern for progression to a dedifferentiated cancer on repeat core biopsy 17 years after initial start of nonoperative selection. A total of 21% of patients had an increase in maximum diameter more than 3 mm, while volume increase of 50% or greater was noted in 25% of patients. Thirteen patients ultimately underwent delayed (rescue) surgery, and no disease recurrence was noted after such treatment. Age and initial nodule size were not predictors of nodule growth. CONCLUSION These data expand consideration of active surveillance of PTC in select patients with intrathyroidal suspected malignancy greater than 1 cm in diameter. Rescue surgery, if required at a later time point, appears effective.
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Affiliation(s)
- Benjamin Altshuler
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Athanasios Bikas
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Theodora Pappa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Ellen Marqusee
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Nancy L Cho
- Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Matthew A Nehs
- Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jason B Liu
- Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Gerard M Doherty
- Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Iñigo Landa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Sara Ahmadi
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Erik K Alexander
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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Leng X, Liu J, Zou Q, Wang C, Yang S. Application of color doppler ultrasound and US shear wave elastography with connective tissue growth factor in the risk assessment of papillary thyroid carcinoma. BMC Med Imaging 2024; 24:173. [PMID: 38997649 PMCID: PMC11241941 DOI: 10.1186/s12880-024-01354-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND This study aims to investigate the role of shear wave elastography (SWE) and connective tissue growth factor (CTGF) in the assessment of papillary thyroid carcinoma (PTC) prognosis. METHODS CTGF expression was detected with immunohistochemistry. Clinical and pathological data were collected. Parameters of conventional ultrasound combined with SWE were also collected. The relationship among CTGF expression, ultrasound indicators, the elastic modulus and the clinicopathological parameters were analyzed. RESULTS Univariate analysis showed that patients with high risk of PTC were characterized with male, Uygur ethnicity, increased expression of CTGF, convex lesions, calcified, incomplete capsule, intranodular blood flow, rear echo attenuation, cervical lymph node metastasis, lesions larger than 1 cm, psammoma bodies, advanced clinical stage, increased TSH and high value in the shear modulus (P < 0.05). Multivariate analysis demonstrated that the risk factors of high expression of CTGF according to contribution size order were irregular shape, aspect ratio ≥ 1, and increased TSH. The logistic regression model equation was Logit (P) = 1.153 + 1.055 × 1 + 0.926 × 2 + 1.190 × 3 and the Area Under Curve value of the logistic regression was calculated to be 0.850, with a 95% confidence interval of 0.817 to 0.883. CONCLUSION SWE and CTGF are of great value in the risk assessment of PTC. The degree of fibrosis of PTC is closely related to the prognosis. The hardness of PTC lesions and the expression level of CTGF are correlated with the main indexes of conventional ultrasound differentiating benign or malignant nodules. Irregular shape, aspect ratio ≥ 1, and increased TSH are independent factors of CTGF.
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Affiliation(s)
- Xiaoling Leng
- Department of Ultrasonography, The Tenth Affiliated Hospital of Southern Medical University(Dongguan People's Hospital), Dongguan, Guangdong, P.R. China.
| | - Jinhui Liu
- Department of Ultrasonography, The Tenth Affiliated Hospital of Southern Medical University(Dongguan People's Hospital), Dongguan, Guangdong, P.R. China
| | - Qiao Zou
- Department of Ultrasound, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, 830011, P.R. China
| | - Changchun Wang
- Department of Ultrasound, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, 830011, P.R. China
| | - Sen Yang
- Department of Ultrasound, The Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, 830011, P.R. China
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Al-Naqeeb G, Munger E, Ramanathan AL, Makarewicz A, Behairy N, Veraraghavan P, Cochran C, Bernaldez P, Clinton I, Devaraj N, Lee K, Fisher T, Owoade O, Maass-Moreno R, Saboury B, Gubbi S, Klubo-Gwiezdzinska J. Paraplegic Patient with Metastatic Papillary Thyroid Cancer: A Multidisciplinary Approach to Radioactive Iodine Therapy Safety and Efficacy Strategy. J Nucl Med 2024:jnumed.123.266955. [PMID: 38991747 DOI: 10.2967/jnumed.123.266955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/22/2024] [Indexed: 07/13/2024] Open
Abstract
High-activity radioactive iodine (RAI) therapy for metastatic thyroid cancer (TC) requires isolation to minimize radiation exposure to third parties, thus posing challenges for patients needing hands-on care. There are limited data on the approach to high-activity RAI treatment in paraplegic patients. We report a state-of-the-art multidisciplinary approach to the management of bedbound patients, covering necessary radiation safety measures that lead to radiation exposure levels as low as reasonably achievable. Given the limited literature resources on standardized approaches, we provide a practical example of the safe and successful treatment of a woman with BRAFV600E-mutant tall-cell-variant papillary TC and pulmonary metastases, who underwent dabrafenib redifferentiation before RAI therapy. The patient was 69 y old and had become paraplegic because of a motor-vehicle accident. Since caring for a paraplegic patient with neurogenic bowel and bladder dysfunction poses radiation safety challenges, a multidisciplinary team comprising endocrinologists, nuclear medicine physicians, radiation safety specialists, and the nursing department developed a radiation mitigation strategy to ensure patient and staff safety during RAI therapy. The proposed standardized approach includes thorough monitoring of radiation levels in the workplace, providing additional protective equipment for workers who handle radioactive materials or are in direct patient contact, and implementing strict guidelines for safely disposing of radioactive waste such as urine collected in lead-lined containers. This approach requires enhanced training, role preparation, and practice; use of physical therapy equipment to increase the exposure distance; and estimation of the safe exposure time for caregivers based on dosimetry. The effective and safe treatment of metastatic TC in paraplegic patients can be successfully implemented with a comprehensive radiation mitigation strategy and thorough surveying of personnel for contamination.
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Affiliation(s)
- Ghadah Al-Naqeeb
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Eric Munger
- Division of Radiation Safety, Office of Research Services, National Institutes of Health, Bethesda, Maryland
| | - Amrita L Ramanathan
- Clinical Endocrine Section, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Andrew Makarewicz
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Noha Behairy
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Padmasree Veraraghavan
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Craig Cochran
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Philip Bernaldez
- Medical Surgical Specialties, Clinical Center Nursing Department, National Institutes of Health, Bethesda, Maryland; and
| | - Iman Clinton
- Medical Surgical Specialties, Clinical Center Nursing Department, National Institutes of Health, Bethesda, Maryland; and
| | - Newbegin Devaraj
- Division of Radiation Safety, Office of Research Services, National Institutes of Health, Bethesda, Maryland
| | - Korressa Lee
- Division of Radiation Safety, Office of Research Services, National Institutes of Health, Bethesda, Maryland
| | - Teresa Fisher
- Division of Radiation Safety, Office of Research Services, National Institutes of Health, Bethesda, Maryland
| | - Olumide Owoade
- Division of Radiation Safety, Office of Research Services, National Institutes of Health, Bethesda, Maryland
| | - Roberto Maass-Moreno
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Sriram Gubbi
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Joanna Klubo-Gwiezdzinska
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland;
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Wang J, Cheng H, Li X. Modified TI-RADS Coupled with BRAFV600E Enhances Diagnostic Efficiency in Papillary Thyroid Carcinoma: Prospective Study. Int J Gen Med 2024; 17:3015-3025. [PMID: 39006910 PMCID: PMC11246655 DOI: 10.2147/ijgm.s456820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/09/2024] [Indexed: 07/16/2024] Open
Abstract
Background Thyroid disorders, relatively common diseases of the endocrine system, have risen gradually in recent years. Early detection and accurate diagnosis of thyroid cancer hold exceptional importance. This study aimed to determine the efficacy of a modified TI-RADS and BRAFV600E mutation testing for thyroid cancer (PTC) diagnosis. Methods Ninety five thyroid nodules (48 benign and 47 malignant) from 81 patients were examined using Kwak Thyroid Imaging Reporting and Data System (TI-RADS) were subjected to shear wave elasticity (SWE), BRAFV600E genotyping and fine needle aspiration (FNA) cytology. Results The modified TI-RADS exhibited superior diagnostic accuracy compared to TI-RADS in differentiating benign nodules from malignant thyroid nodules. Moreover, the AUC of modified TI-RADS in conjunction with BRAFV600E was the highest at 95% CI (0.898-0.992, p=0.003), surpassing other diagnostic methods in enhanced sensitivity and maintaining high specificity. Conclusion The diagnostic efficiency of this combination surpassed that of individual diagnostic methods.
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Affiliation(s)
- Jing Wang
- Department of Ultrasound, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, People’s Republic of China
| | - Hong Cheng
- Department of Ultrasound, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, People’s Republic of China
| | - Xu Li
- Department of Ultrasound, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Chongqing, 402760, People’s Republic of China
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Dellal Kahramanca FD, Sacikara M, Kilicarslan A, Ogmen B, Aydin C, Topaloglu O, Ersoy R, Cakir B. Timing of the repeat thyroid fine-needle aspiration biopsy: does early repeat biopsy change the rate of nondiagnostic or atypia of undetermined significance cytology result? Endocrine 2024:10.1007/s12020-024-03953-7. [PMID: 38987433 DOI: 10.1007/s12020-024-03953-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To determine whether early repeat fine needle aspiration biopsy (FNA) has an effect on adequate or atypia of undetermined significance (AUS) cytology rates in thyroid nodules with inadequate or AUS result in the first FNA. METHODS Nodules of patients who underwent repeat biopsy due to insufficient or AUS cytology between 2019-2022 were included. Data of the patients and ultrasonographic, cytological and histopathological results of the nodules were recorded. Additionally, the time between the two biopsies was noted. The first was called "initial" and the second was called "rebiopsy". Five different paired groups were formed according to the time between two consecutive biopsies; before and after 1 month, 45 days, 2 months, 3 months, and 6 months. The groups were compared in terms of adequate and AUS cytological results. RESULTS We evaluated 1129 patients with 2187 nodules undergoing FNAB. After excluding nodules with one FNA result and/or missing data, 966 nodules of 628 patients who underwent FNA at least twice were included. Initial cytology was nondiagnostic (ND) in 665 (30.4%) and AUS in 301 (13.8%) nodules. The mean age of the patients was 52.0 ± 11.9 years, and the female sex ratio was 78.8% (n = 495). There were no differences in adequate or AUS rebiopsy results according to the different time interval groups (p > 0.05 for all). AUS result was statistically insignificantly more frequent in nodules with initially AUS nodules when rebiopsy was performed before 1 month in comparison to after 1 month (53.8%, 27.1%; p = 0.054). Accuracy of rebiopsy was also similar in the time intervals groups (p > 0.05 for all). CONCLUSION In patients with inadequate or AUS initial biopsy, the rate of adequate or AUS cytology results at rebiopsy did not vary with the timing of repeat biopsy indicating that there may be no need to wait 1 month for a repeat biopsy. In patients with suspicious nodules, biopsy might be repeated before 1 month.
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Affiliation(s)
- Fatma Dilek Dellal Kahramanca
- Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Muhammet Sacikara
- Department of Endocrinology and Metabolism, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Aydan Kilicarslan
- Department of Pathology, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Berna Ogmen
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Cevdet Aydin
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Oya Topaloglu
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Ankara Yildirim Beyazit University, Ankara, Turkey
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Gholami G, Aghaee A, Shafiei S, Rasoulian B, Askari E, Zare Namdar S, Zakavi SR. Comparison of 8th and 7th editions of TNM staging in terms of mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer. Nuklearmedizin 2024. [PMID: 38986492 DOI: 10.1055/a-2344-6638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVE To compare the eighth and seventh editions of TNM staging (TNM-8 and TNM-7) on disease-related mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer (DTC). METHODS AND MATERIALS We studied 400 patients (79% female) with DTC with a mean age of 40.93±14.11 years. TNM staging was recorded according to the 7th and 8th editions and patients were followed for at least 1 year and response to therapy was recorded according to ATA response categorization. RESULTS The mean follow up time was 42.5±15.24 months. Overall, 108 patients (27%) were down-staged using the TNM-8, mainly due to the changes in the age cut-off (14.5%), N (9.25%), and T categorization (3.25%). All patients in stage III and 82.8% in stage IV were down-staged. The mean Tg levels were significantly higher in stages III and IV in TNM-8 compared to TNM-7. Four disease-related death were recorded during follow up, all in stage IV according to TNM-7, while one was in stage II according to TNM-8. One year after treatment, persistent disease was detected in 12% and 77% of patients in stage III according to the 7th and 8th editions, respectively (P= 0.04). Similarly, biochemical incomplete response one year after treatment was seen in 7.3% and 87% in stage III disease using 7th and 8th editions (P = 0.006) that fell to 2.4% and 22% in the last visit respectively (P = 0.04). CONCLUSION Persistent disease and incomplete response to therapy were more common in stages III and IV in TNM-8 compared to TNM-7. The eighth edition was a better predictor of persistent disease in stages III and IV disease.
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Affiliation(s)
- Golnaz Gholami
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
| | | | - Susan Shafiei
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
| | - Bashir Rasoulian
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
| | - Emran Askari
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
| | - Samira Zare Namdar
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
| | - Seyed Rasoul Zakavi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran (the Islamic Republic of)
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229
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Zhu H, Zhang H, Wei P, Zhang T, Hu C, Cao H, Han Z. Development and validation of a clinical predictive model for high-volume lymph node metastasis of papillary thyroid carcinoma. Sci Rep 2024; 14:15828. [PMID: 38982104 PMCID: PMC11233634 DOI: 10.1038/s41598-024-66304-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024] Open
Abstract
The central lymph node metastasis (CLNM) status in the cervical region serves as a pivotal determinant for the extent of surgical intervention and prognosis in papillary thyroid carcinoma (PTC). This paper seeks to devise and validate a predictive model based on clinical parameters for the early anticipation of high-volume CLNM (hv-CLNM, > 5 nodes) in high-risk patients. A retrospective analysis of the pathological and clinical data of patients with PTC who underwent surgical treatment at Medical Centers A and B was conducted. The data from Center A was randomly divided into training and validation sets in an 8:2 ratio, with those from Center B serving as the test set. Multifactor logistic regression was harnessed in the training set to select variables and construct a predictive model. The generalization ability of the model was assessed in the validation and test sets. The model was evaluated through the receiver operating characteristic area under the curve (AUC) to predict the efficiency of hv-CLNM. The goodness of fit of the model was examined via the Brier verification technique. The incidence of hv-CLNM in 5897 PTC patients attained 4.8%. The occurrence rates in males and females were 9.4% (128/1365) and 3.4% (156/4532), respectively. Multifactor logistic regression unraveled male gender (OR = 2.17, p < .001), multifocality (OR = 4.06, p < .001), and lesion size (OR = 1.08 per increase of 1 mm, p < .001) as risk factors, while age emerged as a protective factor (OR = 0.95 per an increase of 1 year, p < .001). The model constructed with four predictive variables within the training set exhibited an AUC of 0.847 ([95%CI] 0.815-0.878). In the validation and test sets, the AUCs were 0.831 (0.783-0.879) and 0.845 (0.789-0.901), respectively, with Brier scores of 0.037, 0.041, and 0.056. Subgroup analysis unveiled AUCs for the prediction model in PTC lesion size groups (≤ 10 mm and > 10 mm) as 0.803 (0.757-0.85) and 0.747 (0.709-0.785), age groups (≤ 31 years and > 31 years) as 0.778 (0.720-0.881) and 0.837 (0.806-0.867), multifocal and solitary cases as 0.803 (0.767-0.838) and 0.809 (0.769-0.849), and Hashimoto's thyroiditis (HT) and non-HT cases as 0.845 (0.793-0.897) and 0.845 (0.819-0.871). Male gender, multifocality, and larger lesion size are risk factors for hv-CLNM in PTC patients, whereas age serves as a protective factor. The clinical predictive model developed in this research facilitates the early identification of high-risk patients for hv-CLNM, thereby assisting physicians in more efficacious risk stratification management for PTC patients.
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Affiliation(s)
- Hanlin Zhu
- Department of Radiology, Hangzhou Ninth People's Hospital, No. 98, Yilong Road, Qiantang District, Hangzhou, 310012, China
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, China
| | - Haifeng Zhang
- Department of Radiology, Hangzhou Ninth People's Hospital, No. 98, Yilong Road, Qiantang District, Hangzhou, 310012, China
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, China
| | - Peiying Wei
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, China
| | - Tong Zhang
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, China
| | - Chunfeng Hu
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, China
| | - Huijun Cao
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, China
| | - Zhijiang Han
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, No. 261, Huansha Road, Shangcheng District, Hangzhou, 310006, China.
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230
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Roh YH, Chung SR, Yang SJ, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. Enhancement on CT for preoperative diagnosis of metastatic lymph nodes in thyroid cancer: a comparison across experience levels. Eur Radiol 2024:10.1007/s00330-024-10919-w. [PMID: 38980412 DOI: 10.1007/s00330-024-10919-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To investigate the diagnostic performance and interobserver agreement of quantitative CT parameters indicating strong lymph node (LN) enhancement in differentiated thyroid cancer (DTC), comparing them with qualitative analysis by radiologists of varying experience. MATERIALS AND METHODS This study included 463 LNs from 399 patients with DTC. Three radiologists independently analyzed strong LN enhancement on CT. Qualitative analysis of strong enhancement was defined as LN cortex showing greater enhancement than adjacent muscles on the arterial phase. Quantitative analysis included the mean attenuation value (MAV) of LN on arterial phase (LNA) and venous phase (LNV), LNA normalized to the common carotid artery (NAVCCA), internal jugular vein (NAVIJV), and sternocleidomastoid muscle (NAVSCM), attenuation difference [AD; (LNA - MAVSCM)], and relative washout ratio [((LNA - LNV)/LNA) × 100]. The interobserver agreement and diagnostic performance of the quantitative and qualitative analyses were evaluated. RESULTS Interobserver agreement was excellent for all quantitative CT parameters (ICC, 0.83-0.94) and substantial for qualitative assessment (κ = 0.61). All CT parameters except for LNV showed good diagnostic performance for metastatic LNs (AUC, 0.81-0.85). NAVCCA (0.85, 95% CI: 0.8-0.9) and AD (0.85, 95% CI: 0.81-0.89) had the highest AUCs. All quantitative parameters except for NAVIJV had significantly higher AUCs than qualitative assessments by inexperienced radiologists, with no significant difference from assessments by an experienced radiologist. CONCLUSION Quantitative assessment of LN enhancement on arterial phase CT showed higher interobserver agreement and AUC values than qualitative analysis by inexperienced radiologists, supporting the need for a standardized quantitative CT parameter-based model for determining strong LN enhancement. CLINICAL RELEVANCE STATEMENT When assessing strong LN enhancement in DTC, quantitative CT parameters indicating strong enhancement can improve interobserver agreement, regardless of experience level. Therefore, the development of a standardized diagnostic model based on quantitative CT parameters might be necessary. KEY POINTS Accurate preoperative assessment of LN metastasis in thyroid cancer is crucial. Quantitative CT parameters indicating strong LN enhancement demonstrated excellent interobserver agreement and good diagnostic performance. Quantitative assessment of contrast enhancement offers a more objective model for the identification of metastatic LNs.
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Affiliation(s)
- Yun Hwa Roh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Su Jeong Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Cogua LM, Tupper CJ, Silberstein PT, Coan KE. Intermediate-sized follicular thyroid cancer surgical trends before and after the 2015 American thyroid association guideline changes. Am J Surg 2024; 238:115830. [PMID: 39029373 DOI: 10.1016/j.amjsurg.2024.115830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/12/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024]
Abstract
In 2015, the ATA updated the guidelines to advocate for a lobectomy for tumors <1.0 cm and total thyroidectomy for tumors >4.0 cm. Treatment for tumors of intermediate size 1.0-4.0 cm is dependent on high-risk characteristics. There is limited research comparing the impact of the updated ATA guidelines on clinical practice on intermediate-sized tumors. In this study, the impact of the 2015 ATA guidelines on the surgical treatment of intermediated-sized FTC will be evaluated using the Surveillance, Epidemiology, and End Results (SEER) database. A total of 9983 patients were included; 7769 patients (74.1 %) were diagnosed pre-ATA guidelines and 2709 patients (25.9 %) post-ATA guidelines. The mean rate of lobectomy for intermediate-sized tumors was 22.1 % which increased to 33.4 % post-ATA updates. The results of the logistic regression showed the rate of lobectomy increased significantly in the post-ATA changes period (p < 0.001). Future research could benefit from evaluating how these trends impact patient outcome measures.
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Affiliation(s)
- Laura M Cogua
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA.
| | - Connor J Tupper
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA
| | - Peter T Silberstein
- Department of Internal Medicine, Division of Hematology/Oncology, Creighton University Medical Center, Omaha, NE, USA
| | - Kathryn E Coan
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA; Department of Surgery, Division of Endocrine Surgery, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA
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232
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Zhang D, Qiu Y, Yang J, Hong Z, Li J, Chen S, Wu SS. Ultrasound-guided percutaneous radiofrequency ablation versus surgery for solitary T1N0M0 papillary thyroid carcinoma in the danger triangle. Eur Radiol 2024:10.1007/s00330-024-10910-5. [PMID: 38980413 DOI: 10.1007/s00330-024-10910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To compare the safety and efficiency of ultrasound-guided percutaneous radiofrequency ablation (RFA) and surgical resection (SR) for thyroid papillary carcinoma (PTC) in the danger triangle area. METHODS The clinical data of 298 patients who underwent either percutaneous RFA or SR for PTC in the thyroid danger triangle at our hospital between January 2018 and April 2020 were retrospectively analyzed. Propensity score matching is employed to regulate for confounding factors. All patients undergoing ablation were treated using a strategy that combined sufficient paratracheal fluid isolation with a low-power, short electrode. Disease progression was analyzed in patients with T1N0M0 PTC (T1a and T1b) employed in Kaplan‒Meier curves. Treatment parameters and the rates of local recurrence, distant metastasis, and complications are recorded and compared. RESULTS Of 182 eligible patients who were included, 91 were in the RFA (age 44.84 ± 13.19; 71 females; 77 T1a) and 91 were in the SR (age 47.36 ± 11.05; 68 females; 69 T1a). The average treatment time, length of hospital stays, blood loss volume, and scar length are substantially less in the RFA than in the SR. Major complications as well as postoperative permanent recurrent laryngeal nerve injury and postoperative transient parathyroid dysfunction occurred only in the SR, with a substantial distinction between the two groups (p < 0.05). There is no substantial distinction in the disease progression between RFA and SR treatment of T1N0M0 PTC. CONCLUSION RFA is as effective as surgery for PTC in the danger triangle area in the short term, with faster recovery and fewer complications. CLINICAL RELEVANCE STATEMENT Radiofrequency ablation has a clinical efficacy comparable to surgery in the treatment of papillary thyroid carcinoma in the danger triangle area in the short term with the advantages of faster recovery and fewer complications when compared with surgery. KEY POINTS Use of radiofrequency ablation (RFA) in the thyroid danger triangle is still controversial. RFA and surgery groups showed no difference in disease progressions, and no major complications occurred with RFA. Radiofrequency ablation offers a new option for papillary thyroid carcinoma patients in the danger triangle.
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Affiliation(s)
- Danling Zhang
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Department of Ultrasonography, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yuhan Qiu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jianchuan Yang
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Zhiliang Hong
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Jianwei Li
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Sheng Chen
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
| | - Song-Song Wu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
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233
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Xu H, Yang JY, Zhao X, Ma Z. Advances in clinical research on ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma. Front Oncol 2024; 14:1422634. [PMID: 39040438 PMCID: PMC11260605 DOI: 10.3389/fonc.2024.1422634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/18/2024] [Indexed: 07/24/2024] Open
Abstract
Ultrasound-guided radiofrequency ablation (RFA) emerges as a minimally invasive strategy for papillary thyroid microcarcinoma (PTMC), offering advantages over traditional surgical approaches. RFA employs high-frequency electric currents under precise ultrasound guidance to ablate cancerous tissue. Clinical trials consistently demonstrate RFA's efficacy in tumor control and patient-reported outcomes. However, long-term studies are essential to validate its durability and monitor for potential complications. Collaborative efforts among various medical disciplines ensure procedural accuracy and comprehensive postoperative care. Technological innovations, such as enhanced ultrasound imaging and temperature control, promise to refine RFA's precision and effectiveness. Nevertheless, challenges persist, including the need for standardized protocols and comparative studies with traditional treatments. Future research should focus on long-term outcomes, patient selection criteria, and optimization of procedural techniques to solidify RFA's role in PTMC management. RFA presents a promising avenue for PTMC treatment, warranting further investigation and refinement in clinical practice.
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Affiliation(s)
- Hua Xu
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Jin-yan Yang
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Xing Zhao
- Department of Medical Technology, Shaanxi Energy Institute, Xianyang, China
| | - Zhe Ma
- Department of Ultrasound, Shaanxi Provincial Hospital of Traditional Chinese Medicine, Xi’an, China
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234
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Wang J, Lan H, Mao X, Chen Y. Pituitary-adrenal axis dysfunction induced by tislelizumab immunotherapy for non-small cell lung cancer: a case series and literature review. BMC Pulm Med 2024; 24:327. [PMID: 38977996 PMCID: PMC11232320 DOI: 10.1186/s12890-024-03140-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Adverse events of secondary adrenal insufficiency caused by anti-PD-1 immune agents are relatively rare in clinical practice, so in this article, we retrospectively analyzed three patients who suffered secondary adrenal cortex dysfunction caused by tislelizumab immunotherapy for Non-Small Cell Lung Cancer (NSCLC)and reviewed the literature. This rare immune-related adverse event was investigated by summarizing the clinical features of the patients. CASE PRESENTATION We reported three NSCLC patients who suffered secondary adrenal cortex dysfunction induced by tislelizumab immunotherapy at our hospital from July 2021 to October 2023. We analyzed and summarized the clinical characteristic, laboratory examination, pathological staging, etc. We also reviewed related literature of pituitary inflammation and adrenal cortex dysfunction caused by immunotherapy. RESULTS The median age of the three patients was 56 years. All the patients had a history of smoking. After receiving tislelizumab treatment (median cycle: 7), laboratory examination showed a decrease in morning cortisol and adrenocorticotropic hormone (ACTH), both were diagnosed with secondary adrenal insufficiency. Only one patient had symptoms of fatigue, vomiting, and weight loss. One of these patients also had simultaneous subclinical hypothyroidism. All three patients discontinued immunotherapy and received replacement therapy with glucocorticoids. At the last follow-up, none of the three patients restarted immunotherapy, because cortisol did not return to normal. This is similar to that of previous reports. CONCLUSION Based on previous reports and our three cases, when laboratory tests of NSCLC patients receiving immunotherapy showed a decrease in morning cortisol and ACTH levels, especially when clinical symptoms were obvious, the possibility of immunotherapy-related pituitary inflammation causing secondary adrenal cortex dysfunction should be considered. Prompt monitoring and hormone replacement therapy should be provided to prevent adrenal crises.
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Affiliation(s)
- Jiayi Wang
- School of Medicine, Shaoxing University, Shaoxing, 312000, Zhejiang, P. R. China
| | - Huanrong Lan
- Department of Surgical Oncology, Hangzhou Cancer Hospital, Hangzhou, 310002, Zhejiang, China
| | - Xiaowei Mao
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China.
| | - Yefeng Chen
- Department of Pulmonary Medicine, Shaoxing People's Hospital, Shaoxing, 312000, China.
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235
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Aras A, Karayıl AR. Optimal Surgical Approaches for Thyroid Cancer: A Comparative Analysis of Efficacy and Complications. Med Sci Monit 2024; 30:e942619. [PMID: 38973140 PMCID: PMC11302178 DOI: 10.12659/msm.942619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 05/12/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Completion thyroidectomy (CTx) is performed following hemithyroidectomy (HTx) when the risk of malignancy persists or is discovered postoperatively. Different surgical approaches, including CTx after HTx (CTx-HTx), total thyroidectomy (TTx), and revision surgery after TTx (RTx-TTx), offer varying risks and benefits, including pathological outcomes and complication rates. Understanding the predictors and rates of malignancy in these procedures is crucial for optimizing surgical management of thyroid disorders. MATERIAL AND METHODS This retrospective study analyzed data from January 2014 to October 2019, including 60 patients each in the CTx-HTx and TTx groups, and 47 in the RTx-TTx group. The CTx-HTx group was subdivided based on benign or malignant findings in CTx specimens. Clinicodemographic data and pathological features such as tumor type, size, side, capsular and vascular invasion, extrathyroidal spread, multifocality, and lymph node metastasis were reviewed. RESULTS Age and sex distributions were similar across groups. In the CTx-HTx group, 76.7% of specimens were benign and 23.3% malignant. No significant predictors of malignancy were found between the benign and malignant subgroups in univariate and multivariable analyses. In the TTx group, 75.0% of initial lobes and 13.3% of contralateral lobes were malignant. TTx was associated with a significant postoperative decrease in calcium and longer hospital stays. Multivariable analysis identified TTx as an independent risk factor for hypocalcemia. CONCLUSIONS Reducing overtreatment in thyroid cancer may involve limiting CTx after HTx and considering more conservative initial surgeries, particularly when indications for TTx are not definitive.
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Affiliation(s)
- Abbas Aras
- Department of General Surgery, Van YYU Medical Faculty, Van, Turkey
| | - Ali R. Karayıl
- General Surgery Unit, SBU Van Training and Research Hospital, Van, Turkey
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236
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Zhou B, Liu J, Yang Y, Ye X, Liu Y, Mao M, Sun X, Cui X, Zhou Q. Ultrasound-based nomogram to predict the recurrence in papillary thyroid carcinoma using machine learning. BMC Cancer 2024; 24:810. [PMID: 38972977 PMCID: PMC11229345 DOI: 10.1186/s12885-024-12546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/20/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND AND AIMS The recurrence of papillary thyroid carcinoma (PTC) is not unusual and associated with risk of death. This study is aimed to construct a nomogram that combines clinicopathological characteristics and ultrasound radiomics signatures to predict the recurrence in PTC. METHODS A total of 554 patients with PTC who underwent ultrasound imaging before total thyroidectomy were included. Among them, 79 experienced at least one recurrence. Then 388 were divided into the training cohort and 166 into the validation cohort. The radiomics features were extracted from the region of interest (ROI) we manually drew on the tumor image. The feature selection was conducted using Cox regression and least absolute shrinkage and selection operator (LASSO) analysis. And multivariate Cox regression analysis was used to build the combined nomogram using radiomics signatures and significant clinicopathological characteristics. The efficiency of the nomogram was evaluated by receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). Kaplan-Meier analysis was used to analyze the recurrence-free survival (RFS) in different radiomics scores (Rad-scores) and risk scores. RESULTS The combined nomogram demonstrated the best performance and achieved an area under the curve (AUC) of 0.851 (95% CI: 0.788 to 0.913) in comparison to that of the radiomics signature and the clinical model in the training cohort at 3 years. In the validation cohort, the combined nomogram (AUC = 0.885, 95% CI: 0.805 to 0.930) also performed better. The calibration curves and DCA verified the clinical usefulness of combined nomogram. And the Kaplan-Meier analysis showed that in the training cohort, the cumulative RFS in patients with higher Rad-score was significantly lower than that in patients with lower Rad-score (92.0% vs. 71.9%, log rank P < 0.001), and the cumulative RFS in patients with higher risk score was significantly lower than that in patients with lower risk score (97.5% vs. 73.5%, log rank P < 0.001). In the validation cohort, patients with a higher Rad-score and a higher risk score also had a significantly lower RFS. CONCLUSION We proposed a nomogram combining clinicopathological variables and ultrasound radiomics signatures with excellent performance for recurrence prediction in PTC patients.
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Affiliation(s)
- Binqian Zhou
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Jianxin Liu
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Yaqin Yang
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xuewei Ye
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Yang Liu
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Mingfeng Mao
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xiaofeng Sun
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| | - Qin Zhou
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
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van de Berg DJ, Mooij CF, van Trotsenburg ASP, van Santen HM, Terwisscha van Scheltinga SCEJ, Vriens MR, Kruijff S, Nieveen van Dijkum EJM, Engelsman AF, Derikx JPM. Long-term oncological outcomes of follicular thyroid cancer in adolescents and young adults: A nationwide population-based study. World J Surg 2024. [PMID: 38972979 DOI: 10.1002/wjs.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Follicular thyroid carcinoma (FTC) in adolescents and young adults (AYAs) is rare and data on long-term oncological outcomes are scarce. This study aimed to describe the long-term recurrence and survival rates of AYAs with FTC, and identify risk factors for recurrence. METHODS This is a retrospective cohort study combining two national databases, including all patients aged 15-39 years, diagnosed with FTC in The Netherlands between 2000 and 2016. Age, sex, tumor size, focality, positive margins, angioinvasion, pT-stage, and pN-stage were included in a Cox proportional hazard model to identify risk factors for recurrence. RESULTS We included 192 patients. Median age was 31.0 years (IQR 24.7-36.3) and the male to female ratio was 1:4.1. Most patients presented with a minimally invasive FTC (MI-FTC) (95%). Five patients presented with synchronous metastases (2.6%), including two with locoregional metastases (1%) and three with distant metastases (1.6%). During a median follow-up of 12.0 years, three patients developed a recurrence (1.6%), of which one patient developed a local recurrence (33%), and two patients a distant recurrence (67%). Five patients died during follow-up (2.6%). Cause of death was not captured. A Cox proportional hazard model could not be performed due to the low number of recurrences. CONCLUSIONS FTC in AYAs is generally characterized as a low-risk tumor, as it exhibits a very low recurrence rate, a high overall survival, and it typically presents as MI-FTC without synchronous metastases. These findings underscore the favorable long-term oncological prognosis of FTC in AYAs.
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Affiliation(s)
- Daniël J van de Berg
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Christiaan F Mooij
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, Utrecht University Medical Center, University of Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, The Netherlands
| | | | - Menno R Vriens
- Department of Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton F Engelsman
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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238
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Diwanji D, Carrodeguas E, Seo Y, Kang H, Soe MH, Chiang JM, Zhang L, Liu C, Behr SC, Flavell RR. Comparative Uptake Patterns of Radioactive Iodine and [18F]-Fluorodeoxyglucose (FDG) in Metastatic Differentiated Thyroid Cancers. J Clin Med 2024; 13:3963. [PMID: 38999527 PMCID: PMC11242608 DOI: 10.3390/jcm13133963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Metastatic differentiated thyroid cancer (DTC) represents a molecularly heterogeneous group of cancers with varying radioactive iodine (RAI) and [18F]-fluorodeoxyglucose (FDG) uptake patterns potentially correlated with the degree of de-differentiation through the so-called "flip-flop" phenomenon. However, it is unknown if RAI and FDG uptake patterns correlate with molecular status or metastatic site. Materials and Methods: A retrospective analysis of metastatic DTC patients (n = 46) with radioactive 131-iodine whole body scan (WBS) and FDG-PET imaging between 2008 and 2022 was performed. The inclusion criteria included accessible FDG-PET and WBS studies within 1 year of each other. Studies were interpreted by two blinded radiologists for iodine or FDG uptake in extrathyroidal sites including lungs, lymph nodes, and bone. Cases were stratified by BRAF V600E mutation status, histology, and a combination of tumor genotype and histology. The data were analyzed by McNemar's Chi-square test. Results: Lung metastasis FDG uptake was significantly more common than iodine uptake (WBS: 52%, FDG: 84%, p = 0.04), but no significant differences were found for lymph or bone metastases. Lung metastasis FDG uptake was significantly more prevalent in the papillary pattern sub-cohort (WBS: 37%, FDG: 89%, p = 0.02) than the follicular pattern sub-cohort (WBS: 75%, FDG: 75%, p = 1.00). Similarly, BRAF V600E+ tumors with lung metastases also demonstrated a preponderance of FDG uptake (WBS: 29%, FDG: 93%, p = 0.02) than BRAF V600E- tumors (WBS: 83%, FDG: 83%, p = 1.00) with lung metastases. Papillary histology featured higher FDG uptake in lung metastasis (WBS: 39%, FDG: 89%, p = 0.03) compared with follicular histology (WBS: 69%, FDG: 77%, p = 1.00). Patients with papillary pattern disease, BRAF V600E+ mutation, or papillary histology had reduced agreement between both modalities in uptake at all metastatic sites compared with those with follicular pattern disease, BRAF V600E- mutation, or follicular histology. Low agreement in lymph node uptake was observed in all patients irrespective of molecular status or histology. Conclusions: The pattern of FDG-PET and radioiodine uptake is dependent on molecular status and metastatic site, with those with papillary histology or BRAF V600E+ mutation featuring increased FDG uptake in distant metastasis. Further study with an expanded cohort may identify which patients may benefit from specific imaging modalities to recognize and surveil metastases.
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Affiliation(s)
- Devan Diwanji
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
- Medical Scientist Training Program, University of California, San Francisco, CA 94143, USA
| | - Emmanuel Carrodeguas
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
- Joint Graduate Group in Bioengineering, University of California, San Francisco, CA 94720, USA
- Department of Nuclear Engineering, University of California, Berkeley, CA 94720, USA
| | - Hyunseok Kang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Myat Han Soe
- Division of Endocrinology, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Janet M Chiang
- Division of Endocrinology, Department of Medicine, University of California, San Francisco, CA 94143, USA
- Division of Endocrinology, Department of Medicine, San Francisco VA Healthcare System, San Francisco, CA 94121, USA
- Division of Endocrinology, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA 94110, USA
| | - Li Zhang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, CA 94143, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA
| | - Chienying Liu
- Division of Endocrinology, Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Spencer C Behr
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
- Molecular Imaging and Therapeutics Clinical Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
- Department of Pharmaceutical Chemistry, University of California, San Francisco, CA 94143, USA
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Conlin PR, Burke BV, Hobbs C, Hurren KM, Lang AE, Morrison JW, Spacek L, Steil EN, Watts SA, Weinreb JE, Pogach LM. Management of Type 2 Diabetes Mellitus: Synopsis of the Department of Veterans Affairs and Department of Defense Clinical Practice Guideline. Mayo Clin Proc 2024; 99:S0025-6196(24)00210-6. [PMID: 39093266 DOI: 10.1016/j.mayocp.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 08/04/2024]
Abstract
The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes. This was the product of a multidisciplinary guideline development committee composed of clinicians from both the VA and the DoD and was overseen by the VA/DoD Evidence Based Practice Work Group. The development process conformed to the standards for trustworthy guidelines as established by the National Academy of Medicine. The guideline development committee developed 12 key questions to guide an evidence synthesis. An independent third party identified relevant randomized controlled trials and systematic reviews that were published from January 2016 through April 2022. This evidence synthesis served as the basis for drafting recommendations. Twenty-six recommendations were generated and rated by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Two algorithms were developed to guide clinical decision-making. This synopsis summarizes key aspects of the VA/DoD Clinical Practice Guideline for diabetes in 5 areas: prediabetes, screening for co-occurring conditions, diabetes self-management education and support, glycemic treatment goals, and pharmacotherapy. The guideline is designed to help clinicians and patients make informed treatment decisions to optimize health outcomes and quality of life and to align with patient-centered goals of care.
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Affiliation(s)
- Paul R Conlin
- Department of Veterans Affairs Boston Healthcare System, Boston, MA.
| | - Brian V Burke
- Department of Veterans Affairs Medical Center, Dayton, OH
| | | | - Kathryn M Hurren
- Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, VA
| | | | - Lance Spacek
- Department of Veterans Affairs South Texas Healthcare System, San Antonio, TX
| | - Evan N Steil
- Medical Readiness Command-Europe, Sembach, Germany
| | - Sharon A Watts
- Office of Nursing Service, Department of Veterans Affairs Long Beach Healthcare System, Long Beach, CA
| | - Jane E Weinreb
- Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Leonard M Pogach
- Specialty Care Program Office, Department of Veterans Affairs, Washington, DC
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240
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Guo X, Tang S, Li Y, Mu C, Zhang H, Jiang Q, Jiang M, Han W, Zheng Y, Piao J. Mechanism underlying the role of integrin α3β1 in adhesive dysfunction between thyroid cells induced by diesel engine exhaust particles. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 947:174535. [PMID: 38972403 DOI: 10.1016/j.scitotenv.2024.174535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 06/30/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
The role and mechanisms of DEP exposure on thyroid injury are not yet clear. This study explores thyroid damage induced by in vivo DEP exposure using a mouse model. This study has observed alterations in thyroid follicular architecture, including rupture, colloid overflow, and the formation of voids. Additionally, there was a significant decrease in the expression levels of proteins involved in thyroid hormone synthesis, such as thyroid peroxidase and thyroglobulin, their trend of change is consistent with the damage to the thyroid structure. Serum levels of triiodothyronine and tetraiodothyronine were raise. However, the decrease in TSH expression suggests that the function of the HPT axis is unaffected. To delve deeper into the intrinsic mechanisms of thyroid injury, we performed KEGG pathway enrichment analysis, which revealed notable alterations in the cell adhesion signaling pathway. Our immunofluorescence results show that DEP exposure impairs thyroid adhesion, and integrin α3β1 plays an important role. CD151 binds to α3β1, promoting multimolecular complex formation and activating adhesion-dependent small GTPases. Our in vitro model has confirmed the pivotal role of integrin α3β1 in thyroid cell adhesion, which may be mediated by the CD151/α3β1/Rac1 pathway. In summary, exposure to DEP disrupts the structure and function of the thyroid, a process that likely involves the regulation of cell adhesion through the CD151/α3β1/Rac1 pathway, leading to glandular damage.
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Affiliation(s)
- Xiaoyin Guo
- School of Public Health, Qingdao University, Qingdao, China
| | - Siying Tang
- Chengyang City Centre for Disease Control and Prevention, Qingdao, China
| | - Yanting Li
- School of Public Health, Qingdao University, Qingdao, China
| | - Chaohui Mu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Hongna Zhang
- School of Public Health, Qingdao University, Qingdao, China
| | - Qixiao Jiang
- School of Public Health, Qingdao University, Qingdao, China
| | - Menghui Jiang
- School of Public Health, Qingdao University, Qingdao, China
| | - Wei Han
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Yuxin Zheng
- School of Public Health, Qingdao University, Qingdao, China.
| | - Jinmei Piao
- School of Public Health, Qingdao University, Qingdao, China.
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Cappellacci F, Canu GL, Noli E, Argiolas A, Peis G, Lai ML, Calò PG, Medas F. Changes in Clinical Practice in Adherence to the 2014 American Thyroid Association Guidelines on Thyroid Cancer: A Retrospective Study from a Tertiary Referral Center. J Pers Med 2024; 14:727. [PMID: 39063981 PMCID: PMC11277973 DOI: 10.3390/jpm14070727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 06/29/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
Thyroidectomy, a pivotal treatment for various thyroid disorders, has seen its indications evolve, particularly with the 2014 American Thyroid Association (ATA) Guidelines advocating for conservative surgical approaches like lobectomy. This retrospective study analyzes thyroidectomy practices at a high-volume center from January 2014 to December 2023, focusing on patients potentially eligible for lobectomy per ATA guidelines. The inclusion criteria were tumors < 4 cm, indeterminate thyroid nodules, or differentiated thyroid carcinoma with clinically uninvolved lymph nodes (cN0). This study analyzed the proportion of patients undergoing lobectomy versus total thyroidectomy (TT) and the oncological outcomes. Of 357 patients, 243 underwent TT and 114 underwent lobectomy. The prevalence of lobectomies rose markedly, comprising 73.9% of surgeries in 2023. TT patients were predominantly female (83.5%) and had higher rates of autoimmune thyroiditis (67.5%) and malignancy (89.7%). Lobectomy patients had larger nodules and more indeterminate cytology. Among 301 malignant cases, TT was associated with higher lymph node metastasis, but similar recurrence rates, compared to lobectomy. This study underscores a shift towards lobectomy, reflecting adherence to ATA guidelines and suggesting conservative surgery is feasible without compromising outcomes. Further research on long-term outcomes and refined patient selection criteria is needed to optimize surgical approaches.
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Affiliation(s)
- Federico Cappellacci
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Eleonora Noli
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Alessandro Argiolas
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Giulia Peis
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Maria Letizia Lai
- Department of Cytomorphology, University of Cagliari, 09124 Cagliari, Italy;
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, “Policlinico Universitario Duilio Casula”, 09042 Cagliari, Italy; (G.L.C.); (E.N.); (A.A.); (G.P.); (P.G.C.); (F.M.)
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242
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Gan J, Jia Z, Wu G, Yang B, Jiang L. Evaluation of the value of combined thyroid function-related indexes in the prognosis prediction of patients with differentiated thyroid cancer. Medicine (Baltimore) 2024; 103:e38787. [PMID: 38968461 PMCID: PMC11224890 DOI: 10.1097/md.0000000000038787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/24/2024] [Indexed: 07/07/2024] Open
Abstract
This study aims to evaluate the prognostic significance of thyroid function-related indices in patients with differentiated thyroid cancer (DTC). This retrospective analysis included 90 patients diagnosed with DTC and treated at our hospital from January 2010 to January 2019. Patients were classified into 2 groups based on whole-body imaging results: 67 with a favorable prognosis and 23 with a poor prognosis. The study compared clinical data and thyroid function indices between these groups to assess their efficacy in prognostic prediction. Patients in the poor prognosis group had a higher occurrence of T3-4 stage cancer (P = .006) and ≥2 lymph node metastases (P = .019). Notably, levels of total thyroxine (TT4), thyroid-stimulating hormone (TSH), and thyroglobulin antibody (Tg-Ab) were significantly elevated in this group (P < .001 for each). Receiver operating characteristic analysis revealed substantial predictive accuracy for TT4, TSH, and Tg-Ab (area under curve of 0.747, 0.820, and 0.720, respectively). The columnar graphical model used for prediction demonstrated a high concordance index (C-index = 0.919), superior to single-indicator evaluations. Thyroid function indices, specifically TT4, TSH, and Tg-Ab, play a crucial role in the prognostic assessment of patients with DTC. The column-line diagram model effectively enhances prophetic prediction, aiding in clinical decision-making.
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Affiliation(s)
- Jiabing Gan
- Department of General Surgery I, Jingdezhen Second People’s Hospital, Jingdezhen China
| | - Zhihong Jia
- Department of Pathology, Jingdezhen Second People’s Hospital, Jingdezhen China
| | - Guoqiang Wu
- Department of Ultrasound, Jingdezhen Second People’s Hospital, Jingdezhen China
| | - Bin Yang
- Department of General Surgery I, Jingdezhen Second People’s Hospital, Jingdezhen China
| | - Liqin Jiang
- Department of Laboratory, Jingdezhen Second People’s Hospital, Jingdezhen China
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Ferraz C, Cunha GB, de Oliveira MMB, Tenório LR, Cury AN, Padovani RDP, Ward LS. The diagnostic and prognostic role of miR-146b-5p in differentiated thyroid carcinomas. Front Endocrinol (Lausanne) 2024; 15:1390743. [PMID: 39036050 PMCID: PMC11257861 DOI: 10.3389/fendo.2024.1390743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Samples classified as indeterminate correspond to 10-20% of cytologies obtained by fine needle biopsy of thyroid nodules, preventing an adequate distinction between benign and malignant lesions and leading to diagnostic thyroidectomies that often prove unnecessary, as most cases are benign. Furthermore, although the vast majority of patients with differentiated thyroid cancer (DTC) have such a good prognosis that active surveillance is permitted as an initial therapeutic option, relapses are not rare, and a non-negligible number of patients experience poor outcomes. MicroRNAs (miR) emerge as potential biomarkers capable of helping to define more precise management of patients in all these situations. Methods Aiming to investigate the clinical utility of miR-146b-5p in the diagnostic of thyroid nodules and evaluating its prognostic potential in a realworld setting, we studied 89 thyroid nodule samples, correlating miR-146b-5p expression with clinical tools such as the 8th edition from the American Joint Committee on Cancer (AJCC/UICC) and the American Thyroid Association Guideline Stratification Systems for the rate of recurrence (RR). Results miR-146b-5p expression levels distinguished benign from malignant thyroid FNA samples (p< 0.0001). For indeterminate nodules, overexpression of miR-146b-5p with a cut-off of 0.497 was able to diagnose malignancy with a 90% accuracy; specificity=87.5%; sensitivity=100%. An increased expression of miR-146b-5p was associated with greater RR (p=0.015). A cut-off of 2.21 identified cases with more vascular involvement (p=0.013) and a cut-off of 2.420 was associated with a more advanced TNM stage (p-value=0.047). Discussion We demonstrated that miR-146b5p expression in FNA samples is able to differentiate benign from malignant indeterminate nodules and is associated with an increased risk of recurrence and mortality, suggesting that this single miRNA may be a useful diagnostic and prognostic marker in the personalized management of DTC patients.
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Affiliation(s)
- Carolina Ferraz
- Thyroid Diseases Unit - Division of Endocrinology, Department of Medicine, Faculty of Medical Sciences/Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Gustavo Bittar Cunha
- Thyroid Diseases Unit - Division of Endocrinology, Department of Medicine, Faculty of Medical Sciences/Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Mariana Mazeu Barbosa de Oliveira
- Thyroid Diseases Unit - Division of Endocrinology, Department of Medicine, Faculty of Medical Sciences/Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Lucas Ribeiro Tenório
- Division of Head and Neck Surgery, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Adriano Namo Cury
- Thyroid Diseases Unit - Division of Endocrinology, Department of Medicine, Faculty of Medical Sciences/Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Rosália do Prado Padovani
- Thyroid Diseases Unit - Division of Endocrinology, Department of Medicine, Faculty of Medical Sciences/Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Laura Sterian Ward
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Loganathan T, George Priya Doss C. Biomarker identification of medullary thyroid carcinoma from gene expression profiles considering without-treatment and with-treatment studies-A bioinformatics approach. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2024; 142:367-396. [PMID: 39059991 DOI: 10.1016/bs.apcsb.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor derived from parafollicular thyroid gland cells. In both hereditary MTC and sporadic forms, genetic changes result in fundamental changes, and prognosis and mutational status are highly correlated. In this work, biomarker genes (DEGs and DEmiRNAs) for MTC will be computationally identified in order to help in their diagnosis and treatment. The gene expression profiles of two different types of studies, namely without-treatment (wo-trt) and with-treatment (w-trt), are considered for discovering biomarkers. The datasets were retrieved from the GEO database, and the DEGs and DEmiRNAs were analyzed using ExpressAnalyst and GEO2R. The functional analysis of DEGs and DEmiRNAs was performed, and most of the pathways enriched related to thyroid oncological pathways such as MAPK pathway,mTOR pathway, and PI3K-AKT Signaling pathway. Through this conclusion, the RET gene was upregulated wo-trt; the dinaciclib treatment RET gene was down-regulated computationally. To optimize the therapeutic targeting of RET, greater research into the mechanisms regulating RET transcription is necessary.
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Affiliation(s)
- Tamizhini Loganathan
- Laboratory of Integrative Genomics, Department of Integrative Biology, School of BioSciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India
| | - C George Priya Doss
- Laboratory of Integrative Genomics, Department of Integrative Biology, School of BioSciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, India.
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Hindawi MD, Ali AHG, Qafesha RM, Soliman W, Salem H, Bali E, Elrosasy A. Transoral endoscopic thyroidectomy submental vestibular approach for early-stage papillary thyroid carcinoma: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:204. [PMID: 38963576 PMCID: PMC11224072 DOI: 10.1007/s00423-024-03377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Our study aimed to compare the effectiveness and complications of the transoral endoscopic thyroidectomy submental vestibular approach (TOETSMVA) versus the transoral endoscopic thyroidectomy vestibular approach (TOETVA) or conventional open thyroidectomy (COT) in patients with early-stage papillary thyroid carcinoma (PTC). METHODS We searched online databases up to January 2024. The outcomes were analyzed using RevMan 5.4 and inverse variance. RESULTS Seven studies (two RCTs and five retrospective cohort studies) were included. We established higher significance differences for TOETSMVA in comparison with TOETVA in terms of all primary outcomes; operation time, hospital stay, number of resected lymph nodes [MD -21.05, 95% CI= -30.98, -11.12; p < 0.0001], [MD -1.76, 95% CI= -2.21, -1.32, p < 0.00001], [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73], [MD -0.83, 95% CI = -1.19 to -0.47; p < 0.00001], respectively, except the drainage volume, it showed no difference [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73]. In secondary outcomes, it was favored only in mandibular numbness and return to normal diet outcomes. Additionally, TOETSMVA compared with COT showed a significant difference in drainage volume, pain, cosmetic effect, and satisfaction score. CONCLUSIONS TOETSMVA showed a significant improvement compared to the TOETVA in operation time, hospital stay, number of resected lymph nodes, mandibular numbness, and return to normal diet but did not show a difference in drainage volume. However, TOETSMVA was better in cosmetic effect, drainage volume, satisfaction, and pain scores compared with COT. Further RCTs with larger sample size, multicentral, and longer follow-up are necessary to evaluate the limitations.
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Affiliation(s)
| | - Ahmed Hamdy G Ali
- Faculty of Medicine, Ogarev Mordovia State University, Saransk, Russia
| | | | - Wesam Soliman
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Haitham Salem
- Faculty of medicine, Ain shams University, Cairo, Egypt
| | - Eslam Bali
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt.
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Volpe F, Nappi C, Zampella E, Di Donna E, Maurea S, Cuocolo A, Klain M. Current Advances in Radioactive Iodine-Refractory Differentiated Thyroid Cancer. Curr Oncol 2024; 31:3870-3884. [PMID: 39057158 PMCID: PMC11276085 DOI: 10.3390/curroncol31070286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Differentiated thyroid cancer (DTC) patients have an outstanding overall long-term survival rate, and certain subsets of DTC patients have a very high likelihood of disease recurrence. Radioactive iodine (RAI) therapy is a cornerstone in DTC management, but cancer cells can eventually develop resistance to RAI. Radioactive iodine-refractory DTC (RAIR-DTC) is a condition defined by ATA 2015 guidelines when DTC cannot concentrate RAI ab initio or loses RAI uptake ability after the initial therapy. The RAIR condition implies that RAI cannot reveal new met-astatic foci, so RAIR-DTC metabolic imaging needs new tracers. 18F-FDG PET/CT has been widely used and has demonstrated prognostic value, but 18F-FDG DTC avidity may remain low. Fibroblast activation protein inhibitors (FA-Pi)s, prostatic-specific membrane antigen (PSMA), and somatostatin receptor (SSTR) tracers have been proposed as theragnostic agents in experimental settings and Arg-Gly-Asp (RGD) peptides in the diagnostic trial field. Multi-targeted tyrosine kinase inhibitors are relatively new drugs approved in RAIR-DTC therapy. Despite the promising targeted setting, they relate to frequent adverse-event onset. Sorafenib and trametinib have been included in re-differentiation protocols aimed at re-inducing RAI accumulation in DTC cells. Results appear promising, but not excellent. CONCLUSIONS RAIR-DTC remains a challenging nosological entity. There are still controversies on RAIR-DTC definition and post-RAI therapy evaluation, with post-therapy whole-body scan (PT-WBS) the only validated criterion of response. The recent introduction of multiple diagnostic and therapeutic agents obliges physicians to pursue a multidisciplinary approach aiming to correct drug introduction and timing choice.
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Affiliation(s)
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (F.V.); (E.Z.); (E.D.D.); (S.M.); (A.C.); (M.K.)
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Machens A, Dralle H. In Reference to Can Calcitonin Levels Guide Prophylactic Neck Dissection in Sporadic Medullary Thyroid Carcinoma? Laryngoscope 2024. [PMID: 38958170 DOI: 10.1002/lary.31622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Andreas Machens
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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Barrio MJ, Pozdeyev N, Raeburn CD, McIntyre RC, Marshall CB, Haugen B, La Greca A. Pre-operative thyroglobulin measurement for thyroid cancer risk of recurrence and response to therapy. Am J Surg 2024:115818. [PMID: 39004566 DOI: 10.1016/j.amjsurg.2024.115818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Thyroid cancer has an overall favorable prognosis, but no pre-operative biochemical marker has been shown to distinguish between low and high-risk disease or predict response to therapy. METHODS We retrospectively reviewed 162 patients that underwent thyroid surgery for thyroid cancer between 2006 and 2022 in whom a pre-operative thyroglobulin level (Tg) was measured. We subdivided patients into low, intermediate and high-risk thyroid cancer and based on their response to therapy per ATA guidelines. RESULTS We showed that as pre-operative Tg level increased, patients were more likely to have high-risk disease (p < 0.01). We found a linear association between the primary tumor size and high-risk histology with pre-operative Tg (p < 0.01). Pre-operative Tg level was significantly associated with response to therapy following initial surgical management. Specifically, as pre-operative Tg increases, patients were less likely to achieve an excellent response (p < 0.01). CONCLUSIONS Our retrospective analysis demonstrated that pre-operative Tg is significantly associated with ATA structural risk of recurrence and response to therapy and may have the potential to guide initial therapy and follow-up management.
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Affiliation(s)
- Martin Jose Barrio
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Nikita Pozdeyev
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States; Department of Biomedical Informatics, University of Colorado School of Medicine, 1890 N. Revere Court, Mailstop F600, Aurora, CO, 80045, United States
| | - Christopher D Raeburn
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Robert C McIntyre
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Carrie B Marshall
- Department of Pathology, University of Colorado School of Medicine, 12605 E. 16th Ave Aurora, CO, 80045, United States
| | - Bryan Haugen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States
| | - Amanda La Greca
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States.
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249
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Hernández-Ramírez LC, Perez-Rivas LG, Theodoropoulou M, Korbonits M. An Update on the Genetic Drivers of Corticotroph Tumorigenesis. Exp Clin Endocrinol Diabetes 2024. [PMID: 38830604 DOI: 10.1055/a-2337-2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
The genetic landscape of corticotroph tumours of the pituitary gland has dramatically changed over the last 10 years. Somatic changes in the USP8 gene account for the most common genetic defect in corticotrophinomas, especially in females, while variants in TP53 or ATRX are associated with a subset of aggressive tumours. Germline defects have also been identified in patients with Cushing's disease: some are well-established (MEN1, CDKN1B, DICER1), while others are rare and could represent coincidences. In this review, we summarise the current knowledge on the genetic drivers of corticotroph tumorigenesis, their molecular consequences, and their impact on the clinical presentation and prognosis.
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Affiliation(s)
- Laura C Hernández-Ramírez
- Red de Apoyo a la Investigación, Coordinación de la Investigación Científica, Universidad Nacional Autónoma de México e Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Marily Theodoropoulou
- Medizinische Klinik und Poliklinik IV, LMU Klinikum, LMU München, Munich 80336, Germany
| | - Márta Korbonits
- Centre for Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London, UK
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250
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Yoon JH, Park JY, Hong AR, Kim HK, Kang HC. Predictors of lateral lymph node metastasis and skip metastasis in patients with papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2024; 15:1392247. [PMID: 39015180 PMCID: PMC11250241 DOI: 10.3389/fendo.2024.1392247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/03/2024] [Indexed: 07/18/2024] Open
Abstract
Background Papillary thyroid microcarcinoma (PTMC) is characterized by its favorable prognosis and potential for active surveillance (AS) as a management option. However, the presence of cervical lymph node (LN) metastasis, especially lateral LN metastasis, significantly impacts management and prognosis. Previous studies have focused on post-surgery risk factors for cervical LN metastasis. This study aims to identify predictors of lateral LN metastasis by analyzing pre-operative ultrasonographic findings alongside clinicopathological factors. Methods A retrospective review of medical records was conducted for patients with PTMC who underwent surgery at Chonnam National University Hwasun Hospital between 2004 and 2013. This is a case-control study that compares patients with lateral LN metastasis (N1b) to age- and sex-matched patients without LN metastasis (N0). Subgroup analysis was performed to evaluate risk factors of skip metastasis. Results The study included 90 patients with PTMC with lateral LN metastasis (N1b) and 268 age- and sex-matched patients without LN metastasis (N0). The mean age was 49.3 years, and female patients were dominant in both groups. Structural recurrences of 4.4% (4/90) were observed only in the N1b group. The N1b group exhibited a higher frequency of upper lobe tumor location compared to the N0 group (38.9% vs. 16.0%, p < 0.001). There was no significant difference in the locations with the presence of invasion to adjacent organs. A higher proportion of non-parallel shape was observed in the N1b group than the N0 group (80.0% vs. 66.0%, p = 0.013). There were no differences in echogenicity, sonographic feature, margin, and AP diameter of the thyroid gland between the two groups. In multivariate analysis, independent risk factors for lateral LN metastasis included extrathyroidal extension, multiplicity, upper lobe tumor location, and non-parallel shape. Skip metastasis in patients with PTMC was associated with upper lobe tumor location. Conclusion Detailed ultrasound examinations, evaluating tumor location, number, orientation, and the presence of ETE, are crucial in accurately predicting lateral LN metastasis especially when primary tumor was in the upper lobe to avoid missing skip metastasis. These evaluations can help guide the decision between AS and immediate surgery in patients with PTMC.
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Affiliation(s)
- Jee Hee Yoon
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Ji Yong Park
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - A Ram Hong
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
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