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Jin X, Jing X, Smola B, Heider A. Malignant risk of pediatric Bethesda category III thyroid nodules subcategorized by nuclear atypia and other: A single institution experience. Cancer Cytopathol 2024. [PMID: 38771850 DOI: 10.1002/cncy.22831] [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: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/26/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The 2023 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) divides AUS diagnoses into two major subcategories: atypia of undetermined significance (AUS) nuclear atypia (AUS-N) and other (AUS-O). This study aims to compare the histological outcome and malignant rate of pediatric AUS thyroid nodules classified into AUS-N and AUS-O subcategories. DESIGN A search of our institutional electronic pathology database for the period from January 2012 to July 2023 was conducted to identify pediatric (<21 years old) thyroid nodules that were interpreted as AUS and subsequently had surgery. Cases were further divided into AUS-N and AUS-O subcategories. Results of follow-up surgical resections were collected. The malignant rate was calculated and compared between AUS-N and AUS-O groups. RESULTS The study identified 62 thyroid nodules from 58 pediatric patients. Among these nodules, 29 and 33 were subcategorized as AUS-N and AUS-O, respectively. Both groups exhibited a female predominance and displayed a similar nodule size distribution. Histological analysis revealed 15 carcinomas in AUS-N nodules, including 11 cases of classic papillary thyroid carcinoma (PTC) and four cases of follicular type of PTC. In contrast, in the AUS-O group, a total of five carcinomas were documented, including two PTCs and three oncocytic thyroid carcinomas. Notably, the malignant rate of AUS-N nodules (52%) is significantly higher than that of AUS-O nodules (15%) (p = .002). CONCLUSION In pediatric AUS thyroid nodules, the malignant risk in AUS-N is significantly higher than that in AUS-O. These findings may guide more appropriate clinical triage and/or improve management of pediatric patients with AUS thyroid nodules.
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Affiliation(s)
- Xiaobing Jin
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Xin Jing
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brian Smola
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Amer Heider
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
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2
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Loberg MA, Tigue ML, Gallant JN, Wang H, Canberk S, Weiss VL. Evolving approaches in paediatric thyroid cytopathology: A review. Cytopathology 2024; 35:60-69. [PMID: 37759375 PMCID: PMC11027193 DOI: 10.1111/cyt.13311] [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: 07/11/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
The guidelines for the workup of thyroid nodules have been established in adult populations and secondarily applied to paediatric populations. In particular, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is commonly applied to both adult and paediatric thyroid nodules. However, as paediatric nodules have distinct molecular drivers and behavioural trajectories, there is renewed interest in diagnostic and management strategies that are paediatric specific. Here, we review key differences between paediatric and adult thyroid cancer and recent literature evaluating the use of TBSRTC in paediatric populations.
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Affiliation(s)
- Matthew A Loberg
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Megan L Tigue
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jean-Nicolas Gallant
- Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Huiying Wang
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sule Canberk
- i3S/ Institute of Molecular Pathology and Immunology of the University of Porto, Porto, Portugal
| | - Vivian L Weiss
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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3
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Hess JR, Van Tassel DC, Runyan CE, Morrison Z, Walsh AM, Schafernak KT. Performance of ACR TI-RADS and the Bethesda System in Predicting Risk of Malignancy in Thyroid Nodules at a Large Children's Hospital and a Comprehensive Review of the Pediatric Literature. Cancers (Basel) 2023; 15:3975. [PMID: 37568791 PMCID: PMC10417028 DOI: 10.3390/cancers15153975] [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: 05/13/2023] [Revised: 06/24/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
While thyroid nodules are less common in children than in adults, they are more frequently malignant. However, pediatric data are scarce regarding the performance characteristics of imaging and cytopathology classification systems validated to predict the risk of malignancy (ROM) in adults and select those patients who require fine-needle aspiration (FNA) and possibly surgical resection. We retrospectively reviewed the electronic medical records of all patients 18 years of age or younger who underwent thyroid FNA at our institution from 1 July 2015 to 31 May 2022. Based on surgical follow-up from 74 of the 208 FNA cases, we determined the ROM for the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) ultrasound risk stratification system and The Bethesda System for Reporting Thyroid Cytopathology and added our results to those of pediatric cohorts from other institutions already published in the literature. We found the following ROMs for 1458 cases using ACR TI-RADS (TR): TR1. Benign: 2.2%, TR2. Not Suspicious: 9.3%, TR3. Mildly Suspicious: 16.6%, TR4. Moderately Suspicious: 27.0%, and TR5. Highly Suspicious 76.5%; and for 5911 cases using the Bethesda system: Bethesda I. Unsatisfactory: 16.8%, Bethesda II. Benign: 7.2%, Bethesda III: Atypia of Undetermined Significance: 29.6%, Bethesda IV. Follicular Neoplasm: 42.3%, Bethesda V. Suspicious for Malignancy: 90.8%, and Bethesda VI. Malignant: 98.8%. We conclude that ACR TI-RADS levels imply higher ROMs for the pediatric population than the corresponding suggested ROMs for adults, and, in order to avoid missing malignancies, we should consider modifying or altogether abandoning size cutoffs for recommending FNA in children and adolescents whose thyroid glands are smaller than those of adults. The Bethesda categories also imply higher ROMs for pediatric patients compared to adults.
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Affiliation(s)
- Jennifer R. Hess
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (J.R.H.); (A.M.W.)
| | - Dane C. Van Tassel
- Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA;
| | - Charles E. Runyan
- Department of Radiology, Valleywise Hospital, Phoenix, AZ 85008, USA;
| | - Zachary Morrison
- Creighton Radiology Residency, Creighton University, Phoenix, AZ 85012, USA;
| | - Alexandra M. Walsh
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (J.R.H.); (A.M.W.)
| | - Kristian T. Schafernak
- Division of Pathology, Laboratory Medicine, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
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4
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Antonia TD, Maria LI, Ancuta-Augustina GG. Preoperative evaluation of thyroid nodules - Diagnosis and management strategies. Pathol Res Pract 2023; 246:154516. [PMID: 37196471 DOI: 10.1016/j.prp.2023.154516] [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: 02/20/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
Thyroid cancer is the most common endocrine malignancy, with increasing incidence over the past few decades. Fine needle aspiration (FNA) biopsy is the gold standard for preoperative diagnosis of thyroid malignancies. Nevertheless, this method renders indeterminate results in up to 30% of the cases. Therefore, these patients are often referred to unnecessary surgery to establish the diagnosis. To improve the accuracy of preoperative diagnosis, several other ways, such as ultrasonography, elastography, immunohistochemical analysis, genetic testing, and core needle biopsy, have been developed and can be used either in association with or as an alternative to FNA. This review aims to evaluate all these diagnostic tools to determine the most appropriate way of managing thyroid nodules and subsequently improve the selection of cases referred to surgery.
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Affiliation(s)
- Tapoi Dana Antonia
- Carol Davila University of Medicine and Pharmacy, Department of Pathology, Bucharest, Romania; University Emergency Hospital, Department of Pathology, Bucharest, Romania
| | - Lambrescu Ioana Maria
- Carol Davila University of Medicine and Pharmacy, Department of Cellular and Molecular Biology and Histology, Bucharest, Romania; Victor Babes National Institute of Pathology, Bucharest, Romania.
| | - Gheorghisan-Galateanu Ancuta-Augustina
- Carol Davila University of Medicine and Pharmacy, Department of Cellular and Molecular Biology and Histology, Bucharest, Romania; CI Parhon National Institute of Endocrinology, Bucharest, Romania
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5
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Tang J, Zhanghuang C, Yao Z, Li L, Xie Y, Tang H, Zhang K, Wu C, Yang Z, Yan B. Development and validation of a nomogram to predict cancer-specific survival in middle-aged patients with papillary thyroid cancer: A SEER database study. Heliyon 2023; 9:e13665. [PMID: 36852028 PMCID: PMC9958280 DOI: 10.1016/j.heliyon.2023.e13665] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
Background Thyroid cancer (TC) accounts for more than 90% of endocrine tumours and is a typical head and neck tumour in adults. The aim of this study was to develop a predictive tool to predict cancer-specific survival (CSS) in middle-aged patients with papillary thyroid carcinoma (PTC). Methods The patients from 2004 to 2015 were randomly divided into a training cohort (n = 25,342) and a internal validation cohort (n = 10,725). The patients from 2016 to 2018 were treated as an external validation cohort (n = 11353). COX proportional hazard model was used to screen meaningful independent risk factors. These factors were constructed into a nomogram to predict CSS in middle-aged patients with PTC. The performance and accuracy of the nomogram were then evaluated using the concordance index (C-index), calibration curve and the area under the curve (AUC). The clinical value of nomogram was evaluated by decision curve analysis (DCA). Results Age, gender, marriage, tumour grade, T stage, N stage, M stage, surgery, chemotherapy, and tumour size were independent prognostic factors. The C-indexes of the training, internal validation, and external validation cohorts were 0.906, 0.887, and 0.962, respectively. The AUC and calibration curves show good accuracy. DCA shows that the clinical value of the nomogram is higher than that of Tumour, Node and Metastasis (TNM) staging. Conclusion We developed a new prediction tool to predict CSS in middle-aged patients with PTC. The model has good performance after internal and external validation, which can be friendly to help doctors and patients predict CSS.
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Affiliation(s)
- Jie Tang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenyang Medical College, Shenyang, China
| | - Chenghao Zhanghuang
- Department of Urology, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China.,Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China.,Department of Oncology; Yunnan Children Solid Tumor Treatment Center, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
| | - Zhigang Yao
- Department of Urology, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
| | - Li Li
- Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
| | - Yucheng Xie
- Department of Pathology, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
| | - Haoyu Tang
- Department of Urology, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
| | - Kun Zhang
- Department of Urology, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
| | - Chengchuang Wu
- Department of Urology, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
| | - Zhen Yang
- Department of Oncology; Yunnan Children Solid Tumor Treatment Center, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
| | - Bing Yan
- Department of Urology, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China.,Yunnan Key Laboratory of Children's Major Disease Research, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China.,Department of Oncology; Yunnan Children Solid Tumor Treatment Center, Kunming Children's Hospital(Children's Hospital Affiliated to Kunming Medical University), Kunming, PR China
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6
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Molecular Landscape of Pediatric Thyroid Cancer: A Review. Diagnostics (Basel) 2022; 12:diagnostics12123136. [PMID: 36553142 PMCID: PMC9776958 DOI: 10.3390/diagnostics12123136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Thyroid carcinomas (TC) are rare in the pediatric population; however, they constitute the most common endocrine malignancy. Despite some similarities with adult carcinomas, they have distinct clinical behavior and responses to therapy due to their unique pathology and molecular characteristics. The age cut-off used for defining the pediatric age group has been variable across different studies, and the universally accepted recommendations influence accurate interpretation of the available data. Moreover, factors such as radiation exposure and germline mutations have greater impact in children than in adults. Papillary TC is the most common and the most evaluated pediatric TC. Others, including follicular, poorly differentiated and medullary carcinomas, are rarer and have limited available literature. Most studies are from the West. Asian studies are primarily from Japan, with few from China, India, Saudi Arabia and Republic of Korea. This review provides a comprehensive account of the well-established and novel biomarkers in the field, including point mutations, fusions, miRNA, and thyroid differentiation genes. Familial and syndromic associations are also discussed. Current management guidelines for pediatric patients are largely derived from those for adults. An awareness of the molecular landscape is essential to acknowledge the uniqueness of these tumors and establish specific diagnostic and therapeutic guidelines.
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7
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Halada S, Baran JA, Bauer AJ, Ricarte-Filho JC, Isaza A, Patel T, Franco AT, Mostoufi-Moab S, Adzick NS, Kazahaya K, Bhatti TR, Baloch Z, Surrey LF. Clinicopathologic Characteristics of Pediatric Follicular Variant of Papillary Thyroid Carcinoma Subtypes: A Retrospective Cohort Study. Thyroid 2022; 32:1353-1361. [PMID: 36103376 PMCID: PMC9700371 DOI: 10.1089/thy.2022.0239] [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] [Indexed: 11/12/2022]
Abstract
Introduction: Follicular patterned thyroid nodules with nuclear features of papillary thyroid carcinoma (PTC) encompass a range of diagnostic categories with varying risks of metastatic behavior. Subtypes include the invasive encapsulated follicular variant of PTC (Ienc-fvPTC) and infiltrative fvPTC (inf-fvPTC), with tumors lacking invasive features classified as noninvasive follicular thyroid neoplasms with papillary-like features (NIFTPs). This study aimed to report the clinical and histological features of pediatric cases meeting criteria for these histological subtypes, with specific focus on Ienc-fvPTC and inf-fvPTC. Methods: In this retrospective cohort study, pediatric patients with thyroid neoplasms showing follicular patterned growth and nuclear features of PTC noted on surgical pathology between January 2010 and January 2021 were retrospectively reviewed and classified according to the recent 2022 World Health Organization (WHO) criteria. Clinical and histopathologic parameters were described for NIFTP, Ienc-fvPTC, and inf-fvPTC subtypes, with specific comparison of Ienc-fvPTC and inf-fvPTC cases. Results: The case cohort included 42 pediatric patients, with 6 (14%), 25 (60%), and 11 (26%) patients meeting criteria for NIFTP, Ienc-fvPTC, and inf-fvPTC, respectively. All cases were rereviewed, and 5 patients originally diagnosed with Ienc-fvPTC before 2017 were reappraised as having NIFTPs. The NIFTP cases were encapsulated tumors without invasive features, lymph node or distant metastasis, or disease recurrence. Ienc-fvPTC tumors demonstrated clearly demarcated tumor capsules and capsular/vascular invasion, while inf-fvPTC tumors displayed infiltrative growth lacking a capsule. inf-fvPTC cases had increased prevalence of malignant preoperative cytology, lymph node metastasis, and distant metastasis (p < 0.01). These cases were treated with total thyroidectomy, lymph node dissection, and subsequent radioactive iodine therapy. Preliminary genetic findings suggest a predominance of fusions in inf-fvPTC cases versus point mutations in Ienc-fvPTC (p = 0.02). Conclusions: Pediatric NIFTP and fvPTC subtypes appear to demonstrate alignment between clinical and histological risk stratification, with indolent behavior in Ienc-fvPTC and invasive features in inf-fvPTC tumors.
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Affiliation(s)
- Stephen Halada
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Julia A. Baran
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julio C. Ricarte-Filho
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Amber Isaza
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Tasleema Patel
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Aime T. Franco
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
| | - Sogol Mostoufi-Moab
- Division of Endocrinology and Diabetes, The Thyroid Center, Philadelphia, Pennsylvania, USA
- Division of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - N. Scott Adzick
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ken Kazahaya
- Department of Otorhinolaryngology: Head and Neck Surgery, Children's Hospital of Philadelphia; University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tricia R. Bhatti
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zubair Baloch
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lea F. Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Back K, Song RY, Choe JH, Kim JS, Choi YS, Kim MK, Kim JH. The clinical impact of extrathyroidal extensions on prognoses in pediatric differentiated thyroid cancers. J Pediatr Surg 2022; 57:1532-1537. [PMID: 34758908 DOI: 10.1016/j.jpedsurg.2021.09.035] [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: 07/02/2021] [Revised: 08/31/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prognostic impact of extrathyroidal extensions (ETE) on clinical outcomes has not been well studied in pediatric thyroid cancers. The aim of this study was to analyze the clinicopathological characteristics and clinical outcomes according to the extent of ETE in pediatric and adolescent thyroid cancers. METHODS This study retrospectively reviewed 89 papillary thyroid carcinoma (PTC) patients less than 19 years of age who underwent total thyroidectomy with central neck dissections (CND) between 1997 and 2018. We compared the clinicopathological features among three groups: no ETE, microscopic ETE, and gross ETE. RESULTS The median follow-up time was 111 months. The mean age was 15.3 years and the mean tumor size was 2.4 cm. Tumor sizes larger than 2 cm (OR = 9.2, p = 0.001), exhibited bilaterality (OR = 4.3, p = 0.006), were an aggressive variant (OR = 5.8, p = 0.006), and exhibited central lymph node metastasis (OR = 1.3, p = 0.018), lateral lymph node metastasis (OR = 9.2, p = 0.001), recurrence (OR = 3.9, p = 0.038), and distant metastasis (OR = 4.4, p = 0.016) were associated with gross ETE. There was no remarkable difference in clinicopathological characteristics between the no ETE group and microscopic ETE group, except for aggressive variants (OR = 5.5, p = 0.008). There was a significant difference in recurrence-free survival (RFS) rates according to the extent of ETE (p = 0.025). Furthermore, the distant metastasis-free survival curve presented a significant difference among the three groups (p = 0.018). Both microscopic ETE and gross ETE were significantly associated with worse prognoses in pediatric thyroid cancers. CONCLUSIONS We recommend that microscopic ETE should be included in the intermediate risk category and that gross ETE should be stratified in the high risk group in future revisions of ATA pediatric guidelines.
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Affiliation(s)
- Kyorim Back
- Department of Surgery, Division of Endocrine Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, South Korea.
| | - Ra-Yeong Song
- Department of Surgery, Division of Endocrine Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, South Korea
| | - Jun-Ho Choe
- Department of Surgery, Division of Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
| | - Jee Soo Kim
- Department of Surgery, Division of Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea
| | - Yoo Shin Choi
- Department of Surgery, Division of Hepatobiliary Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, South Korea
| | - Min Kyoon Kim
- Department of Surgery, Division of Breast Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, South Korea
| | - Jung-Han Kim
- Department of Surgery, Division of Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea.
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9
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Caulley L, Eskander A, Yang W, Auh E, Cairncross L, Cho NL, Golbon B, Iyer S, Liu JC, Lee PJ, Lindeman B, Meltzer C, Molin N, Moore A, Noel J, Nozolino H, Pasternak J, Price B, Ramsay T, Rolighed L, Sajisevi M, Sharma A, Sinclair C, Sorensen M, Tae K, Tang AL, Tsao G, Williams M, Wrenn S, Xing MH, Zafereo M, Stack BC, Randolph G, Davies L. Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms. JAMA Otolaryngol Head Neck Surg 2021; 148:99-106. [PMID: 34817546 DOI: 10.1001/jamaoto.2021.3277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment. Objective To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size. Design, Setting, and Participants This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed. Main Outcomes and Measures Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period. Results Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]). Conclusions and Relevance Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Edel Auh
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lydia Cairncross
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bahar Golbon
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Jeffrey C Liu
- Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Paul J Lee
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenessa Lindeman
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | | | - Nicole Molin
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alessandra Moore
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Halie Nozolino
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Jesse Pasternak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendon Price
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mirabelle Sajisevi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Meredith Sorensen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Alice L Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gabriel Tsao
- The Permanente Medical Group, Santa Rosa, California
| | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean Wrenn
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer Foundation, New York, New York
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Greg Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Louise Davies
- VA Outcomes Group, White River Junction, Vermont.,Section of Otolaryngology-Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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10
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Vuong HG, Chung DGB, Ngo LM, Bui TQ, Hassell L, Jung CK, Kakudo K, Bychkov A. The Use of the Bethesda System for Reporting Thyroid Cytopathology in Pediatric Thyroid Nodules: A Meta-Analysis. Thyroid 2021; 31:1203-1211. [PMID: 33504264 DOI: 10.1089/thy.2020.0702] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Little is known about the application of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. This meta-analysis was aimed to investigate the use of TBSRTC in the pediatric population. Methods: Relevant articles were searched in PubMed and Web of Science. Meta-analysis of proportion and its 95% confidence interval (CI) were computed utilizing the random-effect model. We used subgroup analyses and meta-regression to explore the sources of heterogeneities. Egger's regression test and funnel plot visualization were used to examine publication bias. Results: We included 17 articles comprising of 3687 pediatric thyroid nodules for meta-analyses. TBSRTC outputs including frequency and risk of malignancy (ROM) for the majority of categories were not statistically different from recently published meta-analysis of 145,066 thyroid nodules in adult patients. The resection rate (RR) in the pediatric group was significantly higher in most of the categories compared with published adult data: benign, 23.2% [CI = 18.6-27.9] vs. 13.0% [CI = 9.5-16.5]; atypia of undetermined significance/follicular lesion of undetermined significance, 62.6% [CI = 50.3-74.9] vs. 36.2% [CI = 29.9-42.5]; follicular neoplasm/suspicious for follicular neoplasm, 84.3% [CI = 75.2-93.4] vs. 60.5% [CI = 54.5-66.5]; and suspicious for malignancy, 93.8% [CI = 90.1-97.6] vs. 69.7% [CI = 64.0-75.5]. Conclusion: TBSRTC is a valuable tool to make clinical decisions for pediatric patients with thyroid nodules. Pediatric patients with benign and indeterminate thyroid nodules had a higher RR than adult counterpart, but ROM of these categories in adults and children was not statistically different suggesting a potential risk of overtreatment in pediatric patients. Determining the best treatment guidelines and additional tools for risk stratification must be a top priority to precisely identify the target patient groups for surgical intervention.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology; Oklahoma City, Oklahoma, USA
- Stephenson Cancer Center; Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Duy Giang Bao Chung
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Luan Minh Ngo
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thien Quoc Bui
- Department of Preventive Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lewis Hassell
- Department of Pathology; Oklahoma City, Oklahoma, USA
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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11
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Ozolek JA. Selected Topics in the Pathology of the Thyroid and Parathyroid Glands in Children and Adolescents. Head Neck Pathol 2021; 15:85-106. [PMID: 33723755 PMCID: PMC8010056 DOI: 10.1007/s12105-020-01274-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/11/2020] [Indexed: 01/09/2023]
Abstract
The goals of this chapter in keeping with the overall general themes of this special edition will be (1) to highlight aspects of development of the thyroid and parathyroid glands with particular focus on the role and contribution of the neural crest (or not) and how this may impact on the pathology that is seen, (2) to emphasize those lesions particularly more commonly arising in the pediatric population that actually generate specimens that the surgical pathologist would encounter, and (3) highlight more in depth specific lesions associated with heritable syndromes or specific gene mutations since the heritable syndromes tends to manifest in the pediatric age group. In this light, the other interesting areas of pediatric thyroid disease including medical thyroid diseases, congenital hypothyroidism, anatomic variants and aberrations of development that lead to structural anomalies will not be emphasized here.
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Affiliation(s)
- John A. Ozolek
- West Virginia University School of Medicine, Morgantown, WV USA
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12
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Abdou AG, Aiad H, Asaad N. Case Report: Multifocal non-invasive follicular thyroid neoplasm with papillary-like nuclear features presenting in a female child. F1000Res 2020; 9:645. [PMID: 33149897 PMCID: PMC7594245 DOI: 10.12688/f1000research.23687.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/20/2022] Open
Abstract
Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced as a separate entity by the World Health Organization in 2017 with strict inclusion and exclusion criteria. Most NIFTP cases have been reported in adults and few cases have been diagnosed in children. Here, we present a classic case of NIFTP affecting a 10-year old female child. We also review previous reports of NIFTP in children regarding size, focality, nodal metastasis, recurrence, type of operation and follow-up data. The present report adds a new case of NIFTP in the paediatric age group characterized by multifocality, absence of nodal invasion and indolent course until last follow-up, recommending less aggressive management.
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Affiliation(s)
- Asmaa Gaber Abdou
- Department of Pathology, Menoufia University, Shebein Elkom, Menoufia, 32511, Egypt
| | - Hayam Aiad
- Department of Pathology, Menoufia University, Shebein Elkom, Menoufia, 32511, Egypt
| | - Nancy Asaad
- Department of Pathology, Menoufia University, Shebein Elkom, Menoufia, 32511, Egypt
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13
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Wang H, Correa H, Sanders M, Neblett WW, Liang J. Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features in Children: An Institutional Experience and Literature Review. Pediatr Dev Pathol 2020; 23:121-126. [PMID: 31483741 DOI: 10.1177/1093526619866584] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) in children has a distinctive set of clinicopathologic features and molecular signature compared to their adult counterparts. The recent recommendation to reclassify encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) without invasion as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is based on evidence derived almost exclusively from studies in adults. Clinicopathologic studies restricted to pediatric NIFTP are limited. METHODS We retrospectively analyzed all pediatric PTC and NIFTP diagnosed and treated in our institution from 1999 to 2016 (n = 31). RESULTS Using recently published consensus diagnostic criteria, we identified 3 NIFTP and 2 infiltrative follicular variants of papillary thyroid carcinoma (FVPTC) among 31 cases. Two of the NIFTP cases were initially diagnosed as EFVPTC. All 3 patients with NIFTP had unifocal tumors of lower American Joint Committee on Cancer (AJCC) classification (T2 or lower) and were free of lymph node or distant metastasis. Total (n = 1) or completion (n = 2) thyroidectomy was performed in all cases, and only 1 NIFTP patient received subsequent radioablative therapy. No residual or recurrent disease has been observed during follow-up (15-138 months) in patients with NIFTP. CONCLUSIONS Our experience with NIFTP in children is similar to outcomes reported in adult studies, suggesting that pediatric NIFTP behave indolently as evidenced by the absence of local recurrence in our cohort.
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Affiliation(s)
- Huiying Wang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hernan Correa
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wallace W Neblett
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Macerola E, Proietti A, Basolo F. Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP): a new entity. Gland Surg 2020; 9:S47-S53. [PMID: 32055498 DOI: 10.21037/gs.2019.12.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Since its first official definition in 2016, the new histo-pathological entity of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) has attracted much interest among "thyroidologists" worldwide. This is a subset of encapsulated and noninvasive follicular variant papillary thyroid cancer, whose introduction had the intent of de-escalating treatment given its very low malignant potential, approaching to that of follicular adenomas. Many researchers focused on the possibility of preoperatively identifying NIFTP, and investigated their cyto-morphological and molecular characteristics; other ones explored histological and clinical-pathological NIFTP features. Although the majority of published studies confirmed that NIFTP are indolent lesions, some papers did question their low-risk nature. In this brief review, the main aspects of histology, cytology and molecular pathology of NIFTP are discussed based on the current literature.
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Affiliation(s)
- Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Agnese Proietti
- Section of Anatomical Pathology, University Hospital of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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15
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Paulson VA, Rudzinski ER, Hawkins DS. Thyroid Cancer in the Pediatric Population. Genes (Basel) 2019; 10:genes10090723. [PMID: 31540418 PMCID: PMC6771006 DOI: 10.3390/genes10090723] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022] Open
Abstract
Thyroid cancer is rare in the pediatric population, but thyroid carcinomas occurring in children carry a unique set of clinical, pathologic, and molecular characteristics. In comparison to adults, children more often present with aggressive, advanced stage disease. This is at least in part due to the underlying biologic and molecular differences between pediatric and adult thyroid cancer. Specifically, papillary thyroid carcinoma (which accounts for approximately 90% of pediatric thyroid cancer) has a high rate of gene fusions which influence the histologic subtypes encountered in pediatric thyroid tumors, are associated with more extensive extrathyroidal disease, and offer unique options for targeted medical therapies. Differences are also seen in pediatric follicular thyroid cancer, although there are few studies of non-papillary pediatric thyroid tumors published in the literature due to their rarity, and in medullary carcinoma, which is most frequently diagnosed in the pediatric population in the setting of prophylactic thyroidectomies for known multiple endocrine neoplasia syndromes. The overall shift in the spectrum of histotypes and underlying molecular alterations common in pediatric thyroid cancer is important to recognize as it may directly influence diagnostic test selection and therapeutic recommendations.
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Affiliation(s)
- Vera A Paulson
- Dept. of Laboratory Medicine, University of Washington Medical Center, 1959 NE Pacific St, Box 357110, Seattle, WA 98105, USA.
| | - Erin R Rudzinski
- Dept. of Laboratories, Seattle Children's Hospital, OC.8.720; 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Douglas S Hawkins
- University of Washington Medical Center, Fred Hutchinson Cancer Research Center and Cancer and Blood Disorders Center, Seattle Children's Hospital, MB.8.501, Seattle, WA 98105, USA.
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16
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Cherella CE, Angell TE, Richman DM, Frates MC, Benson CB, Moore FD, Barletta JA, Hollowell M, Smith JR, Alexander EK, Cibas ES, Wassner AJ. Differences in Thyroid Nodule Cytology and Malignancy Risk Between Children and Adults. Thyroid 2019; 29:1097-1104. [PMID: 31298618 PMCID: PMC6707031 DOI: 10.1089/thy.2018.0728] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The Bethesda System for Reporting Thyroid Cytopathology (BSRTC) is used to interpret fine-needle aspiration (FNA) cytology of thyroid nodules in children and adults. Nodule management is guided by the implied malignancy risk of each cytological category, which has been derived from adult populations. Whether these implied risks are applicable to pediatric thyroid nodules remains uncertain. We compared malignancy rates between pediatric and adult thyroid nodules within each cytological category. Methods: We evaluated consecutive thyroid nodules ≥1 cm that underwent FNA at the Boston Children's Hospital and Brigham and Women's Hospital from 1998 to 2016. All cytology was interpreted by a single cytopathology group according to the BSRTC. Malignancy rates were compared between pediatric (<19 years) and adult (≥19 years) patients. Results: Four hundred thirty pediatric thyroid nodules and 13,415 adult nodules were analyzed. Pediatric nodules were more likely to be malignant than adult nodules (19% vs. 12%, p = 0.0002). Within cytological categories, malignancy rates were higher in pediatric nodules than in adult nodules that were cytologically nondiagnostic (11% vs. 4%, p = 0.03), atypia of undetermined significance (AUS; 44% vs. 22%, p = 0.004), or suspicious for follicular neoplasm (SFN; 71% vs. 28%, p = 0.001). There were no significant differences between children and adults in the types of thyroid cancers diagnosed in these cytological categories. Among cytologically benign nodules, the difference in malignancy rates was statistically significant but clinically minimal (0.7% vs. 1%, p = 0.001). Malignancy rates did not differ between children and adults among nodules with cytology suspicious for papillary carcinoma (73% vs. 68%, p = 0.67) or positive for malignancy (97% vs. 95%, p = 1). Among the subset of nodules that were resected, the malignancy rate was higher in children than in adults only in nodules that were SFN (71% vs. 36%, p = 0.007). Conclusions: Among thyroid nodules that are cytologically AUS, SFN, or nondiagnostic, malignancy rates are higher in children than in adults. These discrepancies likely represent true differences in malignancy risk between pediatric and adult patients, rather than differences in cytological interpretation. Our findings provide pediatric-specific data to inform the optimal management of thyroid nodules in children, which may differ from that of adult nodules with equivalent cytology.
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Affiliation(s)
- Christine E. Cherella
- Thyroid Program, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Trevor E. Angell
- Division of Endocrinology, Hypertension, and Diabetes, Brigham and Women's Hospital, Boston, Massachusetts
| | - Danielle M. Richman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mary C. Frates
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carol B. Benson
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Francis D. Moore
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Justine A. Barletta
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Monica Hollowell
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Jessica R. Smith
- Thyroid Program, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Erik K. Alexander
- Division of Endocrinology, Hypertension, and Diabetes, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edmund S. Cibas
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ari J. Wassner
- Thyroid Program, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
- Address correspondence to: Ari J. Wassner, MD, Thyroid Program, Division of Endocrinology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115
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17
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Heider A, Arnold S, Lew M, Pang J, Rabah R, Bruch S, Thomas I, Menon R, Cantley R, Davenport R, Jing X. Malignant risk of indeterminate pediatric thyroid nodules-An institutional experience. Diagn Cytopathol 2019; 47:993-998. [PMID: 31254313 DOI: 10.1002/dc.24266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/24/2019] [Accepted: 06/12/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Few studies focus on pediatric thyroid nodules categorized under indeterminate diagnostic categories. The current study was conducted to assess the risk of malignancy of indeterminate pediatric thyroid nodules. METHODS A search of the institutional electronic pathology database from 01/2011 to 09/2018 was performed to identify pediatric (<21 years old) thyroid nodules that were interpreted as follicular lesion of undetermined significance (FLUS), suspicious for follicular neoplasm (SFN), or suspicious for malignancy (SFM) and subsequently managed with surgery, repeat fine-needle aspiration (FNA), or ≥ 6 months of clinical/imaging monitoring. Results of follow-up (F/U) surgical resections and repeat FNA/Afirma tests, and clinical and radiologic data were collected. RESULTS We identified 46 cases from 42 patients (11-20 years old, 33 females and 9 males), including 30 FLUS, 10 SFN, and 6 SFM. Twenty-five FLUS, ten SFN, and six SFM cases underwent surgery. The histology revealed carcinomas in 36% of FLUS, 20% of SFN, and 100% of SFM categories; follicular adenomas in 32% of FLUS and 80% of SFN categories; and benign nodules in 32% of FLUS category. All five nonsurgically treated FLUS cases were considered benign based on the findings of repeat FNA/Afirma tests (n = 3, 3-22 months F/U) or clinical/radiologic exams (n = 2, 8-12 months F/U). CONCLUSIONS Based on a limited study cohort, malignancy was identified in 36%, 20%, and 100% of surgically managed pediatric thyroid nodules categorized as FLUS, SFN, and SFM, respectively; suggesting a markedly higher malignant rate than the implied malignant risk for FLUS and SFM categories in adults.
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Affiliation(s)
- Amer Heider
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Stacy Arnold
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Madelyn Lew
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Judy Pang
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Raja Rabah
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Steven Bruch
- Department of Surgery, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Inas Thomas
- Department of Pediatrics, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Ram Menon
- Department of Pediatrics, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Richard Cantley
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Robertson Davenport
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Xin Jing
- Department of Pathology, The University of Michigan-Michigan Medicine, Ann Arbor, MI
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18
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Liu Z, Bychkov A, Jung CK, Hirokawa M, Sui S, Hong S, Lai C, Jain D, Canberk S, Kakudo K. Interobserver and intraobserver variation in the morphological evaluation of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features in Asian practice. Pathol Int 2019; 69:202-210. [DOI: 10.1111/pin.12779] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/11/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Zhiyan Liu
- Department of PathologySchool of Basic Medical SciencesCheeloo College of MedicineShandong University Shandong China
- Department of PathologyQilu Hospital of Shandong University Shandong China
| | - Andrey Bychkov
- Department of PathologyFaculty of MedicineChulalongkorn University Bangkok Thailand
- Department of PathologyKameda Medical Center Kamogawa Japan
| | - Chan Kwon Jung
- Department of Hospital PathologyCollege of MedicineThe Catholic University of Korea Seoul South Korea
| | | | - Shaofeng Sui
- Department of Occupational and Environmental Health Monitoring and AssessmentShandong Center for Disease Control and Prevention Jinan China
| | - SoonWon Hong
- Department of PathologyYonsei University College of Medicine Seoul South Korea
| | - Chiung‐Ru Lai
- Department of PathologyTaipei Veterans General Hospital Taipei Taiwan
| | - Deepali Jain
- Department of PathologyAll India Institute of Medical Sciences New Delhi India
| | - Sule Canberk
- Cancer Signalling & MetabolismInstituto de Investigação e Inovação em SaúdeUniversidade do Porto Rua Alfredo Allen Porto Portugal
- Pathology & CytopathologyAcıbadem University Kerem Aydinlar Campus Block‐B, Ataşehir/İstanbul‐Turkey
| | - Kennichi Kakudo
- Faculty of MedicineDepartment of PathologyNara HospitalKindai University Nara Japan
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19
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Wang H, Mehrad M, Ely KA, Liang J, Solórzano CC, Neblett WW, Coogan AC, Weiss VL. Incidence and malignancy rates of indeterminate pediatric thyroid nodules. Cancer Cytopathol 2019; 127:231-239. [DOI: 10.1002/cncy.22104] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Huiying Wang
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Mitra Mehrad
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Kim A. Ely
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Jiancong Liang
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Carmen C. Solórzano
- Division of Surgical Oncology and Endocrine Surgery Vanderbilt University Medical Center Nashville Tennessee
| | - Wallace W. Neblett
- Department of Pediatric Surgery Vanderbilt University Medical Center Nashville Tennessee
| | - Alice C. Coogan
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Vivian L. Weiss
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
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20
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Rosario PW, Mourão GF. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in children and adolescents. Endocrine 2018; 61:542-544. [PMID: 29974337 DOI: 10.1007/s12020-018-1667-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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