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Zhang F, Mei F, Chen W, Zhang Y. Role of Ultrasound and Ultrasound-Based Prediction Model in Differentiating Follicular Thyroid Carcinoma From Follicular Thyroid Adenoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1389-1399. [PMID: 38577871 DOI: 10.1002/jum.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES This study aims to identify distinct ultrasound (US) characteristics for distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA), and construct a user-friendly preoperative risk stratification model for thyroid follicular neoplasms. METHODS In this retrospective study, patients diagnosed with pathologically confirmed FTA or FTC and undergoing US examinations between July 2017 and June 2021 were designated as the training cohort, and those from July 2021 to June 2023 were enrolled as the external validation set. We systematically assessed and compared the sonographic and clinical characteristics of FTC and FTA. Univariable and multivariable logistic regression analyses were used to assess the association of US features with FTC in the training set. A prediction nomogram model, incorporating US features independently associated with FTC, was developed and validated externally to assess its performance. RESULTS A total of 645 patients (FTA/FTC = 530/115) were included in the training set, while 197 patients (FTA/FTC = 165/32) constituted the validation set. In the training set, solid composition, hypo-echogenicity, irregular margin, calcification, protrusion sign, trabecular formation, absent or thick halo, and mainly central hypervascularity were identified as independent factors associated with FTC. The prediction nomogram model constructed using these variables showed good performance in differentiating FTC from FTA with an area under the curve of 0.948 in the training set and 0.915 in the validation set. CONCLUSIONS The preoperative nomogram model constructed based on US features serves as an effective tool for the risk stratification of thyroid follicular neoplasms.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Fang Mei
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Yongyue Zhang
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
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Nilojan JS, Raviraj S, Madhuwantha UVP, Mathuvanthi T, Priyatharsan K. Metastatic thyroid follicular carcinoma presenting as pathological left clavicle fracture: An unusual skeletal metastasis at the time of diagnosis. Int J Surg Case Rep 2024; 114:109131. [PMID: 38128290 PMCID: PMC10800592 DOI: 10.1016/j.ijscr.2023.109131] [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: 10/12/2023] [Revised: 11/24/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Thyroid carcinoma is the most common endocrine malignancy, accounting for 3 % of recent malignancies in world wide. Differentiated thyroid carcinoma constitutes 90 % thyroid malignancies, within that follicular type constitutes 10-15 %. CLINICAL PRESENTATION A 55-year-old female presented with left-sided neck pain and swelling over medial end of clavicle, following normal manual work. Physical examination revealed swelling on medial end of left clavicle and palpable nodule in left thyroid lobe. Imaging studies showed two nodules in both thyroid lobes with left level IV lymphadenopathy and osteolytic lesion with pathological fracture in medial end of clavicle. Histopathological evaluation confirmed well-differentiated follicular thyroid carcinoma with clavicular metastasis. The patient underwent total thyroidectomy, followed by radioiodine therapy for medial end of left clavicle. DISCUSSION Follicular thyroid carcinoma (FTC) is metastasis through the bloodstream, predominantly to flat bones and upper end of long bones, but clavicular deposits are very rarely reported. FNAC only diagnosed the follicular neoplasm. Further tissue evaluation needed to confirm the malignancy. Therefore, hemithyroidectomy of the lesion side is usually carried out for histopathological diagnosis. But in this case, follicular thyroid carcinoma was confirmed through core biopsy from medial end of clavicle, leading to total thyroidectomy and left cervical block dissection, followed by radioiodine therapy for metastatic clavicular involvement. CONCLUSION Clavicular metastasis of follicular thyroid carcinoma is very rare. Early detection and proper management of suspicious thyroid carcinoma in uncommon skeletal sites, like the clavicle, is crucial for enhancing patient outcomes, despite the rarity of follicular carcinoma metastasis to this area.
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Affiliation(s)
| | | | - U V P Madhuwantha
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
| | | | - K Priyatharsan
- Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka
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3
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Ye F, Liao L, Tan W, Gong Y, Li X, Niu C. Case report: Large follicular thyroid carcinoma with multiple cervical lymph node metastases. Front Surg 2022; 9:995859. [PMID: 36081589 PMCID: PMC9445312 DOI: 10.3389/fsurg.2022.995859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Follicular thyroid carcinoma (FTC) rarely metastasizes to regional lymph nodes, as they mainly metastasize through hematogenous route; in particular, a large FTC with only lateral lymph node metastasis and without distant metastasis has rarely been reported. Case report We present a 66-year-old male patient with a progressively growing thyroid for more than 20 years, causing tracheal compression and narrowing. Neck ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging and positron emission tomography–computed tomography (PET/CT) were carried out to obtain images of the thyroid and surrounding tissues. Total thyroidectomy and cervical lateral and central lymph node dissection were undertaken, and histopathological, and immunohistochemical evaluations and molecular pathology confirmed the diagnosis of FTC with multiple cervical lymph node metastases. Conclusion We have reported a rare case of large FTC with diffuse nodal involvement but no distant metastases. We present the thyroid ultrasound, neck CT, MR and whole body PET/CT.
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Affiliation(s)
- Fei Ye
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liyan Liao
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wanlin Tan
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Gong
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaodu Li
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chengcheng Niu
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Center of Ultrasonography, The Second Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Chengcheng Niu
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4
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Asimakopoulos P, Shaha AR, Nixon IJ, Shah JP, Randolph GW, Angelos P, Zafereo ME, Kowalski LP, Hartl DM, Olsen KD, Rodrigo JP, Vander Poorten V, Mäkitie AA, Sanabria A, Suárez C, Quer M, Civantos FJ, Robbins KT, Guntinas-Lichius O, Hamoir M, Rinaldo A, Ferlito A. Management of the Neck in Well-Differentiated Thyroid Cancer. Curr Oncol Rep 2020; 23:1. [PMID: 33190176 DOI: 10.1007/s11912-020-00997-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. RECENT FINDINGS Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant.
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Affiliation(s)
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Jatin P Shah
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Mark E Zafereo
- Head and Neck Endocrine Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luiz P Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain
| | - Miquel Quer
- Department of Otolaryngology-Head and Neck Surgery, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Surgery Department, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - K Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL, USA
| | | | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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5
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Staubitz JI, Musholt PB, Musholt TJ. The surgical dilemma of primary surgery for follicular thyroid neoplasms. Best Pract Res Clin Endocrinol Metab 2019; 33:101292. [PMID: 31434622 DOI: 10.1016/j.beem.2019.101292] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Follicular thyroid carcinoma is the second most prevalent form of differentiated thyroid carcinoma, following papillary thyroid carcinoma. Preoperative diagnosis is hampered by the fact that fine-needle aspiration cytology as well as supplemental molecular analysis cannot unambiguously distinguish between follicular thyroid carcinoma and benign follicular thyroid adenoma. The 2017 WHO classification defines three histological subtypes of follicular thyroid carcinoma: minimally invasive (excellent prognosis), encapsulated angioinvasive, and widely invasive type (higher risk of recurrence and metastatic spread). The fact that definite characterization of follicular neoplasms is predominantly a postoperative histological diagnosis (core criteria: capsular, vascular and adjacent tissue invasion) translates into the challenge for the thyroid surgeon to plan preoperatively for presence of malignancy and, if required, to adapt the surgical strategy according to intraoperative (frozen section) or postoperative histological findings. Until improved tools for pre-/intraoperative diagnosis are available, the malignant potential of a follicular thyroid lesion can be assessed by stratifying the patient according to clinical risk factors (presence of metastases, advanced patient age, tumor size). A stepwise, escalating surgical approach with restricted primary resection (hemithyroidectomy) and completion surgery based on the definite histopathology is another option to solve this dilemma. The currently recommended surgical treatment strategies for FTCs as published by ATA, BTA, CAEK and ESES are discussed. There is consensus that prophylactic lymphadenectomy is not required for FTCs and that hemithyroidectomy is sufficient in low-risk FTCs (capsular invasion only) whereas thyroidectomy with postoperative radioiodine therapy is indicated in high-risk FTCs (angioinvasion; widely invasive FTC).
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Affiliation(s)
- Julia I Staubitz
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Petra B Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Thomas J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
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Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol 2018; 6:500-514. [PMID: 29102432 DOI: 10.1016/s2213-8587(17)30325-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022]
Abstract
Follicular thyroid cancer is the second most common differentiated thyroid cancer histological type and has been overshadowed by its more common counterpart-papillary thyroid cancer-despite its unique biological behaviour and less favourable outcomes. In this Review, we comprehensively review the literature on follicular thyroid cancer to provide an evidence-based guide to the management of these tumours, to highlight the lack of evidence behind guideline recommendations, and to identify changes and challenges over the past decades in diagnosis, prognosis, and treatment. We highlight that correct identification of cancer in indeterminate cytological samples is challenging and ultrasonographic features can be misleading. Despite certain unique aspects of follicular thyroid cancer presentation and prognosis, no specific recommendations exist for follicular thyroid cancer and Hürthle cell carcinoma in evidence-based guidelines. Efforts should be made to stimulate additional research in this field.
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Affiliation(s)
- Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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7
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Pisanu A, Deplano D, Pili M, Uccheddu A. Larger tumor size predicts nodal involvement in patients with follicular thyroid carcinoma. TUMORI JOURNAL 2018; 97:296-303. [DOI: 10.1177/030089161109700307] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aims and background Lymph node metastases are rare in patients with follicular thyroid carcinoma, with an average incidence of 5.5% of all cases reported in the literature. In the present study we focused on the search for risk factors predictive of lymph node involvement in patients with follicular thyroid carcinoma to plan the most appropriate management and follow-up. Methods and study design We carried out a cross-sectional study among patients with follicular thyroid carcinoma and lymph node metastasis at diagnosis and patients without lymph node involvement. From January 1998 to April 2008, 930 patients underwent thyroidectomy in our surgical department for a variety of thyroid disorders, 420 (45.2%) of them for a differentiated thyroid carcinoma. The medical records of 55 patients with histological diagnosis of follicular thyroid carcinoma were analyzed. Results Four patients (7.3%) had lymph node metastasis from follicular thyroid carcinoma at presentation in both the lateral and central neck compartments. Mean tumor size was significantly greater for follicular thyroid carcinomas with nodal metastasis (5.1 ± 1.4 cm) than for those without nodal involvement (3.0 ± 1.2 cm, P <0.010). Among factors supposed to influence the presence of nodal metastasis at diagnosis (age, gender, tumor size, multifocality, tumor poorly differentiated, tumor widely invasive, vascular invasion, thyroid capsular invasion, and extra thyroid invasion), tumor size larger than 4.0 cm was the only factor retained in the multivariate statistical model. Conclusions Lymph node dissection must be planned only in the case of large follicular thyroid carcinomas. Since follicular carcinoma is usually diagnosed postoperatively, more attention should be paid to nodal involvement in the tumor re-staging during follow-up of those patients with tumors larger than 4.0 cm in diameter.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Cagliari, Italy
| | - Daniela Deplano
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Cagliari, Italy
| | - Michela Pili
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Cagliari, Italy
| | - Alessandro Uccheddu
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Cagliari, Italy
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8
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Thick tumor capsule is a valuable risk factor for distant metastasis in follicular thyroid carcinoma. Auris Nasus Larynx 2017; 45:147-155. [PMID: 28506522 DOI: 10.1016/j.anl.2017.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/28/2017] [Accepted: 05/01/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE While the biological behavior of follicular thyroid carcinoma (FTC) has been studied in great detail using clinical experience, few studies have investigated pre- or intraoperative factors related to the risk of distant metastasis (DM) among patients with FTC. The aim of this study was to analyze the characteristics of FTC with DM. METHODS This study retrospectively investigated 102 patients with FTC who underwent surgery between 1988 and 2013. We compared clinicopathological characteristics between FTC with and without DM. RESULTS Univariate analysis revealed nodal metastasis (p=0.045), serum thyroglobulin (Tg) at initial operation (≥1000ng/ml; p<0.0001), widely invasive appearance according to macroscopic findings (p<0.0001), thick tumor capsule (≥1mm; p<0.0001), vascular invasion (p=0.0003), extrathyroidal invasion (p=0.047), and venous tumor embolism (p=0.045) as significant risk factors for DM. Multivariate analysis conducted using pre- and intraoperative factors identified thick tumor capsule (≥1mm), serum Tg at initial operation (≥1000ng/ml), and macroscopically widely invasive appearance as risk factors independently associated with development of DM. CONCLUSION Patients with these risk factors should undergo total thyroidectomy and radioactive iodine ablation.
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9
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Asimakopoulos P, Nixon IJ, Shaha AR. Differentiated and Medullary Thyroid Cancer: Surgical Management of Cervical Lymph Nodes. Clin Oncol (R Coll Radiol) 2017; 29:283-289. [PMID: 28094086 DOI: 10.1016/j.clon.2017.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/13/2016] [Indexed: 11/15/2022]
Abstract
Thyroid cancer metastasises to the central and lateral compartments of the neck frequently and early. The impact of nodal metastases on outcome is affected by the histological subtype of the primary tumour and the patient's age, as well as the size, number and location of those metastases. The impact of extranodal extension has recently been highlighted as an important prognosticating factor. Although clinically evident nodal disease in the lateral neck compartments has a significant impact on both survival and recurrence, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. Here we discuss the surgical management of neck metastases in well-differentiated and medullary thyroid carcinoma.
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Affiliation(s)
- P Asimakopoulos
- Edinburgh Academic Department of Otolaryngology, Head and Neck Surgery, Edinburgh Cancer Centre, Edinburgh, UK.
| | - I J Nixon
- Edinburgh Academic Department of Otolaryngology, Head and Neck Surgery, Edinburgh Cancer Centre, Edinburgh, UK
| | - A R Shaha
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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10
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Renard M, Lloveras B, Flores J, Puig J, Benaiges D, Sitges-Serra A. Current dilemmas in the diagnosis and management of follicular thyroid tumors. Expert Rev Endocrinol Metab 2016; 11:379-385. [PMID: 30058913 DOI: 10.1080/17446651.2016.1218760] [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] [Indexed: 10/21/2022]
Abstract
Follicular carcinoma (FTC) is a relatively uncommon type of differentiated thyroid carcinoma. Guidelines have often dealt with FTC and papillary thyroid cancer as a single disease. Over the last decade, however, a better understanding of these two types of thyroid cancer indicates that they cannot be analysed together. Neither ultrasonography nor fine-needle aspiration cytology can provide a clear distinction between FTC and follicular adenoma. New molecular diagnostic techniques may be used to identify a subpopulation of follicular neoplasms with a low probability of being malignant. Diagnostic surgery-usually hemithyroidectomy- is recommended for most thyroid follicular lesions without a certain preoperative diagnosis. If FTC is diagnosed most-perhaps not all- patients will require a completion thyroidectomy. While widely invasive FTC usually does not pose diagnostic or therapeutic doubts, consensus on the diagnosis of non-invasive follicular lesions is still lacking. Prognosis of FTC is mostly dependent on local invasion and distant metastasis that, in turn, correlate with tumor size.
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Affiliation(s)
- Marine Renard
- a Departments of Endocrinology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - Belén Lloveras
- b Pathology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - Juana Flores
- a Departments of Endocrinology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - Jaume Puig
- a Departments of Endocrinology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - David Benaiges
- a Departments of Endocrinology , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
| | - Antonio Sitges-Serra
- c Department of Surgery , Universitat Autònoma de Barcelona, Hospital del Mar , Barcelona , Spain
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11
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Abstract
Well differentiated thyroid cancer (DTC) in children is characterized by a high rate of response to treatment and low disease-specific mortality. Treatment of children with DTC has evolved toward a greater reliance on evaluation and monitoring with serial serum thyroglobulin measurements and ultrasound examinations. Radioiodine therapy is recommended for thyroid remnant ablation in high-risk patients, treatment of demonstrated radioiodine-avid local-regional disease not amenable to surgical resection, or distant radioiodine-avid metastatic disease. Sufficient time should be given for benefits of radioiodine therapy to be realized, with follow-up monitoring. Re-treatment with radioiodine can be deferred until progression of significant disease manifests.
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Affiliation(s)
- Josef Machac
- Nuclear Medicine, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, Box 1141, 1 Gustave Levy Place, New York, NY 10029, USA.
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12
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Truran P, Harrison B. Central neck dissection in the treatment of well-differentiated thyroid cancer. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Therapeutic central compartment neck dissection (CCND) is required for confirmed nodal metastasis in patients with differentiated thyroid cancer. The need for routine prophylactic CCND in patients with papillary thyroid cancer is controversial. This article presents the current evidence to inform the debate against the background of the recommendations of US and British thyroid cancer guidelines. Potential advantages of pCCND include reduced local recurrence, preventing the need for further central compartment surgery and improved staging. Opponents claim that there is no proven patient benefit and that there is increased risk of recurrent laryngeal nerve injury and hypocalcemia.
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Affiliation(s)
- Peter Truran
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, South Yorkshire S10 2JF, UK
| | - Barney Harrison
- Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, South Yorkshire S10 2JF, UK
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13
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Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM, Dinauer CA, Hamilton J, Hay ID, Luster M, Parisi MT, Rachmiel M, Thompson GB, Yamashita S. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2015; 25:716-59. [PMID: 25900731 PMCID: PMC4854274 DOI: 10.1089/thy.2014.0460] [Citation(s) in RCA: 723] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Previous guidelines for the management of thyroid nodules and cancers were geared toward adults. Compared with thyroid neoplasms in adults, however, those in the pediatric population exhibit differences in pathophysiology, clinical presentation, and long-term outcomes. Furthermore, therapy that may be recommended for an adult may not be appropriate for a child who is at low risk for death but at higher risk for long-term harm from overly aggressive treatment. For these reasons, unique guidelines for children and adolescents with thyroid tumors are needed. METHODS A task force commissioned by the American Thyroid Association (ATA) developed a series of clinically relevant questions pertaining to the management of children with thyroid nodules and differentiated thyroid cancer (DTC). Using an extensive literature search, primarily focused on studies that included subjects ≤18 years of age, the task force identified and reviewed relevant articles through April 2014. Recommendations were made based upon scientific evidence and expert opinion and were graded using a modified schema from the United States Preventive Services Task Force. RESULTS These inaugural guidelines provide recommendations for the evaluation and management of thyroid nodules in children and adolescents, including the role and interpretation of ultrasound, fine-needle aspiration cytology, and the management of benign nodules. Recommendations for the evaluation, treatment, and follow-up of children and adolescents with DTC are outlined and include preoperative staging, surgical management, postoperative staging, the role of radioactive iodine therapy, and goals for thyrotropin suppression. Management algorithms are proposed and separate recommendations for papillary and follicular thyroid cancers are provided. CONCLUSIONS In response to our charge as an independent task force appointed by the ATA, we developed recommendations based on scientific evidence and expert opinion for the management of thyroid nodules and DTC in children and adolescents. In our opinion, these represent the current optimal care for children and adolescents with these conditions.
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Affiliation(s)
- Gary L. Francis
- Division of Pediatric Endocrinology, Virginia Commonwealth University, Children's Hospital of Richmond, Richmond, Virginia
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders and Department of Pediatrics-Patient Care, Children's Cancer Hospital, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J. Bauer
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, The University of Pennsylvania, The Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter Angelos
- Section of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Salvatore Benvenga
- University of Messina, Interdepartmental Program on Clinical & Molecular Endocrinology, and Women's Endocrine Health, A.O.U. Policlinico Universitario G. Martino, Messina, Italy
| | - Janete M. Cerutti
- Department of Morphology and Genetics. Division of Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Catherine A. Dinauer
- Department of Surgery, Division of Pediatric Surgery, Department of Pediatrics, Division of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut
| | - Jill Hamilton
- Division of Endocrinology, University of Toronto, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian D. Hay
- Division of Endocrinology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Markus Luster
- University of Marburg, Marburg, Germany
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Department of Radiology, Seattle, Washington
| | - Marianna Rachmiel
- Pediatric Division, Assaf Haroffeh Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Geoffrey B. Thompson
- Department of Surgery, Division of Subspecialty GS (General Surgery), Mayo Clinic, Rochester, Minnesota
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14
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Podda M, Saba A, Porru F, Reccia I, Pisanu A. Follicular thyroid carcinoma: differences in clinical relevance between minimally invasive and widely invasive tumors. World J Surg Oncol 2015; 13:193. [PMID: 26041024 PMCID: PMC4458056 DOI: 10.1186/s12957-015-0612-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/22/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Evidence on the biological behavior and clinical courses of minimally invasive and widely invasive follicular thyroid carcinoma (MI-FTC, WI-FTC) is still debatable. The current study was conducted to identify differences between MI and WI tumors and those prognostic parameters influencing late outcome such as local recurrence and survival. METHODS From January 1998 to October 2013, 71 patients were operated on in our department because of a FTC. A retrospective cohort study was carried out to compare 42 MI-FTC and 29 WI-FTC. The comparison involved evaluation of patient characteristics, tumor characteristics, tumor staging, and risk assessment. RESULTS A diameter greater than 4.0 cm, the presence of vascular invasion, the TNM stage III-IVA, and the high risk at AMES system risk stratification were independent factors significantly related to the presence of a WI-FTC. The only independent predictor of recurrence and disease-free survival at 10-year follow-up was a tumor size greater than 4.0 cm. CONCLUSIONS More attention must be paid in the postoperative tumor re-staging of those patients with tumor size larger than 4.0 cm, which was the only parameter predicting recurrence and influencing disease-free survival. Nevertheless, definitive recommendations cannot be made without a longer follow-up.
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Affiliation(s)
- Mauro Podda
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
| | - Alessandra Saba
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
| | - Federica Porru
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
| | - Isabella Reccia
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
| | - Adolfo Pisanu
- Department of Surgery, University of Cagliari, Azienda Ospedaliero-Universitaria, Presidio Policlinico di Monserrato, Blocco G, SS 554 km 4, 500 - 09042, Monserrato, Cagliari, Italy.
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15
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 732] [Impact Index Per Article: 73.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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Dionigi G, Kraimps JL, Schmid KW, Hermann M, Sheu-Grabellus SY, De Wailly P, Beaulieu A, Tanda ML, Sessa F. Minimally invasive follicular thyroid cancer (MIFTC)—a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 2013; 399:165-84. [DOI: 10.1007/s00423-013-1140-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022]
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17
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Influence of Prophylactic Neck Dissection on Rate of Retreatment for Papillary Thyroid Carcinoma. World J Surg 2013; 37:1951-8. [DOI: 10.1007/s00268-013-2089-3] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Stack BC, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, Sosa JA, Tufano RP. American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid 2012; 22:501-8. [PMID: 22435914 DOI: 10.1089/thy.2011.0312] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cervical lymph node metastases from differentiated thyroid cancer (DTC) are common. Thirty to eighty percent of patients with papillary thyroid cancer harbor lymph node metastases, with the central neck being the most common compartment involved. The goals of this study were to: (1) identify appropriate methods for determining metastatic DTC in the lateral neck and (2) address the extent of lymph node dissection for the lateral neck necessary to control nodal disease balanced against known risks of surgery. METHODS A literature review followed by formulation of a consensus statement was performed. RESULTS Four proposals regarding management of the lateral neck are made for consideration by organizations developing management guidelines for patients with thyroid nodules and DTC including the next iteration of management guidelines developed by the American Thyroid Association (ATA). Metastases to lateral neck nodes must be considered in the evaluation of the newly diagnosed thyroid cancer patient and for surveillance of the previously treated DTC patient. CONCLUSIONS Lateral neck lymph nodes are a significant consideration in the surgical management of patients with DTC. When current guidelines formulated by the ATA and by other international medical societies are followed, initial evaluation of the DTC patient with ultrasound (or other modalities when indicated) will help to identify lateral neck lymph nodes of concern. These findings should be addressed using fine-needle aspiration biopsy. A comprehensive neck dissection of at least nodal levels IIa, III, IV, and Vb should be performed when indicated to optimize disease control.
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Affiliation(s)
- Brendan C Stack
- Department of Otolaryngology/Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR 72205, USA.
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Abstract
Current treatment guidelines for follicular thyroid carcinoma (FTC) recommend total thyroidectomy, lymphadenectomy and radioiodine ablation. Considering the low malignant potential of minimally invasive follicular thyroid carcinoma (MIFTC), a limited radical therapeutic procedure may be adequate. MIFTC is an intensely discussed group of tumors and a review of the literature reveals disagreement among experts concerning the criteria for a distinct definition. Therefore, in 2005 Rosai proposed a clinically more significant classification of FTC based on the extent of capsular and vascular invasion: MIFTC with capsular invasion only, with limited (< or =3) vascular invasion, encapsulated FTC with extensive (>3) vascular invasion and broadly invasive FTC with extensive invasive growth.For the diagnosis of MIFTC a complete investigation of the encapsulated follicular lesion should be performed by the pathologist and examination of at least 10 tissue blocks is mandatory. Due to the excellent prognosis hemithyroidectomy constitutes an adequate therapeutic approach in MIFTC with capsular invasion only and may also be considered for MIFTC with limited vascular invasion. There are no indications for systematic lymphadenectomy.
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Miccoli P, Miccoli M, Antonelli A, Minuto MN. Clinicopathologic and molecular disease prognostication for papillary thyroid cancer. Expert Rev Anticancer Ther 2009; 9:1261-75. [PMID: 19761430 DOI: 10.1586/era.09.92] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Despite its increasing incidence over the last 30 years, the mortality rate of papillary thyroid cancer (PTC) has decreased significantly. Nevertheless, a minority of patients still present with an aggressive form of PTC that can lead to death, even after a prolonged period of survival. Many classifications exist that allow one to stratify the clinical risk of recurrence and death in patients with PTC; however, the parameters upon which they are established are pathological and molecular and, therefore, are revealed only after surgery. The preoperative identification of these aggressive variants of PTC would allow one to schedule a more aggressive operation (e.g., total thyroidectomy together with central and/or mono- or bi-lateral node dissections) in patients with high-risk PTC. This article reviews the parameters used most commonly to differentiate low-risk PTCs from their more aggressive variants and describes some of the newest molecular therapies for this latter group of tumors.
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Affiliation(s)
- Paolo Miccoli
- Department of Surgery, University of Pisa, Via Roma 67, 56126 Pisa, Italy.
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