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Mou Y, Han X, Li J, Yu P, Wang C, Song Z, Wang X, Zhang M, Zhang H, Mao N, Song X. Development and Validation of a Computed Tomography-Based Radiomics Nomogram for the Preoperative Prediction of Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma. Acad Radiol 2024; 31:1805-1817. [PMID: 38071100 DOI: 10.1016/j.acra.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 05/12/2024]
Abstract
RATIONALE AND OBJECTIVES This study aims to develop and validate a computed tomography (CT)-based radiomics nomogram for pre-operatively predicting central lymph node metastasis (CLNM) in patients with papillary thyroid microcarcinoma (PTMC) and explore the underlying biological basis by using RNA sequencing data. METHODS This study trained 452 PTMC patients across two hospitals from January 2012 to December 2020. The sets were randomly divided into the training (n = 339), internal test (n = 86), external test (n = 27) sets. Radiomics features were extracted from primary lesion's pre-operative CT images for each patient. After screening for features, five algorithms such as K-nearest neighbor, logistics regression, linear-support vector machine (SVM), Gaussian SVM, and polynomial SVM were used to establish the radiomics models. The performance of these five algorithms was evaluated and compared directly to radiologist's interpretation (CT-reported lymph node status). The radiomics signature score (Rad-score) was generated using a linear combination of the selected features. By combining the clinical risk factors and Rad score, a radiomics nomogram was established and compared with Rad-score and clinical model. The performance of the nomogram was evaluated based on the receiver operating characteristic (ROC) curve, calibration curve, and the decision curve analysis (DCA). The potential biological basis of nomogram was revealed by performing genetic analysis based on the RNA sequencing data. RESULTS A total of 25 radiomic features were ultimately selected to train the machine learning models, and the five machine learning models outperformed the radiologists' interpretation by achieving area under the ROC curves (AUCs) ranging from 0.606 to 0.730 in the internal test set. By incorporating the Rad score and clinical risk factors (sex, age, tumor-diameter, and CT-reported lymph node status), this nomogram achieved AUCs of 0.800 and 0.803 in the internal and external test set, which were higher than that of the Rad-score and clinical model, respectively. Calibration curves and DCA also showed that the nomogram had good performance. As for the biological basis exploration, in patients predicted by nomogram to be PTC patients with CLMN, 109 genes were dysregulated, and some of them were associated with pathways and biological processes such as tumor angiogenesis. CONCLUSION This radiomics nomogram successfully identified CLNM on pretreatment imaging across multiple institutions, exceeding the diagnostic ability of radiologists and had the potential to be integrated into clinical decision making as a non-invasive pre-operative tool.
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Affiliation(s)
- Yakui Mou
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases; Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.)
| | - Xiao Han
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Department of Otolaryngology-Head and Neck Surgery, BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China (X.H.)
| | - Jingjing Li
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China (J.L.)
| | - Pengyi Yu
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases; Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.)
| | - Cai Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases; Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.)
| | - Zheying Song
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases; Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); School of Clinical Medicine, Weifang Medical University, Weifang 261042, China (Z.S., X.W.)
| | - Xiaojie Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases; Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); School of Clinical Medicine, Weifang Medical University, Weifang 261042, China (Z.S., X.W.)
| | - Mingjun Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases; Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.)
| | - Haicheng Zhang
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (H.Z., N.M.)
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (H.Z., N.M.)
| | - Xicheng Song
- Department of Otorhinolaryngology Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China (Y.M., X.H., J.L., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases; Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.); Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai 264000, China (Y.M., P.Y., C.W., Z.S., X.W., M.Z., X.S.).
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de Sousa MSA, Nunes IN, Christiano YP, Sisdelli L, Cerutti JM. Genetic alterations landscape in paediatric thyroid tumours and/or differentiated thyroid cancer: Systematic review. Rev Endocr Metab Disord 2024; 25:35-51. [PMID: 37874477 DOI: 10.1007/s11154-023-09840-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
Differentiated thyroid cancer (DTC) is a rare disease in the paediatric population (≤ 18 years old. at diagnosis). Increasing incidence is reflected by increases in incidence for papillary thyroid carcinoma (PTC) subtypes. Compared to those of adults, despite aggressive presentation, paediatric DTC has an excellent prognosis. As for adult DTC, European and American guidelines recommend individualised management, based on the differences in clinical presentation and genetic findings. Therefore, we conducted a systematic review to identify the epidemiological landscape of all genetic alterations so far investigated in paediatric populations at diagnosis affected by thyroid tumours and/or DTC that have improved and/or informed preventive and/or curative diagnostic and prognostic clinical conduct globally. Fusions involving the gene RET followed by NTRK, ALK and BRAF, were the most prevalent rearrangements found in paediatric PTC. BRAF V600E was found at lower prevalence in paediatric (especially ≤ 10 years old) than in adults PTC. We identified TERT and RAS mutations at very low prevalence in most countries. DICER1 SNVs, while found at higher prevalence in few countries, they were found in both benign and DTC. Although the precise role of DICER1 is not fully understood, it has been hypothesised that additional genetic alterations, similar to that observed for RAS gene, might be required for the malignant transformation of these nodules. Regarding aggressiveness, fusion oncogenes may have a higher growth impact compared with BRAF V600E. We reported the shortcomings of the systematized research and outlined three key recommendations for global authors to improve and inform precision health approaches, glocally.
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Affiliation(s)
- Maria Sharmila Alina de Sousa
- Genetic Bases of Thyroid Tumours Laboratory, Division of Genetics, Department of Morphology and Genetics and Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, 11 andar, São Paulo, SP, 04039-032, Brazil
| | - Isabela Nogueira Nunes
- Genetic Bases of Thyroid Tumours Laboratory, Division of Genetics, Department of Morphology and Genetics and Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, 11 andar, São Paulo, SP, 04039-032, Brazil
| | - Yasmin Paz Christiano
- Genetic Bases of Thyroid Tumours Laboratory, Division of Genetics, Department of Morphology and Genetics and Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, 11 andar, São Paulo, SP, 04039-032, Brazil
| | - Luiza Sisdelli
- Genetic Bases of Thyroid Tumours Laboratory, Division of Genetics, Department of Morphology and Genetics and Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, 11 andar, São Paulo, SP, 04039-032, Brazil
- PreScouter Inc., 29 E Madison St #500, Chicago, IL, 60602, USA
| | - Janete Maria Cerutti
- Genetic Bases of Thyroid Tumours Laboratory, Division of Genetics, Department of Morphology and Genetics and Division of Endocrinology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Pedro de Toledo 669, 11 andar, São Paulo, SP, 04039-032, Brazil.
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Abstract
The lymphatic system, composed of initial and collecting lymphatic vessels as well as lymph nodes that are present in almost every tissue of the human body, acts as an essential transport system for fluids, biomolecules and cells between peripheral tissues and the central circulation. Consequently, it is required for normal body physiology but is also involved in the pathogenesis of various diseases, most notably cancer. The important role of tumor-associated lymphatic vessels and lymphangiogenesis in the formation of lymph node metastasis has been elucidated during the last two decades, whereas the underlying mechanisms and the relation between lymphatic and peripheral organ dissemination of cancer cells are incompletely understood. Lymphatic vessels are also important for tumor-host communication, relaying molecular information from a primary or metastatic tumor to regional lymph nodes and the circulatory system. Beyond antigen transport, lymphatic endothelial cells, particularly those residing in lymph node sinuses, have recently been recognized as direct regulators of tumor immunity and immunotherapy responsiveness, presenting tumor antigens and expressing several immune-modulatory signals including PD-L1. In this review, we summarize recent discoveries in this rapidly evolving field and highlight strategies and challenges of therapeutic targeting of lymphatic vessels or specific lymphatic functions in cancer patients.
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Affiliation(s)
- Lothar C Dieterich
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Carlotta Tacconi
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland.,Department of Biosciences, University of Milan, Milan, Italy
| | - Luca Ducoli
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Michael Detmar
- Institute of Pharmaceutical Sciences, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
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Póvoa AA, Teixeira E, Bella-Cueto MR, Melo M, Oliveira MJ, Sobrinho-Simões M, Maciel J, Soares P. Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma. Cancers (Basel) 2020; 12:cancers12113186. [PMID: 33138175 PMCID: PMC7693726 DOI: 10.3390/cancers12113186] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Thyroid cancer incidence is increasing, with overdiagnosis being the major driver of the thyroid cancer “epidemic”. Papillary thyroid carcinoma, usually with excellent prognosis, sometimes has an aggressive metastatic pattern. This heterogeneity in progression makes it difficult to tailor treatment strategies for an individual patient. We aimed to identify clinicopathological factors associated with papillary thyroid carcinoma recurrence, persistence, and specific mortality. Our study supports that both pre-surgical factors, such as male gender, presence of psammoma bodies, gross extra-thyroidal extension, and lateral compartment lymph node metastases, as well as lymph vessel invasion, venous invasion, presence of necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of PTC patients. The same is true when analysis is restricted to stage I patients. The importance of this report is to emphasize clinical and imaging pre-surgical thyroid cancer patients’ evaluation for an appropriate surgical treatment and patient prognosis. Abstract Papillary thyroid cancer (PTC) has an indolent nature and usually excellent prognosis. Some PTC clinicopathological features may contribute to the development of aggressive metastatic disease. In this work, we want to evaluate PTC clinicopathological features that are presurgical prognostic predictors of patients’ outcomes and find which indicators are more adequate for tailoring surgical procedures and follow-up. We studied a series of 241 PTC patients submitted to surgery. All patients’ files and histological tumor samples were reviewed. The 8th edition AJCC/UICC (American Joint Committee on Cancer/Union for International Cancer) Controlstaging system and the 2015 American Thyroid Association risk stratification system were used. Total thyroidectomy was performed in 228 patients, lymphadenectomy in 28 patients. Gross extrathyroidal extension (ETE) was present in 10 patients and 31 tumor resection margins were incomplete. Cervical lymph node metastases (LNMs) were present in 34 patients and distant metastases at diagnosis in four patients. In multivariate analysis, male gender (OR = 15.4, p = 0.015), venous invasion (OR = 16.7, p = 0.022), and lateral compartment LNM (OR = 26.7, p = 0.004) were predictors of mortality; psammoma bodies (PBs) (OR = 4.5, p = 0.008), lymph vessel invasion (OR = 6.9, p < 0.001), and gross ETE (OR = 16.1, p = 0.001) were predictors of structural disease status; male gender (OR = 2.9, p = 0.011), lymph vessel invasion (OR = 2.8, p = 0.006), and incomplete resection margins (OR = 4.6, p < 0.001) were predictors of recurrent/persistent disease. Our study supports that the factors helping to tailor patient’s surgery are male gender, presence of PBs, gross ETE, and lateral compartment LNM. Together with pathological factors, lymph vessel invasion, venous invasion, necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of patients.
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Affiliation(s)
- Antónia Afonso Póvoa
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Correspondence: (A.A.P.); (P.S.); Tel.: +351-969-813-884 (A.A.P.)
| | - Elisabete Teixeira
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Maria Rosa Bella-Cueto
- Department of Pathology, Parc Taulí Sabadell Hospital Universitari-Institut d’Investigació i Innovació Parc Taulí-I3PT-Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
| | - Miguel Melo
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Endocrinology, Centro Hospitalar Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Maria João Oliveira
- Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
| | - Manuel Sobrinho-Simões
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Jorge Maciel
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
| | - Paula Soares
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
- Correspondence: (A.A.P.); (P.S.); Tel.: +351-969-813-884 (A.A.P.)
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Lee S, Lee JY, Yoon RG, Kim JH, Hong HS. The Value of Microvascular Imaging for Triaging Indeterminate Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2020; 12:cancers12102839. [PMID: 33019664 PMCID: PMC7601686 DOI: 10.3390/cancers12102839] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Papillary thyroid carcinomas (PTC) are indolent tumors associated with excellent long-term survival, albeit frequently accompanied by cervical lymph node (LN) metastasis. The imaging criteria using conventional ultrasound (US) techniques showed high diagnostic performance for the suspicious and probably benign LN categories, but showed low diagnostic performance for the indeterminate category. In this retrospective study, we aimed to assess the added value of Superb Microvascular Imaging (SMI) for detecting metastatic PTC in the indeterminate LN category. We confirmed that SMI could effectively stratify indeterminate LNs by visualizing additional vascular signals. The reclassified categories of SMI provided a high diagnostic performance to distinguish metastasis from benign LNs. Therefore, adding SMI to conventional US scans can be useful when evaluating indeterminate LNs in patients with PTC. Abstract Assessment of lymph node (LN) status in patients with papillary thyroid carcinoma (PTC) is often troublesome because of cervical LNs with indeterminate US (ultrasound) features. We aimed to explore whether Superb Microvascular Imaging (SMI) could be helpful for distinguishing metastasis from indeterminate LNs when combined with power Doppler US (PDUS). From 353 consecutive patients with PTC, LNs characterized as indeterminate by PDUS were evaluated by SMI to distinguish them from metastasis. Indeterminate LNs were reclassified according to the SMI, the malignancy risk of each category was assessed, and the diagnostic performance of suspicious findings on SMI was calculated. The incidence of US-indeterminate LNs was 26.9%. Eighty PDUS-indeterminate LNs (39 proven as benign, 41 proven as malignant) were reclassified into probably benign (n = 26), indeterminate (n = 20), and suspicious (n = 34) categories according to SMI, with malignancy risks of 19.2%, 20.0%, and 94.1%, respectively. After combining SMI with PDUS, 80.8% (21/26) of probably benign LNs and 94.1% (32/34) of suspicious LNs could be correctly diagnosed as benign and metastatic, respectively. The diagnostic sensitivity, specificity, and accuracy of categorizing LNs as suspicious based on SMI were 78.1%, 94.9%, and 86.3%, respectively. In conclusion, the combination of SMI with PDUS was helpful for the accurate stratification of indeterminate LNs based on US in patients with PTC.
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Affiliation(s)
- Seongyong Lee
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 01830, Korea; (S.L.); (R.G.Y.)
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: ; Tel.: 82-2-2072-3696
| | - Ra Gyoung Yoon
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 01830, Korea; (S.L.); (R.G.Y.)
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Hyun Sook Hong
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 14584, Korea;
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Chen H, Dai J. miR-409-3p suppresses the proliferation, invasion and migration of tongue squamous cell carcinoma via targeting RDX. Oncol Lett 2018; 16:543-551. [PMID: 29928443 DOI: 10.3892/ol.2018.8687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/22/2017] [Indexed: 12/16/2022] Open
Abstract
The aim of the present study is to investigate the role of microRNA (miRNA/miR)-409-3p in the proliferation, invasion and migration of tongue squamous cell carcinoma (TSCC) cells via targeting radixin (RDX) gene. The expression of miR-409-3p was detected by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) in TSCC tissue and cell lines. The binding of miR-409-3p to RDX was investigated by performing a dual-luciferase reporter gene assay. Tca8113 cells were selected to transfect with miR-409-3p mimic/inhibitor, small interfering (si)-RDX, and miR-409-3p inhibitor + si-RDX, as well as negative control (NC) respectively. The proliferative, migratory and invasive abilities of transfected Tca8113 cells were investigated by cell-counting-kit-8, wound-healing and Transwell assays, respectively. Additionally, a tumor xenograft model was constructed to examine the effects of miR-409-3p on the tumor growth and lymphatic metastasis in nude mice. A significant downregulation was detected in miR-409-3p expression in TSCC tissues and cells (all P<0.05) compared with normal tongue mucosa tissues and cell line, which was associated with lymph node metastasis and tumor-node metastasis staging (both P<0.05). The results from the dual-luciferase reporter gene assay indicated that RDX is a potential target gene of miR-409-3p. Compared with the blank group, a marked reduction in RDX expression, cell proliferation, migration and invasion was detected in the miR-409-3p mimic group and si-RDX group (all P<0.05). Conversely, the reverse was observed in cells that were transfected with the miR-409-3p inhibitor. Furthermore, si-RDX is able to reverse the effect of miR-409-3p inhibitor on cell proliferation, invasion and migration (all P<0.05). The results form the tumor xenograft model of nude mice verified that miR-409-3p mimic is able to inhibit the growth of Tca8113 tumor cells and lymph node metastasis in nude mice. miR-409-3p may delay the proliferation of TSCC cells by inhibiting of RDX so as to decrease its migratory and invasive abilities. Therefore, miR-409-3p may be a potential target for the clinical treatment of TSCC.
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Affiliation(s)
- Hujie Chen
- Department of Stomatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei 434000, P.R. China
| | - Jing Dai
- Department of Stomatology, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou, Hubei 434000, P.R. China
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Amendoeira I, Maia T, Sobrinho-Simões M. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): impact on the reclassification of thyroid nodules. Endocr Relat Cancer 2018; 25:R247-R258. [PMID: 29439059 DOI: 10.1530/erc-17-0513] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 12/19/2022]
Abstract
The 2017 edition of the WHO book on Classification of Tumours of Endocrine Organs includes a new section entitled 'Other encapsulated follicular-patterned thyroid tumours', in which the newly created NIFTP (non-invasive follicular thyroid neoplasm with papillary-like nuclear features) is identified and described in detail. Despite deleting the word 'carcinoma' from its name, NIFTP is not a benign tumor either and is best regarded as a neoplasm with 'very low malignant potential'. The main goal of the introduction of NIFTP category is to prevent overdiagnosis and overtreatment. Sampling constraints, especially when dealing with heterogeneous and/or large nodules, and difficulties in the invasiveness evaluation, are the major weaknesses of the histological characterization of NIFTP. At the cytological level, NIFTP can be separated from classic papillary carcinoma (cPTC) but not from encapsulated, invasive follicular variant PTC. The impact of NIFTP individualization for cytopathology is the drop of rates of malignancy for each Bethesda category in general and for indeterminate categories in particular. The biggest impact will be seen in institutions with a high frequency of FVPTC. The introduction of NIFTP has changed the utility of predictive values of molecular tests because RAS mutations and PAX8-PPARg rearrangements are frequently detected in NIFTP. This turns less promising the application of mutation detection panels as indicators of malignancy and will probably contribute to switch to a rule-out approach of molecular testing. Selection for surgery will go on being determined by a combined detection of clinical, cytological and ultrasound suspicious features.
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Affiliation(s)
- Isabel Amendoeira
- Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
- Department of Pathology, Medical Faculty of the University of Porto, Porto, Portugal
- Ipatimup - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Tiago Maia
- Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
- Department of Pathology, Medical Faculty of the University of Porto, Porto, Portugal
| | - Manuel Sobrinho-Simões
- Department of Pathology, Centro Hospitalar S. João, Porto, Portugal
- Department of Pathology, Medical Faculty of the University of Porto, Porto, Portugal
- Ipatimup - Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
- I3S - Institute of Investigation and Innovation in Health, Porto, Portugal
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Kim TH, Lee M, Kwon AY, Choe JH, Kim JH, Kim JS, Hahn SY, Shin JH, Chung MK, Son YI, Ki CS, Yim HS, Kim YL, Chung JH, Kim SW, Oh YL. Molecular genotyping of the non-invasive encapsulated follicular variant of papillary thyroid carcinoma. Histopathology 2017; 72:648-661. [DOI: 10.1111/his.13401] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Tae Hyuk Kim
- Division of Endocrinology & Metabolism; Department of Medicine; Thyroid Centre; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Minju Lee
- Department of Pathology; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Ah-Young Kwon
- Department of Pathology; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery; Department of Surgery; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery; Department of Surgery; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery; Department of Surgery; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Soo Yeon Hahn
- Department of Radiology; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jung Hee Shin
- Department of Radiology; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Young Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Chang-Seok Ki
- Department of Laboratory Medicine and Genetics; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | | | | | - Jae Hoon Chung
- Division of Endocrinology & Metabolism; Department of Medicine; Thyroid Centre; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism; Department of Medicine; Thyroid Centre; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Young Lyun Oh
- Department of Pathology; Samsung Medical Centre; Sungkyunkwan University School of Medicine; Seoul Korea
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Liu Y, Zhou H, Yang P, Zhou Y, Wu J, Chen C, Ye M, Luo J. Contrast-enhanced ultrasonography features of papillary thyroid carcinoma for predicting cervical lymph node metastasis. Exp Ther Med 2017; 14:4321-4327. [PMID: 29104644 PMCID: PMC5658747 DOI: 10.3892/etm.2017.5087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/21/2017] [Indexed: 12/25/2022] Open
Abstract
The present study was performed to evaluate the predictive value of contrast-enhanced ultrasonography (CEUS) for the risk of cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC). Between May 2014 and November 2016, 42 patients who received surgery for suspicious PTCs were enrolled in the present study. Each individual underwent CEUS with conventional ultrasound (US), preoperative US-guided fine needle aspiration and personalized surgery. Subsequently, the microvascular density (MVD) of all surgical specimens was measured. According to the results of surgical histopathology, individuals were divided into two groups: LNM+ (PTCs with LNM), and LNM− (PTCs without LNM). Clinicopathological characteristics, CEUS enhancement patterns, perfusion parameters and measurements of MVD were compared. The correlation between quantitative variables and LNM was analyzed using Spearman's correlation analysis. Compared with that in the LNM− group, patients in the LNM+ group were younger (P<0.05) and had a larger mean tumor size (P<0.05). The incidence ratio of patients who were ≤45 years old (P<0.05), tumors >10 mm in size (P<0.05) and capsular infiltration (P<0.05) were statistically higher in the LNM+ group. Following the use of a novel classification system, the ratio of PTCs with early partial hyper-enhancement was identified to be significantly higher in the LNM+ group (P<0.01). The mean intensity, intensity increase velocity, MVD ratio and mean intensity ratio of intratumoral/peripheral thyroid parenchyma (MIR) were statistically higher in the LNM+ group compared with that in the LNM− group (all P<0.05). MIR was identified to be positive correlated with LNM (P<0.05). A MIR value of 0.86 was the optimal threshold of LNM in PTCs. In conclusion, LNM may rely on the local rich blood supply of PTC lesions. Partial hyper-enhancements of CEUS and higher values of MIR may suggest a high risk for LNM in PTC.
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Affiliation(s)
- Ying Liu
- Department of Ultrasound, The Third People's Hospital of Chengdu and The Affiliated Clinical Medical College of Southwest Jiao Tong University, Qingyang, Chengdu, Sichuan 610031, P.R. China
| | - Hong Zhou
- Department of Ultrasound, The Third People's Hospital of Chengdu and The Affiliated Clinical Medical College of Southwest Jiao Tong University, Qingyang, Chengdu, Sichuan 610031, P.R. China
| | - Peng Yang
- Department of Pathology, The Third People's Hospital of Chengdu and The Affiliated Clinical Medical College of Southwest Jiao Tong University, Qingyang, Chengdu, Sichuan 610031, P.R. China
| | - Yang Zhou
- Department of Ultrasound, The Third People's Hospital of Chengdu and The Affiliated Clinical Medical College of Southwest Jiao Tong University, Qingyang, Chengdu, Sichuan 610031, P.R. China
| | - Jian Wu
- Department of Thyroid Surgery, The Third People's Hospital of Chengdu and The Affiliated Clinical Medical College of Southwest Jiao Tong University, Qingyang, Chengdu, Sichuan 610031, P.R. China
| | - Changyu Chen
- Department of Ultrasound, The Third People's Hospital of Chengdu and The Affiliated Clinical Medical College of Southwest Jiao Tong University, Qingyang, Chengdu, Sichuan 610031, P.R. China
| | - Ming Ye
- Department of Ultrasound, The Third People's Hospital of Chengdu and The Affiliated Clinical Medical College of Southwest Jiao Tong University, Qingyang, Chengdu, Sichuan 610031, P.R. China
| | - Jing Luo
- Department of Thyroid Surgery, The Third People's Hospital of Chengdu and The Affiliated Clinical Medical College of Southwest Jiao Tong University, Qingyang, Chengdu, Sichuan 610031, P.R. China
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Melo M, Gaspar da Rocha A, Batista R, Vinagre J, Martins MJ, Costa G, Ribeiro C, Carrilho F, Leite V, Lobo C, Cameselle-Teijeiro JM, Cavadas B, Pereira L, Sobrinho-Simões M, Soares P. TERT, BRAF, and NRAS in Primary Thyroid Cancer and Metastatic Disease. J Clin Endocrinol Metab 2017; 102:1898-1907. [PMID: 28323937 DOI: 10.1210/jc.2016-2785] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Little is known about the frequency of key mutations in thyroid cancer metastases and its relationship with the primary tumor genotype. OBJECTIVES To evaluate the frequency of TERT promoter (TERTp), BRAF, and NRAS mutations in metastatic thyroid carcinomas, analyzing primary thyroid tumors, lymph node metastases (LNMs), and distant metastases. DESIGN AND PATIENTS Mutation analysis was performed in 437 tissue samples from 204 patients, mainly with papillary thyroid carcinomas (PTCs; n = 180), including 196 LNMs and 56 distant metastases. All the distant metastases included corresponded to radioiodine-refractory metastatic tissue. RESULTS We found the following mutation frequency in primary PTCs, LNMs, and distant metastases, respectively: TERTp: 12.9%, 10.5%, and 52.4%; BRAF: 44.6%, 41.7%, and 23.8%; and NRAS: 1.2%, 1.3%, and 14.3%. There was a significant concordance between the primary tumor genotype and the corresponding LNM for all the genes, in particular BRAF-mutated PTC. The overall concordance between primary tumors and respective distant metastases was low. In the group of patients with PTCs, we found a high frequency of TERTp mutations and a low frequency of BRAF mutations in distant metastases, in comparison with the paired primary tumors. When present in distant metastases, BRAF mutations frequently coexisted with TERTp mutations. CONCLUSIONS When the genotype of primary tumors is compared with the genotype of LNMs, the concordance is high for all the genes studied. On the other hand, distant metastases show an enrichment in TERTp mutations and a decrease in BRAF mutations. TERTp mutations may play a role in distant metastases.
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Affiliation(s)
- Miguel Melo
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Department of Endocrinology, Diabetes, and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
- Unit of Endocrinology, Faculty of Medicine, University of Coimbra, Coimbra 3000-075, Portugal
| | - Adriana Gaspar da Rocha
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Public Health Unit, ACeS Baixo Mondego, Coimbra 3040-006, Portugal
| | - Rui Batista
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Medical Faculty, University of Porto, Porto 4200-319, Portugal
| | - João Vinagre
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Institute of Biomedical Sciences of Abel Salazar, University of Porto, Porto 4050-313, Portugal
| | - Maria João Martins
- Department of Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Gracinda Costa
- Department of Nuclear Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Cristina Ribeiro
- Department of Endocrinology, Diabetes, and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Francisco Carrilho
- Department of Endocrinology, Diabetes, and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra 3000-075, Portugal
| | - Valeriano Leite
- Unit for Investigation of Molecular Pathobiology, Portuguese Institute of Oncology-Lisbon Center, Lisbon 1099-023, Portugal
- Faculty of Medical Sciences, University of Lisbon, Lisbon 1169-056, Portugal
- Department of Endocrinology, Portuguese Institute of Oncology-Lisbon Center, Lisbon 1099-023, Portugal
| | - Cláudia Lobo
- Department of Pathology, Portuguese Institute of Oncology-Porto Center, Porto 4200-072, Portugal
| | - José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Servizo Galego de Saúde (SERGAS), Medical Faculty, University of Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Bruno Cavadas
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
| | - Luísa Pereira
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Medical Faculty, University of Porto, Porto 4200-319, Portugal
| | - Manuel Sobrinho-Simões
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto 4200-319, Portugal
- Department of Pathology, Hospital São João, Porto 4200-319, Portugal
| | - Paula Soares
- i3S Instituto de Investigação e Inovação em Saúde, Porto 4200-135, Portugal
- Institute of Molecular Pathology and Immunology, University of Porto, Porto 4200-135, Portugal
- Department of Pathology and Oncology, Medical Faculty, University of Porto, Porto 4200-319, Portugal
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Pereira F, Pereira SS, Mesquita M, Morais T, Costa MM, Quelhas P, Lopes C, Monteiro MP, Leite V. Lymph Node Metastases in Papillary and Medullary Thyroid Carcinoma Are Independent of Intratumoral Lymphatic Vessel Density. Eur Thyroid J 2017; 6:57-64. [PMID: 28589086 PMCID: PMC5422756 DOI: 10.1159/000457794] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/19/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Blood and lymph vessel invasion are well-recognized markers of tumor aggressiveness, as these are the routes that lead to metastases. Thyroid tumors, depending on the histological variant, tend to have distinctive biological behaviors and use different vascular routes to metastasize, yet the mechanisms underlying the metastatic process are still poorly understood. OBJECTIVES The aim of this study was to assess how the lymph vessel density (LVD) in different histological types of thyroid tumors, and in their surrounding tissue, correlate with the presence of lymph node metastases (LNM) and tumor pathological features. METHODS Lymph vessels of papillary thyroid carcinomas (PTC), of the classical (CVPTC, n = 50) and follicular variants (FVPTC, n = 18), and medullary thyroid carcinomas (MTC, n = 34) were immunohistochemically stained against antigen D2-40. The stained area was quantified using a computerized morphometric analysis tool and correlated with the tumor pathological characteristics. RESULTS LVD within all analyzed thyroid tumor subtypes was significantly lower than in the surrounding thyroid tissues (p < 0.001). Despite intratumoral LVD being significantly higher in CVPTC than in FVPTC, and peritumoral LVD being significantly higher in MTC than in PTC (p < 0.05), no correlations were found between LVD (either intratumoral or peritumoral) and the presence of lymph node metastasis. CONCLUSIONS As no LVD differences were found amongst thyroid tumors with or without LNM, dissemination is more likely to depend on the tumor ability to invade the abundant lymph vessel network of the surrounding thyroid tissue than on the ability of the tumor to promote de novo lymphangiogenesis.
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Affiliation(s)
- Filipe Pereira
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - Sofia S. Pereira
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Lisbon, Portugal
| | - Marta Mesquita
- Serviço de Anatomia Patológica, Instituto Português Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal
| | - Tiago Morais
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - Madalena M. Costa
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - Pedro Quelhas
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Lisbon, Portugal
- Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
| | - Carlos Lopes
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Lisbon, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Lisbon, Portugal
| | - Mariana P. Monteiro
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - Valeriano Leite
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal
- *Valeriano Leite, Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, R. Prof. Lima Basto, PT-1099-023 Lisbon (Portugal), E-Mail
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12
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Lee JH, Shin HJ, Yoon JH, Kim EK, Moon HJ, Lee HS, Kwon HJ, Kwak JY. Predicting lymph node metastasis in patients with papillary thyroid carcinoma by vascular index on power Doppler ultrasound. Head Neck 2016; 39:334-340. [PMID: 27704649 DOI: 10.1002/hed.24592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND For patients with papillary thyroid carcinoma (PTC), lymph node metastasis is associated with an increased recurrence rate. The purpose of this study was to investigate whether the vascular endothelial growth factor (VEGF), microvessel density (MVD), and vascular index (VI) can predict lymph node metastasis in patients with PTC. METHODS From January 2011 to October 2011, 202 patients with PTCs underwent preoperative staging ultrasound evaluation. To evaluate vascularity, we measured the VI, VEGF expression, and MVD. RESULTS The VI was significantly correlated with MVD (p = .009). On multivariate analysis, young age showed a significant correlation with lymph node metastasis (p < .001; p < .001; p < .001). However, the other clinicopathologic features, VEGF, MVD, and VI failed to show any significant correlations with lymph node metastasis. CONCLUSION Although the VI showed significant correlation with MVD, it was not significantly correlated to lymph node metastasis. © 2016 Wiley Periodicals, Inc. Head Neck 39: 334-340, 2017.
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Affiliation(s)
- Ji Hye Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Hyun Joo Shin
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Biostastistics Collaboration Unit, Medical Research Center, Yonsei University, College of Medicine, Seoul, Korea
| | - Hyeong Ju Kwon
- Department of Pathology, Yonsei University, College of Medicine, Seoul, Korea.,Department of Pathology, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
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13
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Dieterich LC, Detmar M. Tumor lymphangiogenesis and new drug development. Adv Drug Deliv Rev 2016; 99:148-160. [PMID: 26705849 DOI: 10.1016/j.addr.2015.12.011] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/12/2015] [Accepted: 12/09/2015] [Indexed: 02/07/2023]
Abstract
Traditionally, tumor-associated lymphatic vessels have been regarded as passive by-standers, serving simply as a drainage system for interstitial fluid generated within the tumor. However, with growing evidence that tumors actively induce lymphangiogenesis, and that the number of lymphatic vessels closely correlates with metastasis and clinical outcome in various types of cancer, this picture has changed dramatically in recent years. Tumor-associated lymphatic vessels have now emerged as a valid therapeutic target to control metastatic disease, and the first specific anti-lymphangiogenic drugs have recently entered clinical testing. Furthermore, we are just beginning to understand the whole functional spectrum of tumor-associated lymphatic vessels, which not only concerns transport of fluid and metastatic cells, but also includes the regulation of cancer stemness and specific inhibition of immune responses, opening new venues for therapeutic applications. Therefore, we predict that specific targeting of lymphatic vessels and their function will become an important tool for future cancer treatment.
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14
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Follicular variant of papillary thyroid carcinoma (FVPTC): histological features, BRAF V600E mutation, and lymph node status. J Cancer Res Clin Oncol 2015; 141:1749-56. [PMID: 25702102 DOI: 10.1007/s00432-015-1939-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Follicular variant of papillary thyroid carcinoma (FVPTC) is currently treated like conventional papillary thyroid carcinoma (cPTC). Recent reports indicate that encapsulated FVPTC behaves like follicular adenomas, while infiltrative FVPTC behaves like cPTC. This raises the possibility that histology and/or mutation status might help personalize management of FVPTC regarding extent of surgery, intensity of follow-up, and targeted therapy. This study correlates histological features, immunoreactivity for CK19, HBME, and Gal, and BRAF V600E mutation with lymph node (LN) metastasis and follow-up in FVPTC. METHODS Forty-eight FVPTC (21 with regional lymph node metastasis [LN+] and 27 with negative lymph nodes [LN-]) were reviewed. Demographics, tumor focality, size, circumscription, follicular architecture, lymphovascular invasion, extrathyroidal extension (ETE), and margin status were charted. Macrodissected formalin-fixed paraffin-embedded sections from 47 (21 LN+ and 26 LN-) cases were analyzed for BRAF V600E (1799T>A) mutation using real-time PCR. Correlations between the variables and LN status were calculated. RESULTS Sixty-two percent of cases with ETE demonstrated LN metastasis, while 59 % of cases with circumscribed tumors were LN-. In multivariable analysis, ETE and tumor size ≥1 cm were the best predictors of LN+ status, whereas in cases without ETE, the infiltrative pattern and tumor size provided the "best fit." Immunostains and BRAF mutation status were not helpful. All four tumors that recurred were LN+, with infiltrative borders, and lacked the BRAF mutation. CONCLUSIONS Tumor circumscription, extrathyroidal extension, and tumor size ≥ 1.0 cm are predictors of lymph node status in FVPTC.
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15
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Xiang D, Xie L, Xu Y, Li Z, Hong Y, Wang P. Papillary thyroid microcarcinomas located at the middle part of the middle third of the thyroid gland correlates with the presence of neck metastasis. Surgery 2014; 157:526-33. [PMID: 25433730 DOI: 10.1016/j.surg.2014.10.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/19/2014] [Accepted: 10/31/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Papillary thyroid microcarcinomas (PTMCs), located at upper poles of the thyroid, are associated with lateral neck metastasis (LNM) according to previous reports. Controversy remains regarding the correlation between the location of PTMCs and central neck metastasis (CNM). METHODS Medical records of 949 patients with PTMCs diagnosed between 2010 and 2013 were reviewed retrospectively. With a subdivision of the middle third of the thyroid gland, correlations between tumor location and CNM/LNM along with other clinicopathologic factors were analyzed by binary logistic regression. RESULTS PTMCs located in the middle part of the middle third of the thyroid gland (MPMT) showed the greatest rate of CNM (57.5%) among all locations. PTMCs located at isthmus showed the second greatest rate of CNM (44.3%). In the multivariate analysis, MPMT, tumor size >0.5 cm, young and middle age, male sex, multifocality within the affected lobe, and capsular invasion were correlated with CNM. PTMCs located at upper poles and MPMT showed comparatively high rates of LNM (8.6% and 8.3%). Consistent with previous reports, an upper pole location, MPMT, and a tumor size >0.5 cm greatly correlated with LNM in the multivariate analysis. Eleven patients had skip metastases, which only occurred with upper/lower pole locations and MPMT. CONCLUSION PTMCs located in the MPMT correlated with both CNM and LNM. Tumor location along with other clinicopathologic factors such as young and middle age, male sex, and tumor size >0.5 cm could facilitate preoperative stratification and guide operative management for patients with PTMC.
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Affiliation(s)
- Dapeng Xiang
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Liangqi Xie
- Department of Molecular and Cellular Biology, UC Berkeley, Berkeley, CA
| | - Yuanliang Xu
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiyu Li
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, Hangzhou, China.
| | - Yurong Hong
- Department of Ultrasonography, Second Affiliated Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Wang
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, Hangzhou, China
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16
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Shin HJ, Kim EK, Moon HJ, Yoon JH, Han KH, Kwak JY. Can increased tumoral vascularity be a quantitative predicting factor of lymph node metastasis in papillary thyroid microcarcinoma? Endocrine 2014; 47:273-82. [PMID: 24366642 DOI: 10.1007/s12020-013-0131-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/21/2013] [Indexed: 12/15/2022]
Abstract
The aim of the present study was to evaluate the clinical implications of the vascular index (VI) as a predicting factor for central and lateral lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC). From January 2011 to October 2011, 588 patients (495 females, 93 males) who were diagnosed with PTMC were included. Clinicopathologic characteristics of patients and ultrasound (US) features of the lesions including VI were evaluated retrospectively. The VI was measured with QLAB 7.0 quantification software using preoperative Doppler US images. Univariate and multivariate analysis were used to assess predictive factors of LNM. From 588 patients, 140 patients (23.8 %) had central LNM and 26 patients (4.4 %) had lateral LNM on pathologic results. The presence of lateral LNM [odds ratio (OR) 5.46; 95 % confidence interval (CI) = 2.19-13.64], bilaterality (OR 2.16; 95 % CI 1.17-4.01), and increased tumor size (OR 1.15; 95 % CI 1.04-1.28) were significant independent factors for predicting central LNM. The presence of central LNM (OR 5.58; 95 % CI 2.22-14.04), upper third location of malignancy (OR 2.50; 95 % CI 1.01-6.21), and tumor size (OR 1.34; 95 % CI 1.03-1.73) were significant independent factors for predicting lateral LNM. However, the VI was not a significant predicting factor for both central and lateral LNM. Therefore, the VI of PTMC may not be useful for predicting central and lateral LNM in patients with PTMC.
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Affiliation(s)
- Hyun Joo Shin
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 120-752, South Korea
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17
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Hakala T, Sand J, Kellokumpu-Lehtinen PL, Huhtala H, Leinonen R, Kholová I. Recurrent thyroid cancers have more peritumoural lymphatic vasculature than nonrecurrent thyroid cancers. Eur J Clin Invest 2014; 44:825-32. [PMID: 25047155 DOI: 10.1111/eci.12301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The goal of the study was to evaluate angiogenesis and lymphangiogenesis in differentiated thyroid cancer and recurrences. METHODS Twenty-seven patients with recurrent differentiated thyroid cancer (20 papillary and seven follicular thyroid carcinomas) and 24 nonrecurrent thyroid cancers were included in this study. Additionally, 24 thyroid adenomas were included as benign controls. All thyroid cancer recurrences were operatively managed, and local recurrences in cervical lymph nodes or cervical soft tissue were histologically confirmed. Altogether, a total of 108 samples were evaluated using CD31 and D2-40 immunohistochemical staining and microscopy. RESULTS As measured in primary tumours, the median density of CD31-positive vascular structures was 327 vessels (v)/mm(2) for recurrent cancers, 362 v/mm(2) for nonrecurrent cancers and 484 v/mm(2) for thyroid adenomas (P = 0·017). Among the subgroups, the lowest median vascular density of 316 v/mm(2) was found in recurrent papillary cancers and the highest vascular density of 604 v/mm(2) was observed in nonrecurrent follicular cancers (P = 0·018). The median density of D2-40-positive peritumoural lymphatic vessels was 101/mm(2) in recurrent cancers, 56·1/mm(2) in nonrecurrent cancers and 53·9/mm(2) for adenomas (P = 0·015). In the subgroups, peritumoural lymphatic vascular density was 102 v/mm(2) in recurrent papillary cancers and 56·0 v/mm(2) in nonrecurrent papillary cancers (P = 0·044). CONCLUSIONS Recurrent thyroid cancers expressed less intratumoural microvessels than thyroid adenomas. A high density of peritumoural lymphatic vessels was found in recurrent papillary cancers. High blood vessel density may be a marker for less aggressive tumours, while high peritumoural lymphatic vasculature is a marker for more aggressive and recurrence-prone tumours.
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Affiliation(s)
- Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
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Fridman M, Savva N, Krasko O, Mankovskaya S, Branovan DI, Schmid KW, Demidchik Y. Initial presentation and late results of treatment of post-Chernobyl papillary thyroid carcinoma in children and adolescents of Belarus. J Clin Endocrinol Metab 2014; 99:2932-41. [PMID: 24823453 DOI: 10.1210/jc.2013-3131] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this population-based study was to evaluate the clinical and pathological characteristics and outcome of papillary thyroid carcinoma (PTC) that have arisen in the Belarusian childhood population exposed to the radioactive fallout from the Chernobyl accident within a long-term period. PATIENTS AND METHODS The long-term treatment results were investigated in 1078 children and adolescents (<19 years old) with PTC who were surgically treated during the years 1990 through 2005. RESULTS Patients had high rates of metastatic PTC at presentation, with 73.8% of cases having lymph node involvement and 11.1% having distant spread. The most influential factor for lymph node metastases at initial treatment was lymphatic vessel invasion (P < .0001) and for distant metastases, lateral lymph node involvement (P < .0001). The overall survival was 96.9% ± 0.9% with a median follow-up of 16.21 years, and 20-year event-free survival and relapse-free survival were 87.8% ± 1.6% and 92.3% ± 0.9%, respectively. Patients had significantly lower probability of both loco-regional (P < .001) and distant relapses (P = .005) after total thyroidectomy (TT) and radioactive iodine therapy (RAI). For loco-regional relapses after TT, only RAI influenced the prognosis significantly (P < .001). For distant relapses after TT, the refusal to treat with RAI (hazard ratio [HR] = 9.26), vascular invasion (HR = 8.68), and age at presentation (HR = 6.13) were significant risk factors. For loco-regional relapses after non-TT, the principal risk factors were age less than 15 years old at presentation (HR = 5.34) and multifocal growth of tumor (HR = 5.19). For distant relapses after non-TT, the lateral neck metastases were the only unfavorable factor (HR = 9.26). CONCLUSION The outcome of PTC both in children and in adolescents exposed to the post-Chernobyl radioiodine fallout was rather favorable. TT with RAI is recommended for minimizing loco-regional or distant relapses.
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Affiliation(s)
- Mikhail Fridman
- Department of Pathology, Republican Centre for Thyroid Tumors (M.F., S.M., Y.D.), Minsk, Belarus 220013; Belarusian Medical Academy of Post-Graduate Education (M.F., Y.D.), Minsk, Belarus 22013; Research and Clinical Center for Children With Head Abnormalities and Nervous System Disorders (N.S.), Pediatric Palliative Care Department, Moscow, Russian Federation 107143; United Institute of Informatics Problems (O.K.), National Academy of Sciences of Belarus, Minsk, Belarus 220012; Institute of Physiology (S.M.), National Academy of Sciences of Belarus, Minsk, Belarus 220013; Project Chernobyl Inc (D.I.B.), Brooklyn, New York 11235; and Institute of Pathology and Neuropathology (K.W.S.), University Hospital of Essen, University of Duisburg-Essen, Essen, Germany 45147
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Liu X, Yan K, Lin X, Zhao L, An W, Wang C, Liu X. The association between BRAF V600E mutation and pathological features in PTC. Eur Arch Otorhinolaryngol 2014; 271:3041-52. [DOI: 10.1007/s00405-013-2872-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 12/19/2013] [Indexed: 12/21/2022]
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Mai KT, Gulavita P, Lai C, Swift J, Levac J, Olberg B, Purgina B. Topographic Distribution of Papillary Thyroid Carcinoma by Mapping in Coronal Sections of 125 Consecutive Thyroidectomy Specimens. Int J Surg Pathol 2013; 22:303-15. [PMID: 24050958 DOI: 10.1177/1066896913503491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Mapping of different foci in multifocal papillary thyroid carcinoma (PTC) has previously not been done as it is difficult to do so when thyroid specimens are serially sectioned transversely (ie, parallel to the horizontal plane). In this study, thyroidectomy specimens were serially sectioned coronally (ie, parallel to the largest surface of the thyroid gland), which allows for panoramic and 3-dimensional visualization of PTC foci and their relationship to one another. MATERIALS AND METHODS A total of 125 consecutive total thyroidectomies or lobectomies followed by completion thyroidectomies were serially sectioned coronally and reviewed with identification and characterization of PTC foci. PTCs were grouped into either discrete, encapsulated nodule(s) (EN) of both follicular or papillary architecture, usual variant (UV), or tall cell variant (TCV). RESULTS The predominant tumor masses were identified in the right lobe, isthmus, and left lobe in 52%, 8%, and 40%, respectively. The largest tumor nodules ranged from 3 to 60 mm (18.8 ± 6.6) with the UV, EN, and TCV groups accounting for 58%, 24%, and 18% of cases, respectively. Three topographic patterns of PTC can be distinguished as follows: (a) single tumor nodule (37 cases), (b) main tumor nodule with satellite nodule(s) displaying no or varying degrees of fusion with the main one (30 cases), and (c) main tumor nodule with either a second large nodule or randomly occurring tumor nodules (58 cases). Bilaterality can be seen in all 3 patterns but was most prevalent in the group comprising the main tumor nodule with either a second large nodule or random tumor nodules. It was least frequent in the EN group without random tumor nodules. The difference in rates of bilaterality between tumors <10 mm and ≥10 mm was statistically significant (P < .01). For all 3 groups, satellite nodules displayed histopathological features that were similar or dissimilar to the main tumor mass. They may be of a different variant than that of the main tumor nodule. CONCLUSIONS With panaromic and 3-dimensional visualization, individual tumors/satellite or random nodules of multifocal PTC were readily identified in serial coronal sections of thyroidectomy specimens. Bilaterality was frequently observed in tumors associated with random PTC foci, whereas, the EN group tended to be unilateral and was not associated with random foci.
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Affiliation(s)
- Kien T Mai
- The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
| | - Previn Gulavita
- The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
| | - Chi Lai
- The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
| | - Joanne Swift
- The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
| | - Joelle Levac
- The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
| | - Bernhard Olberg
- The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
| | - Bibianna Purgina
- The Ottawa Hospital and Ottawa University, Ottawa, Ontario, Canada
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TGF-beta/Smad pathway and BRAF mutation play different roles in circumscribed and infiltrative papillary thyroid carcinoma. Virchows Arch 2012; 460:587-600. [DOI: 10.1007/s00428-012-1234-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 03/13/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
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