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Characteristics of different histological subtypes of thyroid nodules classified with 99mTc-methoxy-isobutyl-isonitrile imaging and Thyroid Imaging Reporting And Data System. Nucl Med Commun 2021; 42:73-80. [PMID: 33122502 DOI: 10.1097/mnm.0000000000001304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Thyroid Imaging Reporting And Data System (TIRADS) is helpful for risk stratification of thyroid nodules. However, there is a lack of data for TIRADS classification of different histological subtypes [classical papillary thyroid cancer (PTC), follicular variant of papillary thyroid cancer (FVPTC), and follicular thyroid cancer (FTC)], and benign thyroid nodules (follicular adenoma, oncocytic adenoma, and multinodular goiter (MNG)]. Methoxy-isobutyl-isonitrile (MIBI) imaging has a high negative predictive value for the exclusion of thyroid malignancy in hypofunctioning thyroid nodules. The aim of this analysis was to compare malignant and benign subtypes of thyroid nodule using three TIRADS and MIBI imaging. METHODS Retrospective analysis of MIBI imaging studies. Hypofunctioning thyroid nodules were classified with Kwak-TIRADS, EU-TIRADS, and K-TIRADS. MIBI imaging was visually categorized. RESULTS We included 242 thyroid nodules (32 malignant, 19 PTC, 7 FVPTC, and 6 FTC). When using Kwak-TIRADS 4C and 5 as a marker for high-risk nodules, we found 85.5% of the follicular adenoma, 80.8% of the MNG, 100% of the oncocytic adenoma, 100% of the FTC, 57.1% of the FVPTC, and 42.2% of the PTC to be below this cutoff. All PTC and FVPTC were MIBI-positive, 83% of the FTC, 78% of the follicular adenoma, 75% of the oncocytic adenoma, and 60% of the MNG were MIBI-positive. CONCLUSION TIRADS is useful to detect PTC, but FVPTC and FTC may be missed. MIBI imaging seems to be more suitable to detect FVPTC and FTC. However, neither TIRADS nor MIBI imaging are able to differentiate between follicular adenoma and FTC or FVPTC.
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Zhou YF, Zhang YF, Fu HJ, Yang WP, Zhao CK, Xu HX. Improving the diagnosis of AUS/FLUS thyroid nodules using an algorithm with combination of BRAFV600E mutation analysis and ultrasound pattern-based risk stratification. Clin Hemorheol Microcirc 2021; 77:273-285. [PMID: 33185592 DOI: 10.3233/ch-200985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
PURPOSE To propose a diagnostic algorithm for improving the diagnosis of atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) thyroid nodules. METHODS This study retrospectively enrolled 77 consecutive patients with 81 AUS/FLUS nodules who underwent preoperative BRAFV600E mutation analysis. A new diagnostic algorithm was proposed that BRAFV600E mutation analysis for the Fine-needle aspiration cytology specimen was firstly carried out, in which positive BRAFV600E mutation indicated malignancy and classification of the nodules with negative BRAFV600E mutation was further performed based on ultrasound pattern-based risk stratification of American Thyroid Association Guidelines. The diagnostic performance of the new diagnostic algorithm was evaluated. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the receiver operating characteristic curve (AUROC) of new diagnostic algorithm were 94.6%, 84.0%, 91.4%, 86.9%, 90.1%, and 0.893, respectively. The proposed diagnostic algorithm significantly increased the diagnostic performances (AUROC: 0.893 vs. 0.837 and 0.795), sensitivity (94.6% vs. 71.4% and 75.0%), and accuracy (90.1% vs. 79.0% and 77.8%) compared with BRAFV600E mutation analysis alone and ultrasound pattern-based risk stratification alone (all P < 0.05). CONCLUSION The proposed diagnostic algorithm is helpful for improving the diagnosis of AUS/FLUS nodules, which might be as a routine approach.
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Affiliation(s)
- Ya-Fang Zhou
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Department of Medical Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Jun Fu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei-Ping Yang
- Department of Medical Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
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3
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Zhang F, Chen W. Sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and diagnostic performance of the 2017 ACR TI-RADS in FV-PTC. Endocrine 2020; 67:379-386. [PMID: 31919771 DOI: 10.1007/s12020-019-02184-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/29/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To find the sonographic features of follicular variant of papillary thyroid carcinoma (FV-PTC) and evaluate the diagnostic performance of 2017 ACR TI-RADS in FV-PTC. METHODS From June 2017 to June 2019, 104 FV-PTC patients (106 nodules) and 337 classic papillary thyroid carcinoma (C-PTC) patients (343 nodules) with both sonograms and pathologic results were included. Sonographic features of FV-PTC and C-PTC were evaluated and compared, and 2017 ACR TI-RADS scores and levels were calculated. RESULTS Pathologically, the incidence of Hashimoto's thyroiditis and extrathyroidal extension was higher in the FV-PTC group. Most of both the FV-PTC and C-PTC groups were diagnosed as PTC or suspicious PTC by fine-needle aspiration biopsy (FNAB). FV-PTC tended to be isoechoic, while most nodules of C-PTC were hypoechoic or very hypoechoic. Compared with C-PTC, FV-PTC had lower percentages of a taller-than-wide shape (11.3% vs. 46.6%) and lobulated or irregular margin (33.0% vs. 61.8%), and a higher percentage of extrathyroidal extension (20.8% vs. 8.2%). FV-PTC featured macrocalcifications, whereas punctate echogenic foci were more frequently seen in the C-PTC group. Other characteristic US appearances of FV-PTC included uneven hypoechoic halo and peripheral vascularity. The mean TI-RADS score of FV-PTC cases was lower in the FV-PTC group, 11.3%, 44.3%, and 42.5% of which were categorized as TI-RADS 3, 4, and 5, respectively. CONCLUSIONS FV-PTC features isoechoic appearance, macrocalcifications, uneven hypoechoic halo, and peripheral vascularity on US, with lower incidences of microcalcifications and taller-than-wide shape, and tends to have lower TI-RADS scores and levels. For the nodules categorized as TI-RADS 3 or 4, the FNAB criteria should be broaden when these nodules have FV-PTC US features.
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Affiliation(s)
- Fan Zhang
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, PR China
| | - Wen Chen
- Department of Ultrasound, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, PR China.
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Macerola E, Rago T, Proietti A, Basolo F, Vitti P. The mutational analysis in the diagnostic work-up of thyroid nodules: the real impact in a center with large experience in thyroid cytopathology. J Endocrinol Invest 2019; 42:157-166. [PMID: 29704233 DOI: 10.1007/s40618-018-0895-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/20/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Fine-needle aspiration (FNA) cytology is a mainstay in the evaluation of thyroid nodules, but fails to reach reliable results in 25-30% of cases. The role of molecular markers in helping clinical decisions has been investigated for the last years, but their clinical usefulness is still unsettled. METHODS Mutation analysis of BRAF, RAS genes and TERT promoter was performed in a series of 617 consecutive cytological specimens undergoing FNA. RESULTS The 617 nodules had the following cytological diagnosis: non diagnostic 22 (3.6%), benign 425 (68.9%), indeterminate 114 (18.5%), suspicious 11 (1.8%) and malignant 45 (7.3%). BRAF mutations were found in 31 cases (5.0%), all but two in suspicious and malignant nodules. RAS mutations were detected in 47 samples (7.6%): 25 benign (5.9%) and 19 indeterminate nodules (16.7%). TERT promoter mutation alone was detected in three samples. Histological outcome was available for 167 nodules, 81 of which proved malignant: all the 48 with suspicious or malignant cytology; 25 out of 56 (44.6%) with indeterminate and 8 out of 57 (14%) with benign cytology. BRAF mutations were associated with worse tumors pathological features. The presence of RAS mutations was indicative of follicular-patterned malignancies in 5 out of 8 benign nodules and 9 out of 11 indeterminate nodules. CONCLUSIONS Our study established mutational rates for BRAF and RAS genes in a large series of FNA specimens. BRAF mutations were confirmed as highly specific but not able to improve cytological diagnosis, while RAS testing proved effective in assessing malignancy in nodules with indeterminate and benign cytology.
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Affiliation(s)
- E Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, via Savi 10, 56126, Pisa, Italy
| | - T Rago
- Department of Clinical and Experimental Medicine (Endocrinology Section), University of Pisa, via Paradisa 2, 56124, Pisa, Italy
| | - A Proietti
- Division of Anatomical Pathology, University Hospital of Pisa, via Roma 57, 56126, Pisa, Italy
| | - F Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area (Anatomical Pathology Section), University of Pisa, via Savi 10, 56126, Pisa, Italy
| | - P Vitti
- Department of Clinical and Experimental Medicine (Endocrinology Section), University of Pisa, via Paradisa 2, 56124, Pisa, Italy.
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Completion Thyroidectomy in Patients Diagnosed with Papillary Thyroid Cancer: Is There a Predictive Factor for Contralateral Lobe Tumor? MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:262-267. [PMID: 32774088 PMCID: PMC7406558 DOI: 10.14744/semb.2018.83713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/05/2018] [Indexed: 11/20/2022]
Abstract
Objectives: Completion thyroidectomy (CT) is defined as the removal of the residual thyroid tissue in the case of detected malignancy after lobectomy for an indeterminate or non-diagnostic biopsy. Factors such as tumor diameter, aggressive histology, extrathyroidal spread, and positive surgical margin in papillary thyroid cancer (PTC) constitute CT indications. However, the type of surgery is controversial especially in patients with a tumor diameter of 1-4 cm. Determination of predictive factors for contralateral lobe tumors (CLTs) in PTC may be helpful for rough or excessive treatment of patients with this common thyroid pathology. The aim of the present study was to determine the predictive factors and rate of detection of CLTs after CT in patients with papillary thyroid carcinoma after lobectomy. Methods: Medical records of patients who underwent lobectomy with the final histological diagnosis of papillary thyroid carcinoma for the study period 2011 to 2016 were reviewed. Demographic data of the patients, diameter, multicentricity and subtype of tumor, extrathyroidal spread, and vascular invasion rate were obtained. Patients were divided into 2 groups as final histological examination after CT revealed benign (Group 1) and malignant (Group 2). Results: Data of 49 patients were retrospectively analyzed during the study period. The female-to-male ratio was 33/16. The mean age of the patients was 47.59 (23–77) years. Groups 1 and 2 consisted of 30 and 19 patients, respectively. No significant difference was found between the two groups regarding demographic data and tumor characteristics. Conclusion: Despite the fact that we have not been detecting any predictive factor in predicting the presence of tumor on the contralateral lobe in our study, the detection of a tumor on the contralateral lobe is frequent.
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Chakravarthy NS, Chandramohan A, Prabhu AJ, Gowri M, Mannam P, Shyamkumar NK, Naik D, Cherian AJ, Thomas N, Paul MJ, Abraham D. Ultrasound-guided Fine-needle Aspiration Cytology along with Clinical and Radiological Features in Predicting Thyroid Malignancy in Nodules ≥1 cm. Indian J Endocrinol Metab 2018; 22:597-604. [PMID: 30294566 PMCID: PMC6166559 DOI: 10.4103/ijem.ijem_1_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES The aim of the study is to examine the adequacy and accuracy of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in thyroid nodules ≥1 cm and to analyze the clinical, sonological, and cytological features in predicting thyroid malignancy. MATERIALS AND METHODS US-FNAC was done on 290 patients from December 2013 to December 2014 by the radiologist. The Thyroid Imaging Reporting and Data System (TIRADS) was used to record the sonological features. FNAC samples were reported by a dedicated cytopathologist. Accuracy was calculated by comparing US-FNAC, clinical features and ultrasound (US) features for those who had final histopathology till April 2017. RESULTS The adequacy of US-FNAC in this study was 80.2%. Thyroidectomy was performed in 128/290 (44.1%). The sensitivity and specificity of US-FNAC in this study is 83.9 and 76.3%, respectively, with a positive predictive value of 85.2%, negative predictive value of 74.4%, and an accuracy of 81% in predicting malignancy in thyroid nodules ≥1 cm. The malignancy rate in benign FNAC sample was 25% (10/40), and was 69% (8/13) in those with a follicular lesion of undetermined significance (FLUS). Around 80% of benign and 89% of FLUS had follicular variant of papillary carcinoma of thyroid (FVPTC). US-FNAC, a high TIRADS score, and US features such as marked hypoechogenicity, taller than wide, irregular margins, microcalcification, and clinical features, such as hard in consistency and significant cervical lymph nodes, were important in predicting malignancy (P < 0.001). CONCLUSIONS The accuracy of US-FNAC in this study is 81%. The US-FNAC, a high TIRADS score, a hard thyroid nodule, and significant cervical lymph nodes are important in predicting malignancy. The accuracy rate in benign and atypia undetermined significance categories needs to improve in this study. Further research to help in decreasing false negative rates of FVPTC will help in increasing the accuracy of US-FNAC in the present study.
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Affiliation(s)
| | - Anuradha Chandramohan
- Department of Radiology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Anne Jennifer Prabhu
- Department of Pathology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - M. Gowri
- Department of Biostatistics, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Pavithra Mannam
- Department of Radiology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - N. K. Shyamkumar
- Department of Radiology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - A. J. Cherian
- Department of Endocrine Surgery, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - M. J. Paul
- Department of Endocrine Surgery, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Deepak Abraham
- Department of Endocrine Surgery, Christian Medical College (CMC), Vellore, Tamil Nadu, India
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de Koster EJ, de Geus-Oei LF, Dekkers OM, van Engen-van Grunsven I, Hamming J, Corssmit EPM, Morreau H, Schepers A, Smit J, Oyen WJG, Vriens D. Diagnostic Utility of Molecular and Imaging Biomarkers in Cytological Indeterminate Thyroid Nodules. Endocr Rev 2018; 39:154-191. [PMID: 29300866 DOI: 10.1210/er.2017-00133] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Indeterminate thyroid cytology (Bethesda III and IV) corresponds to follicular-patterned benign and malignant lesions, which are particularly difficult to differentiate on cytology alone. As ~25% of these nodules harbor malignancy, diagnostic hemithyroidectomy is still custom. However, advanced preoperative diagnostics are rapidly evolving.This review provides an overview of additional molecular and imaging diagnostics for indeterminate thyroid nodules in a preoperative clinical setting, including considerations regarding cost-effectiveness, availability, and feasibility of combining techniques. Addressed diagnostics include gene mutation analysis, microRNA, immunocytochemistry, ultrasonography, elastosonography, computed tomography, sestamibi scintigraphy, [18F]-2-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET), and diffusion-weighted magnetic resonance imaging.The best rule-out tests for malignancy were the Afirma® gene expression classifier and FDG-PET. The most accurate rule-in test was sole BRAF mutation analysis. No diagnostic had both near-perfect sensitivity and specificity, and estimated cost-effectiveness. Molecular techniques are rapidly advancing. However, given the currently available techniques, a multimodality stepwise approach likely offers the most accurate diagnosis, sequentially applying one sensitive rule-out test and one specific rule-in test. Geographical variations in cytology (e.g., Hürthle cell neoplasms) and tumor genetics strongly influence local test performance and clinical utility. Multidisciplinary collaboration and implementation studies can aid the local decision for one or more eligible diagnostics.
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Affiliation(s)
- Elizabeth J de Koster
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Olaf M Dekkers
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jaap Hamming
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Smit
- Department of Endocrinology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wim J G Oyen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.,Division of Radiotherapy and Imaging, Institute of Cancer Research, and Department of Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Dennis Vriens
- Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, the Netherlands
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8
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Ng SC, Kuo SF, Hua CC, Huang BY, Chiang KC, Chu YY, Hsueh C, Lin JD. Differentiation of the Follicular Variant of Papillary Thyroid Carcinoma From Classic Papillary Thyroid Carcinoma: An Ultrasound Analysis and Complement to Fine-Needle Aspiration Cytology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:667-674. [PMID: 28880405 DOI: 10.1002/jum.14377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES It is difficult to establish a diagnosis of the follicular variant of papillary thyroid carcinoma (PTC) using fine-needle aspiration cytology (FNAC). Preoperative features on ultrasound (US) imaging are different between follicular PTC and classic PTC. This study developed a risk score system to differentiate follicular PTC from classic PTC and to correlate the risk score of follicular PTC with its FNAC categories and pathologic features. METHODS The US features, FNAC results, and pathologic reports of 156 follicular PTC nodules and 152 classic PTC nodules from 296 patients with PTC along with their clinical characteristics were reviewed retrospectively. A risk score system based on US features was developed by multivariate logistic regression to differentiate classic PTC from follicular PTC nodules. The risk scores were then correlated with the FNAC category and pathologic features of the nodules. RESULTS The US risk score (5 × echogenicity + 3 × calcifications + 3 × marginal regularity) had an area under the receiver operating characteristic curve of 0.85 and a cutoff value of 8.0, with specificity of 87% and sensitivity of 69% for predicting a classic PTC nodule. The follicular PTC nodules with low Bethesda categorization (I-III) had a median US risk score of 6 (range, 0-11), which was higher than that of nodules with high categorization (IV-VI; median, 3; range, 0-11). CONCLUSIONS The US risk score may be useful in differentiating classic PTC from follicular PTC and complementary to FNAC in identifying follicular PTC.
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Affiliation(s)
- Soh-Ching Ng
- Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Sheng-Fong Kuo
- Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Chung-Ching Hua
- Departments of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Bie-Yu Huang
- Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Kun-Chun Chiang
- Departments of General Surgery, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Yin-Yi Chu
- Departments of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Chuen Hsueh
- Departments of Pathology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Hsien, Taiwan
| | - Jen-Der Lin
- Departments of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan Hsien, Taiwan
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Öztürk T, Özbek SS, Kavukçu G, Ertan Y, Veral A, Nart D, İçöz RG, Akyıldız M, Makay Ö, Tunçyürek M. Tiroid papiller karsinom folliküler varyantı: Gri-skala ve Doppler sonografik özellikleri. EGE TIP DERGISI 2017. [DOI: 10.19161/etd.390299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Cipolletta Campanile A, Malzone MG, Losito NS, Botti G, Chiofalo MG, Faggiano A, Siciliano R, Colao A, Pezzullo L, Fulciniti F. Accuracy of Fine Needle Cytology in Histological Prediction of Papillary Thyroid Carcinoma Variants: a Prospective Study. Endocr Pathol 2017. [PMID: 28639242 DOI: 10.1007/s12022-017-9488-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Fine needle cytology (FNC) is a crucial procedure in the preoperative diagnosis of thyroid tumors. Papillary thyroid carcinoma (PTC), in its classic variant (cPTC), is the most common malignant neoplasm of the thyroid. Several histological variants of PTC have been described, each one with its own characteristics and prognosis. The ability of FNC to identify the variants represents a challenge even for a skilled pathologist. The aim of this study was to evaluate the diagnostic cytological accuracy of FNC in PTC and to look for specific features that could predict the different variants. This was a single center prospective study on 128 patients who received a diagnosis of PTC on FNC. The smears were blindly reviewed by two cytopathologists to create a frequency score (0, 1, 2, 3) of the features for each variant. The cytological parameters were divided into three groups: architectural, nucleo-cytoplasmic, and background features. Univariate analysis was performed by chi-square test with Yates correction and Fisher exact test as appropriate. Multiple regression analysis was performed among the variables correlated at the linear correlation. The correlation study between cytology and histology showed an accuracy of FNC in classic, follicular, and oncocytic PTC variants of 63.5, 87.5, and 87% respectively. Familiarity with cytological features may allow an early diagnosis of a given PTC variant on FNC samples. This is fundamental in a preoperative evaluation for the best surgical approach and subsequent treatment.
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Affiliation(s)
- Anna Cipolletta Campanile
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", via Mariano Semmola, 80131, Naples, Italy
| | - Maria Gabriella Malzone
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", via Mariano Semmola, 80131, Naples, Italy.
| | - Nunzia Simona Losito
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", via Mariano Semmola, 80131, Naples, Italy
| | - Gerardo Botti
- Pathology and Cytopathology Unit, National Cancer Institute "Fondazione G. Pascale", via Mariano Semmola, 80131, Naples, Italy
| | - Maria Grazia Chiofalo
- Thyroid Surgery Unit, National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | - Antongiulio Faggiano
- Thyroid Surgery Unit, National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | - Roberta Siciliano
- Department of Industrial Engineering, University of Naples "Federico II", via Claudio - 21, 80131, Naples, Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", via Pansini - 5, 80131, Naples, Italy
| | - Luciano Pezzullo
- Thyroid Surgery Unit, National Cancer Institute "Fondazione G. Pascale", Naples, Italy
| | - Franco Fulciniti
- Clinical Cytopathology Service, Institute of Pathology, via A. Franzoni - 45, 6601, Locarno, Switzerland
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11
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Koh J, Kim EK, Kim JY, Kwak JY, Yoon JH, Moon HJ. Comparison of Ultrasound, Pathologic and Prognostic Characteristics of the Follicular Variant of Papillary Thyroid Cancer According to Fine-Needle Aspiration Cytology. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2864-2872. [PMID: 27658752 DOI: 10.1016/j.ultrasmedbio.2016.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
The aim of the study described here was to compare ultrasound features, pathologic characteristics and prognoses of the follicular variant of papillary thyroid carcinoma (FVPTC) according to cytology results. Eighty-seven FVPTCs were classified according to the first cytology results as the surgery group (n = 66, follicular neoplasm/Hürthle cell neoplasm, suspicious for malignancy and malignancy) and the indeterminate group (n = 21, non-diagnostic and benign), for whom the management was follow-up. The indeterminate group had a longer mean interval to surgery (p = 0.020) and larger tumor size (p = 0.018). More tumors were assessed as probably benign in the indeterminate group than in the surgery group (p < 0.001). Extrathyroidal extension and lymph node metastasis did not significantly differ between the two groups, and no patient had a recurrence (mean follow-up interval: 54.9 ± 16.9 mo). The indeterminate group exhibited more probably benign features and larger size on ultrasound, with surgery being performed at a later date. However, aggressive pathologic characteristics and tumor recurrence did not significantly differ between the two groups.
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Affiliation(s)
- Jieun Koh
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Ye Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Patel SG, Carty SE, McCoy KL, Ohori NP, LeBeau SO, Seethala RR, Nikiforova MN, Nikiforov YE, Yip L. Preoperative detection of RAS mutation may guide extent of thyroidectomy. Surgery 2016; 161:168-175. [PMID: 27863786 DOI: 10.1016/j.surg.2016.04.054] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/25/2016] [Accepted: 04/30/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Preoperative detection of RAS mutations can contribute to cancer risk assessment in indeterminate thyroid nodules, although RAS is not always associated with malignancy. METHODS Fine-needle aspiration samples classified in 1 of 3 indeterminate cytology categories were prospectively tested for N-, H-, and K-RAS mutations using next-generation sequencing assay. RESULTS In the study, 93 patients with 94 nodules had preoperative RAS detected, of whom 86 patients had an operation (69% total thyroidectomy, 29% lobectomy). In total, 76% of RAS-positive nodules were malignant and follicular variant papillary thyroid cancer was the most common cancer type (83%). HRAS mutations had the greatest risk of cancer (92%) followed by NRAS (74%) and KRAS (64%; P = .05). No preoperative variables were associated with malignancy including age (P = .07), sex (P = .49), RAS isoform (P = .05), mutational allelic frequency (P = .49), nodule size (P = .14), cytology category (P = .63), or ultrasound bilaterality (P = .24), multifocality (P = .23), or presence of ≥1 suspicious feature (P = .86). Only 60% of patients with a unifocal nodule on ultrasound had single focus low-risk encapsulated follicular variant papillary thyroid cancer or benign disease. CONCLUSION Preoperative RAS mutation detection in thyroid nodules carries a substantial risk of cancer with a greater risk associated with HRAS and NRAS. Most RAS malignancies are follicular variant papillary thyroid cancer, which may inform the extent of operation.
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Affiliation(s)
- Snehal G Patel
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Sally E Carty
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Kelly L McCoy
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA
| | - N Paul Ohori
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Shane O LeBeau
- Department of Medicine, Division of Endocrinology, University of Pittsburgh, Pittsburgh, PA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | | | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA
| | - Linwah Yip
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA.
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Ha EJ, Moon WJ, Na DG, Lee YH, Choi N, Kim SJ, Kim JK. A Multicenter Prospective Validation Study for the Korean Thyroid Imaging Reporting and Data System in Patients with Thyroid Nodules. Korean J Radiol 2016; 17:811-21. [PMID: 27587972 PMCID: PMC5007410 DOI: 10.3348/kjr.2016.17.5.811] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/15/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To validate a new risk stratification system for thyroid nodules, the Korean Thyroid Imaging Reporting and Data System (K-TIRADS), using a prospective design. MATERIALS AND METHODS From June 2013 to May 2015, 902 thyroid nodules were enrolled from four institutions. The type and predictive value of ultrasonography (US) predictors were analyzed according to the combination of the solidity and echogenicity of nodules; in addition, we determined malignancy risk and diagnostic performance for each category of K-TIRADS, and compared the efficacy of fine-needle aspiration (FNA) with a three-tier risk categorization system published in 2011. RESULTS The malignancy risk was significantly higher in solid hypoechoic nodules, as compared to partially cystic or isohyperechoic nodules (each p < 0.001). The presence of any suspicious US features had a significantly higher malignancy risk (73.4%) in solid hypoechoic nodules than in partially cystic or isohyperechoic nodules (4.3-38.5%; p < 0.001). The calculated malignancy risk in K-TIRADS categories 5, 4, 3, and 2 nodules were 73.4, 19.0, 3.5, and 0.0%, respectively; and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy were 95.5, 58.6, 44.5, 96.9, and 69.5%, respectively, in K-TIRADS categories 4 and 5. The efficacy of FNA for detecting malignancy based on K-TIRADS was increased from 18.6% (101/544) to 22.5% (101/449), as compared with the three-tier risk categorization system (p < 0.001). CONCLUSION The proposed new risk stratification system based on solidity and echogenicity was useful for risk stratification of thyroid nodules and the decision for FNA. The malignancy risk of K-TIRADS was in agreement with the findings of a previous retrospective study.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon 16499, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University School of Medicine, Ansan 15355, Korea
| | - Nami Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Soo Jin Kim
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul 06524, Korea.; Department of Radiology, New Korea Hospital, Gimpo 10086, Korea
| | - Jae Kyun Kim
- Department of Radiology, Chung-Ang University Hospital, Seoul 06973, Korea
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Kim SK, Park I, Woo JW, Lee JH, Choe JH, Kim JH, Kim JS. Follicular and Diffuse Sclerosing Variant Papillary Thyroid Carcinomas as Independent Predictive Factors of Loco-Regional Recurrence: A Comparison Study Using Propensity Score Matching. Thyroid 2016; 26:1077-84. [PMID: 27324748 DOI: 10.1089/thy.2016.0113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Only about half of papillary thyroid carcinoma (PTC) cases are classified as conventional PTC (CV-PTC), whereas various histologic variants constitute the remaining cases. Since controversies about the clinical behavior and outcomes of PTC variants continue, the purpose of this study was to compare the outcomes of patients with PTC variants who were treated at a large tertiary referral center in Korea. METHODS The medical records for 15,598 CV-PTCs, 435 follicular variants of PTC (FV-PTCs), and 66 diffuse sclerosing variants of PTC (DSV-PTCs) were retrospectively reviewed. Loco-regional recurrences (LRR) among PTC variants were compared using propensity score matching. RESULTS Analysis I compared CV-PTC with FV-PTC. After rigorous matching, 367 pairs were established. Recurrence-free survival (RFS) rates in CV-PTC were 96.1% at 5 years, 92.2% at 10 years, and 92.2% at 15 years, while those for FV-PTC were 98.8% at 5 years, 98.8% at 10 years, and 98.8% at 15 years (p = 0.026). Analysis II compared CV-PTC with DSV-PTC. Rigorous matching yielded 56 pairs. RFS rates for CV-PTC were 87.4% at 5 years, 87.4% at 10 years, and 87.4% at 15 years, while those for DSV-PTC were 68.9% at 5 years, 57.5% at 10 years, and were not available at 15 years (p = 0.013). CONCLUSIONS Compared with CV-PTC, FV-PTC showed less aggressive behaviors and more favorable outcomes. However, DSV-PTC showed more aggressive behaviors and a less favorable outcome than CV-PTC did. Therefore, the management strategy and follow-up plan for PTC should be differentiated according to the histologic variant.
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Affiliation(s)
- Seo Ki Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Inhye Park
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jung-Woo Woo
- 2 Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Changwon, South Korea
| | - Jun Ho Lee
- 3 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine , Changwon, South Korea
| | - Jun-Ho Choe
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jung-Han Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jee Soo Kim
- 1 Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
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Song YS, Kim JH, Na DG, Min HS, Won JK, Yun TJ, Choi SH, Sohn CH. Ultrasonographic Differentiation Between Nodular Hyperplasia and Neoplastic Follicular-Patterned Lesions of the Thyroid Gland. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1816-1824. [PMID: 27166018 DOI: 10.1016/j.ultrasmedbio.2016.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
We evaluate the gray-scale ultrasonographic characteristics that differentiate between nodular hyperplasia (NH) and neoplastic follicular-patterned lesions (NFPLs) of the thyroid gland. Ultrasonographic features of 750 patients with 832 thyroid nodules (NH, n = 361; or NFPLs, follicular adenoma, n = 123; follicular carcinoma, n = 159; and follicular variant papillary carcinoma, n = 189) were analyzed. Except for echogenicity, over two-thirds of the cases of NH and NFPLs share the ultrasonographic characteristics of solid internal content, a well-defined smooth margin and round-to-ovoid shape. Independent predictors for NH were non-solid internal content (sensitivity 27.1%, specificity 90.2%), isoechogenicity (sensitivity 69.5%, specificity 63.5%) and an ill-defined margin (sensitivity 18.8%, specificity 94.5%). Independent predictors for NFPLs were hypoechogenicity (sensitivity 60.5%, specificity 70.4%), marked hypoechogenicity (sensitivity 2.8%, specificity 99.4%) and taller-than-wide shape (sensitivity 6.6%, specificity 98.1%). Although NH and NFPLs commonly share ultrasonographic characteristics, non-solid internal content and ill-defined margin are specific to NH and marked hypoechogenicity and taller-than-wide shape are specific to NFPLs.
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Affiliation(s)
- Yong Sub Song
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea.
| | - Dong Gyu Na
- Department of Radiology, Thyroid Clinic, Human Medical Imaging & Intervention Center, Seoul, Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea; Department of Preventive Medicine, Graduate School of Public Health, Seoul National University Hospital, Seoul, Korea
| | - Jae-Kyung Won
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Jongno-gu, Seoul, Korea
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Anuradha C, Manipadam MT, Asha HS, Dukhabandhu N, Abraham D, Paul MJ. Can New Ultrasound Signs Help in Identifying Follicular Variant of Papillary Carcinoma of Thyroid? - A Pilot Study. Ultrasound Int Open 2016; 2:E47-53. [PMID: 27689170 PMCID: PMC5032849 DOI: 10.1055/s-0036-1582304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 02/19/2016] [Indexed: 10/21/2022] Open
Abstract
AIM To describe two new ultrasound signs for thyroid nodules - "nodule in nodule" and "hypoechoic internal septae" and assess their usefulness in differentiating follicular variant of papillary thyroid carcinoma (FVPTC) from benign thyroid nodules (BTN). METHODOLOGY Ultrasound findings of 210 patients with histopathologically proven FVPTC (68 nodules, M:F=13:47 with mean age of 39.5±11.9 years) and BTN (165 nodules, (M:F=41:109 with mean age of 44±11.3 years) were retrospectively reviewed from PACS by a single radiologist blinded to the final diagnosis. Logistic regression analysis was performed to identify the best predictors of FVPTC and their diagnostic performance was assessed. RESULTS The "nodule in nodule" sign was seen in 80.9% of FVPTC and only 12.1% of BTN. The "hypoechoic internal septae" sign was seen in 44.1% of FVPTC and 17% of BTN. Younger patients, heterogeneous echotexture, nodule in nodule sign, thick incomplete non-uniform halo and presence of significant nodes were the best predictors of FVPTC (p<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and relative risk for FVPTC given as odds ratio (95% CI) for heterogeneous echotexture and nodule in nodule sign which were the best 2 predictors of FVPTC were 91.2%, 81.8%, 67.3%, 95.7%, 84.5%, 46.5 (18.5-117.4) and 80.9%, 87.7%, 74.3%, 91.2%, 86.2%, 32.5 (15.04-70.2), respectively. There was improvement in the specificity (91.5%) and accuracy (86.6%) when a combined criterion of heterogeneous echotexture and nodule in nodule sign was applied to predict FVPTC. CONCLUSION The "nodule in nodule" sign is common in FVPTC and when combined with heterogeneous echotexture can differentiate FVPTC and BTN with high specificity.
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Affiliation(s)
- C. Anuradha
- Radiology, Christian Medical College, Vellore, India
| | | | - H. S. Asha
- Endocrinology, Christian Medical College, Vellore, India
| | - N. Dukhabandhu
- Endocrinology, Christian Medical College, Vellore, India
| | - D. Abraham
- Endocrine Surgery, Christian Medical College, Vellore, India
| | - M. J. Paul
- Endocrine Surgery, Christian Medical College, Vellore, India
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Na DG, Baek JH, Sung JY, Kim JH, Kim JK, Choi YJ, Seo H. Thyroid Imaging Reporting and Data System Risk Stratification of Thyroid Nodules: Categorization Based on Solidity and Echogenicity. Thyroid 2016; 26:562-72. [PMID: 26756476 DOI: 10.1089/thy.2015.0460] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although ultrasonography (US) has an essential role in assessing the malignancy risk of thyroid nodules, a malignancy risk-stratification system has not been established. The purpose of this study was to develop a clinically feasible US risk-stratification system--the Thyroid Imaging Reporting and Data System (TIRADS)--primarily based on the solidity and echogenicity of thyroid nodules. METHODS From January 2010 to May 2011, a total of consecutive 2000 thyroid nodules (≥ 1 cm) with final diagnoses were enrolled from the database of low and high cancer volume institutions (1000 nodules from each institution). For the development of TIRADS, the type and predictive value of US predictors in the groups categorized by solidity and echogenicity were analyzed, and the US predictors were integrated and categorized according to the malignancy risk. RESULTS The suspicious US features of microcalcification, taller than wide shape, and spiculated/microlobulated margin were independently predictive of malignancy in the solid or hypoechoic nodule group (p < 0.001, respectively). Meanwhile, only microcalcification was independently predictive of malignancy in the partially cystic nodule group (p = 0.006), and microcalcification and spiculated/microlobulated margin were independently predictive of malignancy in the iso- and hyperechoic nodule group (p = 0.002 and p = 0.015, respectively). Although the presence of any suspicious US features had a high malignancy risk in the group of solid hypoechoic nodules, it had an intermediate malignancy risk in the group of partially cystic or iso- and hyperechoic nodules. The malignancy risk of thyroid nodules was stratified into five TIRADS categories by integrating the type and predictive values of US predictors based on solidity and echogenicity. CONCLUSION The malignancy risk of thyroid nodules can be stratified by TIRADS according to US patterns by combining solidity, echogenicity, and suspicious US features. The proposed risk-stratification system based on solidity and echogenicity will be useful for risk stratification and management decision of thyroid nodules.
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Affiliation(s)
- Dong Gyu Na
- 1 Department of Radiology, Human Medical Imaging and Intervention Center , Seoul, Korea
| | - Jung Hwan Baek
- 2 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Jin Yong Sung
- 3 Departments of Radiology, Thyroid Center , Daerim St. Mary's Hospital, Seoul, Korea
| | - Ji-Hoon Kim
- 4 Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine , Seoul, Korea
| | - Jae Kyun Kim
- 5 Department of Radiology, Chung Ang University Medical Center , Seoul, Korea
| | - Young Jun Choi
- 2 Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hyobin Seo
- 6 Department of Radiology, Gangnam Center, Seoul National University Hospital Healthcare System , Seoul, Korea
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Jang EK, Kim WG, Choi YM, Jeon MJ, Kwon H, Baek JH, Lee JH, Kim TY, Shong YK, Song DE, Kim WB. Association between neck ultrasonographic findings and clinico-pathological features in the follicular variant of papillary thyroid carcinoma. Clin Endocrinol (Oxf) 2015; 83:968-76. [PMID: 25400279 DOI: 10.1111/cen.12674] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 11/05/2014] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The follicular variant of papillary thyroid carcinoma (FVPTC) has multiple histological subtypes. Clinical outcomes of FVPTC are variable depending on the subtypes. This study evaluated the association of pre-operative ultrasonographic (US) findings and clinico-pathological features of FVPTC. PATIENTS This retrospective study enrolled patients with FVPTC (n = 70), size-matched classical variant of papillary thyroid carcinoma (CPTC, n = 328), follicular carcinoma (n = 85) and follicular adenoma (FA, n = 120). We defined the histological subtypes of FVPTC as infiltrative (I-FVPTC; n = 19) or encapsulated (E-FVPTC; n = 51) according to the presence of a fibrous capsule. Pre-operative US was reviewed using a US scoring system and classified into low US score (n = 42) and high US score (n = 28). RESULTS The median US score for FVPTC was lower than CPTC (2 vs 7, P < 0·001), but higher than FA (2 vs 0, P < 0·001). The median US score for I-FVPTC was significantly higher than E-FVPTC (4 vs 2, P = 0·009). I-FVPTC was more likely to be diagnosed as a malignancy or suspicious for malignancy on cytology than E-FVPTC (P = 0·002). The cumulative risks of cervical lymph node (LN) or distant metastasis according to tumour size were significantly higher in I-FVPTC than E-FVPTC (all P < 0·001). The cumulative risks for cervical LN metastasis or capsular invasion according to tumour size were significantly higher in FVPTC with high US score than FVPTC with low US score (P = 0·005, P < 0·001, respectively). CONCLUSIONS Pre-operative US findings of thyroid nodules were associated with not only histological subtypes, but also the clinical behaviour in FVPTC.
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Affiliation(s)
- Eun Kyung Jang
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Mi Choi
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyemi Kwon
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
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Rosário PW, Calsolari MR. What Is the Best Criterion for Repetition of Fine-Needle Aspiration in Thyroid Nodules with Initially Benign Cytology? Thyroid 2015; 25:1115-20. [PMID: 26148539 DOI: 10.1089/thy.2015.0253] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Traditionally, repetition of fine-needle aspiration (FNA) is indicated for thyroid nodules with initially benign cytology if they exhibit growth. The importance of a repetition has also been demonstrated in the case of suspicious ultrasonography (US) findings. Some authors even consider routine repetition of FNA. The objective of this study was to evaluate the best criterion for FNA repetition in thyroid nodules with initially benign cytology. METHODS This was a prospective study. Patients with solid nodules that initially showed a benign cytology were selected. The first group was formed by nodules exhibiting suspicious features on initial US (group A, n = 55). The other group consisted of growing nodules without suspicious US features (group B, n = 82). Nongrowing nodules without suspicious features on initial US were divided into two groups: nodules that became suspicious on US (group C.1, n = 18) and those that continued to be unsuspicious (group C.2, n = 398). RESULTS In group A, the second FNA resulted in the diagnosis of malignancy in 10 cases (18.2%). In group B, malignancy was confirmed in two cases (2.4%). In group C.1, two nodules were confirmed to be malignant (11.1%). No case of carcinoma was observed in group C.2. Considering the sensitivity and number of FNA biopsies necessary for the detection of each false-negative case of the first FNA, the best criterion to repeat FNA was a suspicious initial or subsequent US. The growth of nodules with unsuspicious US findings was of poorly specificity and required a larger number of FNA biopsies to detect one case of malignancy. CONCLUSIONS Ultrasonographic features of the nodule are the best parameter for the indication of FNA repetition in nodules with initially benign cytology, while the growth of nodules with unsuspicious US findings has a poor positive predictive value for malignancy.
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Affiliation(s)
- Pedro Weslley Rosário
- 1 Postgraduate Program, Santa Casa de Belo Horizonte , Minas Gerais, Brazil
- 2 Endocrinology Service, Santa Casa de Belo Horizonte , Minas Gerais, Brazil
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Yoon JH, Kwon HJ, Kim EK, Moon HJ, Kwak JY. The follicular variant of papillary thyroid carcinoma: characteristics of preoperative ultrasonography and cytology. Ultrasonography 2015; 35:47-54. [PMID: 26299354 PMCID: PMC4701373 DOI: 10.14366/usg.15037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The goal of this study was to validate the ultrasonography (US) and cytopathological features that are used in the diagnosis of the follicular variant of papillary thyroid carcinoma (FVPTC) and to characterize the role of BRAF (V600E) mutation analysis in the diagnosis of FVPTC. METHODS From May 2012 to February 2014, 40 thyroid nodules from 40 patients (mean age, 56.2 years; range, 26 to 81 years) diagnosed with FVPTC were included in this study. The US features of the nodules were analyzed and the nodules were classified as probably benign or suspicious for malignancy. Twenty-three thyroid nodules (57.5%) underwent BRAF (V600E) mutation analysis. Clinical information and histopathologic results were obtained by reviewing the medical records of the patients. RESULTS Thirty nodules (75.0%) were classified as suspicious for malignancy, while 10 (25.0%) were classified as probably benign. Seven of the eight nodules (87.5%) with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytology showed suspicious US features, while one of the two nodules (50.0%) with follicular neoplasm cytology presented suspicious US features. Five of the 23 nodules (21.7%) that underwent BRAF (V600E) mutation analysis had positive results, all of which were diagnosed as suspicious for malignancy or malignant based on cytology. None of the nodules with benign, AUS/FLUS, or follicular neoplasm cytology were positive for the BRAF (V600E) mutation. CONCLUSION US features allow nodules to be classified as suspicious for malignancy, and the presence of suspicious US features in nodules with ambiguous cytology may aid in the diagnosis of FVPTC. BRAF (V600E) mutation analysis is of limited value in the diagnosis of FVPTC.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeong Ju Kwon
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea ; Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Jung Moon
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Comparison of the clinicopathological behavior of the follicular variant of papillary thyroid carcinoma and classical papillary thyroid carcinoma: A systematic review and meta-analysis. Mol Clin Oncol 2015; 3:753-764. [PMID: 26171175 DOI: 10.3892/mco.2015.540] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/25/2015] [Indexed: 02/05/2023] Open
Abstract
The follicular variant of papillary thyroid carcinoma (FV-PTC) is the second most common type of papillary thyroid carcinoma (PTC), and it has been increasingly diagnosed in recent years. However, whether FV-PTC behaves differently from classical PTC (C-PTC) remains controversial. To address this controversy, a meta-analysis was performed to determine the potential differences between FV-PTC and C-PTC in their clinicopathological behavior. The relevant published studies between January 1, 2003 and August 31, 2014 were reviewed according to the defined selection criteria using the PubMed database. Review Manager was used to calculate the pooled odds ratio (OR) or the mean difference (MD) with a 95% confidence interval (CI), using a random- or fixed-effect model for all analyses. In total, 112 studies were identified and examined; finally, only 36 studies met the inclusion criteria. In the 36 studies, compared to the clinicopathological behavior of patients with C-PTC, patients with FV-PTC had the following parameters: Similar mean age and similar prevalence of gender, tumor size ≥10 mm, multifocality, capsular invasion, vascular invasion, lymphocytic and/or Hashimoto's thyroiditis, and clinical stage; a larger mean tumor size and higher prevalence of age ≥45 years; and lower prevalence of extrathyroidal extensions, lymph node metastases, BRAF mutation and recurrence. The meta-analysis suggested that patients with FV-PTC have a more favorable clinicopathological behavior and improved prognosis compared to patients with C-PTC. Thus, patients with FV-PTC and C-PTC may be managed differently, and the two types of PTC should be clearly distinguished in future retrospective or prospective studies.
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Shin DY, Lee YK, Kim KJ, Park KH, Hwang S, Park SH, Kim EK, Kwon HJ, Lee EJ. Thyroid cancers with benign-looking sonographic features have different lymph node metastatic risk and histologic subtypes according to nodule size. Endocr Pathol 2014; 25:378-84. [PMID: 25182219 DOI: 10.1007/s12022-014-9327-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A decision to perform fine needle aspiration (FNA) on thyroid nodules mainly depends on sonographic features. We investigated if lymph node metastasis (LNM) risk differed by tumor size of thyroid cancers without suspicious sonographic features. Three hundred sixty patients with thyroid cancers with benign looking sonographic features were grouped by nodule size on ultrasonography (US) (≤ or >1 cm). The clinicopathologic parameters were compared between the groups. A multivariate analysis was performed to discover the independent factors predicting the presence of LNM. The nodules greater than 10 mm on US (n = 157) demonstrated a larger tumor size on histology (17.9 ± 14.5 vs. 5.6 ± 2.4 mm, P < 0.001), a lower frequency of classical papillary thyroid carcinoma (PTC) (58.6 vs. 87.2 %, P < 0.001), and a higher frequency of follicular variant PTC and follicular thyroid carcinoma (19.7 and 17.8 % vs. 9.4 and 1.5 %, respectively, P < 0.01). In subgroup analysis of 269 patients with classical PTC, the larger nodule size on US was associated with a higher prevalence of LNM (28.3 vs. 14.7 %, P = 0.007). A multivariate analysis revealed that classical PTC, extrathyroidal extension, and the US nodule size >10 mm were independent predictive factors of LNM after adjusting for age, sex, TSH level, and multifocality. Thyroid cancers larger than 10 mm with benign US features are more likely to be nonclassical PTC than those with smaller diameters. The larger ones also have an increased risk of LNM in classical PTC. These cases require a more aggressive approach to FNA.
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Affiliation(s)
- Dong Yeob Shin
- Division of Endocrinology and Metabolism, Departments of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
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Girardi FM, Barra MB, Zettler CG. Variants of papillary thyroid carcinoma: association with histopathological prognostic factors. Braz J Otorhinolaryngol 2014; 79:738-44. [PMID: 24474487 PMCID: PMC9442390 DOI: 10.5935/1808-8694.20130135] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/27/2013] [Indexed: 11/20/2022] Open
Abstract
Papillary carcinoma is the most common thyroid malignancy. Many variants of this tumor have been described, with different morphological and molecular characteristics. Although most cases have excellent prognosis, the relationship between tumor architecture and its biological behavior remains controversial. Objective To present the experience of a single center on the prevalence of thyroid papillary carcinoma variants and their relationship with other histopathological prognostic factors. Method Retrospective study of all the cases submitted to thyroidectomy for papillary carcinoma in the same institution over 11 years. Results We included 517 patients, 81.9% of them were women. The average age was 47.2 years. The variants recognized to have higher aggressiveness potential corresponded to 5.6% of the sample. We found an association of tumor subtypes with greater lesion diameter, T staging, lymphovascular and gland capsule invasion. Conclusion A small percentage of papillary carcinoma cases is represented by variants recognized by their greater potential for aggression. There are associations between these variants and several other histopathological factors already recognized for their prognostic value, which may, by themselves, influence the outcome of these cases.
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Affiliation(s)
- Fábio Muradás Girardi
- Irmandade Santa Casa de Misericórdia de Porto Alegre, Hospital Santa Rita, equipe de cirurgia de cabeça e pescoço
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Chai YJ, Kim SJ, Kim SC, Koo DH, Min HS, Lee KE, Kim JH, Youn YK. BRAF mutation in follicular variant of papillary thyroid carcinoma is associated with unfavourable clinicopathological characteristics and malignant features on ultrasonography. Clin Endocrinol (Oxf) 2014; 81:432-9. [PMID: 24548081 DOI: 10.1111/cen.12433] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 01/10/2014] [Accepted: 02/08/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Follicular variant of papillary thyroid carcinoma (FVPTC) is a common variant of papillary thyroid carcinoma (PTC), but the association between BRAF mutation and the clinicopathological and ultrasonographical characteristics of FVPTC has not been well studied. The aim of this study was to determine the significance of BRAF mutation in FVPTC. PATIENTS The medical records of the 137 patients with >5 mm FVPTCs and known BRAF mutation status in the interested nodule were reviewed. BRAF mutation analysis was performed routinely and prospectively by Sanger sequencing. Clinicopathological and ultrasonographical characteristics were compared between BRAF mutation-positive and BRAF mutation-negative groups. RESULTS BRAF mutation was detected in 35 (25·5%) patients. The BRAF mutation-positive group was associated with smaller tumour size (P = 0·022), extrathyroidal extension (P = 0·001), multifocality (P = 0·046) and higher (III/IV) TNM stages (P = 0·005). In multivariable analysis, higher (III/IV) TNM stage was an independent predictive factor for BRAF mutation-positive status (adjusted OR 2·966, 95% CI 1·321-6·663). In diagnosis of FVPTC, the presence of BRAF mutation was associated with malignant features on ultrasonography (P < 0·001) and higher incidence of suspicious for malignancy or malignant diagnosis on the fine needle aspiration cytology (P = 0·023). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US for detecting BRAF mutation were 82·9%, 57·8%, 40·3%, 90·8% and 64·2%, respectively. Conclusions BRAF mutation in FVPTC is associated with unfavourable clinicopathological characteristics and malignant features on ultrasonography and may be a potential prognostic factor as it is in classical PTC.
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Affiliation(s)
- Young Jun Chai
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Yeo MK, Bae JS, Oh WJ, Park GS, Jung CK. Macrofollicular variant of papillary thyroid carcinoma with extensive lymph node metastases. Endocr Pathol 2014; 25:265-72. [PMID: 24671758 DOI: 10.1007/s12022-014-9306-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The macrofollicular variant of papillary thyroid carcinoma is a rare subtype of the follicular variant of papillary thyroid carcinoma and is usually characterized by an indolent clinical course. The tumors are prone to be misdiagnosed as benign due to their macrofollicular architecture and bland cytologic features. We report a rare case of the macrofollicular variant of papillary thyroid carcinoma with extensive lymph node metastases. The patient was a 48-year-old female with a right thyroid nodule and multiple enlarged lymph nodes in the right neck. It was not possible to make a definitive diagnosis of malignancy on fine-needle aspiration cytology and intraoperative frozen section. She underwent total thyroidectomy with right modified radical neck dissection. The surgical specimen showed a 2.5 × 1.5 × 10 cm, well-circumscribed macrofollicular variant of papillary thyroid carcinoma in the right lobe and multiple central and right lateral neck lymph node metastases. Molecular testing for BRAF, NRAS, HRAS, and KRAS was all negative. We then reviewed the demographic and clinicopathologic characteristics of 71 patients with the macrofollicular variant of papillary thyroid carcinoma. The cytologic or histopathologic diagnosis of macrofollicular variant of papillary thyroid carcinoma can be difficult. Extensive lymph node metastases caused by the macrofollicular variant of papillary thyroid carcinoma may occur even in the absence of capsular or lymphovascular invasion. This review will help to better understand the nature of the macrofollicular variant of papillary thyroid carcinoma.
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Affiliation(s)
- Min-kyung Yeo
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 137-701, Republic of Korea
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Guney G, Tezel GG, Kosemehmetoglu K, Yilmaz E, Balci S, Ersoy R, Cakir B, Guler G. Molecular features of follicular variant papillary carcinoma of thyroid: comparison of areas with or without classical nuclear features. Endocr Pathol 2014; 25:241-7. [PMID: 24277231 DOI: 10.1007/s12022-013-9275-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We aimed to compare the genetic background of different areas in follicular variant papillary thyroid carcinomas (FVPTC) with or without classical nuclear changes. Sixteen cases of FVPTC were included in our study. All tumors were well demarcated from surrounding thyroid tissue and had both areas with nuclear features (WNF) and areas without nuclear features (WONF) of papillary carcinoma. DNA is obtained by laser microdissection from WNF and WONF areas of each case. Point mutations for NRAS codon 61, HRAS codon 61, and BRAF were investigated by direct sequencing. In 11 cases, reverse transcription PCR was performed for the presence of PAX8-PPARɣ and RET/PTC1-3 gene rearrangements. Point mutation for NRAS codon 61 was also studied in 15 colloidal nodules. Seven cases (44 %) showed at least one mutation; two cases (13 %) revealed the same mutation in both WNF and WONF areas, while in the rest only WNF areas were mutated. None of the studied 11 cases demonstrated RET/PTC1-3 gene rearrangement and in only one case PAX8-PPARɣ gene rearrangement was found. Six cases (38 %) showed NRAS codon 61 mutation, involving only WNF areas in five cases and both WNF and WONF areas in one case. Neither HRAS codon 61 nor BRAF mutations were present. Fifteen colloidal nodules were also wild type for NRAS codon 61. Our findings suggest that NRAS codon 61 point mutations and PAX8-PPARɣ gene rearrangement play a role in the FVPTC pathogenesis and may be established before the morphological/phenotypical features fully develop.
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Affiliation(s)
- Guven Guney
- Department of Pathology, Hitit University Corum Research and Education Hospital, Çorum, Turkey, 19000,
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Shin DY, Kim KJ, Chang S, Kim H, Hwang S, Kim W, Bae J, Park S, Kang SW, Chung WY, Lee EJ. Follicular variant of papillary thyroid carcinoma with B-type Raf(V600E) showing higher frequency of suspicious sonographic features and multifocality. Head Neck 2014; 37:1590-5. [PMID: 24909403 DOI: 10.1002/hed.23793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/20/2014] [Accepted: 06/04/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the correlation between B-type Raf (BRAF) kinase mutation and clinicopathological features of follicular variant of papillary thyroid carcinoma (PTC). METHODS Eighty-four patients with pathologically confirmed follicular variant of PTC, who underwent a preoperative BRAF(V600E) study, were analyzed. Clinicopathological parameters and ultrasonographic features were compared between the BRAF(V600E) -positive and negative groups. RESULTS A total of 41.7% of the patients showed BRAF(V600E) . The BRAF(V600E) -positive group showed the smaller tumor size (7.3 ± 3.6 mm vs 10.7 ± 8.9 mm; p = .018) and the more frequent multifocality (25.7% vs 8.2%; p = .028). Follicular variant of PTC with BRAF(V600E) showed suspicious ultrasonographic features (88.6% vs 57.1%; p = .002) more frequently. BRAF(V600E) positivity is associated with multifocality after adjusting for age, sex, the presence of suspicious ultrasonographic features, pathological tumor size, and thyrotropin level. CONCLUSION BRAF(V600E) was correlated with smaller tumor size and suspicious ultrasonographic features in follicular variant of PTC. BRAF(V600E) was a significant parameter for predicting multifocality of follicular variant of PTC.
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Affiliation(s)
- Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kwang Joon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Severance Executive Healthcare Clinic, Yonsei University Health System, Seoul, Republic of Korea
| | - Sooyun Chang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sena Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wonjin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jaehyun Bae
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seulkee Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Fujimoto T, Hirokawa M, Ota H, Yabuta T, Fukushima M, Kobayashi K, Amino N, Miyauchi A. Characteristic sonographic features of cribriform papillary thyroid carcinoma for differentiation from other thyroid nodules. J Med Ultrason (2001) 2014; 42:83-7. [PMID: 26578494 DOI: 10.1007/s10396-014-0555-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/28/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this paper is to clarify the sonographic features and differential diagnoses of the cribriform variant of papillary thyroid carcinoma (CV-PTC). METHODS We retrospectively reviewed 24 nodules obtained from 22 CV-PTC cases. As control groups, we chose 50 cases each of conventional papillary carcinoma (C-PTC), follicular tumor, and nodular goiter. RESULTS All of the cases were young women aged 35 years or younger. Serum thyroglobulin levels were normal or slightly elevated. The incidences of smooth or focal jagged margin, hypoechoic nodule, lateral shadow, posterior acoustic enhancement, poor marginal and internal vascularity, and no microcalcification were 100, 100, 91.7, 95.8, 100, and 95.8 %, respectively. The sensitivity and specificity of the requirement were 87.5 and 92.5 %, respectively. Sonographic findings of CV-PTC were similar to those of follicular tumor or nodular goiter rather than C-PTC. CONCLUSION The criteria for suspecting CV-PTC we proposed provided high sensitivity and specificity. We should be aware that the sonographic findings of CV-PTC are similar to those of follicular tumor or nodular goiter rather than C-PTC. Clinical findings including gender, age, and serum thyroglobulin level may provide us with useful information.
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Affiliation(s)
- Tomoko Fujimoto
- Department of Clinical Laboratory, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-Ku, Kobe, Hyogo, 650-0011, Japan.
| | | | - Hisashi Ota
- Department of Clinical Laboratory, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-Ku, Kobe, Hyogo, 650-0011, Japan
| | | | | | | | - Nobuyuki Amino
- Department of Internal Medicine, Kuma Hospital, Kobe, Hyogo, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan
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D M, T M K, Khan DM, Raman R T. Follicular variant of papillary thyroid carcinoma: cytological indicators of diagnostic value. J Clin Diagn Res 2014; 8:46-8. [PMID: 24783078 DOI: 10.7860/jcdr/2014/7477.4103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 01/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is an important investigation in preoperative diagnosis of thyroid lesions. Follicular variant of papillary carcinoma thyroid (FVPTC) is a well defined entity in histopathology, but its diagnosis in FNAC is usually missed and is challenging compared to classic papillary thyroid carcinoma. AIMS The purpose of this study is to retrospectively analyze cytological features in histologically confirmed cases of FVPTC, compare them with literature and document the features that could increase the sensitivity of FNAC diagnosis. MATERIALS AND METHODS Cytological smears from 22 histologically confirmed cases of FVPTC were evaluated for microscopic pattern and nuclear features by two independent pathologists and results compared with previous studies. Statistical analysis was done based on bivariate Pearson's correlation coefficient. RESULTS Among 22 cases 21 were female and one male with age range 21 - 50 years. All patients had a solitary nodule except one with multicentric presentation. Preoperative cytological diagnosis were, classic papillary thyroid carcinoma (PTC); 7, FVPTC; 3, suspicious for PTC; 4, follicular neoplasm; 5 and adenomatous goiter;3. Diagnosis upon cytological review were, FVPTC; 11, classic PTC; 7 , suspicious for PTC; 2, follicular adenoma;1 and adenomatous goiter; 1. CONCLUSION We conclude that cellular smears with features as observed in our case like microfollicular pattern, syncytial clusters, fine powdery chromatin, anisonucleosis and nucleomegaly should alert the pathologist to look carefully for other more specific features like nuclear grooves and nuclear pseudoinclusions. This approach will help in avoiding misdiagnosis of FVPTC and would aid in choosing the right treatment modality.
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Affiliation(s)
- Manimaran D
- Associate Professor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute , Tiruporur, Tamilnadu, India
| | - Karthikeyan T M
- Associate Professor, Department of Pathology, Melmaruvathur Adhiparasakthi Institute of Medical Science and Research , Melmaruvathur, Tamil Nadu, India
| | - Dost Mohamed Khan
- Assistant Professor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute , Tiruporur, Tamilnadu, India
| | - Thulasi Raman R
- Assistant Professor, Department of Pathology, Shri Sathya Sai Medical College and Research Institute , Tiruporur, Tamilnadu, India
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Yoon JH, Kim EK, Youk JH, Moon HJ, Kwak JY. Better understanding in the differentiation of thyroid follicular adenoma, follicular carcinoma, and follicular variant of papillary carcinoma: a retrospective study. Int J Endocrinol 2014; 2014:321595. [PMID: 25309594 PMCID: PMC4189763 DOI: 10.1155/2014/321595] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 09/08/2014] [Indexed: 11/22/2022] Open
Abstract
Background. To evaluate the role of ultrasonography (US), US-guided fine-needle aspiration (USFNA) and intraoperative frozen section (FS) in follicular neoplasm. Methods. US features, USFNA cytology, and FS results were compared based on the pathology results of patients with follicular adenoma (FA), follicular carcinoma (FC), and follicular variant of papillary thyroid carcinoma (FVPTC). Results. FC and FVPTC showed significantly higher rates of suspicious US features (P < 0.05) and positive findings on either US or cytology, 80.0% and 90.7%, compared to FA, 64.5% (P = 0.001). Intraoperative FS showed higher malignant rates in FVPTC and FC (81.8% and 75.0%, resp.), compared to FA (3.8%, P < 0.001). Conclusion. Suspicious US features were more significantly seen in FC and FVPTC compared to FA. Intraoperative FS is useful in the differential diagnosis of these lesions and supplements cytology results of USFNA.
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Affiliation(s)
- Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Hee Jung Moon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea
- *Jin Young Kwak:
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Gupta N, Dasyam AK, Carty SE, Nikiforova MN, Ohori NP, Armstrong M, Yip L, LeBeau SO, McCoy KL, Coyne C, Stang MT, Johnson J, Ferris RL, Seethala R, Nikiforov YE, Hodak SP. RAS mutations in thyroid FNA specimens are highly predictive of predominantly low-risk follicular-pattern cancers. J Clin Endocrinol Metab 2013; 98:E914-22. [PMID: 23539734 PMCID: PMC5393462 DOI: 10.1210/jc.2012-3396] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 02/20/2013] [Indexed: 01/21/2023]
Abstract
INTRODUCTION RAS mutations are common in thyroid tumors and confer a high risk of cancer when detected in fine-needle aspiration (FNA) specimens. Specific characteristics of RAS-positive thyroid cancers are not well described. METHODS From April 2007 to April 2009, 921 consecutive patients undergoing FNA were evaluated prospectively with a panel of molecular markers. Ultrasonographic, cytological, histological, and surgical outcomes were retrospectively assessed. RESULTS Sixty-eight aspirates from 66 patients were positive for RAS mutations including 63 cytologically indeterminate (93%), 3 malignant (4%), and 2 benign (3%) specimens. Cancer was histologically confirmed in 52 of 63 aspirates (83%) including the following: 46 papillary thyroid cancers, 4 follicular thyroid cancers, 1 medullary cancer, and 1 anaplastic cancer. All 46 RAS-positive papillary thyroid cancers, including 1 metastatic cancer, had follicular variant histology papillary thyroid cancer; only 11 tumors demonstrated vascular/capsular invasion and 4 had infiltrative growth. Of 48 patients with differentiated thyroid cancer, lymph node metastasis was uncommon and bilateral cancer was present in 48%. Only 33% of malignant nodules were suspicious by preoperative ultrasonography. At a mean follow-up of 22 months, 31 of 35 differentiated thyroid cancer patients (89%) have no evidence of recurrence, 4 patients (9%) have detectable thyroglobulin, 1 patient has bone metastases, and both patients with medullary and anaplastic cancer have died. CONCLUSION Most RAS-positive thyroid cancers have indeterminate cytology, lack suspicious ultrasound features, and are histologically low-grade follicular variant histology papillary thyroid cancer. Lymph node and distant metastases are uncommon but bilateral disease is frequent. Total thyroidectomy should be considered for initial surgical management of most patients with RAS-positive FNA results. The role of prophylactic lymphadenectomy remains unclear.
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Affiliation(s)
- Nikhil Gupta
- Division of Endocrinology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Takeda M, Mikami T, Numata Y, Okamoto M, Okayasu I. Papillary thyroid carcinoma with heterotopic ossification is a special subtype with extensive progression. Am J Clin Pathol 2013; 139:587-98. [PMID: 23596110 DOI: 10.1309/ajcpqzqn50hkiaha] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
An immunohistochemical study was conducted of 108 papillary carcinoma cases, including 48 cases with intratumoral heterotopic ossification (IHO). In 48 cases, papillary carcinoma with IHO was accompanied by nodular fibrosis. Cases of papillary carcinoma with IHO or nodular fibrosis showed higher incidences of lymph node metastasis, multifocal lesions, and extrathyroidal invasion than those without IHO and nodular fibrosis. A higher number of stromal myofibroblasts was observed in papillary carcinoma with IHO or nodular fibrosis than in that without fibrosis. Expression of both basic fibroblast growth factor (bFGF) and bone morphogenetic protein (BMP)-2 was the highest in papillary carcinoma with IHO. Papillary carcinoma with IHO showed higher vascular invasion and higher numbers of capillaries expressing nestin, which is associated with high expression of vascular endothelial growth factor (VEGF). Papillary carcinoma with IHO is a unique subtype with extensive progression including frequent lymph node metastasis, multifocality, and invasive behavior. Papillary carcinoma with IHO was correlated with expression of bFGF, BMP-2, and VEGF in the carcinoma cells, leading to neovascularization.
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Affiliation(s)
- Masahiko Takeda
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetuo Mikami
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshiko Numata
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Makito Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Isao Okayasu
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
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Ertek S, Yılmaz NC, Cicero AF, Vurupalmaz Ö, Demiröz AS, Erdoğan G. Increasing diagnosis of thyroid papillary carcinoma follicular variant in south-east Anatolian region: comparison of characteristics of classical papillary and follicular variant thyroid cancers. Endocr Pathol 2012; 23:157-60. [PMID: 22711546 DOI: 10.1007/s12022-012-9216-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We aimed to compare ratios of thyroid cancers diagnosed in our regional reference hospital Pathology Center in Sanliurfa city located in southeast Anatolia, and evaluate the characteristics related with follicular variant papillary thyroid carcinoma (FVPTC). We re-evaluated the specimens of last 5 years thyroidectomies by same five pathologists, by same criteria and immunohistochemical evaluation. Chi-square test was used to compare characteristics of classical pure papillary thyroid carcinomas and FVPTC groups. Stepwise multiple regression analysis was used to evaluate the factors related with presence of FVPTC. Among 400 thyroidectomies, there were 105 papillary thyroid carcinoma, 42 of them with pure PTC, and 56 with FVPC, also seven with other variants. There was increase in ratios of FVPTC/PTC between 2010 and 2011 (68.4 vs 76.7%, p < 0.005). Radius, vascular invasion, and extrathyroidal invasion showed statistically significant difference between pure PTC and FVPTC. In regression analysis radius (p = 0.001, OR = 2.611; 95%CI, 2.010-3.391), age (p = 0.018, OR = 0.959; 95%CI, 0.927-0.993), and multicentricity (p = 0.044, OR = 0.403; 95%CI, 0.167-0.975) were related with presence of FVPTC. Besides, further need for studies to understand whether total prevalence of FVPTC is higher in this region, and the related factors, our study showed that the ratio of FVPTC/PTC is higher in our reference hospital. Age of the patients and the radius and multicentricity of the nodules could be alarming factors for us to suspect for FVPTC.
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Affiliation(s)
- Sibel Ertek
- Endocrinology and Metabolic Diseases Department, Turkish Ministry of Health, Şanlıurfa Education and Research Hospital, Esentepe, Şanlıurfa, Turkey.
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