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Luvhengo TE, Bombil I, Mokhtari A, Moeng MS, Demetriou D, Sanders C, Dlamini Z. Multi-Omics and Management of Follicular Carcinoma of the Thyroid. Biomedicines 2023; 11:biomedicines11041217. [PMID: 37189835 DOI: 10.3390/biomedicines11041217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Follicular thyroid carcinoma (FTC) is the second most common cancer of the thyroid gland, accounting for up to 20% of all primary malignant tumors in iodine-replete areas. The diagnostic work-up, staging, risk stratification, management, and follow-up strategies in patients who have FTC are modeled after those of papillary thyroid carcinoma (PTC), even though FTC is more aggressive. FTC has a greater propensity for haematogenous metastasis than PTC. Furthermore, FTC is a phenotypically and genotypically heterogeneous disease. The diagnosis and identification of markers of an aggressive FTC depend on the expertise and thoroughness of pathologists during histopathological analysis. An untreated or metastatic FTC is likely to de-differentiate and become poorly differentiated or undifferentiated and resistant to standard treatment. While thyroid lobectomy is adequate for the treatment of selected patients who have low-risk FTC, it is not advisable for patients whose tumor is larger than 4 cm in diameter or has extensive extra-thyroidal extension. Lobectomy is also not adequate for tumors that have aggressive mutations. Although the prognosis for over 80% of PTC and FTC is good, nearly 20% of the tumors behave aggressively. The introduction of radiomics, pathomics, genomics, transcriptomics, metabolomics, and liquid biopsy have led to improvements in the understanding of tumorigenesis, progression, treatment response, and prognostication of thyroid cancer. The article reviews the challenges that are encountered during the diagnostic work-up, staging, risk stratification, management, and follow-up of patients who have FTC. How the application of multi-omics can strengthen decision-making during the management of follicular carcinoma is also discussed.
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Affiliation(s)
- Thifhelimbilu Emmanuel Luvhengo
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa
| | - Ifongo Bombil
- Department of Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg 1864, South Africa
| | - Arian Mokhtari
- Department of Surgery, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Maeyane Stephens Moeng
- Department of Surgery, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Parktown, Johannesburg 2193, South Africa
| | - Demetra Demetriou
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Hatfield 0028, South Africa
| | - Claire Sanders
- Department of Surgery, Helen Joseph Hospital, University of the Witwatersrand, Auckland Park, Johannesburg 2006, South Africa
| | - Zodwa Dlamini
- SAMRC Precision Oncology Research Unit (PORU), DSI/NRF SARChI Chair in Precision Oncology and Cancer Prevention (POCP), Pan African Cancer Research Institute (PACRI), University of Pretoria, Hatfield 0028, South Africa
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Kamboj M, Mehta A, Pasricha S, Gupta G, Sharma A, Durga G. Cytomorphological categorization of thyroid lesions according to the bethesda system for reporting thyroid cytology and correlation with their histological outcome: An indian oncology centre experience. J Cytol 2022; 39:44-50. [PMID: 35341109 PMCID: PMC8955694 DOI: 10.4103/joc.joc_79_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/17/2021] [Accepted: 01/15/2022] [Indexed: 11/04/2022] Open
Abstract
Objective: Material and Methods: Results: Conclusion:
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Kim K, Jung CK, Lim DJ, Bae JS, Kim JS. Clinical and pathologic features for predicting malignancy in thyroid follicular neoplasms. Gland Surg 2021; 10:50-58. [PMID: 33633961 DOI: 10.21037/gs-20-500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The cytologic findings of follicular neoplasm do not distinguish between benign follicular adenoma and follicular thyroid carcinoma (FTC). The objective of this retrospective study was to identify clinical and cytologic/pathologic features to predict malignancy in patients preoperatively diagnosed with follicular neoplasms. Methods In total, 416 patients with follicular neoplasms who underwent thyroidectomy were reviewed at Seoul St. Mary's Hospital (Seoul, Korea) from January 2010 to June 2018. Clinicopathological features were analyzed retrospectively by complete medical chart review and pathologic slide review. Results Thyroid malignancy/noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was diagnosed in 209 patients (50.2%). In total, 59 patients (14.2%) were diagnosed with FTC, 55 patients (13.3%) were diagnosed with follicular variant papillary thyroid carcinoma (fvPTC). The number of patients with PTC-related nuclear changes was higher in the malignancy/NIFTP group than in the benign group (16.3% vs. 1.9%, P<0.001). Multivariate analysis indicated that the significant risk factors for the diagnosis of malignancy/NIFTP include cytologic or pathologic diagnosis with PTC-related nuclear changes, NRAS mutation, and male sex. Conclusions The prevalence of malignancy in patients with a preoperative diagnosis of follicular neoplasm was much higher in our study than in previous reports. Cytologic or pathologic PTC-related nuclear changes is a useful predictor of the presence of malignancy. Further studies must be conducted to support our results.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, the Catholic University of Korea, Seoul, Korea
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A Novel Nanoproteomic Approach for the Identification of Molecular Targets Associated with Thyroid Tumors. NANOMATERIALS 2020; 10:nano10122370. [PMID: 33260544 PMCID: PMC7761166 DOI: 10.3390/nano10122370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/24/2022]
Abstract
A thyroid nodule is the most common presentation of thyroid cancer; thus, it is extremely important to differentiate benign from malignant nodules. Within malignant lesions, classification of a thyroid tumor is the primary step in the assessment of the prognosis and selection of treatment. Currently, fine-needle aspiration biopsy (FNAB) is the preoperative test most commonly used for the initial thyroid nodule diagnosis. However, due to some limitations of FNAB, different high-throughput “omics” approaches have emerged that could further support diagnosis based on histopathological patterns. In the present work, formalin-fixed paraffin-embedded (FFPE) tissue specimens from normal (non-neoplastic) thyroid (normal controls (NCs)), benign tumors (follicular thyroid adenomas (FTAs)), and some common types of well-differentiated thyroid carcinoma (follicular thyroid carcinomas (FTCs), conventional or classical papillary thyroid carcinomas (CV-PTCs), and the follicular variant of papillary thyroid carcinomas (FV-PTCs)) were analyzed. For the first time, FFPE thyroid samples were deparaffinized using an easy, fast, and non-toxic method. Protein extracts from thyroid tissue samples were analyzed using a nanoparticle-assisted proteomics approach combined with shotgun LC-MS/MS. The differentially regulated proteins found to be specific for the FTA, FTC, CV-PTC, and FV-PTC subtypes were analyzed with the bioinformatic tools STRING and PANTHER showing a profile of proteins implicated in the thyroid cancer metabolic reprogramming, cancer progression, and metastasis. These proteins represent a new source of potential molecular targets related to thyroid tumors.
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Classification of Thyroid Tumors Based on Mass Spectrometry Imaging of Tissue Microarrays; a Single-Pixel Approach. Int J Mol Sci 2020; 21:ijms21176289. [PMID: 32878024 PMCID: PMC7503764 DOI: 10.3390/ijms21176289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 12/29/2022] Open
Abstract
The primary diagnosis of thyroid tumors based on histopathological patterns can be ambiguous in some cases, so proper classification of thyroid diseases might be improved if molecular biomarkers support cytological and histological assessment. In this work, tissue microarrays representative for major types of thyroid malignancies—papillary thyroid cancer (classical and follicular variant), follicular thyroid cancer, anaplastic thyroid cancer, and medullary thyroid cancer—and benign thyroid follicular adenoma and normal thyroid were analyzed by mass spectrometry imaging (MSI), and then different computation approaches were implemented to test the suitability of the registered profiles of tryptic peptides for tumor classification. Molecular similarity among all seven types of thyroid specimens was estimated, and multicomponent classifiers were built for sample classification using individual MSI spectra that corresponded to small clusters of cells. Moreover, MSI components showing the most significant differences in abundance between the compared types of tissues detected and their putative identity were established by annotation with fragments of proteins identified by liquid chromatography-tandem mass spectrometry in corresponding tissue lysates. In general, high accuracy of sample classification was associated with low inter-tissue similarity index and a high number of components with significant differences in abundance between the tissues. Particularly, high molecular similarity was noted between three types of tumors with follicular morphology (adenoma, follicular cancer, and follicular variant of papillary cancer), whose differentiation represented the major classification problem in our dataset. However, low level of the intra-tissue heterogeneity increased the accuracy of classification despite high inter-tissue similarity (which was exemplified by normal thyroid and benign adenoma). We compared classifiers based on all detected MSI components (n = 1536) and the subset of the most abundant components (n = 147). Despite relatively higher contribution of components with significantly different abundance and lower overall inter-tissue similarity in the latter case, the precision of classification was generally higher using all MSI components. Moreover, the classification model based on individual spectra (a single-pixel approach) outperformed the model based on mean spectra of tissue cores. Our result confirmed the high feasibility of MSI-based approaches to multi-class detection of cancer types and proved the good performance of sample classification based on individual spectra (molecular image pixels) that overcame problems related to small amounts of heterogeneous material, which limit the applicability of classical proteomics.
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Sohn SY, Lee JJ, Lee JH. Molecular Profile and Clinicopathologic Features of Follicular Variant Papillary Thyroid Carcinoma. Pathol Oncol Res 2019; 26:927-936. [DOI: 10.1007/s12253-019-00639-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 03/11/2019] [Indexed: 12/30/2022]
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Trabzonlu L, Paksoy N. Cytomorphological Analysis of Thyroid Nodules Diagnosed as Follicular Variant of Papillary Thyroid Carcinoma: a Fine Needle Aspiration Study of Diagnostic Clues in 42 Cases and the Impact of Using Bethesda System in Reporting-an Institutional Experience. Endocr Pathol 2018; 29:351-356. [PMID: 30315491 DOI: 10.1007/s12022-018-9550-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common subtype of papillary thyroid carcinoma (PTC) after classical PTC (cPTC). Follicular thyroid lesions such as follicular adenomas/carcinomas, FVPTC, and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) pose some diagnostic challenges for FNAC. In this study, we aimed to explore whether FNAC can demonstrate diagnostic clues by re-evaluating cytology slides from histopathologically diagnosed FVPTC cases. A total of 42 patients were enrolled in this study: patients were diagnosed with FVPTC via surgical resection between 2006 and 2016, and all patients were subjected to preoperative FNAC, which was conducted at either a private center or at the teaching hospital of Kocaeli University and reported by the same cytopathologist (NP). Clinical and cytomorphological characteristics were reviewed by both authors .Most cases (76.2%) are diagnosed either Bethesda IV or V. The majority of cases had a high cellularity (38/42; 90.5%), and the most frequent observations were monolayer and large syncytial groups of cells (95.2%). While microfollicular structures were observed in 30 (71.4%) cases, nuclear crowding and large naked nuclei were observed in all cases. Nuclear grooves were sparsely detected in 23 (54.8%) cases, and nuclear pseudoinclusions were detected in only six (14.3%) cases. Because thyrocytes often have a mixed architecture in FVPTC, despite a distinct follicular morphology, we believe that nuclear overcrowding, enlargement, and hyperchromasia in cases presenting with increased cellularity are notable clues for the cytodiagnosis of FVPTC. We believe that the primary aim of FNAC in such cases is to give preoperative diagnosis as either category IV or V. Nuclear crowding, monolayered clusters with large syncytial formations, nuclear enlargement, and hyperchromasia are notable cytomorphologic clues for the diagnosis of FVPTC on FNAC.
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Affiliation(s)
- Levent Trabzonlu
- Department of Pathology, Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
- Pathology Department, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nadir Paksoy
- Department of Pathology, Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey.
- Dr Paksoy's Private Cytopathology/FNA Practice, Hurriyet Cad. Safak Apt. 125/17, 41300, Izmit, Kocaeli, Turkey.
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Gawin M, Wojakowska A, Pietrowska M, Marczak Ł, Chekan M, Jelonek K, Lange D, Jaksik R, Gruca A, Widłak P. Proteome profiles of different types of thyroid cancers. Mol Cell Endocrinol 2018; 472:68-79. [PMID: 29183805 DOI: 10.1016/j.mce.2017.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/20/2017] [Accepted: 11/23/2017] [Indexed: 12/21/2022]
Abstract
Proteomics profiling of tissue specimens representative for major types of thyroid cancers: papillary (classical and follicular variant), follicular, anaplastic and medullary, as well as benign follicular adenoma, was performed using shotgun LC-MS/MS approaches. A combination of Orbitrap and MALDI-TOF approach allowed to identify protein products of 3700 unique genes and revealed large differences between medullary, anaplastic and epithelium-derived differentiated cancers (papillary and follicular). Proteins characteristic for medullary and anaplastic cancers included factors associated with neuroendocrine functions and factors typically associated with advanced malignancies, respectively. Proteomes of different types of epithelium-derived differentiated cancers and follicular adenoma were compared using multi-enzyme LC-MS/MS approach, which revealed products of 4800 unique genes. A comparable overall similarity of follicular cancers to both variants of papillary cancers was found. Moreover, follicular adenoma showed higher overall similarity to follicular cancer than to either variant of papillary cancer. Proteins discriminating differentiated thyroid neoplasms included factors associated with lipid and hormone metabolism, regulation of gene expression and maintenance of DNA structure. Importantly, proteome data matched several features of transcriptome and metabolome profiles of thyroid cancers contributing to systems biology of this malignancy.
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Affiliation(s)
- Marta Gawin
- Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland
| | - Anna Wojakowska
- Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland
| | - Monika Pietrowska
- Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland
| | - Łukasz Marczak
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, ul. Noskowskiego 12/14, 61-704 Poznań, Poland
| | - Mykola Chekan
- Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland
| | - Karol Jelonek
- Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland
| | - Dariusz Lange
- Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland
| | - Roman Jaksik
- Institute of Automatic Control, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44-100 Gliwice, Poland
| | - Aleksandra Gruca
- Institute of Informatics, Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44-100 Gliwice, Poland
| | - Piotr Widłak
- Maria Sklodowska-Curie Institute - Oncology Center, Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
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Mariani RA, Kadakia R, Arva NC. Noninvasive encapsulated follicular variant of papillary thyroid carcinoma: Should it also be reclassified in children? Pediatr Blood Cancer 2018; 65:e26966. [PMID: 29380524 DOI: 10.1002/pbc.26966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/12/2017] [Accepted: 12/16/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Noninvasive encapsulated follicular variant of papillary thyroid carcinoma (noniEFVPTC) has low risk of adverse outcome in adults, warranting reclassification as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). In children, thyroid nodules have higher risk of malignancy and it is unknown if encapsulated FVPTC (EFVPTC) and infiltrative FVPTC (IFVPTC) tumors have different behavior. We analyzed the clinicopathologic features of follicular variant of papillary thyroid carcinoma (FVPTC) subtypes in our pediatric population to determine if noniEFVPTC has an indolent course as reported in adults. PROCEDURE We retrospectively studied all patients diagnosed with FVPTC at our institution. The clinicopathologic characteristics of the histologic subtypes were compared. RESULTS Eighteen patients were identified, all treated with total thyroidectomy. No significant differences in age, sex, tumor size, focality, or prior malignancy were detected between subtypes. Extrathyroidal extension had significantly higher incidence in IFVPTC (5/8) compared with EFVPTC (1/10, P = 0.03), translating in significantly more T3 tumors within IFVPTC subtype (5/8), whereas most EFVPTC cases had T1 staging (6/10, T1 vs. T3, P = 0.05). EFVPTC had significantly lower rate of lymph node involvement (N1 in 2/8) compared with IFVPTC (N1 in 8/8, P = 0.003). Only one patient diagnosed with IFVPTC developed extranodal recurrence. When noniEFVPTC and iEFVPTC were separately compared, the noninvasive form showed no propensity for invasive growth (T3 staging: 0/4 vs. 2/6), lymph node metastasis (N1: 0/3 vs. 2/5) or extranodal recurrence. CONCLUSION In children, noniEFVPTC/NIFTP has indolent behavior, warranting consideration of less aggressive management, similar to adults.
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Affiliation(s)
- Rachel A Mariani
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Rachel Kadakia
- Division of Endocrinology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nicoleta C Arva
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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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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Kim MJ, Won JK, Jung KC, Kim JH, Cho SW, Park DJ, Park YJ. Clinical Characteristics of Subtypes of Follicular Variant Papillary Thyroid Carcinoma. Thyroid 2018; 28:311-318. [PMID: 29343212 DOI: 10.1089/thy.2016.0671] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Among follicular variant papillary thyroid carcinomas (FVPTCs), the noninvasive encapsulated subtype has an excellent prognosis. For this reason, reclassification of noninvasive encapsulated FVPTC (EFVPTC) as a new entity called "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) has been proposed, but controversy remains. To characterize noninvasive EFVPTC in an Asian population, the clinicopathologic features of each FVPTC subtype were compared in a Korean population. METHODS FVPTC patients (n = 142) who underwent thyroidectomy between 2009 and 2014, and whose tumor size was >1 cm, were included in the study. The surgical pathology of each patient was reevaluated by two independent expert pathologists. RESULTS The percentages of noninvasive and invasive EFVPTC and infiltrative FVPTC (IFVPTC) in the study were 30%, 31%, and 39%, respectively. There was no difference in preoperative cytological diagnosis or the extent of surgery between noninvasive and invasive EFVPTC. However, the proportion of Bethesda category IV was lower in IFVPTC (16%) than in noninvasive and invasive EFVPTC (35% and 36%, respectively). Therefore, thyroid lobectomy was more common in noninvasive or invasive EFVPTC (54% or 48%, respectively) than in IFVPTC (16%). Noninvasive EFVPTC showed lower multiplicity, extrathyroidal extension, and BRAFV600E mutation frequency (three cases; 8%) than did invasive EFVPTC, but other pathological characteristics were similar. However, IFVPTC showed significant differences in tumor size, extrathyroidal extension, lymph node metastasis, Tumor Node Metastasis stage, and American Thyroid Association high-risk category compared with noninvasive and invasive EFVPTC. In the noninvasive EFVPTC group, there were six (14%) cases with multifocality and three (7%) cases with lymph node metastasis. However, only two cases with multifocality and one case with lymph node metastasis originated from noninvasive FVPTC, while the other cases were from coexisting conventional PTCs. CONCLUSIONS Noninvasive EFVPTC has favorable pathological features, but lymph node metastasis or BRAFV600E mutations were observed in some patients. Therefore, in order for the distinction between noninvasive EFVPTC and invasive EFVPTC to have more clinical significance, the criteria for NIFTP need to be more strictly revised.
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Affiliation(s)
- Min Joo Kim
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Jae-Kyung Won
- 2 Department of Pathology, Seoul National University Hospital and College of Medicine , Seoul, Republic of Korea
| | - Kyeong Cheon Jung
- 2 Department of Pathology, Seoul National University Hospital and College of Medicine , Seoul, Republic of Korea
| | - Ji-Hoon Kim
- 3 Department of Radiology, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Sun Wook Cho
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Do Joon Park
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
| | - Young Joo Park
- 1 Department of Internal Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea
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Rossi ED, Mehrotra S, Kilic AI, Toslak IE, Lim-Dunham J, Martini M, Fadda G, Lombardi CP, Larocca LM, Barkan GA. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features in the pediatric age group. Cancer Cytopathol 2017; 126:27-35. [PMID: 29024469 DOI: 10.1002/cncy.21933] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The most common malignant thyroid neoplasm in children is papillary thyroid carcinoma (PTC). In 2015, the Endocrine Pathology Society introduced the terminology "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) to replace the noninvasive follicular variant of PTC. The objective of the current study was to evaluate previously diagnosed PTC in the pediatric population, reappraise it for NIFTP, and discuss the impact of NIFTP on the risk of malignancy (ROM) for each The Bethesda System for Reporting Thyroid Cytopathology category in the pediatric population. METHODS The electronic databases of both study institutions were searched for all thyroidectomy specimens in patients aged <19 years from June 1, 2001 through June 1, 2016. The patient's age, sex, diagnosis, previous fine-needle aspiration cytology diagnosis, and follow-up were tabulated. Slides for available cases were reviewed and cases qualifying as NIFTP were separated. RESULTS The cohort included 101 resected nodules; cytological diagnoses were available for 95 cases. These cases included diagnoses of nondiagnostic (5 cases; 5.2%), benign (21 cases; 22.1%), atypia/follicular lesion of undetermined significance (9 cases; 9.5%), follicular neoplasm/suspicious for follicular neoplasm (FN/SFN) (25 cases; 26.3%), suspicious for malignancy (7 cases; 7.4%), and malignant (28 cases; 29.5%). On the histological follow-up, 50 cases (49.5%) were benign, 49 cases (48.5%) were malignant, and 2 cases (1.9%) were NIFTP. These NIFTP cases originally were diagnosed as FNs on fine-needle aspiration cytology. The average ROM for FNs with and without NIFTPs was 28% and 25%, respectively CONCLUSIONS: According to our rate of 1.9% for NIFTPs on reappraisal for resected nodules, this entity is likely to be less frequent in the pediatric population due to the higher prevalence of PTCs and/or more aggressive variants. NIFTPs do not appear to affect the ROM for The Bethesda System for Reporting Thyroid Cytopathology categories in the pediatric population. However, large-scale studies are necessary to determine whether NIFTPs could affect the pediatric population. Cancer Cytopathol 2018;126:27-35. © 2017 American Cancer Society.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, "Agostino Gemelli" School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Swati Mehrotra
- Department of Pathology, Loyola University School of Medicine, Maywood, Illinois
| | - Ayse Irem Kilic
- Department of Pathology, Loyola University School of Medicine, Maywood, Illinois
| | - Iclal Erdem Toslak
- Department of Radiology, Loyola University School of Medicine, Maywood, Illinois
| | - Jennifer Lim-Dunham
- Department of Radiology, Loyola University School of Medicine, Maywood, Illinois
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, "Agostino Gemelli" School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, "Agostino Gemelli" School of Medicine, Catholic University of the Sacred Heart, Rome, Italy.,Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, "Agostino Gemelli" School of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Güliz A Barkan
- Department of Pathology, Loyola University School of Medicine, Maywood, Illinois
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Zhou H, Baloch ZW, Nayar R, Bizzarro T, Fadda G, Adhikari-Guragain D, Hatem J, Larocca LM, Samolczyk J, Slade J, Rossi ED. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP): Implications for the risk of malignancy (ROM) in the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Cancer Cytopathol 2017; 126:20-26. [DOI: 10.1002/cncy.21926] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Haijun Zhou
- Department of Pathology; Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital; Chicago Illinois
| | - Zubair W. Baloch
- Department of Pathology; Hospital of University of Pennsylvania; Philadelphia Pennsylvania
| | - Ritu Nayar
- Department of Pathology; Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital; Chicago Illinois
| | - Tommaso Bizzarro
- Department of Anatomic Pathology and Histology, “A. Gemelli” University Polyclinic Foundation; University Rome; Italy
| | - Guido Fadda
- Department of Anatomic Pathology and Histology, “A. Gemelli” University Polyclinic Foundation; University Rome; Italy
| | | | - Joseph Hatem
- Department of Pathology; Hospital of University of Pennsylvania; Philadelphia Pennsylvania
| | - Luigi M. Larocca
- Department of Anatomic Pathology and Histology, “A. Gemelli” University Polyclinic Foundation; University Rome; Italy
| | - Julia Samolczyk
- Department of Pathology; Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital; Chicago Illinois
| | - Jamie Slade
- Department of Pathology; Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital; Chicago Illinois
| | - Esther Diana Rossi
- Department of Anatomic Pathology and Histology, “A. Gemelli” University Polyclinic Foundation; University Rome; Italy
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14
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Chandler JB, Colunga M, Prasad ML, Callender GG, Quinn C, Chhieng D, Adeniran AJ. Identification of distinct cytomorphologic features in the diagnosis of NIFTP at the time of preoperative FNA: Implications for patient management. Cancer Cytopathol 2017; 125:865-875. [PMID: 28834409 DOI: 10.1002/cncy.21910] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND A major reclassification occurred with the redesignation of noninvasive encapsulated follicular variant of papillary thyroid carcinoma as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) due to its indolent nature. The aim of this study was to determine whether distinct cytomorphologic features could be identified on preoperative fine-needle aspiration (FNA) when NIFTP cases were compared with invasive follicular variant of papillary thyroid carcinoma (FVPTC) subtypes. METHODS Thyroid resection cases with the diagnosis of FVPTC from 2012 to 2016 were reclassified as NIFTP, invasive encapsulated follicular variant of papillary thyroid carcinoma (IEFVPTC), and invasive FVPTC subtypes. Corresponding FNA specimens were retrieved and retrospectively reviewed. A univariate analysis using Fisher's exact test was performed to determine any differences in the frequencies of various cytomorphologic features among NIFTP, IEFVPTC, and FVPTC cases. A multivariate analysis was performed to identify any independent salient features that would be helpful in differentiating NIFTP from its invasive counterparts. RESULTS The study population consisted of 93 cases, including 51 cases of NIFTP, 21 cases of IEFVPTC, and 21 cases of infiltrative FVPTC. Demographics such as age, sex, and tumor size were comparable across the 3 groups. A predominantly microfollicular pattern, an absence of nuclear pseudo-inclusions, and less frequent nuclear elongations and grooves were significantly more likely to be associated with NIFTP versus its invasive counterparts. The absence of nuclear pseudo-inclusions and the presence of a microfollicular pattern were the only independent predictors of a NIFTP diagnosis. CONCLUSIONS This study demonstrates that NIFTP cases have distinguishing cytomorphologic characteristics in comparison with invasive FVPTC cases. Therefore, a preoperative cytologic evaluation provides clues that can aid in the distinction between NIFTP and its invasive counterparts. Cancer Cytopathol 2017;125:865-75. © 2017 American Cancer Society.
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Affiliation(s)
- Jocelyn B Chandler
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | | | - Manju L Prasad
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | | | - Courtney Quinn
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - David Chhieng
- Department of Pathology, University of Washington, Seattle, Washington
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15
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Singh R, Avila J, Jo K, Nguyen KTK, Carrillo NR, Huang EC, Campbell MJ. Patients with Non-invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features are Unlikely to have Malignant Preoperative Cytology. Ann Surg Oncol 2017; 24:3300-3305. [DOI: 10.1245/s10434-017-6038-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 12/12/2022]
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16
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Rossi ED, Martini M. New Insight in a New Entity: NIFTPS and Valuable Role of Ancillary Techniques. The Role of PD-L1. EBioMedicine 2017; 18:11-12. [PMID: 28363611 PMCID: PMC5405177 DOI: 10.1016/j.ebiom.2017.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 03/25/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Esther Diana Rossi
- Division of Pathology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - Maurizio Martini
- Division of Pathology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy.
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17
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Elsayed A, Murdoch C, Murray S, Bashir K. Can thyroid surgery be decided based on ultrasonographic findings, irrespective of cytopathological findings? Five-year retrospective study in a district general hospital. Clin Radiol 2017; 72:170-174. [DOI: 10.1016/j.crad.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 11/17/2022]
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18
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Sullivan MC, Graham PH, Alexander EK, Ruan DT, Nehs MA, Gawande AA, Moore FD, Howitt BE, Strickland KC, Krane JF, Barletta JA, Cho NL. Prevalence of Contralateral Tumors in Patients with Follicular Variant of Papillary Thyroid Cancer. J Am Coll Surg 2016; 224:1021-1027. [PMID: 28017809 DOI: 10.1016/j.jamcollsurg.2016.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Thyroid lobectomy alone is being performed increasingly for patients with encapsulated follicular variant of papillary thyroid carcinoma (fvPTC). However, the prevalence of contralateral disease in these patients is unknown. We investigated the presence of synchronous disease in fvPTC to improve decision making about the extent of surgical resection and need for surveillance. STUDY DESIGN We performed a retrospective review of patients who underwent thyroid surgery from October 2009 to February 2013 with a diagnosis of fvPTC as their primary lesion. We collected information on patient demographics, nodule size, multifocality, fine-needle aspiration results, lymphovascular invasion, extrathyroidal extension, and lymph node metastasis. Tumors were divided into noninvasive and invasive/infiltrative fvPTC categories. Characteristics of solitary and bilateral fvPTC were compared. RESULTS We identified 124 patients with final pathology demonstrating fvPTC. The most common fine-needle aspiration diagnosis was "suspicious for malignancy" (n = 53). Sixty-five contralateral tumors were identified in 44 of 124 patients (35.5%) and included fvPTC (n = 40), classical PTC (n = 22), tall cell PTC (n = 2), and follicular carcinoma (n = 1). Fifty contralateral tumors were 1 to 5 mm, 10 measured 6 to 9 mm, and 5 were ≥10 mm. Contralateral disease correlated significantly with lymphovascular invasion (p = 0.037) and larger primary lesions (p = 0.020). There was no significant difference noted in extrathyroidal extension or lymph node metastasis. Both noninvasive and invasive/infiltrative fvPTC demonstrated similar rates of contralateral disease. CONCLUSIONS Bilateral disease is common in fvPTC, primarily in the form of papillary microcarcinomas. Future monitoring of the contralateral lobe should be discussed with fvPTC patients who do not undergo completion thyroidectomy.
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Affiliation(s)
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erik K Alexander
- Department of Medicine, Thyroid Unit, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA
| | - Daniel T Ruan
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA.
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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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20
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Pietrowska M, Diehl HC, Mrukwa G, Kalinowska-Herok M, Gawin M, Chekan M, Elm J, Drazek G, Krawczyk A, Lange D, Meyer HE, Polanska J, Henkel C, Widlak P. Molecular profiles of thyroid cancer subtypes: Classification based on features of tissue revealed by mass spectrometry imaging. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2016; 1865:837-845. [PMID: 27760391 DOI: 10.1016/j.bbapap.2016.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/07/2016] [Accepted: 10/11/2016] [Indexed: 02/08/2023]
Abstract
Determination of the specific type of thyroid cancer is crucial for the prognosis and selection of treatment of this malignancy. However, in some cases appropriate classification is not possible based on histopathological features only, and it might be supported by molecular biomarkers. Here we aimed to characterize molecular profiles of different thyroid malignancies using mass spectrometry imaging (MSI) which enables the direct annotation of molecular features with morphological pictures of an analyzed tissue. Fifteen formalin-fixed paraffin-embedded tissue specimens corresponding to five major types of thyroid cancer were analyzed by MALDI-MSI after in-situ trypsin digestion, and the possibility of classification based on the results of unsupervised segmentation of MALDI images was tested. Novel method of semi-supervised detection of the cancer region of interest (ROI) was implemented. We found strong separation of medullary cancer from malignancies derived from thyroid epithelium, and separation of anaplastic cancer from differentiated cancers. Reliable classification of medullary and anaplastic cancers using an approach based on automated detection of cancer ROI was validated with independent samples. Moreover, extraction of spectra from tumor areas allowed the detection of molecular components that differentiated follicular cancer and two variants of papillary cancer (classical and follicular). We concluded that MALDI-MSI approach is a promising strategy in the search for biomarkers supporting classification of thyroid malignant tumors. This article is part of a Special Issue entitled: MALDI Imaging, edited by Dr. Corinna Henkel and Prof. Peter Hoffmann.
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Affiliation(s)
- Monika Pietrowska
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44101 Gliwice, Poland
| | - Hanna C Diehl
- Medizinisches Proteom-Center, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Grzegorz Mrukwa
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44100 Gliwice, Poland
| | - Magdalena Kalinowska-Herok
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44101 Gliwice, Poland
| | - Marta Gawin
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44101 Gliwice, Poland
| | - Mykola Chekan
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44101 Gliwice, Poland
| | - Julian Elm
- Medizinisches Proteom-Center, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Grzegorz Drazek
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44100 Gliwice, Poland
| | - Anna Krawczyk
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44100 Gliwice, Poland
| | - Dariusz Lange
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44101 Gliwice, Poland
| | - Helmut E Meyer
- Medizinisches Proteom-Center, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany; Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Bunsen-Kirchhoff-Straße 11, 44139 Dortmund, Germany
| | - Joanna Polanska
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, ul. Akademicka 16, 44100 Gliwice, Poland.
| | - Corinna Henkel
- Medizinisches Proteom-Center, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany; Leibniz-Institut für Analytische Wissenschaften - ISAS - e.V., Bunsen-Kirchhoff-Straße 11, 44139 Dortmund, Germany.
| | - Piotr Widlak
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, ul. Wybrzeze Armii Krajowej 15, 44101 Gliwice, Poland.
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21
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Strickland KC, Vivero M, Jo VY, Lowe AC, Hollowell M, Qian X, Wieczorek TJ, French CA, Teot LA, Sadow PM, Alexander EK, Cibas ES, Barletta JA, Krane JF. Preoperative Cytologic Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: A Prospective Analysis. Thyroid 2016; 26:1466-1471. [PMID: 27457786 DOI: 10.1089/thy.2016.0280] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The term noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been proposed to replace noninvasive follicular variant of papillary thyroid carcinoma (FVPTC) in recognition of the indolent behavior of this tumor. The ability to differentiate NIFTP from classical papillary thyroid carcinoma (cPTC) by fine-needle aspiration (FNA) would facilitate conservative management for NIFTP. The aim of this study was to determine if NIFTP can be distinguished prospectively from cPTC. METHODS From June 2015 to January 2016, thyroid FNAs with a diagnosis of "malignant" or "suspicious for malignancy" were prospectively scored for features associated with NIFTP/FVPTC (microfollicular architecture) or cPTC (papillae, psammomatous calcifications, sheet-like architecture, and nuclear pseudoinclusions) and categorized as NIFTP/FVPTC, cPTC, or indeterminate. Results were correlated with subsequent histologic diagnoses. RESULTS The study included 52 patients with 56 resected nodules with a cytologic diagnosis of "malignant" (43/56) or "suspicious for malignancy" (13/56). Forty-nine patients (94%) underwent initial total thyroidectomy. Histopathologic diagnoses included 42 cPTC, 8 NIFTP, 3 invasive FVPTC, 2 follicular adenomas, and 1 poorly differentiated carcinoma. Excluding 7 indeterminate cases, 89% (8/9) of nodules classified as NIFTP/FVPTC on FNA demonstrated follicular-patterned lesions on histology (5 NIFTP, 1 invasive FVPTC, 2 follicular adenomas). Cytopathologists prospectively identified cPTC in 95% (38/40) of cases. CONCLUSIONS In thyroid FNAs with cytologic features concerning for PTC, NIFTP/FVPTC can be distinguished from cPTC in most cases by assessing a limited number of features. Therefore, it is both feasible and appropriate to attempt to separate NIFTP/FVPTC from cPTC on FNA to promote appropriate clinical management.
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Affiliation(s)
- Kyle C Strickland
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Marina Vivero
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Vickie Y Jo
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Alarice C Lowe
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Monica Hollowell
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Xiaohua Qian
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Tad J Wieczorek
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Christopher A French
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Lisa A Teot
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Peter M Sadow
- 2 Department of Pathology, Massachusetts General Hospital , Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- 3 Department of Medicine, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F Krane
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
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22
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Bizzarro T, Martini M, Capodimonti S, Straccia P, Lombardi CP, Pontecorvi A, Larocca LM, Rossi ED. Young investigator challenge: The morphologic analysis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on liquid-based cytology: Some insights into their identification. Cancer Cytopathol 2016; 124:699-710. [DOI: 10.1002/cncy.21777] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/22/2016] [Accepted: 08/08/2016] [Indexed: 01/21/2023]
Affiliation(s)
- Tommaso Bizzarro
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Sara Capodimonti
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Celestino Pio Lombardi
- Department of Endocrine Surgery; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Alfredo Pontecorvi
- Department of Endocrinology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology; Catholic University of the Sacred Heart, “Agostino Gemelli” School of Medicine; Rome Italy
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23
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Krane JF, Alexander EK, Cibas ES, Barletta JA. Coming to terms with NIFTP: A provisional approach for cytologists. Cancer Cytopathol 2016; 124:767-772. [DOI: 10.1002/cncy.21769] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Jeffrey F. Krane
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Erik K. Alexander
- Department of Medicine; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Edmund S. Cibas
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Justine A. Barletta
- Department of Pathology; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
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Wong KS, Angell TE, Strickland KC, Alexander EK, Cibas ES, Krane JF, Barletta JA. Noninvasive Follicular Variant of Papillary Thyroid Carcinoma and the Afirma Gene-Expression Classifier. Thyroid 2016; 26:911-5. [PMID: 27219469 DOI: 10.1089/thy.2015.0644] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is now recognized that noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) is a distinct subset of FVPTC with an exceedingly indolent clinical course. The Afirma gene-expression classifier (GEC) helps guide clinicians in the management of thyroid nodules with indeterminate fine-needle aspiration (FNA) results. Thyroid surgery is recommended for nodules with a suspicious Afirma result, whereas observation is deemed reasonable for most nodules with a benign result. The aim of this study was to confirm that the Afirma test detects NFVPTCs and to determine how many carcinomas detected by the Afirma GEC represent NFVPTCs. METHODS From a database of 249 FNAs sent for Afirma testing between January 2012 and October 2014, a search was conducted for cases with a preceding FNA diagnosis of atypia/follicular lesion of undetermined significance (AUS/FLUS) or suspicious for a follicular neoplasm (SFN), a suspicious Afirma result, and a corresponding resection specimen reviewed at Brigham and Women's Hospital. The diagnoses of the prior FNAs and subsequent resection specimens were recorded. Slides for all resection specimens with a diagnosis of FVPTC were reviewed to identify NFVPTCs. RESULTS Sixty-three cases met the inclusion criteria. The preceding FNA diagnosis was AUS/FLUS in 34 (54%) cases and SFN in 29 (46%) cases. The surgical resection specimen demonstrated 16 (25%) FVPTCs, five (8%) follicular thyroid carcinomas, one (2%) classical type PTC, and 41 (65%) benign tumors/nodules. Of the 16 FVPTCs, 14 (88%) were NFVPTCs. Thus, NFVPTCs accounted for 64% of the carcinomas in the cohort. CONCLUSION These results indicate that the Afirma GEC detects NFVPTCs and that many of the carcinomas detected by Afirma are NFVPTCs. While all care should be individualized and include clinical and sonographic assessment, these results suggest lobectomy as opposed to total thyroidectomy should be considered for nodules with a preceding AUS/FLUS or SFN on cytology and a suspicious Afirma result.
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Affiliation(s)
- Kristine S Wong
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Trevor E Angell
- 2 Division of Endocrinology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Kyle C Strickland
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- 2 Division of Endocrinology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Jeffrey F Krane
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | - Justine A Barletta
- 1 Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
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Fazeli R, VandenBussche CJ, Bishop JA, Ali SZ. Cytological Diagnosis of Follicular Variant of Papillary Thyroid Carcinoma before and after the Bethesda System for Reporting Thyroid Cytopathology. Acta Cytol 2016; 60:14-8. [PMID: 27007511 DOI: 10.1159/000444669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/05/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The follicular variant of papillary thyroid carcinoma (FVPTC) is the second most common subtype of papillary carcinoma after the classical variant. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been introduced to standardize the practice of thyroid fine needle aspiration (FNA) reporting. We evaluated the impact of TBSRTC on the FNA interpretation of histologically proven FVPTCs. METHOD Cytology reports of 455 histologically proven FVPTCs were reviewed. The rate of each TBSRTC category was compared between pre- and post-TBSRTC eras. RESULTS The distribution of FNA diagnoses for pre-TBSRTC cases included suspicious for follicular neoplasm (SFN; n = 51, 28.7%), papillary thyroid carcinoma (PTC; n = 47, 26.4%), suspicious for malignancy (SFM; n = 32, 18%), atypia of undetermined significance (AUS; n = 23, 13%), benign (n = 18, 10.1%), and nondiagnostic (ND; n = 7, 4%). Post-TBSRTC diagnoses were: AUS (n = 68, 24.6%), PTC (n = 64, 23.1%), SFM (n = 50, 18%), SFN and benign (n = 42, 15.2%) and ND (n = 11, 4%). SFN rate decreased significantly from 28.7 to 15.2% (p = 0.001) and AUS increased from 12.9 to 24.5% (p = 0.003). CONCLUSION Following implementation of TBSRTC, the frequency of AUS diagnoses on FNA prior to surgical resection increased. Given that the rate of FVPTC diagnoses on thyroidectomy increased over the same period, this suggests that the use of AUS has resulted in greater surgical resection of FVPTC.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adult
- Biopsy, Fine-Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/pathology
- Cytodiagnosis/methods
- Cytodiagnosis/standards
- Cytodiagnosis/statistics & numerical data
- Diagnosis, Differential
- Female
- Humans
- Male
- Middle Aged
- Practice Guidelines as Topic/standards
- Reproducibility of Results
- Sensitivity and Specificity
- Thyroid Gland/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Roghayeh Fazeli
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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26
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Gill KS, Tassone P, Hamilton J, Hjelm N, Luginbuhl A, Cognetti D, Tuluc M, Martinez-Outschoorn U, Johnson JM, Curry JM. Thyroid Cancer Metabolism: A Review. JOURNAL OF THYROID DISORDERS & THERAPY 2016; 5:200. [PMID: 27213120 PMCID: PMC4874252 DOI: 10.4172/2167-7948.1000200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Metabolic dysregulation within the tumor microenvironment (TME) is critical to the process of tumorigenesis in various cancer types. Thyrocyte metabolism in papillary and anaplastic thyroid cancer, however, remains poorly characterized, and studies analyzing the role of multicompartment metabolism in thyrocyte oncogenesis are sparse. We present a review of the current knowledge on cellular metabolism in non-cancerous and cancerous thyroid tissues, focusing on the monocarboxylate transporters MCT1 and MCT4, and on a transporter of the outer mitochondrial membrane TOMM20. Understanding the metabolic phenotype of tumor cells and associated stromal cells in thyroid cancer can have profound implications on the use of biomarker staining in detecting subclinical cancer, imaging as it relates to expression of various transport proteins, and therapeutic interventions that manipulate this dysregulated tumor metabolism to halt tumorigenesis and eradicate the cancer. Future studies are required to confirm the prognostic significance of these biomarkers and their correlation with existing staging schemas such as the AGES, AMES, ATA and MACIS scoring systems.
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Affiliation(s)
- Kurren S Gill
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Patrick Tassone
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - James Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Nikolaus Hjelm
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Adam Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - David Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
| | - Madalina Tuluc
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, USA
| | | | - Jennifer M Johnson
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, USA
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27
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Wojakowska A, Chekan M, Marczak Ł, Polanski K, Lange D, Pietrowska M, Widlak P. Detection of metabolites discriminating subtypes of thyroid cancer: Molecular profiling of FFPE samples using the GC/MS approach. Mol Cell Endocrinol 2015; 417:149-57. [PMID: 26415588 DOI: 10.1016/j.mce.2015.09.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/24/2015] [Accepted: 09/22/2015] [Indexed: 11/24/2022]
Abstract
One of the critical issues in thyroid cancer diagnostic is differentiation between follicular adenoma, follicular carcinoma and the follicular variant of papillary carcinoma, which in some cases is not possible based on histopathological features only. In this paper we performed molecular profiling of thyroid tissue aiming to identify metabolites characteristic for different types of thyroid cancer. FFPE tissue specimens were analysed from 5 different types of thyroid malignancies (follicular, papillary/classical variant, papillary/follicular variant, medullary and anaplastic cancers), benign follicular adenoma and normal thyroid. Extracted metabolites were identified and semi-quantified using the GC/MS approach. There were 28 metabolites identified, whose abundances were significantly different among different types of thyroid tumours, including lipids, carboxylic acids, and saccharides. We concluded, that multi-component metabolome signature could be used for classification of different subtypes of follicular thyroid lesions. Moreover, potential applicability of the GC/MS-based analysis of FFPE tissue samples in diagnostics of thyroid cancer has been proved.
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Affiliation(s)
- Anna Wojakowska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Mykola Chekan
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Łukasz Marczak
- Institute of Bioorganic Chemistry Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznan, Poland.
| | | | - Dariusz Lange
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Monika Pietrowska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Piotr Widlak
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
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Howitt BE, Chang S, Eszlinger M, Paschke R, Drage MG, Krane JF, Barletta JA. Fine-needle aspiration diagnoses of noninvasive follicular variant of papillary thyroid carcinoma. Am J Clin Pathol 2015; 144:850-7. [PMID: 26572991 DOI: 10.1309/ajcpeie12poiculi] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Endocrine pathologists are reconsidering whether tumors characterized as noninvasive follicular variant of papillary thyroid carcinoma (NFVPTC) warrant a diagnosis of carcinoma. A change in terminology would affect cytology diagnoses; thus, our aim was to study the preceding fine-needle aspiration (FNA) diagnoses of this group of tumors. METHODS We evaluated the FNA diagnoses of a primary cohort of 72 consecutively resected NFVPTCs and the cytologic and molecular features of an additional cohort of 39 tumors that included both NFVPTCs and classical papillary thyroid carcinomas (cPTCs). RESULTS For our primary cohort, the preceding FNA diagnosis associated with the highest risk of malignancy was suspicious for PTC in nearly half (48.6%) of cases. In contrast to the majority of cPTCs, no NFVPTCs in our second cohort had papillae or pseudoinclusions on cytologic evaluation of the FNA specimens, and none harbored a BRAF V600E mutation. CONCLUSIONS If NFVPTCs were no longer termed carcinomas, this would affect the rate of malignancy of FNA diagnostic categories. Cytologic and molecular features could aid in identifying NFVPTCs at the time of FNA diagnosis.
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29
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Chai YJ, Suh H, Yi JW, Yu HW, Lee JH, Kim SJ, Won JK, Lee KE. Factors associated with the sensitivity of fine-needle aspiration cytology for the diagnosis of follicular variant papillary thyroid carcinoma. Head Neck 2015; 38 Suppl 1:E1467-71. [PMID: 26580475 DOI: 10.1002/hed.24261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the factors associated with diagnostic accuracy of preoperative fine-needle aspiration (FNA) for follicular variant papillary thyroid carcinoma (FVPTC). METHODS The patients with FVPTC who underwent thyroidectomy were divided into 2 groups: "group A" (Bethesda category II, III, or IV) versus "group B" (category V or VI). RESULTS A total of 225 patients (117 in group A and 108 in group B) were included. Group B was associated with older age, malignant ultrasonographic features, smaller tumor size, extrathyroidal extension, higher stage, and B-type Raf (BRAF)(V600E) mutation compared with group A. In multivariable analysis, malignant ultrasonographic features and tumor size ≤3.0 cm were independent predictive factors for group B. CONCLUSION FVPTCs >3.0 cm are unlikely to be diagnosed as category V or VI. Clinicians should keep FVPTC in mind and consider diagnostic lobectomy for the nodules regardless of FNA or ultrasonographic findings. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1467-E1471, 2016.
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Affiliation(s)
- Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunsuk Suh
- Department of Surgery, Mount Sinai Beth Israel Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jin Wook Yi
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Hyeong Won Yu
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Joon-Hyop Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Su-Jin Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Jae-Kyung Won
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Pathology, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
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30
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Li WF, Wang G, Zhao ZB, Liu CA. High expression of metadherin correlates with malignant pathological features and poor prognostic significance in papillary thyroid carcinoma. Clin Endocrinol (Oxf) 2015; 83:572-80. [PMID: 25418110 DOI: 10.1111/cen.12683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/27/2014] [Accepted: 11/19/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Metadherin (MTDH) protein, also called astrocyte elevated gene-1 (AEG-1) is over expressed in a variety of malignant tumours, and is closely related to tumour invasion and the poor prognosis. OBJECTIVE This study tries to explore the clinical pathological significance of MTDH expression in a large cohort of patients with PTC. DESIGN AND PATIENTS Immunohistochemistry was used to detect MTDH expression in 156 cases of PTC, 6 cases of anaplastic thyroid carcinoma (ATC), 10 cases of multinodular goitre (MNG) and 10 cases of thyroid adenoma tissues who received a thyroid operation between June 2003 and July 2008. MEASUREMENTS Clinical pathological data of 156 cases of PTC were analysed according to MTDH expression. The Kaplan-Meier method was used to plot survival curves and log-rank test to compare the postoperative survival results. The prognostic meaning of MTDH expression in PTC was evaluated by Cox regression analysis. RESULTS The positive expression rates of MTDH in PTC and ATC tissues were 37·2% (58/156) and 50% (3/6), respectively, and MTDH positive expression rates were both 10% (1/10) in MNG and thyroid adenoma tissues. High MTDH expression in PTC was associated with larger tumour size (P = 0·030), high rates of lymph node (P = 0·041) and distant metastasis (P = 0·028), but no relation with the patient age, gender, tumour multicenter, extrathyroid invasion and tumour grade. High MTDH expression was associated with recurrence-free survival (RFS) and disease-specific survival rate (DSS) (P = 0·014, P = 0·001, respectively). Cox regression analysis showed that high MTDH expression was independent prognostic indicators for RFS and DSS in patients with PTC (P = 0·023 and P = 0·035, respectively). CONCLUSION High MTDH expression in PTC might play an important role in tumour growth and metastasis, and targeting MTDH treatment might have potential therapeutic value for patients with PTC.
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Affiliation(s)
- Wen-Fang Li
- Department of General Surgery, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
| | - Gen Wang
- Department of General Surgery, Taihe Hospital Affiliated to Hubei Medical University, Shiyan City, China
| | - Zong-Bin Zhao
- Department of General Surgery, Taihe Hospital Affiliated to Hubei Medical University, Shiyan City, China
| | - Chang-An Liu
- Department of General Surgery, the Second Hospital Affiliated to Chongqing Medical University, Chongqing, China
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31
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Yang SE, Sullivan PS, Zhang J, Govind R, Levin MR, Rao JY, Moatamed NA. Has Afirma gene expression classifier testing refined the indeterminate thyroid category in cytology? Cancer Cytopathol 2015; 124:100-9. [PMID: 26422098 DOI: 10.1002/cncy.21624] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 08/10/2015] [Accepted: 08/21/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thyroid fine-needle aspiration (FNA) plays a pivotal role in the evaluation of thyroid nodules. Up to 30% of cases are diagnosed as indeterminate by FNA, including atypia of undetermined significance, follicular lesion of undetermined significance, suspicious for a follicular neoplasm, and follicular neoplasm, with approximately two-thirds having a benign outcome. The gene expression classifier (GEC) test is a molecular test for cases with indeterminate cytology. The purpose of the current study was to examine the refining role of the GEC test within a single institution. METHODS Retrospective analysis of all thyroid FNAs during a 20-month period after implementation of GEC was performed. Cases of indeterminate cytology with concomitant GEC testing were selected and divided further in 4 subgroups. Correlation with surgical follow-up, when available, was performed. The results were compared with previously published data from the study institution before the implementation of GEC testing. RESULTS Among the 217 cases, there were 189 with indeterminate cytology, 42% of which were benign and 50% of which were suspicious by GEC. The excisional rate of atypia of undetermined significance-follicular lesion of undetermined significance in the pre-GEC category was 63%, which decreased to 35% in the post-GEC category, whereas the malignancy rate in the excised thyroids increased from 35% in the pre-GEC category to 47% in the post-GEC category. Similar findings also were obtained for suspicious for a follicular neoplasm-follicular neoplasm lesions. CONCLUSIONS The strength of the GEC test appears to lie in its ability to reclassify 42% of indeterminate cytology cases as benign, thereby decreasing the number of unnecessary surgical procedures.
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Affiliation(s)
- Sung-Eun Yang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Peggy S Sullivan
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Jianhua Zhang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Rekha Govind
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Mary R Levin
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Jian-Yu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Neda A Moatamed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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32
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Hadjisavva IS, Dina R, Talias MA, Economides PA. Prevalence of Cancer in Patients with Thyroid Nodules in the Island of Cyprus: Predictive Value of Ultrasound Features and Thyroid Autoimmune Status. Eur Thyroid J 2015; 4:123-8. [PMID: 26279998 PMCID: PMC4521064 DOI: 10.1159/000430438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 04/11/2015] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the prevalence of thyroid carcinoma in patients who underwent ultrasound-guided fine needle aspiration biopsy (USgFNA) of thyroid nodules in the island of Cyprus. Ultrasound features as well as the presence of autoimmune thyroid disease were evaluated as risk factors for malignancy. METHODS 322 consecutively examined patients (272 females/50 males, age 13-81) underwent USgFNA of thyroid nodules in a referral endocrine clinic between July 2007 and July 2009. The ultrasonographic characteristics examined were: echogenicity, margin irregularity, composition, calcifications, presence of increased vasculature and nodule size. The presence or absence of autoimmune thyroid disease was recorded. RESULTS From the 548 nodules examined, 74 (13.6%) were classified as THY3, 4 or 5. 75 patients (123 nodules) underwent surgical resection. 46 patients (64 nodules) proved to have thyroid carcinoma by histology. There was a significant correlation of suspicious/malignant cytology with solid composition, hypoechogenicity, irregular margins and the presence of calcifications. A significant association was also noted between the presence of positive antithyroglobulin antibodies (p < 0.05) and Graves' disease (p = 0.01) with suspicious/malignant cytology. CONCLUSION The overall prevalence of thyroid cancer was 14.3%. Ultrasound characteristics were highly predictive of thyroid malignancy. Thyroid autoimmunity should be considered as a risk factor.
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Affiliation(s)
- Irini S. Hadjisavva
- Economides Nicosia Endocrinology Center, Open University of Cyprus, Nicosia, Cyprus, London, UK
| | - Roberto Dina
- Department of Cellular Pathology, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK
| | - Michael A. Talias
- Healthcare Management Postgraduate Program, Open University of Cyprus, Nicosia, Cyprus, London, UK
| | - Panayiotis A. Economides
- Economides Nicosia Endocrinology Center, Open University of Cyprus, Nicosia, Cyprus, London, UK
- *Dr. Panayiotis A. Economides, MD, PhD, FACE, Economides Nicosia Endocrinology Center, 9 Iona Nicolaou, Engomi 2406, Nicosia (Cyprus), E-Mail
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33
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Wojakowska A, Chekan M, Widlak P, Pietrowska M. Application of metabolomics in thyroid cancer research. Int J Endocrinol 2015; 2015:258763. [PMID: 25972898 PMCID: PMC4417976 DOI: 10.1155/2015/258763] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/27/2015] [Indexed: 01/10/2023] Open
Abstract
Thyroid cancer is the most common endocrine malignancy with four major types distinguished on the basis of histopathological features: papillary, follicular, medullary, and anaplastic. Classification of thyroid cancer is the primary step in the assessment of prognosis and selection of the treatment. However, in some cases, cytological and histological patterns are inconclusive; hence, classification based on histopathology could be supported by molecular biomarkers, including markers identified with the use of high-throughput "omics" techniques. Beside genomics, transcriptomics, and proteomics, metabolomic approach emerges as the most downstream attitude reflecting phenotypic changes and alterations in pathophysiological states of biological systems. Metabolomics using mass spectrometry and magnetic resonance spectroscopy techniques allows qualitative and quantitative profiling of small molecules present in biological systems. This approach can be applied to reveal metabolic differences between different types of thyroid cancer and to identify new potential candidates for molecular biomarkers. In this review, we consider current results concerning application of metabolomics in the field of thyroid cancer research. Recent studies show that metabolomics can provide significant information about the discrimination between different types of thyroid lesions. In the near future, one could expect a further progress in thyroid cancer metabolomics leading to development of molecular markers and improvement of the tumor types classification and diagnosis.
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Affiliation(s)
- Anna Wojakowska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Mykola Chekan
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Piotr Widlak
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
| | - Monika Pietrowska
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
- *Monika Pietrowska:
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