1
|
Lu MY, Zhou Y, Bo XW, Li XL, Luo J, Li CN, Peng CZ, Chai HH, Yue WW, Sun LP. A Prediction Model for Assessing the Efficacy of Thermal Ablation in Treating Benign Thyroid Nodules ≥ 2 cm: A Multi-Center Retrospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1515-1521. [PMID: 39085001 DOI: 10.1016/j.ultrasmedbio.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVES To develop and validate a prediction model utilizing clinical and ultrasound (US) data for preoperative assessment of efficacy following US-guided thermal ablation (TA) in patients with benign thyroid nodules (BTNs) ≥ 2 cm. MATERIALS AND METHODS We retrospectively assessed 962 patients with 1011 BTNs who underwent TA at four tertiary centers between May 2018 and July 2022. Ablation efficacy was categorized into therapeutic success (volume reduction rate [VRR] > 50%) and non-therapeutic success (VRR ≤ 50%). We identified independent factors influencing the ablation efficacy of BTNs ≥ 2 cm in the training set using multivariate logistic regression. On this basis, a prediction model was established. The performance of model was further evaluated by discrimination (area under the curve [AUC]) in the validation set. RESULTS Of the 1011 nodules included, 952 (94.2%) achieved therapeutic success at the 12-month follow-up after TA. Independent factors influencing VRR > 50% included sex, nodular composition, calcification, volume, and largest diameter (all p < 0.05). The prediction equation was established as follows: p = 1/1 + Exp∑[8.113 -2.720 × (if predominantly solid) -2.790 × (if solid) -1.275 × (if 10 mL < volume ≤ 30mL) -1.743 × (if volume > 30 mL) -1.268 × (if with calcification) -2.859 × (if largest diameter > 3 cm) +1.143 × (if female)]. This model showed great discrimination, with AUC of 0.908 (95% confidence interval [CI]: 0.868-0.947) and 0.850 (95% CI: 0.748-0.952) in the training and validation sets, respectively. CONCLUSIONS A clinical prediction model was successfully developed to preoperatively predict the therapeutic success of BTNs larger than 2 cm in size following US-guided TA. This model aids physicians in evaluating treatment efficacy and devising personalized prognostic plans.
Collapse
Affiliation(s)
- Meng-Yu Lu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Ying Zhou
- Department of Surgery, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Xiao-Long Li
- Department of Ultrasound, Institute of Ultrasound in Medicine and Engineering, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Luo
- Department of Diagnostic Ultrasound, Sichuan Provincial People's Hospital, Chengdu, China
| | - Chao-Nan Li
- Department of Diagnostic Ultrasound, Sichuan Provincial People's Hospital, Chengdu, China
| | - Cheng-Zhong Peng
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Hui-Hui Chai
- Department of Diagnostic Ultrasound, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Wen-Wen Yue
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China; Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai, China.
| |
Collapse
|
2
|
Velez Torres JM, Vaickus LJ, Kerr DA. Thyroid Fine-Needle Aspiration: The Current and Future Landscape of Cytopathology. Surg Pathol Clin 2024; 17:371-381. [PMID: 39129137 DOI: 10.1016/j.path.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Thyroid cytology is a rapidly evolving field that has seen significant advances in recent years. Its main goal is to accurately diagnose thyroid nodules, differentiate between benign and malignant lesions, and risk stratify nodules when a definitive diagnosis is not possible. The current landscape of thyroid cytology includes the use of fine-needle aspiration for the diagnosis of thyroid nodules with the use of uniform, tiered reporting systems such as the Bethesda System for Reporting Thyroid Cytopathology. In recent years, molecular testing has emerged as a reliable preoperative diagnostic tool that stratifies patients into different risk categories (low, intermediate, or high) with varying probabilities of malignancy and helps guide patient treatment.
Collapse
Affiliation(s)
- Jaylou M Velez Torres
- University of Miami Hospital, Miller School of Medicine, 1400 NW 12th Avenue, Room 4078, Miami, FL 33136, USA. https://twitter.com/JaylouVelez
| | - Louis J Vaickus
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.
| |
Collapse
|
3
|
Velez Torres JM, Curnow PM, Tjendra Y, Jorda M, Fernandez CG, Buitrago MG, Zuo Y, Cordero RR. Exploring the atypia of undetermined significance: Malignant ratio, ThyroSeq v3 positive call rate, molecular-derived risk of malignancy, and risk of malignancy as possible quality metric tools in thyroid cytology. Cancer Cytopathol 2024; 132:491-498. [PMID: 38594180 DOI: 10.1002/cncy.22820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The atypia of undetermined significance (AUS) category is heterogeneous, leading to variations in its use. To prevent excessive usage, the AUS rate should be ≤10%. Although this recommendation aims to maintain diagnostic quality, it lacks supporting data. The AUS:Malignant (AUS:M) ratio has been proposed as a metric tool to evaluate AUS use. Furthermore, integrating ThyroSeq v3 (TSV3) positive call rate (PCR) and the molecular-derived risk of malignancy (MDROM) have been put forward as performance improvement tools. The authors reviewed their AUS:M ratios, TSV3 PCR, MDROM, and ROM. METHODS Thyroid aspirates evaluated in the laboratory (from August 2022 to September 2023) by seven cytopathologists (CPs) were identified. AUS:M ratio, MDROM, ROM, and TSV3 PCR results for the laboratory and each CP were recorded and analyzed. RESULTS A total of 2248 aspirates were identified (462 AUS and 80 malignant). The AUS:M ratio for the laboratory was 5.8 (CPs range, 2.8 to 7.3). The TSV3 PCR for the laboratory was 23% (CPs range, 11% to 41%). The MDROM for the laboratory was 19% (CPs range, 9% to 31%), whereas the ROM was 36% (CPs range, 29% to 50%). Linear regression analysis of AUS:M ratio versus TSV3 PCR and MDROM demonstrated a moderate positive correlation but a weak negative correlation to the ROM. Deviations from established targets were attributed to multiple factors. CONCLUSION The findings of this study underscore the importance of using a combination of metrics to evaluate diagnostic practices. By dissecting the practice patterns of each CP, the authors can measure different aspects of their performance and provide individualized feedback.
Collapse
Affiliation(s)
- Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Porshya M Curnow
- LabCorp of America, Department of Pathology and Laboratory Medicine, University of Miami Hospital, Miami, Florida, USA
| | - Youley Tjendra
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carmen Gomez Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Monica Garcia Buitrago
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yiqin Zuo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roberto Ruiz Cordero
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
4
|
Sirotnikov S, Griffith CC, Lubin D, Zhang C, Saba NF, Li D, Kornfield A, Chen A, Shi Q. ThyroSeq overview on indeterminate thyroid nodules: An institutional experience. Diagn Cytopathol 2024; 52:353-361. [PMID: 38554032 DOI: 10.1002/dc.25311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/31/2024] [Accepted: 03/20/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Molecular triage of indeterminate thyroid aspirates offers the opportunity to stratify the risk of malignancy (ROM) more accurately. Here we examine our experience with ThyroSeq v3 testing. METHODS We analyzed 276 of 658 (42%) fine needle aspiration samples classified as indeterminate thyroid nodules using ThyroSeq v3 (Sept 2017-Dec 2019). The test provides a ROM and detects specific mutations. Surgical diagnoses were reviewed. RESULTS Of 276 ThyroSeq-tested cases, 42% (n = 116) harbored genetic alterations, whereas 64% (n = 74) had surgical follow-up. Notably, 79% cases within intermediate to higher risk mutations were highly associated with surgical intervention, resulting in a 77.5% ROM when including both cancer and noninvasive follicular thyroid neoplasia with papillary-like features (cancer+NIFTP) and 68% malignant diagnosis when excluding NIFTP. RAS-like alterations were most common (66%), exhibiting a 73.4% ROM and a 59% malignant diagnosis. Interestingly, this group included 24 encapsulated follicular variant papillary thyroid carcinomas (EFVPTCs), 1 infiltrative FVPTC, 9 follicular carcinomas, and 7 NIFTP. Additionally, three high-risk mutations and eight BRAF/V600E mutations had a 100% ROM, all diagnosed as classic-type papillary thyroid carcinoma (cPTC). Combined analysis of thyroid nodules from Bethesda III and IV categories revealed a 78.2% positive predictive value (PPV) and a 75.9% negative predictive value (NPV). CONCLUSION ThyroSeq v3 effectively stratifies the ROM in indeterminate thyroid nodules based on specific genetic alterations, guiding appropriate surgical management. Notably, the BRAFV600E/high-risk group and RAS-like groups exhibited ROM of 100% and 77.5%, respectively, with promising predictive accuracy (PPV of 78.2% and NPV of 75.9%).
Collapse
Affiliation(s)
- Sam Sirotnikov
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | | | - Daniel Lubin
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Chao Zhang
- Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Nabil F Saba
- Department of Hematology & Medical Oncology and Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Dehong Li
- Center for the Cancer Research and Therapeutic Development (CCRTD), Clark Atlanta University, Atlanta, Georgia, USA
| | - Amanda Kornfield
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Amy Chen
- Department of Otolaryngology, Emory University, Atlanta, Georgia, USA
| | - Qiuying Shi
- Department of Pathology, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Montejo-Marcos B, López-Plasencia Y, Marrero-Arencibia D, Rodríguez-Pérez CA, Boronat M. Serum cholesterol levels are inversely associated with the risk of malignancy in subjects with Bethesda category IV thyroid nodules. ENDOCRINOL DIAB NUTR 2024; 71:246-252. [PMID: 38986628 DOI: 10.1016/j.endien.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/27/2024] [Accepted: 03/20/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Some epidemiological data suggest that there may be an inverse relationship between cholesterol levels and the risk of thyroid cancer in the overall population. The present study was aimed to evaluate the lipid profile specifically in subjects with Bethesda category IV thyroid nodules, and compare whether there were any differences between those with benign and malignant nodules. METHODS Single-centre, retrospective study on 204 subjects treated by partial or total thyroidectomy for excision of a Bethesda category IV thyroid nodule, who had undergone a blood lipid profile test in the 12 months prior to surgery. In addition to lipid measures, other demographic, clinical, biochemical and ultrasound data were collected. RESULTS Seventy-five subjects (36.8%) were diagnosed with thyroid carcinoma in the definitive histopathological examination. Patients with thyroid cancer had lower levels of total cholesterol, LDL-cholesterol and non-HDL-cholesterol than subjects with benign thyroid diseases. There were no differences in HDL-cholesterol, triglycerides or total cholesterol/HDL-cholesterol ratio. There were no differences either between groups in other clinical, biochemical and ultrasound variables, including the use of lipid-lowering drugs. In multivariate analysis, only LDL-cholesterol was independently associated with malignancy. Subjects with follicular carcinoma showed the lowest cholesterol levels, while those with papillary carcinoma had intermediate values between the group with follicular carcinoma and the group with benign thyroid diseases. CONCLUSIONS In subjects with cytologically indeterminate Bethesda category IV thyroid nodules, levels of total cholesterol, non-HDL-cholesterol and, particularly, LDL-cholesterol are lower among those with malignant nodules.
Collapse
Affiliation(s)
- Beatriz Montejo-Marcos
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Yaiza López-Plasencia
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Dunia Marrero-Arencibia
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Carlos A Rodríguez-Pérez
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - Mauro Boronat
- Section of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain; Research Institute in Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, Spain.
| |
Collapse
|
6
|
Jin X, Jing X, Smola B, Heider A. Malignant risk of pediatric Bethesda category III thyroid nodules subcategorized by nuclear atypia and other: A single institution experience. Cancer Cytopathol 2024. [PMID: 38771850 DOI: 10.1002/cncy.22831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/26/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND The 2023 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) divides AUS diagnoses into two major subcategories: atypia of undetermined significance (AUS) nuclear atypia (AUS-N) and other (AUS-O). This study aims to compare the histological outcome and malignant rate of pediatric AUS thyroid nodules classified into AUS-N and AUS-O subcategories. DESIGN A search of our institutional electronic pathology database for the period from January 2012 to July 2023 was conducted to identify pediatric (<21 years old) thyroid nodules that were interpreted as AUS and subsequently had surgery. Cases were further divided into AUS-N and AUS-O subcategories. Results of follow-up surgical resections were collected. The malignant rate was calculated and compared between AUS-N and AUS-O groups. RESULTS The study identified 62 thyroid nodules from 58 pediatric patients. Among these nodules, 29 and 33 were subcategorized as AUS-N and AUS-O, respectively. Both groups exhibited a female predominance and displayed a similar nodule size distribution. Histological analysis revealed 15 carcinomas in AUS-N nodules, including 11 cases of classic papillary thyroid carcinoma (PTC) and four cases of follicular type of PTC. In contrast, in the AUS-O group, a total of five carcinomas were documented, including two PTCs and three oncocytic thyroid carcinomas. Notably, the malignant rate of AUS-N nodules (52%) is significantly higher than that of AUS-O nodules (15%) (p = .002). CONCLUSION In pediatric AUS thyroid nodules, the malignant risk in AUS-N is significantly higher than that in AUS-O. These findings may guide more appropriate clinical triage and/or improve management of pediatric patients with AUS thyroid nodules.
Collapse
Affiliation(s)
- Xiaobing Jin
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Xin Jing
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Brian Smola
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| | - Amer Heider
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
7
|
Conradie W, Baatjes K, Luvhengo T, Buitendag J, Razack R, Davies J, Crabbia F, Afrogheh A, Lübbe J. Performance of Thyroid Fine-Needle Aspiration Biopsy in a Low- and Middle-Income Country. Acta Cytol 2024:1-8. [PMID: 38735277 DOI: 10.1159/000539153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION The 6 categories of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) with associated risk of malignancy (ROM) provide evidence-based clinical management guidelines. This study aimed to determine the ROM and accuracy of FNAB in South Africa (SA). METHODS Thyroid specimens from 3 pathology laboratories registered between January 2015 and December 2019 were considered for inclusion. ROM was obtained per TBSRTC category by cytohistological correlation and dividing the total number of specimens with malignant histology by the total number of cases operated. Accuracy was calculated based on the Bethesda category and eventual malignant histology. RESULTS Seventeen thousand seven hundred and seventy-three histology and 4,791 cytology cases were identified. Of the 4,791 cytology cases, 931 (19%) underwent surgery. More than a third (333, 35.8%) of cases were confirmed as malignant following histological assessment, with the majority being benign (584, 62.7%). The ROM for the nondiagnostic and benign categories was 24.3% and 20.5%. The highest ROM was for category VI (91.5%), followed by categories V (69.5%), IV (51.9%), and III (38.8%). Thyroid FNAB had a sensitivity of 73%, specificity of 74%, and overall accuracy of 74%. CONCLUSION Bethesda categories II and IV have a relatively higher ROM in SA compared to findings from other developed countries. The diagnostic accuracy of thyroid FNAB in SA and the high rate of nondiagnostic diagnoses (38%) require further investigation. A national thyroid registry could provide location-specific data to aid the implementation of appropriate local policies and national guidelines for practicing thyroid surgeons.
Collapse
Affiliation(s)
- Wilhelmina Conradie
- Tygerberg Hospital, Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| | - Karin Baatjes
- Tygerberg Hospital, Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| | | | - Johannes Buitendag
- Tygerberg Hospital, Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| | - Rubina Razack
- Division of Anatomical Pathology, National Health Laboratory Service, University of Stellenbosch, Cape Town, South Africa
| | | | - Fabio Crabbia
- Pathcare Laboratory (Dietrich, Voigt, Mia and Partners), Cape Town, South Africa
| | - Amir Afrogheh
- National Health Laboratory Service, Department of Oral and Maxillofacial Pathology, University of Western Cape, Cape Town, South Africa
| | - Jeanne Lübbe
- Tygerberg Hospital, Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| |
Collapse
|
8
|
Cho YY, Ahn SH, Lee EK, Park YJ, Choi D, Kim BY, Jung CH, Mok JO, Kim CH, Kim SW. Malignancy Risk of Follicular Neoplasm (Bethesda IV) With Variable Cutoffs of Tumor Size: A Systemic Review and Meta-Analysis. J Clin Endocrinol Metab 2024; 109:1383-1392. [PMID: 38113188 DOI: 10.1210/clinem/dgad684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Indexed: 12/21/2023]
Abstract
CONTEXT The decision on diagnostic lobectomy for follicular neoplasms (FN) is challenging. OBJECTIVE This meta-analysis investigates whether an appropriate size cutoff exists for recommending surgery for thyroid nodules diagnosed as FN by fine needle aspiration. METHODS The Ovid-Medline, EMBASE, Cochrane, and KoreaMed databases were searched for studies reporting the malignancy rate of FN/suspicious for FN (FN/SFN) according to tumor size, using search terms "fine needle aspiration," "follicular neoplasm," "lobectomy," "surgery," and "thyroidectomy." RESULTS Fourteen observational studies comprising 2016 FN/SFN nodules with postsurgical pathologic reports were included, and 2 studies included malignancy rates with various tumor sizes. The pooled malignancy risk of FN/SFN nodules according to size was: odds ratio (OR) 2.29 (95% CI, 1.68-3.11) with cutoff of 4 cm (9 studies), OR 2.39 (95% CI, 1.45-3.95) with cutoff of 3 cm (3 studies), and OR 1.81 (95% CI, 0.94-3.50) with cutoff of 2 cm (5 studies). However, tumors ≥2 cm also showed a higher risk (OR 2.43; 95% CI, 1.54-3.82) based on the leave-one-out meta-analysis after removal of 1 influence study. When each cutoff size was evaluated by summary receiver operating characteristic (sROC) curves, the cutoff of 4 cm showed the highest summary area under the curve (sAUC, 0.645) compared to other cutoffs (sAUC, 0.58 with 2 cm, and 0.62 with 3 cm), although there was no significant difference. CONCLUSION Although the risk of malignancy increases with increasing tumor size, the risk remains significant at all tumor sizes and no cutoff limit can be recommended as a decision-making parameter for diagnostic surgery in Bethesda IV thyroid nodules.
Collapse
Affiliation(s)
- Yoon Young Cho
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Soo Hyun Ahn
- Department of Mathematics, Ajou University, Suwon 16499, South Korea
| | - Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang 10408, South Korea
| | - Young Joo Park
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul 03080, South Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Dughyun Choi
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Bo-Yeon Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Chan-Hee Jung
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Ji Oh Mok
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Chul-Hee Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
| | - Sun Wook Kim
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul 06351, South Korea
| |
Collapse
|
9
|
Huang Y, Chan SJ, Wright JD, Kuo JH, McManus CM, Lee JA, Kuo EJ. Does the Adoption of Molecular Testing Cause Decreased Thyroidectomy Rates in a National Cohort? A Quasiexperimental Study of High- Versus Low-Adoption States. Thyroid 2024; 34:388-398. [PMID: 38251649 DOI: 10.1089/thy.2023.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background: Over the last decade, the utilization of molecular testing (MT) for the evaluation of thyroid nodules has increased. Rates and patterns of adoption of MT and its effect on thyroidectomy rates nationally are unknown. Varying rates of MT adoption at the state level provide an opportunity to study the effects of MT on thyroidectomy rates using a quasiexperimental study design. Methods: We performed a retrospective analysis of American adult patients in the Merative™ MarketScan® Research Databases who underwent thyroid fine-needle aspiration (FNA) from 2011 to 2021. MT included commercially available DNA and RNA platforms and traditional targeted mutational analysis. Interrupted time series analysis was used to evaluate the inflection of MT adoption and thyroidectomy rates after 2015. Difference-in-differences (DID) analysis was used to causally analyze the effect of MT adoption on thyroidectomy rates in high-adoption (at least a 10% increase in MT utilization) versus low-adoption states (no more than 5% increase in MT utilization) from 2015 to 2021. Results: We identified 471,364 patients who underwent thyroid FNA. The utilization of MT increased over the study period from 0.01% [confidence interval, CI: 0.00% to 0.02%] to 10.1% [CI: 9.7% to 10.5%], in 2021, with an immediate (β2 = 1.61, p = 0.002) and deeper (β3 = 0.6, p < 0.001) increase in MT adoption after 2015. Utilization of MT was lower in black patients, the elderly, rural areas, and patients with Medicaid (p < 0.05). Thyroidectomy rates were inversely correlated with MT utilization (r = -0.98, p < 0.0001). From 2015 to 2021, the average MT utilization rate increased from 2.4% to 15.3% in high-adoption states and 1.6% to 5.6% in low-adoption states. In low-adoption states, thyroidectomy rates decreased more but to similar levels (18.5-13.2%) compared with high-adoption states (15.9-13.4%) with an adjusted DID rate of -3.3% [CI -5.6% to -0.8%]. Conclusions: The acceleration in adoption of MT after 2015 likely coincides with the publication of American Thyroid Association guidelines. Black, elderly, and rural patients are less likely to receive MT. Although thyroidectomy rates were inversely correlated with MT utilization, our study suggests that this correlation is not causal. The effect of MT on thyroidectomy rates may be overshadowed by decreasing aggressiveness of thyroid nodule evaluation.
Collapse
Affiliation(s)
- Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Stephanie J Chan
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
| | - Jennifer H Kuo
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| | - Catherine M McManus
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| | - James A Lee
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| | - Eric J Kuo
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| |
Collapse
|
10
|
Decaussin-Petrucci M, Cochand Priollet B, Leteurtre E, Albarel F, Borson-Chazot F. [SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Interest and place of thyroid cytology]. Ann Pathol 2024; 44:20-29. [PMID: 38092572 DOI: 10.1016/j.annpat.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/09/2023] [Indexed: 02/07/2024]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a symptom that is a frequent reason for consultation in endocrinology. Thyroid nodules are very common and mostly benign. Thyroid ultrasound and thyroid fine-needle aspiration biopsy (FNAB) are the reference tests for the analysis of these nodules. The aim of this article is to describe for the cytopathologist the key points of the SFE-AFCE-SFMN 2022 consensus involving thyroid cytology: the indications for thyroid FNAB, the technique and analysis, and the management (treatment, follow-up) following this cytological screening examination, a key element in the management of the thyroid nodule.
Collapse
Affiliation(s)
- Myriam Decaussin-Petrucci
- Pathology department, centre hospitalier Lyon Sud, hospices civils de Lyon, Pierre Bénite, EA 3738, Lyon 1 University, Lyon, France.
| | | | - Emannuelle Leteurtre
- University of Lille, CNRS, Inserm, CHU de Lille, UMR9020-U1277 - CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000 Lille, France
| | - Frédérique Albarel
- Service d'endocrinologie, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital de la Conception, centre de référence des maladies rares de l'hypophyse HYPO, 13005 Marseille, France
| | - Françoise Borson-Chazot
- Fédération d'endocrinologie, hospices civils de Lyon, groupement hospitalier Est, Bron, université Lyon 1, Claude-Bernard, Lyon, France
| |
Collapse
|
11
|
Li Q, Yang L, Yang L, Jiang X, Li S. Utility of Six Ultrasound-Based Risk Stratification Systems in the Diagnosis of AUS/FLUS Thyroid Nodules. Acad Radiol 2024; 31:131-141. [PMID: 37225530 DOI: 10.1016/j.acra.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/22/2023] [Accepted: 04/22/2023] [Indexed: 05/26/2023]
Abstract
RATIONALE AND OBJECTIVES To estimate the diagnostic performance of the currently used ultrasound (US)-based risk stratification systems (RSSs) (American Thyroid Association, American Association of Clinical Endocrinologists, American College of Endocrinology, and Association Medici Endocrinology Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules, European Thyroid Association Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules in Adults [EU-TIRADS], American College of Radiology Thyroid Imaging Reporting and Data System [ACR-TIRADS], Chinese Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules [C-TIRADS], and Thyroid Imaging Reporting and Data System Developed by Kwak et al [Kwak-TIRADS]) for atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) thyroid nodules. MATERIALS AND METHODS This retrospective study included 514 consecutive AUS/FLUS nodules in 481 patients with final diagnosis. The US characteristics were reviewed and classified using the categories defined by each RSS. The diagnostic performance was evaluated and compared using a generalized estimating equation method. RESULTS Of the 514 AUS/FLUS nodules, 148 (28.8%) were malignant and 366 (71.2%) were benign. The calculated malignancy rate increased from the low-risk to high-risk categories for all RSSs (all P < .001). Interobserver correlation for both US features and RSSs showed substantial to almost perfect agreement. The diagnostic efficacy of Kwak-TIRADS (AUC=0.808) and C-TIRADS (AUC=0.804) were similar (P = .721) and higher than those of other RSSs (all P < .05). The EU-TIRADS and Kwak-TIRADS exhibited similar sensitivity (86.5% vs 85.1%, P = .739) and were only higher than that of the C-TIRADS (all P < .05). The specificity of C-TIRADS and ACR-TIRADS were similar (78.1% vs 72.1%, P = .06) and were higher than those of other RSSs (all P < .05). CONCLUSION Currently used RSSs can provide risk stratification for AUS/FLUS nodules. Kwak-TIRADS and C-TIRADS have the highest diagnostic efficacy in identifying malignant AUS/FLUS nodules. A detailed knowledge of the benefits and shortcomings of the various RSSs is essential.
Collapse
Affiliation(s)
- Qiang Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.)
| | - Lu Yang
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.)
| | - Liming Yang
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.)
| | - Xianfeng Jiang
- Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China (X.J.)
| | - Shiyan Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, 3 Rd East Qingchun, Hangzhou 310016, China (Q.L., L.Y., L.Y., S.L.).
| |
Collapse
|
12
|
Shen J, Yan M, Chen L, Ou D, Yao J, Feng N, Zhou X, Lei Z, Xu D. Prognosis and influencing factors of follicular thyroid cancer. Cancer Med 2024; 13:e6727. [PMID: 38102879 PMCID: PMC10807623 DOI: 10.1002/cam4.6727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/25/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Follicular thyroid cancer (FTC) is prone to distant metastasis, and patients with distant metastasis often have poor prognosis. In this study, the impact of metastasis and other relevant factors on the prognosis of follicular thyroid carcinoma was examined. METHODS This was a retrospective study. Data were obtained from Zhejiang Cancer Hospital, Sun Yat-sen University Cancer Center and Hangzhou First People's Hospital affiliated with Zhejiang University School of Medicine, from January 2009 to June 2021 for 153 FTC patients. The patients were assigned into three groups according to their distant metastasis: distant metastasis at initial diagnosis (M1), distant metastasis during follow-up (M2), and no evidence of distant metastasis over the course of the study (M0). Data were collected and summarized on clinical data, laboratory parameters, imaging features, postoperative pathologic subtypes, and metastases. The Cox proportional hazard model was used to perform the univariate and multivariate analysis. Kaplan-Meier curves were used to evaluate cancer-specific survival (CSS). RESULTS Based on metastasis, the patients were assigned into three groups, including 31 in the M1 group, 15 in the M2 group, and 107 in the M0 group. These individuals were followed up for an average of 5.9 years, and the group included 46 patients with distant metastasis (31 confirmed at diagnosis and 15 found during follow-up). Univariate Cox regression analysis showed that age, Hashimoto's thyroiditis (HT), surgery method, postoperative adjuvant therapy, histologic subtype, nodule size, calcification, TSH, and distant metastasis all impacted prognosis. Multivariate Cox regression analysis suggested that histologic subtype (widely invasive; HR: 7.440; 95% CI: 3.083, 17.954; p < 0.001), nodule size (≥40 mm; HR: 8.622; 95% CI: 3.181, 23.369; p < 0.001) and distant metastasis (positive; HR: 6.727; 95% CI: 2.488, 18.186; p < 0.001) were independent risk factors affecting the prognosis of follicular thyroid cancer. CONCLUSIONS Histologic subtype, nodule size, and distant metastasis are important risk factors for the prognosis of follicular thyroid cancer. Patients with metastatic follicular thyroid cancer have a poor prognosis, especially with metastasis at the time of initial diagnosis. As a result, this group of patients requires individualized treatment and closer follow-up.
Collapse
Affiliation(s)
- Jiafei Shen
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| | - Meiying Yan
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| | - Long Chen
- Zhejiang University School of Medicine, Affiliated Hangzhou First People's HospitalHangzhouChina
| | - Di Ou
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| | - Jincao Yao
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| | - Na Feng
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| | | | - Zhikai Lei
- Zhejiang University School of Medicine, Affiliated Hangzhou First People's HospitalHangzhouChina
| | - Dong Xu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of SciencesHangzhouChina
| |
Collapse
|
13
|
Kim MK, Park H, Oh YL, Shin JH, Kim TH, Hahn SY. Association of Ultrasonography Features of Follicular Thyroid Carcinoma With Tumor Invasiveness and Prognosis Based on WHO Classification and TERT Promoter Mutation. Korean J Radiol 2024; 25:103-112. [PMID: 38184773 PMCID: PMC10788599 DOI: 10.3348/kjr.2023.0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/20/2023] [Accepted: 11/02/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE To investigate the association of ultrasound (US) features of follicular thyroid carcinoma (FTC) with tumor invasiveness and prognosis based on the World Health Organization (WHO) classification and telomerase reverse transcriptase (TERT) promoter mutations. MATERIALS AND METHODS This retrospective study included 54 surgically confirmed FTC patients with US images and TERT promoter mutations (41 females and 13 males; median age [interquartile range], 40 years [30-51 years]). The WHO classification consisted of minimally invasive (MI), encapsulated angioinvasive (EA), and widely invasive (WI) FTCs. Alternative classifications included Group 1 (MI-FTC and EA-FTC with wild type TERT), Group 2 (WI-FTC with wild type TERT), and Group 3 (EA-FTC and WI-FTC with mutant TERT). Each nodule was categorized according to the US patterns of the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and American College of Radiology-TIRADS (ACR-TIRADS). The Jonckheere-Terpstra and Cochran-Armitage tests were used for statistical analysis. RESULTS Among 54 patients, 29 (53.7%) had MI-FTC, 16 (29.6%) had EA-FTC, and nine (16.7%) had WI-FTC. In both the classifications, lobulation, irregular margins, and final assessment categories showed significant differences (all Ps ≤ 0.04). Furthermore, the incidences of lobulation, irregular margin, and high suspicion category tended to increase with increasing tumor invasiveness and worse prognosis (all Ps for trend ≤ 0.006). In the WHO groups, hypoechogenicity differed significantly among the groups (P = 0.01) and tended to increase in proportion as tumor invasiveness increased (P for trend = 0.02). In the alternative group, punctate echogenic foci were associated with prognosis (P = 0.03, P for trend = 0.03). CONCLUSION Increasing tumor invasiveness and worsening prognosis in FTC based on the WHO classification and TERT promoter mutation results were positively correlated with US features that indicate malignant probability according to both K-TIRADS and ACR-TIRADS.
Collapse
Affiliation(s)
- Myoung Kyoung Kim
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyunju Park
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Hyuk Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
14
|
Nacchio M, Palladino R, Vigliar E, Pisapia P, Salatiello M, Malapelle U, Porcelli T, Luongo C, Fonderico F, Masone S, Salvatore D, Troncone G, Bellevicine C. Evaluating local thyroid cytopathology practices by molecular quality metrics: A multi-institutional study on 4651 FNAs with a focus on the role of the interventional cytopathologist. Cancer Cytopathol 2023; 131:772-780. [PMID: 37635646 DOI: 10.1002/cncy.22756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The diagnostic accuracy of thyroid fine-needle aspiration (FNA) can be highly influenced by the technical skills of the operator performing the procedure and by interobserver variability in microscopic interpretation. This is particularly true for the indeterminate categories. Recently, molecular testing has been proposed as an ancillary tool for monitoring the performance of different thyroid cytopathology practices. The objective of this multicenter study was to evaluate the quality of different local cytopathology practices by assessing the impact of interventional cytopathologists on FNA adequacy for molecular testing and the variations in mutation rates across different health care centers operating in the Campania region. METHODS The study included 4651 thyroid FNA samples diagnosed in different Southern Italian clinical laboratories belonging to the TIRNET (the Tiroide Network). FNA samples were collected by different proceduralists and were classified by local cytopathologists according to The Bethesda System for Reporting Thyroid Cytopathology. FNAs classified as atypia of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant were centralized for a real-time polymerase chain reaction-based, seven-gene test at the authors' institution. RESULTS Centers that employed interventional cytopathologists obtained fewer unsatisfactory FNA samples for molecular testing (11.3%) than centers that employed noncytopathologists (16.7%; p < .05). Furthermore, a significant variation in the mutation rate was observed in FNAs diagnosed by different local cytopathologists; indeterminate categories had the highest percentage of mutation rate variability among centers. CONCLUSIONS Interventional cytopathologists obtained higher yields of diagnostic material for molecular testing. Finally, the current results suggest that the variability in mutation rates among different centers may highlight the low reproducibility of microscopic criteria among cytopathologists, particularly for indeterminate cases.
Collapse
Affiliation(s)
- Mariantonia Nacchio
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Maria Salatiello
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Tommaso Porcelli
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Cristina Luongo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Fonderico
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Stefania Masone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Domenico Salvatore
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| |
Collapse
|
15
|
Prévot J, Potard G, Thuillier P, Roudaut N, Le Pennec R, Leclère JM, Mahéo C, Marianowski R, Leclère JC. Risk factors for hypothyroidism following hemithyroidectomy. ANNALES D'ENDOCRINOLOGIE 2023; 84:739-745. [PMID: 37517518 DOI: 10.1016/j.ando.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Hypothyroidism is the most common complication of hemithyroidectomy for thyroid nodules. This retrospective cohort study investigated the prognostic factors for hypothyroidism following hemithyroidectomy. METHODS We included patients who underwent hemithyroidectomy between 2016 and 2017, excluding those with history of preoperative hypothyroidism or malignancy on histopathological examination. The primary endpoint was development of hypothyroidism during follow-up (TSH≥2 above normal). RESULTS Twenty-six of the 128 included patients (20%) developed postoperative hypothyroidism. The following independent prognostic factors were found: preoperative TSH level>1.5 mIU/L (OR 2.11; P=0.013), and remaining thyroid volume adjusted for body surface area<4.0mL/m2 (OR 1.77; P=0.015). Twenty-one patients (81%) had first TSH values above the upper limit of normal. Postoperatively, first TSH level correlated significantly with the preoperative value (R=0.5779, P<0.001). Levothyroxine was prescribed to 16% of patients, with a mean dose of 0.92μg/kg/day. CONCLUSION Patients with TSH>1.5 mIU/or remaining thyroid volume adjusted for body surface area<4.0mL/m2 should have intensified clinical and biological follow-up in the first year after surgery.
Collapse
Affiliation(s)
- Julien Prévot
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France
| | - Gaël Potard
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France
| | - Philippe Thuillier
- Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Nathalie Roudaut
- Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Romain Le Pennec
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Jean-Michel Leclère
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France; School of Medicine, University of Limerick, Limerick, Ireland
| | - Clémentine Mahéo
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France
| | - Rémi Marianowski
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France
| | - Jean-Christophe Leclère
- Department of Head, Neck surgery, University Hospital of Brest, 4, avenue Foch, 29200 Brest, France.
| |
Collapse
|
16
|
Zhou B, Lu X, Hei H, Zhang S, Li Y, Fang J, Qin J, Ge H. Single BRAFV600E mutation is not associated with aggressive biological behavior in adolescent and pediatric papillary thyroid carcinoma. Cancer Cytopathol 2023; 131:716-723. [PMID: 37519275 DOI: 10.1002/cncy.22746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Papillary thyroid carcinoma is more likely to show aggressive biological behaviors in the majority of pediatric patients than in adult patients. The aim of this study was to investigate the mutation rate of the BRAFV600E gene in adolescents and children with papillary thyroid carcinoma and to analyze the association between BRAFV600E gene mutation and tumor-aggressive pathological factors. METHODS A total of 42 pediatric patients with papillary thyroid carcinoma who underwent thyroid surgery from 2017 to 2022 were studied retrospectively. Whether the BRAFV600E gene mutation in papillary thyroid carcinoma was related to aggressive biological behavior was analyzed. RESULTS Among the 42 pediatric patients with papillary thyroid carcinoma, the median patient age was 15.71 ± 2.51 years (mean ± SD) and the median tumor diameter was 24.95 ± 12.29 mm (mean ± SD). Among all enrolled patients, the mutation rate of the BRAFV600E gene was 54.76% (23 of 42). There were 33 patients with classic papillary thyroid carcinoma, and 22 (66.67%) with classic subtypes were BRAFV600E positive. The BRAFV600E mutation was associated with lower distant metastasis (p = .013) and less Hashimoto's thyroiditis (p = .006). There was no significant difference in clinicopathological factors such as sex, age, tumor size, capsular invasion, multifocality, hypothyroidism, recurrence, lymph node metastasis, and extrathyroidal extension. CONCLUSIONS The BRAFV600E mutation is not uncommon in pediatric papillary thyroid carcinoma but is not significantly associated with aggressive biological behavior. It is not possible to determine whether to adopt more active diagnosis and treatment measures on the basis of the mutation of a single BRAFV600E gene.
Collapse
Affiliation(s)
- Bin Zhou
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xiaoyu Lu
- Department of Pathology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Hu Hei
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Songtao Zhang
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yanqing Li
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jugao Fang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jianwu Qin
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| |
Collapse
|
17
|
Richmond BK, Gallimore J. Genetic Considerations in the Tumorigenesis, Diagnosis, and Treatment of Differentiated Thyroid Cancer: Current State of the Science. Am Surg 2023; 89:4853-4859. [PMID: 37253623 DOI: 10.1177/00031348231180952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Thyroid nodules remain a common diagnosis encountered in general and endocrine surgical practice, and thyroid cancer appears to be increasing in incidence in both the United States and worldwide. The understanding of the complex genetics surrounding thyroid neoplasia has increased substantially in recent years and, consequently, has become a consideration in risk stratification, diagnosis, prognosis, and treatment. Molecular genetic analysis of thyroid nodules is now a readily available technology for diagnostic purposes via analysis of fine-needle aspiration biopsy (FNAB) specimens. Although their routine use is controversial, they may aid in selecting which patients require surgery and those who may be safely observed. In the following review, the genetics of the tumorigenesis of thyroid cancer are reviewed, focusing on the most common and clinically relevant of the literally hundreds of known mutations. Following this, the current status of the use of genetic analysis and molecular diagnostics in the workup of thyroid nodules and the diagnosis of differentiated thyroid cancer is explored. Finally, evolving concepts relating to the use of thyroid cancer genetics in individualizing treatment planning, follow-up, and management of recurrent disease is discussed. The goal is to provide the general surgeon with a working knowledge of the most common genetic alterations present in differentiated thyroid cancer, their relevance in clinical practice, and how they impact prognosis and treatment.
Collapse
Affiliation(s)
- Bryan K Richmond
- West Virginia University/Charleston Division, CAMC Institute for Academic Medicine, Charleston, WV, USA
| | - Jade Gallimore
- West Virginia University/Charleston Division, CAMC Institute for Academic Medicine, Charleston, WV, USA
| |
Collapse
|
18
|
Kaliszewski K, Diakowska D, Miciak M, Jurkiewicz K, Kisiel M, Makles S, Dziekiewicz A, Biernat S, Ludwig M, Ludwig B, Sutkowska-Stępień K, Sebastian M, Domosławski P, Sutkowski K, Wojtczak B. The Incidence Trend and Management of Thyroid Cancer-What Has Changed in the Past Years: Own Experience and Literature Review. Cancers (Basel) 2023; 15:4941. [PMID: 37894308 PMCID: PMC10605595 DOI: 10.3390/cancers15204941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 09/30/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Because of ambiguous and widely debated observations concerning the incidence, trend, and management of TC, we performed this analysis. We drew attention to some events, such as "cancer screening activity", introduction of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) to TC types, possibility of papillary thyroid microcarcinoma (PTMC) active surveillance (AS), occurrence of personalized medicine in TC management, and, finally, COVID-19 pandemic time. Because of the opinion that all changes have been made mostly by PTC, we compared it to the remaining types of TC in terms of incidence, clinical and pathological characteristics, and treatment. We analyzed patients treated in a single surgical center in eastern Europe (Poland). The prevalence of TC significantly increased from 5.15% in 2008 to 13.84% in 2015, and then significantly decreased to 1.33% in 2022 when the COVID-19 pandemic lasted (p < 0.0001). A similar trend was observed for PTC, when the incidence significantly increased to 13.99% in 2015 and then decreased to 1.38% in 2022 (p < 0.0001). At that time, the NIFTP category was introduced, and observation of PTMC began. The prevalence of FTC and MTC also increased until 2015 and then decreased. Significant differences in age, types of surgery, necessity of reoperation, and pTNM between PTCs and other types of TCs were observed. The average age was significantly lower in PTC patients than in patients with the remaining types of TC (p < 0.0001). Four milestones, including NIFTP introduction, the possibility of PTMC AS, personalized cancer medicine, and the COVID-19 pandemic, may have influenced the general statistics of TC.
Collapse
Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Dorota Diakowska
- Department of Basic Sciences, Faculty of Health Science, Wroclaw Medical University, 50-367 Wrocław, Poland;
| | - Michał Miciak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Krzysztof Jurkiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Michał Kisiel
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Szymon Makles
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Anna Dziekiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Szymon Biernat
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Maksymilian Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Bartłomiej Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Karolina Sutkowska-Stępień
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Maciej Sebastian
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Paweł Domosławski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| |
Collapse
|
19
|
Li JJX. Spotlight: Rising stars in cytology. Cancer Cytopathol 2023; 131:603-604. [PMID: 37530100 DOI: 10.1002/cncy.22750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Joshua J X Li
- Department of Anatomical and Cellular Pathology, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China
| |
Collapse
|
20
|
Ladenson PW, Klopper JP, Hao Y, Kaushik P, Walsh PS, Huang J, Kloos RT, Ali SZ. Combined Afirma Genomic Sequencing Classifier and TERT promoter mutation detection in molecular assessment of Bethesda III-VI thyroid nodules. Cancer Cytopathol 2023; 131:609-613. [PMID: 37544986 DOI: 10.1002/cncy.22744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Molecular analysis of thyroid nodules can provide diagnostic and prognostic information as well as indicate opportunities for targeted therapy. Whole RNA exome analysis offers information that can be leveraged to predict tumor behavior.
Collapse
Affiliation(s)
- Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua P Klopper
- Department of Medical Affairs, Veracyte, South San Francisco, California, USA
| | - Yangyang Hao
- Department of Research and Development, Veracyte, South San Francisco, California, USA
| | - Praveen Kaushik
- Department of Marketing, Veracyte, South San Francisco, California, USA
| | - P Sean Walsh
- Department of Research and Development, Veracyte, South San Francisco, California, USA
| | - Jing Huang
- Department of Research and Development, Veracyte, South San Francisco, California, USA
| | - Richard T Kloos
- Department of Medical Affairs, Veracyte, South San Francisco, California, USA
| | - Syed Z Ali
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
21
|
Tjendra Y, Kerr DA, Zuo Y, Menendez SG, Jorda M, Gomez-Fernandez C, Velez Torres JM. Probability of malignancy and molecular alterations as determined by ThyroSeq v3 genomic classifier in Bethesda Category IV. Cancer Cytopathol 2023; 131:586-595. [PMID: 37358081 DOI: 10.1002/cncy.22737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND ThyroSeq molecular testing assesses the probability of malignancy (POM) in thyroid fine-needle aspiration cytology (FNAC) with indeterminate cytology. The aim was to investigate whether Bethesda category IV (BIV) subcategories are associated with specific molecular alterations, molecular-derived risk of malignancy (MDROM), and risk of malignancy (ROM). METHODS FNAC slides, associated ThyroSeq, version 3, Genomic Classifier results, and surgical follow-up were retrieved for BIV nodules. Nodules were subcategorized as follicular neoplasm (FN) with or without cytologic atypia or oncocytic follicular neoplasm (OFN). The MDROM, ROM, and frequency of molecular alterations in FN and OFN were analyzed. p < .05 was considered significant. RESULTS A total of 92 FNAC were identified and subcategorized into 46 FN (15 with and 31 without cytologic atypia) and 46 OFN. The benign call rate and the positive call rate were 49% and 51%, respectively. The MDROM in BIV was 34.3%, trending lower in OFN than in FN. RAS mutations were significantly more frequent in FN when compared to OFN (p = .02). Chromosomal copy number alterations were more often present in OFN than in FN (p < .01). On histologic follow-up, ROM in OFN was trending lower than in FN (p = .1). The most common diagnosis in OFN was oncocytic adenoma, whereas follicular variant papillary thyroid carcinoma was most common in FN. CONCLUSIONS The MDROM and ROM were trending lower in OFN compared with FN, and the molecular alterations differed between OFN and FN subcategories.
Collapse
Affiliation(s)
- Youley Tjendra
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Yiqin Zuo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Silvia Gra Menendez
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carmen Gomez-Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
22
|
Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda System for Reporting Thyroid Cytopathology. Thyroid 2023; 33:1039-1044. [PMID: 37427847 DOI: 10.1089/thy.2023.0141] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Since the publication of the first edition in 2010, The Bethesda System for Reporting Thyroid Cytopathology has allowed cytopathologists to use a standardized, category-based reporting system for thyroid fine needle aspirations. The third edition builds on the success of the 2 earlier editions and offers several key updates. The most important is the assignment of a single name for each of the 6 diagnostic categories: (i) nondiagnostic; (ii) benign; (iii) atypia of undetermined significance; (iv) follicular neoplasm; (v) suspicious for malignancy; and (vi) malignant. Each of the categories has an implied risk of malignancy (ROM), which has been updated and refined based on data reported after the second edition. The third edition offers an average ROM for each category, in addition to the expected range of cancer risk. The atypia of undetermined significance subcategorization is simplified into 2 subgroups based on the implied ROM and molecular profiling. A discussion of pediatric thyroid disease has been added, and pediatric ROMs and management algorithms are discussed in the relevant sections. Nomenclature has been updated to align with the 2022 World Health Organization Classification of Thyroid Neoplasms. Two new chapters have been added: one that addresses the significant and expanded use of molecular and ancillary testing in thyroid cytopathology, and another that summarizes clinical perspectives and imaging findings in thyroid disease.
Collapse
Affiliation(s)
- Syed Z Ali
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | | | - Fernando C Schmitt
- Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Philippe Vielh
- Department of Pathology, Medipath and the American Hospital of Paris, Paris, France
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
23
|
Belovarac B, Zhou F, Sharma J, Brandler TC. Indeterminate Thyroid Nodules and Advances in Molecular Pathology. Semin Diagn Pathol 2023; 40:349-352. [PMID: 37173165 DOI: 10.1053/j.semdp.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Thyroid cytology has in recent years been augmented by molecular testing for indeterminate lesions. Three commercial molecular tests are available which provide variable amounts of detail regarding the genetic alterations identified in a sample. This paper will describe these tests, as well as the common molecular drivers associated with papillary thyroid carcinoma (PTC) and follicular patterned lesions, in order to help the practicing pathologist and clinician better interpret the results of these tests and incorporate this information into their management of cytologically indeterminate thyroid lesions.
Collapse
Affiliation(s)
- Brendan Belovarac
- NYU Langone Health, Department of Pathology, 560 First Avenue 4th Floor, New York NY 10016, USA
| | - Fang Zhou
- NYU Langone Health, Department of Pathology, 560 First Avenue 4th Floor, New York NY 10016, USA
| | - Jake Sharma
- NYU Langone Health, Department of Pathology, 560 First Avenue 4th Floor, New York NY 10016, USA
| | - Tamar C Brandler
- NYU Langone Health, Department of Pathology, 560 First Avenue 4th Floor, New York NY 10016, USA; Rutgers Robert Wood Johnson Medical School, Middlesex Pavilion, 3rd floor, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901, USA.
| |
Collapse
|
24
|
Ali SZ, Baloch ZW, Cochand-Priollet B, Schmitt FC, Vielh P, VanderLaan PA. The 2023 Bethesda System for reporting thyroid cytopathology. J Am Soc Cytopathol 2023; 12:319-325. [PMID: 37438235 DOI: 10.1016/j.jasc.2023.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Since the publication of the first edition in 2010, The Bethesda System for Reporting Thyroid Cytopathology has allowed cytopathologists to use a standardized, category-based reporting system for thyroid fine needle aspirations. The third edition builds on the success of the 2 earlier editions and offers several key updates. The most important is the assignment of a single name for each of the 6 diagnostic categories: (i) nondiagnostic; (ii) benign; (iii) atypia of undetermined significance; (iv) follicular neoplasm; (v) suspicious for malignancy; and (vi) malignant. Each of the categories has an implied risk of malignancy (ROM), which has been updated and refined based on data reported after the second edition. The third edition offers an average ROM for each category, in addition to the expected range of cancer risk. The atypia of undetermined significance subcategorization is simplified into 2 subgroups based on the implied ROM and molecular profiling. A discussion of pediatric thyroid disease has been added, and pediatric ROMs and management algorithms are discussed in the relevant sections. Nomenclature has been updated to align with the 2022 World Health Organization Classification of Thyroid Neoplasms. Two new chapters have been added: one that addresses the significant and expanded use of molecular and ancillary testing in thyroid cytopathology, and another that summarizes clinical perspectives and imaging findings in thyroid disease.
Collapse
Affiliation(s)
- Syed Z Ali
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | | | - Fernando C Schmitt
- Department of Pathology, Medical Faculty of Porto University, Porto, Portugal
| | - Philippe Vielh
- Department of Pathology, Medipath and the American Hospital of Paris, Paris, France
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
25
|
Chetty M, Mbatha B, Fru P. The association between cytology and histopathology in thyroid nodules over a 6-year period in an urban hospital in South Africa. S Afr Med J 2023; 113:58-62. [PMID: 37882116 DOI: 10.7196/samj.2023.v113i8.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Thyroid cancer is prevalent both internationally and locally, and is the most common cause of endocrine malignancies in Africa. The prognosis of thyroid cancer in general is quite good, but to achieve good outcomes, appropriate methods for diagnosis are important. A cytology result obtained from a fine needle aspiration and biopsy (FNAB) is one such method, and is less invasive and has less risk compared with obtaining a histological result via open surgery. However, there are accuracy differences that have been reported in different literature findings. OBJECTIVES To determine the diagnostic accuracy rate of thyroid FNAB compared with histopathological samples at an urban hospital in South Africa (SA), and compare this with international standards. METHODS A retrospective observational study was conducted of patients who had undergone both FNAB and thyroidectomies at Helen Joseph Hospital, Gauteng Province, SA, a public tertiary hospital, between 1 January 2016 and 31 December 2021. Various analytical methods were used, including Poisson generalised linear model, binomial generalised linear model, a two-proportion z-test, McNemar's test and the F1 score. RESULTS There were 164 participants in this study who were between the ages of 21 and 82 years old. Thirty-six records were excluded for use as a comparison between cytology and histology, as they were in Bethesda categories 1, 3 and 4. Out of the 128 records that were compared, there was statistically significant agreement v. non-agreement between cytology and histology findings for thyroid nodules (109 v. 19, p<0.001, respectively). A comparison between our sample population and internationally published standards in terms of rate of malignancy noted that our rate of malignancy was slightly higher in Bethesda 2 patients (5.88%) v. internationally published standards (0 - 3%), and slightly lower in Bethesda 4 (23.52%) and 6 (77.77%) v. internationally published standards (25 - 40% and 97 - 99%, respectively. CONCLUSION There was good correlation between cytology and histology for thyroid nodules. Differences were noted between the percentage of malignant cases in the different Bethesda categories compared with international standards as noted above. We recommend that further studies are conducted locally to improve knowledge on this topic.
Collapse
Affiliation(s)
- M Chetty
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - B Mbatha
- Department of Endocrine and Bariatrics, Helen Joseph Hospital, Johannesburg, South Africa.
| | - P Fru
- Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| |
Collapse
|
26
|
Noltes ME, Bader M, Metman MJH, Vonk J, Steinkamp PJ, Kukačka J, Westerlaan HE, Dierckx RAJO, van Hemel BM, Brouwers AH, van Dam GM, Jüstel D, Ntziachristos V, Kruijff S. Towards in vivo characterization of thyroid nodules suspicious for malignancy using multispectral optoacoustic tomography. Eur J Nucl Med Mol Imaging 2023; 50:2736-2750. [PMID: 37039901 PMCID: PMC10317911 DOI: 10.1007/s00259-023-06189-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/05/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Patient-tailored management of thyroid nodules requires improved risk of malignancy stratification by accurate preoperative nodule assessment, aiming to personalize decisions concerning diagnostics and treatment. Here, we perform an exploratory pilot study to identify possible patterns on multispectral optoacoustic tomography (MSOT) for thyroid malignancy stratification. For the first time, we directly correlate MSOT images with histopathology data on a detailed level. METHODS We use recently enhanced data processing and image reconstruction methods for MSOT to provide next-level image quality by means of improved spatial resolution and spectral contrast. We examine optoacoustic features in thyroid nodules associated with vascular patterns and correlate these directly with reference histopathology. RESULTS Our methods show the ability to resolve blood vessels with diameters of 250 μm at depths of up to 2 cm. The vessel diameters derived on MSOT showed an excellent correlation (R2-score of 0.9426) with the vessel diameters on histopathology. Subsequently, we identify features of malignancy observable in MSOT, such as intranodular microvascularity and extrathyroidal extension verified by histopathology. Despite these promising features in selected patients, we could not determine statistically relevant differences between benign and malignant thyroid nodules based on mean oxygen saturation in thyroid nodules. Thus, we illustrate general imaging artifacts of the whole field of optoacoustic imaging that reduce image fidelity and distort spectral contrast, which impedes quantification of chromophore presence based on mean concentrations. CONCLUSION We recommend examining optoacoustic features in addition to chromophore quantification to rank malignancy risk. We present optoacoustic images of thyroid nodules with the highest spatial resolution and spectral contrast to date, directly correlated to histopathology, pushing the clinical translation of MSOT.
Collapse
Affiliation(s)
- Milou E Noltes
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Maximilian Bader
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Madelon J H Metman
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jasper Vonk
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pieter J Steinkamp
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan Kukačka
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
| | - Henriette E Westerlaan
- Department of Radiology, University Medical Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gooitzen M van Dam
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- AxelaRx/TRACER Europe BV, Groningen, the Netherlands
| | - Dominik Jüstel
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging at the Central Institute for Translational Cancer Research (TranslaTUM), School of Medicine, Technical University of Munich, Munich, Germany
- Institute of Biological and Medical Imaging, Helmholtz Zentrum München, Neuherberg, Germany
- Munich Institute of Robotics and Machine Intelligence (MIRMI), Technical University of Munich, Munich, Germany
| | - Schelto Kruijff
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| |
Collapse
|
27
|
Matalka L, Rahman AF, Sparks S, Lindeman B, Iyer P. Evaluation and management of pediatric thyroid nodules and thyroid cancer at a single institution after adoption of the American Thyroid Association 2015 guidelines. J Pediatr Endocrinol Metab 2023:jpem-2022-0334. [PMID: 37218509 DOI: 10.1515/jpem-2022-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES The study purpose is to correlate clinical findings with rates of differentiated thyroid cancer (DTC) in a cohort of children presenting with thyroid nodules at a single institution since the adoption of the 2015 American Thyroid Association (ATA) Guidelines Task Force on Pediatric Thyroid Cancer. METHODS Clinical, radiographic, and cytopathologic findings were retrospectively analyzed in a pediatric cohort (≤19 years) identified with ICD-10 codes for thyroid nodules and thyroid cancer from January 2017 until May 2021. RESULTS We analyzed 183 patients with thyroid nodules. The mean patient age was 14 years (interquartile range 11-16) with a female (79.2 %) and white Caucasian (78.1 %) predominance. The overall DTC in our pediatric patient cohort was 12.6 % (23 out of 183). Most of the malignant nodules measured from 1-4 cm (65.2 %) with TI-RADS score of ≥4 (69.6 %). Among the fine-needle aspiration results (n=49), the highest frequency of DTC was within the malignant category (16.33 %), followed by suspicious for malignancy (6.12 %), then atypia or follicular lesion of undetermined significance (8.16 %), and lastly follicular lesion or neoplasm and benign with 4.08 % and 2.04 % respectively. Of the forty-four thyroid nodules that underwent surgical intervention, pathology was remarkable for 19 papillary thyroid carcinoma (43.18 %) and 4 follicular thyroid carcinoma (9.09 %). CONCLUSIONS Based on the analysis of our pediatric cohort in the southeast region at a single institution, adoption of the 2015 ATA guidelines could lead to an increased accuracy in detecting DTC while reducing the number of patients requiring interventions, such as FNA biopsy and/or surgeries. Further, based on our small cohort, it would be reasonable for thyroid nodules 1 cm or less to be monitored clinically with physical exam and ultrasonography, with further therapeutic or diagnostic intervention considered based on concerning features or parental shared decision making.
Collapse
Affiliation(s)
- Leen Matalka
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, University of Alabama at Birmingham, Birmingham, USA
| | - Akm Fazlur Rahman
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Sarah Sparks
- Children's of Alabama, Endocrinology, Birmingham, USA
| | - Brenessa Lindeman
- Department of Surgery, Section of Endocrine Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Pallavi Iyer
- Department of Pediatrics, Division of Endocrinology and Diabetes, Medical College of Wisconsin, Milwaukee, USA
| |
Collapse
|
28
|
Rivera-Buse JE, Patajalo-Villalta SJ, Donadi EA, Barbosa F, Magalhães PKR, Maciel LMZ. Impact of lead exposure on the thyroid glands of individuals living in high- or low-lead exposure areas. Medicine (Baltimore) 2023; 102:e33292. [PMID: 36961188 PMCID: PMC10036069 DOI: 10.1097/md.0000000000033292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/24/2023] [Indexed: 03/25/2023] Open
Abstract
Ecuador was an endemic area for iodine deficiency; however, due to the population consumption of iodized table salt, the country is nowadays considered iodine sufficient. Despite the population consumption of iodized salt for more than 50 years, the prevalence of hypothyroidism has increased in recent years. A similar increment has been reported for thyroid cancer (TC) becoming the second most common cancer in women and seventh most common cancer in men. High blood lead (BPb) level is a controversial causal factor for impaired thyroid function as well as a debated environmental cause for the increased incidence of TC. To study the association between BPb and thyroid function, anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies, and the presence of benign and malignant thyroid nodules in Ecuadorian individuals living in high lead exposure (HE) areas compared with those living in low lead exposure (LE) area. We evaluated 197 euthyroid individuals: 70 from Esmeraldas (close to a petrol refinery) and 27 from La Victoria de Pujilí (Pb-glazing ceramics), considered HE areas, and 100 from Quito, considered the LE area. In parallel, we evaluated 187 patients with hypothyroidism (60, 27, and 100 patients from Esmeraldas, Pujilí, and Quito, respectively). BPb was detected using atomic absorption spectroscopy, while thyroid-stimulating hormone (TSH), free-thyroxine (FT4), and autoantibodies were measured using chemiluminescence assays. Thyroid ultrasonography was performed in 300 individuals and fine-needle aspiration biopsy (FNA) was performed only when required based on the guidelines of the American Thyroid Association. The BPb levels (mean ± SD) in the HE areas were increased (8.5 ± 7.4) than those in the LE area (3.2 ± 2.4, P < .001). No significant associations were observed between BPb and TSH, FT4, or thyroid antibody levels. Enlarged thyroid glands and larger thyroid nodules were primarily observed in HE areas. Just 1 TC was observed. High BPb levels detected in HE areas were not associated with thyroid function or thyroid autoantibodies; however, increased thyroid size and numbers of thyroid nodules were observed, demanding further actions to control lead contamination in these Ecuadorian areas.
Collapse
Affiliation(s)
- José Estefano Rivera-Buse
- Medicine School, Medical Sciences Faculty – Universidad Central del Ecuador, Quito, Ecuador
- Department of Internal Medicine, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sheila Jissela Patajalo-Villalta
- Medicine Faculty – Pontifical Catholic University of Ecuador (PUCE), Quito, Ecuador
- Department of Internal Medicine, Hospital Vozandes, Quito, Ecuador
| | - Eduardo Antônio Donadi
- Department of Internal Medicine, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Fernando Barbosa
- Department of Clinical, Toxicological, and Bromatological Analysis, Ribeirão Preto Pharmaceutical Sciences School, Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Léa Maria Zanini Maciel
- Department of Internal Medicine, Ribeirão Preto Medical School – University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
29
|
Characteristics of PTEN Mutation in Thyroid Tumours: A Retrospective Chart Review. Cancers (Basel) 2023; 15:cancers15051575. [PMID: 36900366 PMCID: PMC10001390 DOI: 10.3390/cancers15051575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
While some studies suggest that PTEN mutations correlate with a low-risk phenotype in pediatric thyroid nodules, the relationship between the mutation and malignancy in the adult populations is abstruse. This study investigated whether PTEN mutations result in thyroid malignancy, and whether these malignancies are aggressive. This multicenter study involved 316 patients who underwent preoperative molecular testing, and subsequent lobectomy or total thyroidectomy at two quaternary care hospitals. A four-year retrospective review was performed on the 16 charts of patients that opted for surgery following a positive PTEN mutation on molecular testing results from January 2018 to December 2021. Of the total 16 patients, 37.5% (n = 6) had malignant tumours, 18.75% (n = 3) had non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs), and 43.75% (n = 7) had benign disease. Aggressive features were detected in 33.33% of the malignant tumours. Malignant tumours were found to have a statistically significant higher allele frequency (AF). The aggressive nodules were all poorly differentiated thyroid carcinomas (PDTCs) with copy number alterations (CNAs) and the highest AFs.
Collapse
|
30
|
Velez Torres JM, Tjendra Y, Kerr DA. A Triumvirate:: Correlating Thyroid Cytopathology, Molecular Testing, and Histopathology. Surg Pathol Clin 2023; 16:1-14. [PMID: 36739157 DOI: 10.1016/j.path.2022.09.003] [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: 12/13/2022]
Abstract
Risk stratification is essential in the preoperative evaluation and management of thyroid nodules, most of which are benign. Advances in DNA and RNA sequencing have shed light on the molecular drivers of thyroid cancer. Molecular testing of cytologically indeterminate nodules has helped refine risk stratification, triage patients for surgery, and determine the extent of surgery. Molecular platforms with high negative predictive values can help identify nodules that may be spared surgery and can be managed conservatively. Here we discuss the importance of integrating cytomorphologic, molecular, and histologic features to help avoid errors and improve patient management.
Collapse
Affiliation(s)
- Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12(th) Avenue, Miami, FL 33136, USA. https://twitter.com/JaylouVelez
| | - Youley Tjendra
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, 1400 NW 12(th) Avenue, Miami, FL 33136, USA. https://twitter.com/Y_Tjendra
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA; Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA.
| |
Collapse
|
31
|
Li Q, Yang L, Lv J, Xu L, Zhang M, Li S. The combination of BRAF V600E mutation and Chinese Thyroid Imaging Reporting and Data System is helpful in the management of AUS/FLUS thyroid nodules. Endocrine 2022; 78:507-516. [PMID: 36152114 DOI: 10.1007/s12020-022-03176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/16/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE To explore the utility of the BRAFV600E mutation in combination with the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in the management of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) thyroid nodule (TN). METHODS 138 AUS/FLUS TNs in 129 patients were included. Each TN underwent preoperative BRAFV600E mutation analysis and was classified using the C-TIRADS. Histopathologic diagnosis served as reference standard. RESULTS 46 benign TNs and 92 malignant TNs were identified. The C-TIRADS 4C and 5 (OR = 10.409, P = 0.000), BRAFV600E mutation (OR = 36.493, P = 0.000) were independent predictors of malignant nodules. There were significant differences in malignancy rate among the different C-TIRADS TNs (P = 0.000), and these TNs with higher C-TIRADS were associated with increased malignancy rate (P for trend = 0.000). The rate of the nodule with BRAFV600E mutation increased with the increase of C-TIRADS (P for trend = 0.001). For AUS/FLUS TNs without BRAFV600E mutation, the malignancy rates of the C-TIRADS 3, 4A, 4B, 4C, and 5 were 0%, 21.4%, 20.8%, 70.8%, and 100%, respectively (P = 0.000), and the malignancy rate increased from C-TIRADS 3 to C-TIRADS 5 (P for trend = 0.000). C-TIRADS and BRAFV600E mutation had similar diagnostic efficacy (P > 0.05), and the sensitivity, negative predictive value, and accuracy of the combination were significantly higher than BRAFV600E gene or C-TIRADS alone (P < 0.05). CONCLUSIONS C-TIRADS can effectively provide risk stratification for AUS/FLUS nodules. The combination is helpful in selecting appropriate management for AUS/FLUS patients.
Collapse
Affiliation(s)
- Qiang Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Lu Yang
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Jianghong Lv
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Lilong Xu
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Murui Zhang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Shiyan Li
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou, China.
| |
Collapse
|
32
|
Decaussin-Petrucci M, Albarel F, Leteurtre E, Borson-Chazot F, Cochand Priollet B. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules : Recommendations in thyroid cytology: from technique to interpretation. ANNALES D'ENDOCRINOLOGIE 2022; 83:389-394. [PMID: 36283459 DOI: 10.1016/j.ando.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons, but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This section deals with the technique and interpretation of thyroid fine-needle aspiration biopsy (FNAB), a reference test for the analysis of thyroid nodules.
Collapse
Affiliation(s)
- M Decaussin-Petrucci
- Pathology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France, EA 3738, Lyon 1 University, Lyon, France.
| | - F Albarel
- Service d'Endocrinologie, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de Référence des Maladies Rares de l'Hypophyse HYPO, 13005 Marseille, France
| | - E Leteurtre
- University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000 Lille, France
| | - F Borson-Chazot
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France; Université Lyon 1, Claude Bernard, Lyon, France
| | - B Cochand Priollet
- Hôpital Cochin, Paris 75014, France; APHP Centre; université Paris-Cité, Paris, France
| |
Collapse
|
33
|
Fu Y, Sun Y, Pei Q, Han X, Qin W, Mei F, Tan S, Cui L. Factors Influencing the Sample Adequacy of Ultrasound-Guided Fine-Needle Aspiration from Solid Thyroid Nodules for Liquid-Based Cytology: A Demographic, Sonographic, and Technical Perspective. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111639. [PMID: 36422179 PMCID: PMC9698410 DOI: 10.3390/medicina58111639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: To identify factors that influence the sample adequacy of solid thyroid nodules based on ultrasound-guided fine-needle aspiration (FNA) with subsequent liquid-based cytology. Materials and Methods: We retrospectively reviewed 855 patients who underwent ultrasound-guided FNA at our hospital between July 2019 and July 2020. The final analysis included 801 solid thyroid nodules in 801 patients. After reviewing the demographic data, ultrasonic features, and FNA technique-related factors, we defined 14 potential variables. For cytological results, the Bethesda categories II−VI were defined as adequate sample results. Univariate and multivariate analyses were performed to identify factors that influenced sample adequacy. Results: The adequate sample rate was 87.1%. The univariate analysis showed that four factors were related to adequate sampling in patients with thyroid FNA. These factors included age (p < 0.001), nodule orientation (p = 0.0232), calcification (p = 0.0034), and operator experience (p = 0.0286). After the multivariate analysis, five independent factors were identified to improve the diagnostic results of FNA for solid thyroid nodules: (1) the presence of Hashimoto’s thyroiditis (odds ratio (OR) = 1.810; 95% confidence interval (CI): 1.076−3.045; p = 0.0254), (2) a taller-than-wide orientation (OR = 2.038; 95% CI: 1.260−3.296; p = 0.0037), (3) the presence of calcification (OR = 1.767; 95% CI: 1.115−2.799; p = 0.0153), (4) four needle passes to obtain material (OR = 1.750; 95% CI: 1.094−2.799; p = 0.0196), and (5) an experienced operator (OR = 0.561; 95% CI: 0.319−0.987; p = 0.0451). Conclusions: A taller-than-wide orientation, the presence of calcification, and the presence of Hashimoto’s thyroiditis were found to affect the sample adequacy of ultrasound-guided FNA with liquid-based cytology. The sample adequacy could be improved when FNA is performed with four needle passes by experienced doctors.
Collapse
Affiliation(s)
- Ying Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Yan Sun
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Qianqian Pei
- Department of Ultrasound, Tongxiang First People’s Hospital, Tongxiang 314500, China
| | - Xiaobo Han
- Department of Ultrasound, Qinhuangdao Third Hospital, Qinhuangdao 066000, China
| | - Wen Qin
- Department of Ultrasound, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang 441021, China
| | - Fang Mei
- Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Shi Tan
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Ligang Cui
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
- Correspondence: ; Tel.: +86-13263493931
| |
Collapse
|
34
|
Combined Shear Wave Elastography and EU TIRADS in Differentiating Malignant and Benign Thyroid Nodules. Cancers (Basel) 2022; 14:cancers14225521. [PMID: 36428614 PMCID: PMC9688054 DOI: 10.3390/cancers14225521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Although multimodal ultrasound approaches have been suggested to potentially improve the diagnosis of thyroid cancer; the diagnostic utility of the combination of SWE and malignancy-risk stratification systems remains vague due to the lack of standardized criteria. The purpose of the study was to assess the diagnostic value of the combination of grey scale ultrasound assessment using EU TIRADS and shear wave elastography. 121 patients (126 nodules−81 benign; 45 malignant) underwent grey scale ultrasound and SWE imaging of nodules between 0.5 cm and 5 cm prior to biopsy and/or surgery. Nodules were analyzed based on size stratifications: <1 cm (n = 43); 1−2 cm (n = 52) and >2 cm (n = 31) and equivocal cytology status (n = 52), and diagnostic performance assessments were conducted. The combination of EU TIRADS with SWE using the SD parameter; maintained a high sensitivity and significantly improved the specificity of sole EU TIRADS for nodules 1−2 cm (SEN: 72.2% vs. 88.9%, p > 0.05; SPEC: 76.5% vs. 55.9%, p < 0.01) and >2 cm (SEN: 71.4% vs. 85.7%, p > 0.05; SPEC: 95.8% vs. 62.5%, p < 0.01). For cytologically-equivocal nodules; the combination with the SWE minimum parameter resulted in a significant reduction in sensitivity with increased specificity (SEN: 60% vs. 80%; SPEC: 83.4% vs. 37.8%; all p < 0.05). SWE in combination with EU TIRADS is diagnostically efficient in discriminating nodules > 1 cm but is not ideal for discriminating cytologically-equivocal nodules.
Collapse
|
35
|
Koh HH, Oh YL. Papillary and medullary thyroid carcinomas coexisting in the same lobe, first suspected based on fine-needle aspiration cytology: a case report. J Pathol Transl Med 2022; 56:301-308. [PMID: 36128867 PMCID: PMC9510044 DOI: 10.4132/jptm.2022.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Because different types of thyroid malignancies have distinct embryological origins, coexisting tumors are rarely observed. We describe a coexisting papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) first suspected by fine-needle aspiration cytology (FNAC). A 57-year-old female presented with an irregular mass in the right thyroid lobe. The cytopathologic findings of fine-needle aspiration showed two components: a papillary-like arrangement consisting of cells with pale enlarged nuclei indicative of PTC and loose clusters comprised of oval cells with granular chromatin indicative of MTC. The diagnosis of a coexisting PTC and MTC was initially confirmed by calcitonin immunocytochemistry and later after total thyroidectomy. Although some surgical case reports of PTC and MTC coexisting in either the same or different lobes have been documented, a case suspected by FNAC before the surgery has rarely been reported. Because appropriate treatment and prognosis of PTC and MTC are different, cytopathologists should be aware of this rare entity.
Collapse
Affiliation(s)
- Hyun Hee Koh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
36
|
Conroy PC, Wilhelm A, Calthorpe L, Ullmann TM, Davis S, Huang CY, Shen WT, Gosnell J, Duh QY, Roman S, Sosa JA. Endocrine surgeons are performing more thyroid lobectomies for low-risk differentiated thyroid cancer since the 2015 ATA guidelines. Surgery 2022; 172:1392-1400. [PMID: 36002375 DOI: 10.1016/j.surg.2022.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/20/2022] [Accepted: 06/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The 2015 American Thyroid Association guidelines recommended either total thyroidectomy or lobectomy for surgical treatment of low-risk differentiated thyroid cancer and de-escalated recommendations for central neck dissections. The study aim was to investigate how practice patterns among endocrine surgeons have changed over time. METHODS All adult patients with low-risk differentiated thyroid cancers (T1-T2, N0/Nx, M0/Mx) in the Collaborative Endocrine Surgery Quality Improvement Program (2014-2021) were identified. The outcomes between patients undergoing lobectomy versus total thyroidectomy were compared using multivariable logistic regression. The annual percent change in the proportion of lobectomies and central neck dissections performed was estimated using joinpoint regression. RESULTS In total, 5,567 patients with low-risk differentiated thyroid cancers were identified. Of these, 2,261 (40.6%) were very low-risk tumors ≤1 cm, and 2,983 (53.6%) were low-risk tumors >1 and <4 cm. Most patients (67.9%) underwent total thyroidectomy. Compared to total thyroidectomy, lobectomy was associated with outpatient surgery (adjusted odds ratio 5.19, P < .001), a decreased risk of postoperative emergency department visits (adjusted odds ratio 0.63, P = .03), and decreased risk of hypoparathyroidism events (adjusted odds ratio 0.03, P < .001). Compared to before (2014-2015), patients undergoing surgery after publication of the revised guidelines (2016-2021) had higher odds of lobectomy and lower odds of central neck dissection for tumors ≤1 cm (lobectomy adjusted odds ratio 2.70, P < .001; central neck dissections adjusted odds ratio 0.64, P = .03) and tumors between 1 and 4 cm (lobectomy adjusted odds ratio 2.27, P < .001; central neck dissection adjusted odds ratio 0.62, P < .001). CONCLUSION After publication of the 2015 American Thyroid Association guidelines, there has been an increase in thyroid lobectomies as a proportion of all thyroid operations performed by endocrine surgeons for low-risk differentiated thyroid cancer. This has implications for reduced health care use and costs, with potential population-level benefits.
Collapse
Affiliation(s)
- Patricia C Conroy
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/PatriciaCConroy
| | | | - Lucia Calthorpe
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/CalthorpeLucia
| | - Timothy M Ullmann
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/TUllmannMD
| | - Stephanie Davis
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/stedavis21_MD
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Wen T Shen
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/wshen16
| | - Jessica Gosnell
- Department of Surgery, University of California, San Francisco, CA
| | - Quan-Yang Duh
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/EndoSurgSF
| | - Sanziana Roman
- Department of Surgery, University of California, San Francisco, CA. https://twitter.com/PheoSurgeon
| | - Julie Ann Sosa
- Department of Surgery, University of California, San Francisco, CA.
| |
Collapse
|
37
|
Gajzer DC, Tjendra Y, Kerr DA, Algashaamy K, Zuo Y, Menendez SG, Jorda M, Garcia-Buitrago M, Gomez-Fernandez C, Velez Torres JM. Probability of malignancy as determined by ThyroSeq v3 genomic classifier varies according to the subtype of atypia. Cancer Cytopathol 2022; 130:881-890. [PMID: 35775861 DOI: 10.1002/cncy.22617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/21/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND ThyroSeq assesses the probability of malignancy (POM) in thyroid fine-needle aspiration cytology specimens diagnosed as atypia of undetermined significance (AUS). The authors investigated whether defined AUS subcategories are associated with specific molecular alterations, the molecular-derived risk of malignancy (MDROM), and the risk of malignancy (ROM). METHODS Fine-needle aspiration cytology reports of AUS and corresponding results from the ThyroSeq version 3 genomic classifier results were retrieved and subcategorized as follicular cells with either cytologic atypia (FC-C), architectural atypia (FC-A), both cytologic and architectural atypia (FC-CA), or a predominance of Hurthle cells (PHC). The MDROM, ROM, and frequency of molecular alterations by subcategory were computed and analyzed, and p < .05 was considered significant. RESULTS The final analysis included 541 cases subdivided into 233 with FC-A, 104 with FC-C, 116 with FC-CA, and 88 with PHC. The benign call rate and positive call rate for the AUS category were 72% and 28%, respectively, which varied between AUS subcategories. The MDROM by subcategory was 15.9% FC-A, 20.5% FC-C, 33.8% FC-CA, and 14.4% PHC. Histologic follow-up was available for 155 (28%) AUS cases with a follow-up period ≥12 months. The 95% confidence intervals of the MDROMs overlapped with the ROMs. The highest MDROM and ROM were in the FC-CA subcategory. RAS mutations were present in all subcategories. BRAF V600E mutations and papillary thyroid carcinoma were most frequent in the FC-CA subcategory. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features was significantly more frequent in the FC-C subcategory. CONCLUSIONS The current results demonstrated that AUS subcategories are associated with specific genetic alterations, the MDROM, and the ROM. Molecular results and an awareness of various cancer probabilities within AUS subcategories can allow for a more tailored management.
Collapse
Affiliation(s)
- David C Gajzer
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Youley Tjendra
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Darcy A Kerr
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Khaled Algashaamy
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yiqin Zuo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Silvia Gra Menendez
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Merce Jorda
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Monica Garcia-Buitrago
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carmen Gomez-Fernandez
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
38
|
Macerola E, Poma AM, Proietti A, Rago T, Romani R, Vignali P, Ugolini C, Torregrossa L, Basolo A, Santini F, Basolo F. Down-regulation of miR-7-5p and miR-548ar-5p predicts malignancy in indeterminate thyroid nodules negative for BRAF and RAS mutations. Endocrine 2022; 76:677-686. [PMID: 35347579 PMCID: PMC9156468 DOI: 10.1007/s12020-022-03034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The value of molecular markers in refining preoperative risk assessment of indeterminate thyroid nodules is being widely investigated. MicroRNAs (miRNA) are emerging as promising biomarkers for diagnostic and prognostic purposes. The aim of this study is to identify miRNAs specifically deregulated in mutation-negative indeterminate thyroid nodules. METHODS Ninety-eight nodules preoperatively diagnosed as TIR 3A or TIR 3B with available histological diagnosis of follicular adenoma (FA), noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP), and follicular variant papillary thyroid carcinoma (FV-PTC) have been retrospectively selected. Mutations in BRAF and RAS genes have been tested in all samples by real-time PCR; miRNAs were purified from cytology slides of 60 samples; expression analysis of 798 miRNAs was measured by the nCounter system. RESULTS Point mutations in BRAF and RAS genes were detected in 32 out of 98 nodules (32.7%), the majority of which in FV-PTCs. Differential expression of miRNA in wild-type nodules highlighted that two miRNAs, namely miR-7-5p and miR-548ar-5p, were downregulated in FV-PTCs compared to FAs. The combined expression of these miRNAs, tested by ROC analysis, showed an area under the curve of 0.79. Sensitivity and negative predictive value were high both in wild-type (93% and 92%, respectively) and in mutated nodules (94% and 85%, respectively). CONCLUSION The analysis of miR-7-5p and miR-548ar-5p expression in indeterminate thyroid nodules demonstrated a promising value in ruling out malignancy.
Collapse
Affiliation(s)
- Elisabetta Macerola
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Anello Marcello Poma
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Agnese Proietti
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Teresa Rago
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Rossana Romani
- University Hospital of Pisa - via Roma, 67 56126, Pisa, Italy
| | - Paola Vignali
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Clara Ugolini
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Liborio Torregrossa
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Alessio Basolo
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Ferruccio Santini
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Fulvio Basolo
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy.
| |
Collapse
|
39
|
Fawcett C, Eppenberger-Castori S, Zechmann S, Hanke J, Herzog M, Savic Prince S, Christ ER, Ebrahimi F. Effects of Rapid On-Site Evaluation on Diagnostic Accuracy of Thyroid Fine-Needle Aspiration. Acta Cytol 2022; 66:371-378. [PMID: 35512664 PMCID: PMC9501752 DOI: 10.1159/000522662] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is well-established for the evaluation of suspicious thyroid nodules. However, a significant proportion is nondiagnostic. Rapid on-site evaluation (ROSE) has been proposed to improve the overall adequacy of FNA. METHODS Retrospective cohort study comparing adequacy of thyroid FNA findings pre- and postimplementation of ROSE at a tertiary center in Switzerland. Patients undergoing thyroid FNA from January 2016 to December 2019 were included. The primary outcome was the rate of nondiagnostic findings (Bethesda System for Reporting Thyroid Cytopathology category I). RESULTS In total, 410 thyroid nodule FNAs were performed. Of those, 309 with standard FNA and 101 with ROSE. The majority of patients were female (71%), with a median age of 56 years (IQR 46-68) and a nodule diameter of 1.9 cm (IQR 1.2-2.9). Implementation of ROSE led to a decrease in nondiagnostic findings from 41.1% to 23.8%, with an odds ratio of 0.42 (95% CI: 0.24-0.72; p = 0.002). Implementation of ROSE was associated with significantly higher rates of Bethesda category III (27.7% vs. 19.1%), category IV (15.8% vs. 5.5%), and Bethesda category VI (6.9% vs. 2.3%). Repeated FNA was performed in 29.1% before and 20.8% after implementation of ROSE (p = 0.18). The mean number of FNA per nodule was reduced from 1.4 (0.6) to 1.2 (0.4) with ROSE (p = 0.04). CONCLUSIONS Implementation of ROSE of thyroid nodule specimen improved diagnostic adequacy of FNA, reducing nondiagnostic findings. However, due to increased equivocal findings (Bethesda category III), there was no significant reduction of repeat FNA.
Collapse
Affiliation(s)
- Celia Fawcett
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | | | - Stefan Zechmann
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Jasmin Hanke
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Michelle Herzog
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Spasenija Savic Prince
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Emanuel Remigius Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Clarunis, University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
- *Fahim Ebrahimi,
| |
Collapse
|
40
|
Belovarac B, Zhou F, Modi L, Sun W, Shafizadeh N, Negron R, Yee-Chang M, Szeto O, Simsir A, Sheth S, Brandler TC. Evaluation of ACR TI-RADS cytologically indeterminate thyroid nodules and molecular profiles: a single-institutional experience. J Am Soc Cytopathol 2022; 11:165-172. [PMID: 35181254 DOI: 10.1016/j.jasc.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/03/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The American College of Radiology (ACR) Thyroid Imaging Reporting and Data Systems (TI-RADS) was developed to standardize thyroid ultrasound reports and predict the likelihood of malignancy. In our study, we aimed to correlate indeterminate thyroid fine needle aspiration cytology cases with preceding ultrasound (US) ACR TI-RADS scores and concurrent molecular testing results to examine how well the use of the ACR TI-RADS in our institution predicted which patients with indeterminate cytology might harbor molecular alterations. MATERIALS AND METHODS We performed a retrospective review of thyroid nodules. Patients with US reports that included TI-RADS scores, fine needle aspiration specimens with indeterminate cytology (Bethesda class III-V), and molecular testing results were included. RESULTS A total of 46 indeterminate cytology cases had had preceding US reports with TI-RADS scores and molecular testing (Bethesda class III, n = 37; Bethesda class IV, n = 6; Bethesda class V, n = 3). Most of the indeterminate cases had had a TI-RADS score of TR4 (31 of 46; 67.39%) or TR5 (9 of 46; 19.57%). RAS mutations were the most common alteration (n = 12). Of the 46 cases, 22 (47.85%) showed no alterations. Ten cases proceeded to surgery, of which seven displayed malignancies. CONCLUSIONS Molecular testing in cytologically indeterminate thyroid nodules provided valuable information for TR4 and TR5 lesions; however, the TR2 and TR3 lesions often had no molecular alterations. These findings highlight the potential value of including US imaging features when assessing the significance of indeterminate cytology findings.
Collapse
Affiliation(s)
- Brendan Belovarac
- Department of Pathology, New York University Langone Health, New York, New York
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York, New York
| | - Lopa Modi
- Department of Pathology, New York University Langone Health, New York, New York; Department of Pathology, Englewood Health, Englewood, New Jersey
| | - Wei Sun
- Department of Pathology, New York University Langone Health, New York, New York
| | - Negin Shafizadeh
- Department of Pathology, New York University Langone Health, New York, New York
| | - Raquel Negron
- Department of Pathology, New York University Langone Health, New York, New York
| | - Melissa Yee-Chang
- Department of Pathology, New York University Langone Health, New York, New York
| | - Oliver Szeto
- Department of Pathology, New York University Langone Health, New York, New York
| | - Aylin Simsir
- Department of Pathology, New York University Langone Health, New York, New York
| | - Sheila Sheth
- Department of Radiology, New York University Langone Health, New York, New York
| | - Tamar C Brandler
- Department of Pathology, New York University Langone Health, New York, New York.
| |
Collapse
|
41
|
Substantial interreader agreement for biopsy with reduction in biopsy rate: A multireader diagnostic performance study of ACR TI-RADS. Clin Imaging 2022; 84:93-97. [DOI: 10.1016/j.clinimag.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 12/26/2022]
|
42
|
Yao K, Jing X, Cheng J, Balis UGJ, Pantanowitz L, Lew M. A Study of Thyroid Fine Needle Aspiration of Follicular Adenoma in the "Atypia of Undetermined Significance" Bethesda Category Using Digital Image Analysis. J Pathol Inform 2022; 13:100004. [PMID: 35242444 PMCID: PMC8864759 DOI: 10.1016/j.jpi.2022.100004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background Originally designed for computerized image analysis, ThinPrep is underutilized in that role outside gynecological cytology. It can be used to address the inter/intra-observer variability in the evaluation of thyroid fine needle aspiration (TFNA) biopsy and help pathologists to gain additional insight into thyroid cytomorphology. Methods We designed and validated a feature engineering and supervised machine learning-based digital image analysis method using ImageJ and Python scikit-learn . The method was trained and validated from 400 low power (100x) and 400 high power (400x) images generated from 40 TFNA cases. Result The area under the curve (AUC) for receiver operating characteristics (ROC) is 0.75 (0.74–0.82) for model based from low-power images and 0.74 (0.69–0.79) for the model based from high-power images. Cytomorphologic features were synthesized using feature engineering and when performed in isolation, they achieved AUC of 0.71 (0.64–0.77) for chromatin, 0.70 (0.64–0.73) for cellularity, 0.65 (0.60–0.69) for cytoarchitecture, 0.57 (0.51–0.61) for nuclear size, and 0.63 (0.57–0.68) for nuclear shape. Conclusion Our study proves that ThinPrep is an excellent preparation method for digital image analysis of thyroid cytomorphology. It can be used to quantitatively harvest morphologic information for diagnostic purpose.
Collapse
Affiliation(s)
- Keluo Yao
- City of Hope National Medical Center, Department of Pathology, Bellaire, Texas, USA
| | - Xin Jing
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Jerome Cheng
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Ulysses G J Balis
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Liron Pantanowitz
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Madelyn Lew
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| |
Collapse
|
43
|
Tolaba N, Spedalletti Y, Bazzoni P, Galindez M, Cerioni V, Santillan C, Richter G, Herrera C, Sanchez L, Van Cawulaert L, Toscano MA, Nallar M, Monteros Alvi M, Moya CM. Testing of mutations on thyroid nodules with indeterminate cytology: A prospective study of 112 patients in Argentina. ENDOCRINOL DIAB NUTR 2022; 69:122-130. [PMID: 35256055 DOI: 10.1016/j.endien.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/21/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The study of genetic mutations in thyroid nodules makes it possible to improve the preoperative diagnosis of and reduce unnecessary surgeries on benign nodules. In this study, we analysed the impact of implementing a 7-gene mutation panel that enables mutations to be detected in BRAF and RAS (H/N/K) and the gene fusions PAX8/PPARG, RET/PTC1 and RET/PTC2, in a population in northern Argentina. METHODS We performed a prospective analysis of 112 fine needle aspirations diagnosed as having indeterminate cytology according to the Bethesda classification system. These include the Bethesda III or atypia of unknown significance/follicular lesion of unknown significance and Bethesda IV or follicular neoplasm/suspicious for follicular neoplasm categories. The mutations of the 7-gene panel were analysed and this information was linked to the available histology and ultrasound monitoring. RESULTS The BRAF V600E and RET/PTC1 mutations were associated with carcinoma in 100% of cases (n = 8), whereas only 37.5% (n = 3) of the nodules with RAS and 17% (n = 1) with PAX8/PPARG mutations were associated with carcinoma. From the histological diagnosis and ultrasound monitoring of patients, we can estimate that this panel has a sensitivity of 86% in detecting malignant carcinoma, a specificity of 77%, a positive predictive value (PPV) of 54% and a negative predictive value (NPV) of 94%. In this study, it was possible to reduce the number of surgeries by 48% in the patients analysed. CONCLUSION The implementation of the mutation panel allowed the appropriate surgical strategy to be selected for each patient, the number of two-step surgeries to be reduced, and active follow-up to be established in low-risk patients.
Collapse
Affiliation(s)
- Norma Tolaba
- Programa de Anatomía Patológica y Genética, Hospital Dr. Arturo Oñativia, Salta, Argentina.
| | - Yamila Spedalletti
- Programa de Anatomía Patológica y Genética, Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Paola Bazzoni
- Programa de Anatomía Patológica y Genética, Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Macarena Galindez
- Programa de Endocrinología, Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Valeria Cerioni
- Programa de Endocrinología, Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Cecilia Santillan
- Programa de Endocrinología, Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Gilda Richter
- Área de Cirugía Percutánea, Técnicas Cardíacas e Imágenes. Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Cecilia Herrera
- Área de Cirugía Percutánea, Técnicas Cardíacas e Imágenes. Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Laura Sanchez
- Área de Cirugía Percutánea, Técnicas Cardíacas e Imágenes. Hospital Dr. Arturo Oñativia, Salta, Argentina
| | | | - Marta A Toscano
- Programa de Anatomía Patológica y Genética, Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Marcelo Nallar
- Área de Cirugía Percutánea, Técnicas Cardíacas e Imágenes. Hospital Dr. Arturo Oñativia, Salta, Argentina
| | - Marcelo Monteros Alvi
- Programa de Anatomía Patológica y Genética, Hospital Dr. Arturo Oñativia, Salta, Argentina.
| | | |
Collapse
|
44
|
Arrigoni G, Crosetti E, Freddi M, Piovesan A, Rossetto Giaccherino R, Succo G, Palestini N. Comparison between 2015 ATA guidelines and Italian Consensus for DTC management. A commented report. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:41-54. [PMID: 35292787 PMCID: PMC9058931 DOI: 10.14639/0392-100x-n1572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022]
Abstract
The 2015 ATA guidelines and 2018 Italian Consensus have produced a series of generally concordant recommendations on clinical and therapeutic management of thyroid nodules and thyroid carcinoma. Currently, the goals of treatment are to achieve the highest disease-free survival rates through the best ratio between minimum invasiveness and cost/impact on quality of life. By analysis and comparison of the ATA Guidelines and Italian Consensus, we highlighted and commented upon the key points of differentiated thyroid cancer management. Furthermore, the aim of this work is to identify and promote uniform clinical approaches among all specialists who treat differentiated thyroid cancer and represent a starting point for a consensus drafted by the Italian Society of Otolaryngology - Head and Neck Surgery.
Collapse
|
45
|
Canberk S, Thodou E, Bongiovanni M. Small-Cell Malignancies of Thyroid: Challenge Solved? Acta Cytol 2022; 66:307-318. [PMID: 35016187 DOI: 10.1159/000520876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
"Small-cell malignancies of thyroid" is an unsolved dilemma. This term represents an umbrella terminology in thyroid, encompassing for a small group of tumors in which some of them are well-recognized tumors like medullary thyroid carcinoma, poorly differentiated thyroid carcinoma, and primary thyroid lymphomas and teratoma, whereas the remaining are less known as primary neuroendocrine carcinoma of thyroid, primary extraskeletal Ewing family tumors, and adamantinoma-like Ewing sarcoma. When the issue comes to evaluate a cytological sample predominantly composed of small-cell morphology, metastatic small-cell carcinomas to thyroid also should be excluded. In this review, our group focused on the main cytomorphological and clinical clues of each entity that help to set up a correct differential diagnosis. The literature discussions were also included for the entities that are not yet recognized by the mother publication WHO. A key point of the issue's simple algorithm based on FNAC with small-cell morphology of thyroid was suggested by the authors.
Collapse
Affiliation(s)
- Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal
- Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Eleni Thodou
- Department of Pathology, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | | |
Collapse
|
46
|
Park JJ, Frank E, Simental AA, Park JS, Kim S, Imperio-Lagabon K, Van der Werf O. Outcomes of Early Versus Delayed Completion Thyroidectomy for Malignancy. Am Surg 2022:31348211067999. [DOI: 10.1177/00031348211067999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To determine whether time interval between hemi-thyroidectomy and subsequent completion thyroidectomy impacts outcomes. Methods Retrospective review of 68 patients having completion thyroidectomy from August 2012 to December 2019. Patients were separated into two groups based on the time interval between surgeries: early (≤10 days) or delayed (≥90 days). Results Patients who underwent delayed completion thyroidectomy (n = 17) had significantly higher rates of hypocalcemia and/or hypoparathyroidism ( P = .03) and higher rates of requiring postoperative hospitalization ( P=.07) compared to those who underwent early completion thyroidectomy (n = 51). Delayed completion had significantly lower risk of developing one or more of dysphonia, dysphagia, or vocal cord paresis postoperatively ( P=.02). No patients developed hematoma or wound infection. Conclusions Delayed completion thyroidectomy is associated with increased rates of hypocalcemia, but lower rates of dysphonia and dysphagia. Given the low risk of long-term complications in both groups, it may be beneficial to perform completion thyroidectomy early in order to expedite cancer treatment.
Collapse
Affiliation(s)
- Jaimie J. Park
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ethan Frank
- Department of Otolaryngology, Loma Linda University Health, Loma Linda, CA, USA
| | - Alfred A. Simental
- Department of Otolaryngology, Loma Linda University Health, Loma Linda, CA, USA
| | - Joshua S. Park
- Department of Otolaryngology, Loma Linda University Health, Loma Linda, CA, USA
| | - Stephanie Kim
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | | |
Collapse
|
47
|
Taccogna S, Papini E, Novizio R, D’Angelo M, Turrini L, Persichetti A, Pontecorvi A, Guglielmi R. An innovative synthetic support for immunocytochemical assessment of cytologically indeterminate (Bethesda III) thyroid nodules. Front Endocrinol (Lausanne) 2022; 13:1078019. [PMID: 36531453 PMCID: PMC9752034 DOI: 10.3389/fendo.2022.1078019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Fine needle aspiration (FNA) is the procedure of choice in the evaluation of thyroid nodules. Nodules with indeterminate cytological categories, Bethesda III and IV, pose challenges in clinical practice and are frequently submitted to diagnostic surgery. CytoFoam Core (CFCS) uses an absorbent foam device inserted into the needle hub to collect the cytological sample aspirated during FNA. Specimen is formalin-fixed and paraffin-embedded. AIM OF THE STUDY Assessing diagnostic efficacy of CFCS, compared to traditional cytology, in re-evaluating thyroid nodules classified as Bethesda III, using post-surgical histology as reference standard. METHOD Retrospective study on 89 patients with a first indeterminate cytological report who were referred to the Department of Endocrinology of Regina Apostolorum Hospital (Albano L. Rome, Italy) for a second FNA. FNA was performed after at least one month under ultrasound guidance with a 23G needle according to the established procedure. During the second procedure, both traditional cytological (TC) smears and a single-pass CFCS specimen were obtained for each patient. On CFCS samples immunocytochemical staining for Galectin-3, HBME-1, and CK-19 was also performed. 51 patients eventually underwent surgery, and their histological diagnoses were compared to the TC and CFCS reports. Four parameters were evaluated: inadequacy rate, rate of persistent indeterminate (Bethesda III and IV) reports, rate of malignancy in persistently indeterminate nodules, and rate of cancer in lesions cytologically classified as malignant. RESULTS Non-diagnostic samples were 6 (11.8%) in TC vs 3 (5.9%) in CFCS (p=0.4). Persistent indeterminate samples were 31 (60.8%) in TC vs 19 (37.2%) in CFCS (p=0.01). Rate of malignancy in persistently indeterminate nodules was 8/19 (42.1%) in CFCS vs 9/31 (29%) in TC group (p=0.3). Nine/51 (17.6%) samples were classified as benign by TC vs 21/51 (41.2%) samples by CFCS (p<0.01). All nodules resulted benign at post-surgical evaluation. Five/51 (9.8%) samples were classified as suspicious for malignancy/malignant in TC group against 8/51 (15.7%) samples in CFCS (p=0.5). Post-surgical evaluation confirmed malignancy in all these cases. CONCLUSION CFCS demonstrated greater diagnostic accuracy than TC in repeat FNA assessment of cytologically indeterminate nodules. CFCS increased the conclusive diagnosis rate and decreased the number of cytologically indeterminate cases.
Collapse
Affiliation(s)
- Silvia Taccogna
- Pathology, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Enrico Papini
- Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Roberto Novizio
- Endocrinology and Metabolism, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
- *Correspondence: Roberto Novizio,
| | | | - Luca Turrini
- Pathology, Ospedale Regina Apostolorum, Albano Laziale, Italy
| | - Agnese Persichetti
- Service of Pharmacovigilance, Regina Elena National Cancer Institute, Hospital Physiotherapy Institutes (IRCCS), Rome, Italy
| | - Alfredo Pontecorvi
- Endocrinology and Metabolism, Agostino Gemelli University Polyclinic (IRCCS), Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Rinaldo Guglielmi
- Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| |
Collapse
|
48
|
Al-Maghrabi H, Tashkandi M, Khayyat W, Alghamdi A, Alsalmi M, Alzahrani A, Al-Hakami H, Alqarni M. Non-invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) lowers the risk of malignancy in the bethesda system for reporting thyroid cytopathology diagnostic categories. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:105-110. [PMID: 35602399 PMCID: PMC9121695 DOI: 10.4103/sjmms.sjmms_202_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 12/25/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: The introduction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been shown to decrease the risk of malignancy (ROM) in The Bethesda System for Reporting Thyroid Cytopathology. This knowledge may alter the management of patients with thyroid nodules. Objectives: To correlate cytological diagnosis with histological diagnosis for establishing the ROM of all Bethesda system categories after the introduction of NIFTP. Methods: This was a retrospective cohort study. All consecutive fine-needle aspiration cytology (FNAC) specimens collected from January 1, 2013, to December 31, 2017, at King Abdullah Medical City, Jeddah, Saudi Arabia, were assessed, and patients who underwent surgical excision of thyroid nodules were further analyzed. The ROM and overall ROM for each Bethesda category were calculated with and without considering NIFTP as a malignant tumor. Results: Overall, 1066 FNAC specimens were collected, of which 281 had a surgical correlation. Our cases included 18 (6.4%) non-diagnostic (ND), 109 (38.8%) benign, 28 (9.9%) atypia/follicular lesion of undetermined significance (AUS/FLUS), 39 (13.8%) follicular neoplasm or suspicion for follicular neoplasm (FN/SFN), 20 (7.1%) suspicion for malignancy (SM), and 67 (23.8%) malignant (POM) cases. After considering NIFTP diagnosis on resection specimens, the ROM decreased as follows: ND, 38.8% to 27.7% (P = 0.2388); benign, 21.1% to 11.9% (P = 0.0343); AUS/FLUS, 50% to 39.2% (P = 0.2089); FN/SFN, 53.8% to 33.3% (P = 0.0336); SM, 85% to 75% (P = 0.2147); POM, 95.5% to 88% (P = 0.0582). Conclusion: The introduction of NIFTP would significantly decrease the ROM of thyroid FNAC in both benign and FN/SFN categories of the Bethesda system.
Collapse
|
49
|
Tagliabue M, Giugliano G, Mariani MC, Rubino M, Grosso E, Chu F, Calastri A, Maffini FA, Mauri G, De Fiori E, Manzoni MF, Ansarin M. Prevalence of Central Compartment Lymph Node Metastases in Papillary Thyroid Micro-Carcinoma: A Retrospective Evaluation of Predictive Preoperative Features. Cancers (Basel) 2021; 13:cancers13236028. [PMID: 34885138 PMCID: PMC8656465 DOI: 10.3390/cancers13236028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/21/2021] [Accepted: 11/28/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary The present study focused on patients affected by stage pT1a papillary thyroid micro-carcinomas that were treated with surgery and central lymph node dissection. In this study, male sex, low age, and sub-capsular carcinoma localization resulted as independent predictive factors for central lymph node metastases. Abstract Papillary thyroid micro-carcinomas are considered relatively indolent carcinomas, often occult and incidental, with good prognosis and favorable outcomes. Despite these findings, central lymph node metastases are common, and are related to a poor prognosis for the patient. We performed a retrospective analysis on patients treated with surgery for stage pT1a papillary thyroid micro-carcinomas. One hundred ninety-five patients were included in the analyses. The presence of central lymph node metastases was identified and studied. A multivariate analysis employing binary logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals of possible central lymph node metastases risk factors. In the performed multivariate analysis, male gender, younger age, and histopathological characteristics, such as a tumor sub-capsular localization, were significantly associated with central lymph node metastases in pT1a patients. Central compartment lymph node metastases are present in a non-negligible number of cases in patients with papillary thyroid micro-carcinoma undergoing surgical resection. Studying these factors could be an effective tool for predicting patients’ central lymph node metastases in papillary thyroid micro-carcinomas, defining a tailored surgical treatment in the future.
Collapse
Affiliation(s)
- Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (M.T.); (G.G.); (M.C.M.); (E.G.); (F.C.); (M.F.M.); (M.A.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (M.T.); (G.G.); (M.C.M.); (E.G.); (F.C.); (M.F.M.); (M.A.)
| | - Maria Cecilia Mariani
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (M.T.); (G.G.); (M.C.M.); (E.G.); (F.C.); (M.F.M.); (M.A.)
| | - Manila Rubino
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy;
| | - Enrica Grosso
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (M.T.); (G.G.); (M.C.M.); (E.G.); (F.C.); (M.F.M.); (M.A.)
| | - Francesco Chu
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (M.T.); (G.G.); (M.C.M.); (E.G.); (F.C.); (M.F.M.); (M.A.)
| | - Anna Calastri
- Department of Otorhinolaryngology, Fondazione IRCCS, Policlinico San Matteo, 27100 Pavia, Italy;
| | | | - Giovanni Mauri
- Department of Oncology and Hematology-Oncology, University of Milan, 20122 Milan, Italy
- Division of Interventional Radiology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy
- Correspondence:
| | - Elvio De Fiori
- Department of Radiology, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy;
| | - Marco Federico Manzoni
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (M.T.); (G.G.); (M.C.M.); (E.G.); (F.C.); (M.F.M.); (M.A.)
- Institute of Endocrine and Metabolic Sciences, San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO) IRCCS, 20141 Milan, Italy; (M.T.); (G.G.); (M.C.M.); (E.G.); (F.C.); (M.F.M.); (M.A.)
| |
Collapse
|
50
|
Haaga E, Kalfert D, Ludvíková M, Kholová I. Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features Is Not a Cytological Diagnosis, but It Influences Cytological Diagnosis Outcomes: A Systematic Review and Meta-Analysis. Acta Cytol 2021; 66:85-105. [PMID: 34781293 DOI: 10.1159/000519757] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/16/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A low-risk thyroid tumour, non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced in 2016. NIFTP criteria require a thorough histological examination to rule out capsular and lymphovascular invasion, which denies the possibility of preoperative cytological diagnosis. Nevertheless, since the adoption of the new entity, the cytology of NIFTP has been a subject of interest. OBJECTIVES The present systematic review and meta-analysis investigate the cytological diagnosis of NIFTP. METHOD An online PubMed literature search was conducted between March 1, 2020, and June 30, 2020, for all original articles considering the cytology of histologically proven NIFTP. The studies including data on fine needle aspiration specimens classified by The Bethesda System for Reporting Thyroid Cytology (TBSRTC) categories, risk of malignancy (ROMs) in the TBSRTC categories, and cytomorphological features of NIFTP were included in the meta-analysis. Non-English studies and case reports were excluded. The data were tabulated and statistical analysis was performed with Open Meta-Analyst program. RESULTS Fifty-eight studies with a total of 2,553 NIFTP cases were included in the study. The pooled prevalence of NIFTP cases was calculated among 25,892 surgically resected cases from 20 studies and the results show that NIFTP consisted 4.4% (95% confidence interval [CI]: 3.5-5.4%) of all cases. Most of the NIFTP cases (79.0%) belonged to the intermediate categories of TBSRTC. The pooled distribution of NIFTP cases in each TBSRTC category was 1.3% (95% CI: 0.8-1.7%) in non-diagnostic (ND), 8.9% (95% CI: 6.9-10.8%) in benign, 29.2% (95% CI: 25.0-33.4%) in atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), 24.2% (95% CI: 19.6-28.9%) in follicular neoplasm (FN), 19.5% (95% CI: 16.1-22.9%) in suspicious for malignancy (SM), and 6.9% (95% CI: 5.2-8.7%) in malignant. Compared to pre-NIFTP era, the pooled risk differences of ROM were reduced by 2.4% in ND, 2.7% in benign, 8.2% in AUS/FLUS, 8.2% in FN, 7.3% in SM, and 1.1% in the malignant category. The cytomorphological features of NIFTP were similar to follicular variant of papillary thyroid carcinoma (FVPTC) but lesser to papillary thyroid carcinoma (PTC). CONCLUSIONS Based on our results, NIFTP remains a histological diagnosis. Although cytomorphological features cannot be used in differentiating NIFTP from FVPTC, they may guide in separating NIFTP from PTC. Features such as papillae, microfollicles, giant cells, psammoma bodies, and the amount of papillary-like nuclear features should be taken into account when suspicious of NIFTP. NIFTP should not have papillae or psammoma bodies, and giant cells were rarely observed.
Collapse
Affiliation(s)
- Elina Haaga
- Pathology, Fimlab Laboratories, Tampere, Finland
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - David Kalfert
- Department of Otorhinolaryngology and Head and Neck Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czechia
| | - Marie Ludvíková
- Department of Biology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - Ivana Kholová
- Pathology, Fimlab Laboratories, Tampere, Finland
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| |
Collapse
|