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Borlea A, Moisa-Luca L, Popescu A, Bende F, Stoian D. Combining CEUS and ultrasound parameters in thyroid nodule and cancer diagnosis: a TIRADS-based evaluation. Front Endocrinol (Lausanne) 2024; 15:1417449. [PMID: 38952390 PMCID: PMC11215041 DOI: 10.3389/fendo.2024.1417449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/20/2024] [Indexed: 07/03/2024] Open
Abstract
Contrast-enhanced ultrasonography (CEUS) has been established as a diagnostic tool for assessing microvascularization, essential for understanding angiogenesis in neoplastic development. AIM This study assesses the effectiveness of CEUS as a supplementary tool to TIRADS in enhancing the ultrasound-based diagnosis of thyroid cancer. METHODS AND MATERIALS Over one year, 157 nodules in 133 patients, with predominantly solid thyroid nodules, were examined using ultrasound and CEUS and underwent thyroidectomy, allowing for a comparison of ultrasound findings with pathological reports. RESULTS Thyroid cancer was identified in 31.21% (49/157) of cases. Significant CEUS high-risk features included inhomogeneous enhancement, enhancement defects, and complete hypoenhancement (AUC 0.818, 0.767, 0.864 respectively). Nodules exhibiting any of these features were classified as high-risk in CEUS. The diagnostic performance of TIRADS improved when combined with CEUS, with AUC increasing from 0.707 to 0.840 and improved sensitivity. CONCLUSION The integration of CEUS with TIRADS significantly enhances the diagnostic accuracy and specificity in identifying thyroid cancer. This combination proves to be a more effective method for risk stratification and diagnosis, highlighting the value of CEUS as an adjunctive tool in thyroid cancer evaluation.
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Affiliation(s)
- Andreea Borlea
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Luciana Moisa-Luca
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
| | - Alina Popescu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Felix Bende
- Division of Gastroenterology and Hepatology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Dana Stoian
- Division of Endocrinology, Department of Internal Medicine II, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Centre for Molecular Research in Nephrology and Vascular Disease, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania
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Oteri V, Piane S, Cocci E. The use of telecytology for the evaluation of thyroid nodules fine-needle aspiration biopsy specimens: a systematic review. J Endocrinol Invest 2024:10.1007/s40618-024-02378-3. [PMID: 38704449 DOI: 10.1007/s40618-024-02378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Fine needle aspiration biopsy (FNAB) is currently the gold standard for diagnosis and treatment of thyroid nodules, but the growing need for anatomic pathology services in small communities is becoming a challenge. Telecytology (TC) is defined as the electronic transmission of cytological digital images, and allows for the collection of samples, primary diagnosis, and other applications without the physical presence of a pathologist. Our aim is to systematically report, summarize, and critically analyze the most up to date applications of TC to thyroid nodules FNAB evaluation. METHODS We performed a systematic literature review by searching PubMed, Embase, and Cochrane Library databases. Only studies published in peer-reviewed scientific journals were included. Data were extracted using the PICO framework and critically analyzed. PRISMA guidelines were applied, and the risk of bias in the included studies was assessed using the ROBINS-I tools. The methodological quality was assessed following GRADE criteria. RESULTS We included 13 observational studies, resulting in a total of 3856 evaluated FNAB specimens. The majority of studies (63.6%) showed an excellent concordance rate of diagnosis via TC and conventional cytology. TC can be used to perform preliminary assessment of samples with a concordance rate ranging from 74 and 100%, showing a significant reduction of the non-diagnostic rate. Image quality was referred to as perfect or nearly perfect in most cases, regardless of telecytology technique. CONCLUSION Telecytology could be a valuable implementation for thyroid FNAB evaluation both for primary diagnosis and preliminary assessment of samples.
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Affiliation(s)
- V Oteri
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Hospital, Catania, Italy.
| | - S Piane
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - E Cocci
- Department of Clinical and Experimental Medicine, Marche Polytechnic University, Ancona, Italy
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Chen Y, Yin M, Zhang Y, Zhou N, Zhao S, Yin H, Shao J, Min X, Chen B. Imprinted gene detection effectively improves the diagnostic accuracy for papillary thyroid carcinoma. BMC Cancer 2024; 24:359. [PMID: 38509485 PMCID: PMC10953243 DOI: 10.1186/s12885-024-12032-z] [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: 08/29/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most frequent histological type of thyroid carcinoma. Although an increasing number of diagnostic methods have recently been developed, the diagnosis of a few nodules is still unsatisfactory. Therefore, the present study aimed to develop and validate a comprehensive prediction model to optimize the diagnosis of PTC. METHODS A total of 152 thyroid nodules that were evaluated by postoperative pathological examination were included in the development and validation cohorts recruited from two centres between August 2019 and February 2022. Patient data, including general information, cytopathology, imprinted gene detection, and ultrasound features, were obtained to establish a prediction model for PTC. Multivariate logistic regression analysis with a bidirectional elimination approach was performed to identify the predictors and develop the model. RESULTS A comprehensive prediction model with predictors, such as component, microcalcification, imprinted gene detection, and cytopathology, was developed. The area under the curve (AUC), sensitivity, specificity, and accuracy of the developed model were 0.98, 97.0%, 89.5%, and 94.4%, respectively. The prediction model also showed satisfactory performance in both internal and external validations. Moreover, the novel method (imprinted gene detection) was demonstrated to play a role in improving the diagnosis of PTC. CONCLUSION The present study developed and validated a comprehensive prediction model for PTC, and a visualized nomogram based on the prediction model was provided for clinical application. The prediction model with imprinted gene detection effectively improves the diagnosis of PTCs that are undetermined by the current means.
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Affiliation(s)
- Yanwei Chen
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, 212000, Zhenjiang, Jiangsu, China
| | - Ming Yin
- Department of Medical Ultrasound, The Affiliated Taizhou People's Hospital of Nanjing Medical University , 225300, Taizhou, Jiangsu, China
| | - Yifeng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, School of Medicine, Tongji University, 200072, Shanghai, China
| | - Ning Zhou
- Lisen Imprinting Diagnostics, Inc., 214135, Wuxi, Jiangsu, China
| | - Shuangshuang Zhao
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, 212000, Zhenjiang, Jiangsu, China
| | - Hongqing Yin
- Department of Medical Ultrasound, The First People's Hospital of Kunshan, 215300, Kunshan, Jiangsu, China
| | - Jun Shao
- Department of Medical Ultrasound, The First People's Hospital of Kunshan, 215300, Kunshan, Jiangsu, China
| | - Xin Min
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, 212000, Zhenjiang, Jiangsu, China
| | - Baoding Chen
- Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, 212000, Zhenjiang, Jiangsu, China.
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Rong Y, Torres-Luna C, Tuszynski G, Siderits R, Chang FN. Differentiating Thyroid Follicular Adenoma from Follicular Carcinoma via G-Protein Coupled Receptor-Associated Sorting Protein 1 (GASP-1). Cancers (Basel) 2023; 15:3404. [PMID: 37444514 DOI: 10.3390/cancers15133404] [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: 05/17/2023] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Follicular neoplasms are classified as benign or malignant depending on the presence or absence of capsular and/or vascular invasion. Due to incomplete capsular penetration or equivocal vascular invasion, the evaluation of these features can be challenging using histologic examination. In the current study, we analyzed the involvement of G-protein coupled receptor-associated sorting protein 1 (GASP-1) in the development and progression of thyroid neoplasms. Affinity-purified anti-GASP-1 polyclonal antibodies were used for routine immunohistochemistry (IHC) analysis. Thyroid tissue microarrays containing normal thyroid tissue, follicular adenoma, follicular carcinoma, papillary thyroid carcinoma, and anaplastic carcinoma were analyzed. We found that the level of GASP-1 expression can differentiate follicular adenoma from follicular carcinoma. When numerous cases were scored for GASP-1 expression by a board-certified pathologist, we found that GASP-1 expression is 7-fold higher in thyroid malignant neoplasms compared to normal thyroid tissue, and about 4-fold higher in follicular carcinoma compared to follicular adenoma. In follicular adenoma tissues, we observed the presence of many mini-glands that are enriched in GASP-1 and some mini-glands contain as few as three cells. GASP-1 IHC also possesses several advantages over the conventional H&E and can be used to identify early thyroid cancer and monitor cancer progression.
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Affiliation(s)
- Yuan Rong
- Department of Pathology and Laboratory Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA
| | - Cesar Torres-Luna
- Halcyon Diagnostics, 1200 Corporate Blvd. Ste. 10C, Lancaster, PA 17601, USA
| | - George Tuszynski
- Halcyon Diagnostics, 1200 Corporate Blvd. Ste. 10C, Lancaster, PA 17601, USA
| | - Richard Siderits
- Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ 08854, USA
| | - Frank N Chang
- Halcyon Diagnostics, 1200 Corporate Blvd. Ste. 10C, Lancaster, PA 17601, USA
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Jansen T, Stikkelbroeck N, van de Ven A, van Engen-van Grunsven I, Janssen M, Bonenkamp H, Gotthardt M, Netea-Maier RT. Clinical Characteristics, Diagnostic Approach and Outcome of Thyroid Incidental Findings vs. Clinically Overt Thyroid Nodules: An Observational Single-Centre Study. Cancers (Basel) 2023; 15:cancers15082350. [PMID: 37190278 DOI: 10.3390/cancers15082350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Context: Thyroid nodules are common and can present as clinically overt nodules (visible, palpable or symptomatic nodules) and so-called incidentalomas (coincidental findings on imaging techniques). The majority are benign but recognizing clinically relevant nodules remains a challenge. Current Dutch guidelines recommend to refrain from additional diagnostic testing in incidentalomas other than FDG-PET-incidentalomas, unless there are suspicious clinical and/or sonographic features. However, there is no consensus on the further approach and no "real-life" data on the outcome of such an approach. Objective: To compare clinical characteristics, diagnostic approaches and clinical outcome between patients referred with thyroid incidentalomas and non-incidentalomas at one academic referral thyroid clinic. Methods: Clinical and demographical characteristics, diagnostic and therapeutic approaches and outcome were retrospectively obtained from the files of all patients newly referred because of thyroid incidentalomas or non-incidentalomas to our institution (between March 2011 and January 2017). Subsequently, the data were compared between both groups. Results: In total, 351 patients (64.3%) were referred because of non-incidentalomas and 195 (35.7%) because of incidentalomas. Incidentalomas were smaller (48.7% <2 cm) than non-incidentalomas (23.4% <2 cm). Furthermore, incidentalomas were less often symptomatic (15.9 vs. 42.7% p < 0.001). Fine-needle aspiration was performed in a similar percentage of the patients in the two groups (62.6% of incidentalomas vs. 69.8% in non-incidentaloma, p = 0.08). Significantly less malignancies were found among incidentalomas compared to non-incidentalomas (5.1% vs. 11.1%, p = 0.019). Moreover, significantly more malignancies occurred in PET-incidentalomas than non-PET-incidentalomas (11.8% vs. 2.8%, p = 0.023). In fact, the proportion of malignancies in PET-incidentalomas and non-incidentalomas was similar (11.8% vs. 11.1%, p = 0.895). Stability or decrease in size was observed in 96.5% of nodules receiving ultrasound follow-up. Conclusions: Patients with small asymptomatic thyroid incidentalomas represent an important proportion of the patients referred for additional diagnostic evaluation. The risk of malignancy in these patients is lower than in those with symptomatic palpable lesions, particularly in the patients with incidentalomas discovered on CT, MRI or US. Our findings support the current recommendations from the Dutch guidelines to not indiscriminately perform additional analysis and treatment on all incidentalomas, but prioritize this to FDG-PET-incidentalomas and clinically relevant non-PET-incidentalomas. Moreover, US features can further refine the selection of the patients who require immediate FNAC and/or surgery.
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Affiliation(s)
- Tom Jansen
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Nike Stikkelbroeck
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Annenienke van de Ven
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ilse van Engen-van Grunsven
- Department of Pathology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Marcel Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Han Bonenkamp
- Department of Surgery, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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NKD2 is correlated with the occurrence, progression and prognosis of thyroid carcinoma. Eur J Med Res 2022; 27:235. [PMID: 36348408 PMCID: PMC9641892 DOI: 10.1186/s40001-022-00853-2] [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: 01/13/2022] [Accepted: 10/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background Thyroid carcinoma (THCA) is the most prevalent type of tumor in endocrine system. NKD2 has been increasingly evidenced to play crucial roles in many cancers, except for THCA. We herein aimed to explore the potential role of NKD2 in THCA. Methods Totally 502 THCA patient data were downloaded from TCGA (The Cancer Genome Atlas) database. Overall survival was estimated by Kaplan–Meier method. Gene set enrichment analysis was conducted to obtain significant functional pathways. Wilcoxon rank sum test was used to determine the NKD2 expression differences among various groups. The NKD2 expression was validated in cell lines and tissue microarray. Results Significantly higher NKD2 expression was observed in THCA samples compared with adjacent samples, which were successfully verified in cell lines and tissue microarray. Moreover, NKD2 expression gradually elevated along with the increase of TNM Stage, and NKD2 expression was significantly higher in elder THCA patients compared with young patients. NKD2 highly expressed THCA patients had worse prognosis compared with NKD2 low-expressed patients. Furthermore, 53 pathways were significantly activated in the high NKD2 expression patients compared with low NKD2 expression THCA patients. Conclusions In summary, high NKD2 expression was probably related to the progression and poor prognosis of THCA. NKD2 is a promising prognostic biomarker and pathogenic target of THCA. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00853-2.
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Yu H, Li J, Sun J, Zheng J, Wang S, Wang G, Ding Y, Zhao J, Zhang J. Intelligent diagnosis algorithm for thyroid nodules based on deep learning and statistical features. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Alshaikh R, Almaghribi K, Alshammari DM, Mohamad H, Ebrahim W, Alshammari SM, Sabra O. Correlation Between Ultrasound and Cytological Findings of Patients With Suspicious Thyroid Nodules: The King Hamad University Hospital Experience. Cureus 2022; 14:e22877. [PMID: 35399395 PMCID: PMC8980678 DOI: 10.7759/cureus.22877] [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] [Accepted: 03/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Thyroid nodules are a common presentation in otolaryngology-head and neck clinics. The detection of thyroid nodules has increased significantly with the advancements in radiological technology such as computed tomography and ultrasound (US). The present study aims to improve the clinical practice and management of thyroid disorders by establishing correlations between US and cytological findings in the diagnosis of thyroid nodules. Methodology A retrospective cohort study was conducted at the King Hamad University Hospital (KHUH), Bahrain. A total of 189 cases met the study criteria. Pathological records for thyroid nodule fine needle aspiration (FNA) cytology and US features of sampled nodules from the patients were obtained. The cytological results were categorized into the Bethesda grading system, while the US features were organized into internationally accepted features using the Thyroid Imaging Reporting and Data System (TIRADS). Results The radiologic characteristics from US showed positive features largely for the composition (76.2%) and vascularity (59.3%). Very few showed echogenicity (6.9%). Most records indicated negatively for the shape (94.7%), margins (76.2%), echogenicity (63.5%), or echogenic foci (66.1%). Of the 47 cases in TIRADS 1 and 2, only two were found to be Bethesda 4 classification, showing that most of these nodules were benign. Among those with TIRADS 3 on US, 85% turned were benign (Bethesda 2), two of the remaining six were grade 3, and the other four were suspiciously malignant. Of the 100 cases in TIRADS 4 and 5, 63% were of Bethesda grade 2, and therefore, benign, 14% were mildly suspicious, and only 23% were in Bethesda grades 4-6. A significant positive correlation was noted between the TIRADS and Bethesda scores (r = 0.338, p ≤ 0.001). Conclusions If the thyroid nodules are classified properly by US using the TIRADS system, the probability of a nodule being malignant can be established with a certain level of confidence. The appropriate management of the nodule can be initiated avoiding unwarranted FNA procedures.
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Rodriguez Escobedo R, Martinez Tames G, Lanes Iglesias S, Alonso Felgueroso C, Montes Garcia AM, Prieto Fernandez A, Sanchez Ragnarsson C, Menendez Torre EL. Efficacy in size and symptom reduction of radiofrequency ablation of benign non-functioning thyroid nodules. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rodriguez Escobedo R, Martinez Tames G, Lanes Iglesias S, Alonso Felgueroso C, Montes Garcia AM, Prieto Fernandez A, Sanchez Ragnarsson C, Menendez Torre EL. Efficacy in size and symptom reduction of radiofrequency ablation of benign non-functioning thyroid nodules. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2022; 69:194-200. [PMID: 35396117 DOI: 10.1016/j.endien.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/08/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) plays an increasing role in the management of thyroid nodules. The purpose of this study was to evaluate the safety and efficacy of RFA of benign thyroid nodules in terms of volume reduction and symptom relief. METHODS We reviewed the medical records of patients with a solitary thyroid nodule who received RFA at our centre from April 2016 to January 2020. Ultrasound-guided RFA was performed by the moving-shot technique. Patients were followed up with ultrasound examinations and thyroid function tests. We evaluated changes in volume and in compressive (0-10 scale) and cosmetic (4-point scale) symptoms to analyse efficacy and complications, and in thyroid function to evaluate safety. RESULTS A total of 72 patients were included in the study. The mean follow-up was 11.1±0.7 months. There was a statistically significant reduction in size of the nodules at Month 1, 3, 6 and 12 after RFA (expressed as volume reduction rate: 34%±2.1, 50.8%±2.2, 60.3%±2.6, 58.87%±3.5, p<0.0001). We found statistically significant improvement in compressive symptoms (from 7.1±0.26 to 1.76±0.33, p<0.0001) and in cosmetic alteration (from 3.66±0.09 to 2.14±0.14, p<0.0001). No major complications were observed. DISCUSSION RFA achieved significant volume reduction and improved compressive symptoms as well as cosmetic complaints, with minimum side effects. Our results are in line with recent available evidence and further support the use of RFA as a safe and effective therapeutic option in the management of benign thyroid nodules.
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Affiliation(s)
- Raul Rodriguez Escobedo
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Gema Martinez Tames
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Soraya Lanes Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Carlos Alonso Felgueroso
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Spain
| | - Ana Maria Montes Garcia
- Department of Radiology, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Amador Prieto Fernandez
- Department of Radiology, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain
| | - Cecilia Sanchez Ragnarsson
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edelmiro Luis Menendez Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Asturias, Spain; Grupo de investigación en Endocrinología, Nutrición, Diabetes y Obesidad, Instituto de Investigación del Principado de Asturias (ISPA), Oviedo, Spain
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Abstract
BACKGROUND The presence of nodules in the thyroid gland is common in iodine-deficient areas of the world. Recently, vitamin D levels were found to be lower than normal and sometimes deficient in malignant nodules of the thyroid. OBJECTIVE Evaluate the relationship between the serum vitamin D levels and benign thyroid nodules in euthyroid patients. DESIGN Cross-sectional. SETTING Tertiary care center in Turkey. PATIENTS AND METHODS Patients referred to the general surgery outpatient clinic and diagnosed with thyroid nodules were the study group. The control group consisted of healthy individuals without thyroid nodules. Age, BMI, thyroid ultrasonography, serum 25-hydroxyvitamin D, free T3, free T4, thyroid stimulating hormone, calcium, magnesium, phosphorous, total protein, albumin, glucose, creatinine levels and glomerular filtration rate (GFR) were compared between groups. MAIN OUTCOME MEASURE Serum 25-hydroxy-vitamin D levels and size of the thyroid nodules. SAMPLE SIZE AND CHARACTERISTICS Of 849 individuals, 453 were patients with thyroid nodules and 396 were healthy individuals. RESULTS The mean serum vitamin D levels of patients with thyroid nodules were significantly lower than controls (P<.001). Serum vitamin D levels along with serum total protein levels and eGFR were independent variables associated with the presence of a thyroid nodule (P<.001, p=.005 and P=.017, respectively). CONCLUSION These findings suggest vitamin D deficiency might be one of the pathophysiologic factors in development of thyroid nodules. LIMITATION Single-center and possible information bias. CONFLICTS OF INTEREST None.
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Affiliation(s)
- Hacı Bolat
- From the Department of General Surgery, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Aliriza Erdoğan
- From the Department of General Surgery, Faculty of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
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Popova NM, Radzina M, Prieditis P, Liepa M, Rauda M, Stepanovs K. Impact of the Hypoechogenicity Criteria on Thyroid Nodule Malignancy Risk Stratification Performance by Different TIRADS Systems. Cancers (Basel) 2021; 13:cancers13215581. [PMID: 34771743 PMCID: PMC8583198 DOI: 10.3390/cancers13215581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary This study is aimed at raising the question of the use of several TIRADS systems that stratify the risk of thyroid nodule malignancy. Approximately 5–20% of thyroid nodules are malignant, but most nodules are benign, and they are scored by FNA biopsy. One of the goals is to reduce the number of unnecessary FNA and the associated with-it possible complications for the patient and financial cost. Most TIRADS systems are based on the fact that one suspicious feature of a thyroid nodule classifies it as malignant, but there is a modified Kwak et al. system that is based on the count of malignant features. Therefore, this study is intended to estimate the specificity, sensitivity, and accuracy of the systems and, in the future, think about reducing the number of FNA biopsies. The result of this study can be important for all doctors who face thyroid changes, such as radiologists, ultrasonography specialists, and endocrinologists, those who must decide about the need for an FNA. Abstract Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of hypoechogenicity as a sign of risk of malignancy on the overall assessment of diagnostic accuracy. Methods: The prospective study includes 274 patients with 289 thyroid nodules to whom US and risk of malignancy were assessed according to four TIRADS systems—European (EU-TIRADS), Korean (K-TIRADS), TIRADS by American College of Radiology (ACR TIRADS), and modified Kwak et al. TIRADS (L-TIRADS) systems, in which mild hypoechogenicity is not included in malignancy risk suggestive signs. For all thyroid nodules, a fine needle aspiration (FNA) biopsy was performed and evaluated according to the Bethesda system. For all systems, diagnostic accuracy was calculated. Results: Assessing the echogenicity of the thyroid nodules: from 81 of isoechogenic nodules, 2 were malignant (2.1%), from 151 mild hypoechogenic, 18 (12%) were malignant, and from 48 marked hypoechogenic nodules, 16 (33%) were malignant. In 80 thyroid nodules, mild hypoechogenicity was the only sign of malignancy and none appeared malignant. Assessing various TIRADS systems on the same cohort, sensitivity, specificity, PPV, NPV, and accuracy, firstly for EU-TIRADS, they were 97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively; for K-TIRADS they were 97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for ACR-TIRADS they were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%, respectively; finally, for L-TIRADS they were 80.6%; 72.7%; 29.6%; 96.3%, and 73.3%. Conclusions: This comparative research has highlighted that applying different TIRADS systems can alter the number of necessary biopsies by re-categorization of the thyroid nodules. The main pattern that affected differences was inconsistent hypoechogenicity interpretation, giving the accuracy superiority to the systems that raise the malignancy risk with marked hypoechogenicity, at the same time with minor compensation for sensitivity.
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Affiliation(s)
- Nina Malika Popova
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
- Faculty of Medicine, University of Latvia, 1004 Riga, Latvia
- Correspondence: (N.M.P.); (M.R.); Tel.: +371-26069563 (N.M.P.); +371-29623585 (M.R.)
| | - Maija Radzina
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
- Faculty of Medicine, University of Latvia, 1004 Riga, Latvia
- Radiology Research Laboratory, Riga Stradins University, 1002 Riga, Latvia
- Correspondence: (N.M.P.); (M.R.); Tel.: +371-26069563 (N.M.P.); +371-29623585 (M.R.)
| | - Peteris Prieditis
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
- Radiology Research Laboratory, Riga Stradins University, 1002 Riga, Latvia
| | - Mara Liepa
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
- Radiology Research Laboratory, Riga Stradins University, 1002 Riga, Latvia
| | - Madara Rauda
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
| | - Kaspars Stepanovs
- Institute of Diagnostic Radiology, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia; (P.P.); (M.L.); (M.R.); (K.S.)
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Wu SC, Chi SY, Rau CS, Kuo PJ, Huang LH, Wu YC, Wu CJ, Lin HP, Hsieh CH. Identification of circulating biomarkers for differentiating patients with papillary thyroid cancers from benign thyroid tumors. J Endocrinol Invest 2021; 44:2375-2386. [PMID: 33646556 DOI: 10.1007/s40618-021-01543-2] [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: 12/22/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to identify the potential circulating biomarkers of protein, mRNAs, and long non-coding RNAs (lncRNAs) to differentiate the papillary thyroid cancers from benign thyroid tumors. METHODS The study population of 100 patients was classified into identification (10 patients with papillary thyroid cancers and 10 patients with benign thyroid tumors) and validation groups (45 patients with papillary thyroid cancers and 35 patients with benign thyroid tumors). The Sengenics Immunome Protein Array-combined data mining approach using the Open Targets Platform was used to identify the putative protein biomarkers, and their expression validated using the enzyme-linked immunosorbent assay. Next-generation sequencing by Illumina HiSeq was used for the detection of dysregulated mRNAs and lncRNAs. The website Timer v2.0 helped identify the putative mRNA biomarkers, which were significantly over-expressed in papillary thyroid cancers than in adjacent normal thyroid tissue. The mRNA and lncRNA biomarker expression was validated by a real-time polymerase chain reaction. RESULTS Although putative protein and mRNA biomarkers have been identified, their serum expression could not be confirmed in the validation cohorts. In addition, seven lncRNAs (TCONS_00516490, TCONS_00336559, TCONS_00311568, TCONS_00321917, TCONS_00336522, TCONS_00282483, and TCONS_00494326) were identified and validated as significantly downregulated in patients with papillary thyroid cancers compared to those with benign thyroid tumors. These seven lncRNAs showed moderate accuracy based on the area under the curve (AUC = 0.736) of receiver operating characteristic in predicting the occurrence of papillary thyroid cancers. CONCLUSIONS We identified seven downregulated circulating lncRNAs with the potential for predicting the occurrence of papillary thyroid cancers.
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Affiliation(s)
- S-C Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - S-Y Chi
- Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - C-S Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - P-J Kuo
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - L-H Huang
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - Y-C Wu
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - C-J Wu
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - H-P Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan
| | - C-H Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City 833, Taiwan.
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An autophagy-related lncRNA prognostic risk model for thyroid cancer. Eur Arch Otorhinolaryngol 2021; 279:1621-1631. [PMID: 34724113 DOI: 10.1007/s00405-021-07134-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Thyroid cancer (TC) is the most common malignancy of the endocrine system and its incidence is gradually rising. Research has demonstrated a close link between autophagy and thyroid cancer. We constructed a prognostic model of autophagy-related long non-coding RNA (lncRNA) in thyroid cancer and explored its prognostic value. METHODS The data used in this study were all obtained from The Cancer Genome Atlas (TCGA) database and the Human Autophagy Database (HADb). We construct a co-expression network by autophagy-related genes and lncRNA to obtain autophagy-related lncRNAs. After univariate Cox regression analysis and multivariate Cox regression analysis, autophagy-related lncRNAs significantly associated with prognosis were identified. Based on the risk score of lncRNA, thyroid cancer patients are divided into high-risk group and low-risk group. RESULTS A total of 14,142 lncRNAs and 212 autophagy-related genes (ATGs) were obtained from the TCGA database and the HADb, respectively. We performed lncRNA-ATGs correlation analysis and finally obtained 1,166 autophagy-associated lncRNAs. Subsequently, we conducted univariate Cox regression analysis and multivariate Cox regression analysis, nine autophagy-related lncRNAs (AC092279.1, AC096677.1, DOCK9-DT, LINC02454, AL136366.1, AC008063.1, AC004918.3, LINC02471 and AL162231.2) significantly associated with prognosis were identified. Based on these autophagy-related lncRNAs, a risk model was constructed. The area under the curve (AUC) of the risk score was 0.905, proving that the accuracy of risk signature was superior. In addition, multiple regression analysis showed that risk score was a significant independent prognostic risk factor for thyroid cancer. CONCLUSION In this study, nine autophagy-related lncRNAs in thyroid cancer were established to predict the prognosis of thyroid cancer patients.
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Chen X, Wang JJ, Yu L, Wang HY, Sun H. The association between BMI, smoking, drinking and thyroid disease: a cross-sectional study in Wuhan, China. BMC Endocr Disord 2021; 21:184. [PMID: 34517857 PMCID: PMC8436425 DOI: 10.1186/s12902-021-00852-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 08/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is no clear conclusion on the relationship between thyroid disease and obesity and lifestyle factors such as smoking and drinking. In this study, we analysed the association of body mass index (BMI), smoking and drinking with subclinical hypothyroidism (SHO) and thyroid nodules (TNs) with the results of a cross-sectional survey of urban residents in central China and discussed the potential mechanism linking these predictive factors and the two diseases. METHODS This study included 1279 participants who were recruited from a Chinese community in 2011 and 2012. A questionnaire, laboratory examination and ultrasound diagnosis were conducted on these participants. Binary logistic regression analysis was used to analyse these factors. RESULTS Overweight (BMI ≥ 25 kg/m2) was closely related to SHO and TNs in univariate and multivariate logistic regression analyses. Smoking had a protective effect on SHO and TNs, while drinking had a protective effect on TNs in univariate logistic regression and multivariate logistic regression with some covariates, but there was no significant difference between smoking and drinking and the two kinds of thyroid diseases in multivariate logistic regression analysis with all the covariates. In subgroup analysis, BMI ≥ 25 kg/m2 was significantly associated with SHO in people with positive thyroid antibodies (odds ratio (OR) = 2.221, 95 % confidence interval (CI): 1.168-4.184, P = 0.015) and smokers (OR = 2.179, 95 % CI: 1.041-4.561, P = 0.039). BMI ≥ 25 kg/m2 was significantly associated with TNs in people over 60 years old (OR = 2.069, 95 % CI: 1.149-3.724, P = 0.015) and drinkers (OR = 3.065, 95 % CI: 1.413-6.648, P = 0.005). Drinking alcohol had a protective effect on TNs in smokers (OR = 0.456, 95 % CI: 0.240-0.865, P = 0.016) and people with BMI ≥ 25 kg/m2 (OR = 0.467, 95 % CI: 0.236-0.925, P = 0.029). No significant association was found between smoking and the two thyroid diseases in different subgroups. CONCLUSIONS Obesity is a risk factor for both TNs and SHO, especially in elderly individuals and people with positive thyroid autoantibodies. Obesity and metabolic syndrome may be more associated with TNs than SHO. Smoking may have a protective effect on thyroid disease, while drinking may have a protective effect only on TNs.
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Affiliation(s)
- Xiao Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, 430022, Wuhan, Hubei, China
| | - Juan-Juan Wang
- Department of Endocrinology, The Central Hospital of Wuhan, 430022, Wuhan, China
| | - Li Yu
- Department of Emergency, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430022, Wuhan, China
| | - Han-Yu Wang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, 430022, Wuhan, Hubei, China
| | - Hui Sun
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, 430022, Wuhan, Hubei, China.
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Rossi D, Belotti A, di Tonno C, Midolo V, Maffini FA, Nicosia L, De Fiori E, Mauri G. Changes in thyroid fine needle aspiration practice during the COVID-19 pandemic. Cytopathology 2021; 32:732-737. [PMID: 34137099 PMCID: PMC8597111 DOI: 10.1111/cyt.13020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 12/30/2022]
Abstract
Purpose To investigate the diagnostic accuracy of a different sample preparation protocol for fine needle aspiration cytology (FNAC) of thyroid nodules established during the COVID‐19 pandemic. Methods From April 2020, conventional smears during FNAC were ceased according to World Health Organization recommendations due to the increased infection risk for operators, and a new protocol using only liquid‐based cytology (LBC) was adopted. FNACs performed between April and July 2020 (COVID‐19 group) were retrospectively compared with those from December 2019 through March 2020 (Pre‐COVID‐19 group). The distribution of diagnoses based on SIAPEC‐IAP categories and the concordance between cytological and histological results were compared using the chi‐squared test. Results Categories based on FNAC for 90 and 82 thyroid nodules in the Pre‐COVID‐19 and COVID‐19 groups showed no significant difference in distribution (P = .081), with the following respective cases (and percentages): TIR1, 7 (8%) and 8 (10%); TIR1C, 0 (0%) and 6 (7%); TIR2, 59 (66%) and 55 (67%); TIR3A, 8 (9%) and 5 (6%); TIR3B, 1 (1%) and 2 (3%); TIR4, 5 (6%) and 1 (1%); and TIR5, 10 (12%) and 5 (7%). Among patients with potentially malignant lesions, surgery was performed for 12/16 (75%) nodules in the Pre‐COVID‐19 and 7/8 (88%) nodules in the COVID‐19 groups, with no significant differences between cytological and histological diagnoses (P = .931). Conclusion The new LBC‐only protocol provided similar diagnostic accuracy in comparison with conventional smears, and can be effectively applied during a viral pandemic improving operator safety.
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Affiliation(s)
- Duccio Rossi
- Postgraduate School of Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Alessia Belotti
- Postgraduate School of Pathology, Università Degli Studi di Milano, Milan, Italy
| | - Clementina di Tonno
- Division of Cytopathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Valeria Midolo
- Division of Cytopathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Luca Nicosia
- Department of Breast Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elvio De Fiori
- Department of Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanni Mauri
- Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy.,Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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Erdoğan M, Korkmaz H, Torus B, Avcı M, Boylubay ŞM, Çiriş M, Yıldız M, Şengül SS. The Role of Metabolic Volumetric Parameters in Predicting Malignancy in Incidental Thyroid Nodules Detected in 18F-FDG PET/CT Scans. Mol Imaging Radionucl Ther 2021; 30:86-92. [PMID: 34082507 PMCID: PMC8185484 DOI: 10.4274/mirt.galenos.2021.75983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives The metabolic activities of tumors can be calculated volumetrically during positron emission tomography/computed tomography (PET/CT) imaging using metabolic tumor volume (MTV) and total lesion glycolysis (TLG). This study aimed to evaluate the roles of MTV and TLG in predicting the malignancy risk of incidental thyroid nodules detected by PET/CT imaging. Methods Active metabolic areas of each section were manually drawn by region of interest to calculate the MTV of nodules, and all obtained values were then summed. TLG, the product of mean standardized uptake value and MTV, was calculated by multiplying two values. All participants underwent thyroid ultrasonography imaging. All nodules were divided into risk classes according to the European Thyroid Image Reporting and Data System (EU-TIRADS) that was developed by the European Thyroid Association. The American Thyroid Association Guidelines were used to determine which thyroid nodules would undergo thyroid fine-needle biopsy (FNAB). Results were classified according to the Bethesda scoring system. Results TLG levels were significantly higher in malignant or malignant-suspicious nodules than in benign nodules (p=0.013). Although MTV levels were high in malignant or malignant-suspicious nodules than in benign and non-diagnostic nodules, it was statistically insignificant at limit values (p=0.079). Areas under curve (AUC) were 0.726 (p=0.005) and AUC: 0.668 (p=0.039) for TLG and MTV, respectively. The 2.3 g cut-off value of TLG has a sensitivity of 85.7% and specificity of 59.0%. The 1.7 mL cut-off value of MTV has a sensitivity of 78.6% and specificity of 60.4%. Conclusion We believe that TLG evaluation will be useful in predicting high-risk malignancy or malignancy suspicion based on EU-TIRADS risk classification of incidental thyroid nodules detected in PET/CT images. We believe that unnecessary thyroid FNABs can be avoided for thyroid incidental nodules if such relation and cut-off values are determined and that it will be useful in hastening the operation of the necessary patients.
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Affiliation(s)
- Mehmet Erdoğan
- Süleyman Demirel University Faculty of Medicine, Department of Nuclear Medicine, Isparta, Turkey
| | - Hakan Korkmaz
- Süleyman Demirel University Faculty of Medicine, Department of Endocrinology and Metabolism, Isparta, Turkey
| | - Bora Torus
- Süleyman Demirel University Faculty of Medicine, Department of Endocrinology and Metabolism, Isparta, Turkey
| | - Mustafa Avcı
- Süleyman Demirel University Faculty of Medicine, Department of Nuclear Medicine, Isparta, Turkey
| | - Şerife Mehtap Boylubay
- Süleyman Demirel University Faculty of Medicine, Department of Endocrinology and Metabolism, Isparta, Turkey
| | - Metin Çiriş
- Süleyman Demirel University Faculty of Medicine, Department of Pathology, Isparta, Turkey
| | - Mustafa Yıldız
- Süleyman Demirel University Faculty of Medicine, Department of Nuclear Medicine, Isparta, Turkey
| | - Sevim Süreyya Şengül
- Süleyman Demirel University Faculty of Medicine, Department of Nuclear Medicine, Isparta, Turkey
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Liu H, Jin J, Chen Q, Li Z. A Single-Center Retrospective Study of the Impact of Thyroid Cancer on the Malignant Risk of Contralateral TI-RADS 3 and 4 Nodules. Int J Endocrinol 2021; 2021:5538395. [PMID: 34659403 PMCID: PMC8516561 DOI: 10.1155/2021/5538395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The incidence of thyroid nodules increases in the general population. Similarly, we have also seen a dramatic increase in the number of thyroid surgeries. However, the mortality rate of thyroid cancer remained stable or even decreased. The purpose of our study was to investigate whether thyroid cancer affects the malignant risk of the contralateral TI-RADS 3 and 4 nodules. METHODS We conducted a retrospective cohort study in our institution for all thyroid procedures due to nodules from December 2018 to December 2019. All eligible patients were divided into the experimental group (bilateral nodules) and the control group (unilateral nodules) to assess whether the proportion of malignant nodules was different between the two groups. Multivariate logistic regression analysis was used to control potential confounding factors to investigate whether their differences were statistically significant. RESULTS A total of 330 patients underwent thyroid surgery, of whom 137 were eligible, including 84 in the experimental group and 53 in the control group. The proportion of malignant nodules was significantly different between the experimental group and the control group (29.8% versus 58.5%, unadjusted OR 0.30, 95% CI: 0.17-0.82, p=0.001). However, after controlling for potential confounding factors, including age (p=0.004), gender (p=0.775), and TI-RADS classification (p ≤ 0.001), we found that the difference was not significant (adjusted OR 1.08, 95% CI: 0.39-3.01, p=0.886). CONCLUSION There is no evidence that thyroid cancer affects the malignant risk of the contralateral TI-RADS 3 and 4 nodules. This study has been registered with the Chinese Clinical Trial Registry (clinical trial registration number: ChiCTR2000038611, registration time: September 26, 2020).
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Affiliation(s)
- Huan Liu
- Department of General Surgery, Liaoyang Central Hospital of China Medical University, Liaoyang 111000, China
| | - Jun Jin
- Department of General Surgery, Liaoyang Central Hospital of China Medical University, Liaoyang 111000, China
| | - Qiao Chen
- Department of Endocrinology, Liaoyang Central Hospital of China Medical University, Liaoyang 111000, China
| | - Zhongmin Li
- Department of General Surgery, Liaoyang Central Hospital of China Medical University, Liaoyang 111000, China
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Han B, Yang X, Hosseini DK, Luo P, Liu M, Xu X, Zhang Y, Su H, Zhou T, Sun H, Chen X. Development and validation of a survival model for thyroid carcinoma based on autophagy-associated genes. Aging (Albany NY) 2020; 12:19129-19146. [PMID: 33055358 PMCID: PMC7732287 DOI: 10.18632/aging.103715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/29/2020] [Indexed: 01/24/2023]
Abstract
Abnormalities in autophagy-related genes (ARGs) are closely related to the occurrence and development of thyroid carcinoma (THCA). However, the effect of ARGs on the prognosis of THCA remains unclear. Here, by analyzing data from TCGA, 26 differentially expressed ARGs were screened. Cox regression and Lasso regression were utilized to analyze the prognosis of the training group, and a risk model was constructed. Our results show that low-risk patients had better overall survival (OS) than high-risk patients, and the area under the ROC curve in the training and testing groups was significant (3-year AUC, 0.735 vs 0.796; 5-year AUC, 0.821 vs 0.804). In addition, a comprehensive analysis of the 5 identified ARGs demonstrated that most of them were related to OS in THCA patients, and two of them (CX3CL1 and CDKN2A) were differentially expressed in THCA and normal thyroid tissues at the protein level. GSEA suggested that the inactivation of the cell defense system and the activation of some classical tumor signaling pathways are important driving forces for the progression of THCA. This study demonstrated that the 5 ARGs in the survival model are promising multidimensional biomarkers for the diagnosis, prognosis, and treatment of THCA.
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Affiliation(s)
- Baoai Han
- Public Laboratory, Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Medical University, Tianjin 30000, China
| | - Xiuping Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Davood K. Hosseini
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA,Department of Internal Medicine, Stanford University School of Medicine, Stanford, USA 94305, USA
| | - Pan Luo
- Department of Otorhinolaryngology, Head and Neck surgery, Wuhan Central Hospital, Wuhan 430014, China
| | - Mengzhi Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Xiaoxiang Xu
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Ya Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Hongguo Su
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Tao Zhou
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Haiying Sun
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA,Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiong Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Computer aided diagnosis of thyroid nodules based on the devised small-datasets multi-view ensemble learning. Med Image Anal 2020; 67:101819. [PMID: 33049580 DOI: 10.1016/j.media.2020.101819] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/12/2020] [Accepted: 09/08/2020] [Indexed: 11/22/2022]
Abstract
With the development of deep learning, its application in diagnosis of benign and malignant thyroid nodules has been widely concerned. However, it is difficult to obtain medical images, resulting in insufficient number of data, which contradicts the large amount of data required for acquiring effective deep learning diagnostic models. A multi-view ensemble learning based on voting mechanism is proposed herein to boost the performance of the models trained by small-dataset thyroid nodule ultrasound images. The method integrates three kinds of diagnosis results which are obtained from 3-view dataset which is composed of thyroid nodule ultrasound images, medical features extracted based on U-Net output and useful features selected by mRMR from the statistical features and texture features. To obtain preliminary diagnosis results, the images are utilized for training GoogleNet. For improving the results, supplementary methods were proposed based on the medical features and the selected features. To analyze the contribution of these features and acquire two groups of diagnosis results, the designed Xgboost classifier is utilized for obtaining two groups of features respectively. Subsequently, the boosting final results are obtained through majority voting mechanism. Furthermore, the proposed method is utilized to diagnose sequence images (the images extracted by frame from videos) to solve the poor results caused by slight differences. Finally, better final results are obtained for both of the normal dataset and the sequence dataset (consisting of sequence images). Compared with the accuracies obtained by only training deep learning models with small datasets, the diagnostic accuracies of the above two datasets are improved to 92.11% and 92.54% respectively by utilizing the proposed method.
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Signore G, Albano D, Giovanella L, Bertagna F, Treglia G. Evidence-Based Data About Prevalence and Risk of Malignancy of Thyroid Incidentalomas Detected by Different PET Radiopharmaceuticals. Curr Radiopharm 2020; 13:89-93. [DOI: 10.2174/1874471012666191212115732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 11/22/2022]
Abstract
Background:
To date, several meta-analyses and systematic reviews have reported data
about the prevalence and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals.
Objective:
This article aims to summarize the published evidence-based data about the prevalence and
risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals.
Methods:
A comprehensive computer literature search of systematic reviews and meta-analyses published
up to July 2019 in PubMed/MEDLINE and Cochrane library databases regarding the prevalence
and risk of malignancy of thyroid incidentalomas detected by different PET radiopharmaceuticals was
carried out.
Results:
We have summarized the data about prevalence and risk of malignancy of thyroid incidentalomas
detected by different PET radiopharmaceuticals (fluorine-18 fluorodeoxyglucose, radiolabelled
choline and prostate-specific membrane antigen) taking into account 8 evidence-based articles.
Conclusion:
Evidence-based data demonstrated that thyroid incidentalomas detected by different PET
radiopharmaceuticals are not infrequent and their risk of malignancy is not negligible, in particular if
focal pattern is evident at PET, thus requiring further clinical and instrumental evaluation.
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Affiliation(s)
- Giovanni Signore
- School of Medicine, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili of Brescia, Brescia, Italy
| | - Luca Giovanella
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona/Lugano, Switzerland
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili of Brescia, Brescia, Italy
| | - Giorgio Treglia
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona/Lugano, Switzerland
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TI-RADS Diagnostic Performance: Which Algorithm is Superior and How Elastography and 4D Vascularity Improve the Malignancy Risk Assessment. Diagnostics (Basel) 2020; 10:diagnostics10040180. [PMID: 32225078 PMCID: PMC7235757 DOI: 10.3390/diagnostics10040180] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022] Open
Abstract
Given the increased prevalence of thyroid nodules in the general population (~50%), the real challenge resides in correctly recognizing the suspicious ones. This study proposes to compare four important Thyroid Imaging and Reporting Data Systems (TI-RADS) and evaluate the contribution of elastography and 4D Color Doppler assessment of vascularity in estimating the risk of malignancy. In the study, 133 nodules with histopathological examination were included. Of these, 35 (26.31%) proved to be malignant. All nodules were classified using the four selected systems and our proposed improved score. The American College of Radiology (ACR) and EU TI-RADS had good sensitivity (94.28%, 97.14%) and NPV (93.33%, 95.83%), but fairly poor specificity (31.81%, 23.46%) and PPV (35.48%, 31.19%), with an accuracy of 42.8% and 45.8%, respectively. Horvath TI-RADS had better accuracy of 66.9% and somewhat improved specificity (62.24%), but poorer sensitivity (80%). Russ’ French TI-RADS includes elastography in the risk assessment strategy. This classification proved superior in all aspects (Se: 91.42%, Sp:82.65%, NPV:96.42%, PPV:65.30%, and Acc of 84.96%). The mean strain ratio (SR) value for malignant lesions was 5.56, while the mean SR value for benign ones was significantly lower, 2.54 (p < 0.05). It also correlated well with the response variable: histopathological result (p < 0.001). Although, adding 4D vascularity to the French score generated a similar calculated accuracy and from a statistical point of view, the parameter itself proved beneficial for predicting the malignancy risk (p < 0.001) and may add important knowledge in uncertain situations. Advanced ultrasound techniques definitely improved the risk estimation and should be used more extensively.
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Su A, Zhao W, Wu W, Wei T, Ruan M, Li Z, Zhu J. The association of preoperative thyroid-stimulating hormone level and the risk of differentiated thyroid cancer in patients with thyroid nodules: A systematic review and meta-analysis. Am J Surg 2020; 220:634-641. [PMID: 31955813 DOI: 10.1016/j.amjsurg.2020.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND This systematic review and meta-analysis was conducted to determine the value of preoperative thyroid-stimulating hormone (TSH) levels in assessing the risk of differentiated thyroid cancer (DTC) in patients with thyroid nodules. METHODS This meta-analysis included 23,799 subjects (15,406 non-Chinese and 8,393 Chinese) with thyroid nodules. Multivariate and individual adjusted odds ratios (OR) were calculated for a 1 mU/L increase in preoperative TSH levels to determine the risk of malignant DTC. RESULTS The OR for DTC in relation to preoperative TSH levels was significant in Chinese (1.25 [1.11, 1.40], Z = 3.67, p = 0.0002) and non-Chinese subjects (1.12 [1.03, 1.22], Z = 2.72, p = 0.006). The overall random-effects model indicated that there was a significantly increased risk for DTC in patients with thyroid nodules (OR 1.16 [1.06, 1.27], Z = 3.29, p = 0.007). CONCLUSIONS A significant association between higher TSH levels and risk of DTC was observed in both population groups investigated, with higher ORs for Chinese subjects.
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Affiliation(s)
- Anping Su
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Wanjun Zhao
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Wenshuang Wu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Tao Wei
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Meifang Ruan
- Department of Medical Affairs, Merck Serono Co., Ltd, Beijing, China.
| | - Zhihui Li
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Jingqiang Zhu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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The impact of obesity and insulin resistance on thyroid cancer: A systematic review. Maturitas 2019; 125:45-49. [DOI: 10.1016/j.maturitas.2019.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
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Schwaiger K, Koeninger F, Wimbauer J, Heinrich K, Gala-Kokalj A, Wechselberger G. Occult papillary thyroid cancer presenting as cystic metastasis of the lateral neck: A case report. Medicine (Baltimore) 2019; 98:e16659. [PMID: 31348321 PMCID: PMC6708659 DOI: 10.1097/md.0000000000016659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
RATIONALE Papillary thyroid cancer accounts for up to 85% of all cases of thyroid carcinoma. This disease entity is notorious for metastatic invasion of adjacent lymph nodes, including the cervical lymph nodes, potentially presenting as a growing lateral neck mass. However, these lesions tend to be recognized and diagnosed soon due to the palpable mass. PATIENT CONCERNS This report describes a very rare case of a huge slow-growing neck metastasis based on a 6 mm papillary thyroid microcarcinoma. This patient presented with a painless, but continuously growing right lateral neck mass. Aside from that, no specific complaints were mentioned. DIAGNOSIS The underlying cause of this patient's neck mass turned out to be an occult papillary thyroid microcarcinoma (Ø 6 mm) with metastatic invasion and subsequent cystic degeneration of cervical lymph nodes. Accurate diagnosis was made after surgical intervention through histopathological analysis. INTERVENTIONS The patient underwent complete resection of the cervical mass in conjunction with total thyroidectomy and right cervical neck dissection, followed by adjuvant iodine- and chemotherapy. OUTCOME Margin free surgical resection without any postoperative complications could be achieved. The patient received iodine supplementation and remained free of recurrence during regular clinical follow-ups for 2 years. The therapy was curative. LESSONS This case report emphasizes the importance of a thorough diagnostic work-up including preoperative tissue sampling of any cervical neck mass, since a benign appearance on imaging does not exclude a malignant process.
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Jackson BS. Controversy regarding when clinically suspicious thyroid nodules should be subjected to surgery: Review of current guidelines. Medicine (Baltimore) 2018; 97:e13634. [PMID: 30558052 PMCID: PMC6320209 DOI: 10.1097/md.0000000000013634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/19/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The work-up of a thyroid nodule to diagnose malignancy is not always straightforward. There are various international thyroid societies each with their own guidelines on the approach to a thyroid nodule. The aim is therefore to determine whether a clinically suspicious thyroid nodule should be subjected to surgery. METHOD A review of various international thyroid society guidelines on their approach to a suspicious thyroid nodule. RESULTS Sixty-two relevant articles were identified of which 4 current international thyroid guidelines, consisting of 6 different international societies, were reviewed. The commonalities of each of the thyroid society guidelines are imaging, with ultrasound, and cytopathology as the main diagnostic investigations. The description and the size of the nodule are the 2 most important factors on ultrasound; however, the guidelines vary in their recommendations whether to biopsy a suspicious thyroid nodule. An indeterminate group exists whereby thyroid nodules cannot be confirmed as malignant even with fine needle aspiration cytology (FNA). Although further investigations (Technetium-99m -sestamethoxyisobutylisonitryl scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography scan, and molecular testing) may assist in the diagnosis, there are limitations. There are differences in the guidelines whether suspicious nodules should be subjected to surgery. CONCLUSION Ultrasound and cytopathology are the 2 most appropriate investigations to diagnose whether a suspicious thyroid nodule is benign or malignant. The clinician needs to be aware of the differences between the guidelines from the various international thyroid societies, specifically concerning the indeterminate group of patients where a definitive diagnosis cannot be made. Management decisions should be discussed with a thyroid multidisciplinary team for a consensus decision whether or not to subject a patient with a suspicious thyroid nodule to surgery.
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Livadas S, Bothou C, Androulakis I, Boniakos A, Angelopoulos N, Duntas L. Levothyroxine Replacement Therapy and Overuse: A Timely Diagnostic Approach. Thyroid 2018; 28:1580-1586. [PMID: 30351232 DOI: 10.1089/thy.2018.0014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Levothyroxine (LT4) is one of the most prescribed drugs worldwide. Once started, approximately 90% of patients continue treatment long term. However, accumulating evidence suggests that many patients, for whom the indication for its administration is not adequately established and the diagnosis is not well documented, are overusing it. This study aimed to evaluate the necessity for and determine potential prognostic factors of long-term LT4 supplementation. METHODS A prospective clinical cohort follow-up study was carried out. In 291 subjects (84% females) aged 48 ± 16 years on LT4 replacement therapy without a solid diagnosis of hypothyroidism being provided, the treatment was paused. At the beginning and after six to eight weeks of treatment discontinuation, thyrotropin (TSH) and free thyroxine levels were assessed, and thyroid ultrasound was performed. A TSH value of ≥4.5 IU/mL was considered as underlying hypothyroidism. RESULTS Among the 291 individuals, 114 became hypothyroid (group A), while 177 subjects remained euthyroid off LT4 (group B; 39.2% vs. 60.8%, p < 0.001). The groups were comparable regarding sex, family history, age, body mass index, duration of treatment, basal TSH and free thyroxine values, thyroid volume, and presence of thyroid autoantibodies. However, diffuse inhomogeneous echogenicity on ultrasound examination was significantly higher (p < 0.001) in group A. CONCLUSIONS These findings suggest considerable overuse of thyroxine therapy. The results underline the initial need to establish the diagnosis firmly before treatment initiation and to undertake periodic evaluation of all patients on chronic LT4 treatment as to the necessity for treatment continuation. In all patients on long-term LT4 therapy in whom the diagnosis has not been definitively established, it appears rational to introduce a six- to eight-week period of LT4 replacement therapy discontinuation, preceded and followed by TSH tests, as the first-line approach-a procedure that could be implemented as part of a common strategy among the scientific community to decrease current LT4 overuse.
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Affiliation(s)
| | - Christina Bothou
- 2 Division of Endocrinology, Diabetes and Metabolism, Medical Department 1, University Hospital, Goethe University , Frankfurt am Main, Germany
| | | | | | | | - Leonidas Duntas
- 3 Endocrine Unit, Evgenidion Hospital, University of Athens , Athens, Greece
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Elevated serum growth differentiation factor 15 levels are associated with thyroid nodules in type 2 diabetes aged over 60 years. Oncotarget 2018; 8:41379-41386. [PMID: 28489602 PMCID: PMC5522289 DOI: 10.18632/oncotarget.17328] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/30/2017] [Indexed: 11/25/2022] Open
Abstract
In order to investigate whether serum growth differentiation factor 15 is associated with thyroid nodules in type 2 diabetes. We recruited 723 type 2 diabetic patients aged over 30 years who attended the clinic of Endocrinology of Xinhua Hospital from January 2013 to January 2015. Thyroid nodule was diagnosed by thyroid ultrasonographic examination. Serum growth differentiation factor 15, thyroid function, thyroid autoantibodies, thyroglobulin and other biochemical indicators were measured and compared between thyroid nodule positive and negative groups. We found that overall, serum growth differentiation factor 15 levels were significantly higher in subjects with thyroid nodules compared with nodule negative subjects (181.76±98.49 pg/ml vs. 162.32±83.63 pg/ml, p<0.05), and this was influenced by age. In the patients over 60 years, this difference became more significant (211.23±103.66 pg/ml vs. 177.38±85.51 pg/ml, p<0.01), but in patients under 60 years, there was no difference between the two groups. Multivariate logistic regression analysis showed that serum growth differentiation factor 15 levels were independently associated with thyroid nodule in diabetic patients over 60 years (P <0.001). After multiple adjustments, the odds ratios were substantially higher for thyroid nodule (odds ratio 2.63, 95% confidence interval 1.30-5.13, p<0.01) in the highest growth differentiation factor 15 quartile compared to those in the lowest quartile in patients over 60 years. In conclusion, serum growth differentiation factor 15 is increased significantly in subjects with thyroid nodules in type 2 diabetic patients aged over 60 years.
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Liu MJ, Men YM, Zhang YL, Zhang YX, Liu H. Improvement of diagnostic efficiency in distinguishing the benign and malignant thyroid nodules via conventional ultrasound combined with ultrasound contrast and elastography. Oncol Lett 2017; 14:867-871. [PMID: 28693244 PMCID: PMC5494667 DOI: 10.3892/ol.2017.6245] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/24/2017] [Indexed: 12/17/2022] Open
Abstract
We aimed to evaluate the diagnostic values of conventional ultrasound (US), ultrasound contrast (UC) and ultrasound elastography (UE) in distinguishing the benign and malignant thyroid nodules. A total of 100 patients with thyroid nodules receiving operative treatment were selected; they underwent the conventional US, UE and UC examinations before operation, respectively. The nodules received pathological examination after operation to distinguish benign from malignant lesions. The sensitivity, specificity and diagnostic accordance rate of each diagnostic method was evaluated by receiver operating characteristic (ROC) curve, and the area under the curve (AUC) of ROC was calculated. The manifestations of malignant thyroid nodules in conventional US examination were mostly the hypoecho, heterogeneous echo, irregular shape, unclear boundary, aspect ratio <1, microcalcification and irregular peripheral echo halo, and there were statistically significant differences compared with the benign nodules (P<0.05). UE showed that the differences between benign and malignant nodules in 2, 3 and 4 points were statistically significant (P<0.05). The manifestations of malignant nodules in UC were mostly the irregular shape, obscure boundary, no obvious enhancement, heterogeneous enhancement and visible perfusion defects, and there were statistically significant differences compared with the benign nodules (P<0.05). ROC curve showed that both sensitivity and specificity of UE and UC were superior to those of conventional US. AUC was the largest (AUC = 0.908) and the diagnostic value was the highest in the conventional US combined with UE and UC. Conventional US combined with elastography and UC can significantly improve the sensitivity, specificity and accuracy of diagnosis of benign and malignant thyroid nodules.
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Affiliation(s)
- Mei-Juan Liu
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264001, P.R. China
| | - Yan-Ming Men
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264001, P.R. China
| | - Yong-Lin Zhang
- Department of Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264001, P.R. China
| | - Yu-Xi Zhang
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264001, P.R. China
| | - Hao Liu
- Department of Ultrasound, Yantai Hospital of Traditional Chinese Medicine, Yantai, Shandong 264001, P.R. China
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