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Rossi ED, Bruno C, Tralongo P, Policardo F, Vegni F, Feraco A, Zhang Q, Pontecorvi A, Fadda G, Lombardi CP, Raffaelli M, Mulè A, Larocca LM. Updates from Our Institutional Experience with Thyroid Nodules Diagnosed as Metastases. Diagnostics (Basel) 2023; 13:2388. [PMID: 37510131 PMCID: PMC10378055 DOI: 10.3390/diagnostics13142388] [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: 06/22/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Thyroid metastases (TMs) are a rare entity, ranging between 0 and 24% in the autopsy series. In the assessment of the best management, the discrimination between a primary and a metastatic thyroid lesion is crucial. In this regard, fine needle aspiration cytology (FNAC) is likely to play a crucial role especially when ancillary techniques (i.e., immunocytochemistry (ICC) and molecular testing) are carried out. METHODS We searched for all the TMs diagnosed using FNAC and analyzed between 2014 and 2023. The cases were processed with liquid-based (LBC) and ICC and molecular testing performed on LBC-stored material. RESULTS We reported 2.2% (19 cases) of TMs out of 1022 malignancies. TMs included: 1 larynx carcinoma (LX-Ca), 1 melanoma, 2 breast carcinomas (B-Ca), 3 lung carcinomas (LG-Ca), 4 gastro-intestinal carcinomas (GI-Ca), and 8 clear cell renal carcinomas (CCRC). All patients had a previous cancer history, between 300 and 2 months from the primary cancers. The morphological features were supported by ICC, which were contributive in 100% of cases. All TMs cases were characterized by multiple thyroid nodules except the melanoma case. Four cases underwent total thyroidectomy (1 B, 1 LX, 1 melanoma, and 1 CCRC) whilst 15 TMs were treated with radio-chemotherapy. CONCLUSIONS FNAC empowered the diagnostic workup of patients with TMs avoiding useless surgery. The low sensitivity of cytology might be reinforced by the application of ancillary techniques. We found a predominant rate of kidney metastatic carcinomas, followed by lung and breast. TMs are frequently multifocal and in a context of a systemic disease so a tailored therapy seems to be the best treatment.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Carmine Bruno
- Division of Endocrinology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Federica Policardo
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Federica Vegni
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Angela Feraco
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Qianqian Zhang
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine Surgery, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Antonino Mulè
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, 00168 Rome, Italy
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Song Y, Dai L, Xu G, Wang T, Yu W, Chen K, Zhang B. Video mediastinoscopy-assisted superior mediastinal dissection in the treatment of thyroid carcinoma with mediastinal lymphadenopathy: preliminary results. BMC Surg 2021; 21:329. [PMID: 34407789 PMCID: PMC8371822 DOI: 10.1186/s12893-021-01326-9] [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: 02/26/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background Mediastinal lymph node metastases (MLNM) are not rare in thyroid cancer, but their treatment has not been extensively studied. This study aimed to explore the preliminary application of video mediastinoscopy-assisted superior mediastinal dissection in the diagnosis and treatment of thyroid carcinoma with mediastinal lymphadenopathy. Materials and methods We retrospectively reviewed the clinical pathologic data and short-term outcomes of thyroid cancer patients with suspicious MLNM treated with video mediastinoscopy-assisted mediastinal dissection at our institution from 2017 to 2020. Results Nineteen patients were included: 14 with medullary thyroid carcinoma and five with papillary thyroid carcinoma. Superior mediastinal nodes were positive in nine (64.3%) patients with medullary thyroid carcinoma and in four (80.0%) patients with papillary carcinoma. No fatal bleeding occurred. There were three cases of temporary recurrent laryngeal nerve (RLN) palsy postoperatively, one of which was bilateral. Four patients had temporary hypocalcemia requiring supplementation, one had a chyle fistula, and one developed wound infection after the procedure. Postoperative serum molecular markers decreased in all patients. One patient died of cancer while the other 18 patients remained disease-free, with a median follow-up of 33 months. Conclusion Video mediastinoscopy-assisted superior mediastinal dissection can be performed relatively safely in patients with suspicious MLNM. This diagnostic and therapeutic approach may help control locoregional recurrences.
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Affiliation(s)
- Yuntao Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, China
| | - Liang Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Guohui Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, China
| | - Tianxiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, China
| | - Wenbin Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, China
| | - Keneng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), First Department of Thoracic Surgery, Peking University Cancer Hospital and Institute, Beijing, China
| | - Bin Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck Surgery, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, China.
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Song Y, Xu G, Wang T, Zhang B. Lateral neck multilevel fine-needle aspiration cytology and thyroglobulin estimation in papillary thyroid carcinoma. Laryngoscope Investig Otolaryngol 2021; 6:570-575. [PMID: 34195379 PMCID: PMC8223459 DOI: 10.1002/lio2.570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 04/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To assess the accuracy of preoperative ultrasound-guided multilevel fine-needle aspiration (FNA) cytology and thyroglobulin (Tg) estimation in mapping metastatic levels in the lateral neck, in patients with papillary thyroid carcinoma (PTC). METHODS Patients with PTC clinically metastasizing to the lateral neck who were initially treated at the Peking University Cancer Hospital from June 2018 to September 2020 were included. FNA was performed preoperatively in each suspicious neck level; cytological examination (FNA-C) and Tg measurement of the needle-washout fluid (FNA-Tg) were combined to determine metastasis. FNA-Tg cutoff value was calculated, and the accuracy of FNA at different levels were evaluated. RESULTS In total, 111 patients underwent 124 lymph node dissections. The best cutoff value of FNA-Tg for the diagnosis of metastatic level was 1.0 ng/mL. Multilevel FNA showed sensitivity, specificity, positive predictive value, and negative predictive value in predicting single-level metastasis of 100%, 61.0%, 43.9%, and 100%, respectively. In 64 (51.6%) cases, the involved levels diagnosed by FNA were consistent with that diagnosed by postoperative pathology. CONCLUSION FNA-Tg improves the diagnostic performance of FNA-C in lateral neck lymph node metastases. However, limited accuracy was obtained for preoperative multilevel FNA in predicting the extent of metastasis in the lateral compartment.
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Affiliation(s)
- Yuntao Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck SurgeryPeking University Cancer Hospital and InstituteBeijingChina
| | - Guohui Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck SurgeryPeking University Cancer Hospital and InstituteBeijingChina
| | - Tianxiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck SurgeryPeking University Cancer Hospital and InstituteBeijingChina
| | - Bin Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head and Neck SurgeryPeking University Cancer Hospital and InstituteBeijingChina
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Abstract
The incidence of thyroid cancer is increasing, largely attributable to overdetection related to prevalent diagnostic and radiologic imaging modalities. Papillary thyroid cancer remains the most common thyroid malignancy. It has a high tendency for regional metastasis to the cervical lymph nodes. The optimal management of the neck in patients with thyroid carcinoma has long been an important topic of debate. This article addresses central and lateral neck dissection, providing a simplified guide to the most up-to-date and evidence-based practices.
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Affiliation(s)
- Ahmad M Eltelety
- Endocrine Head and Neck Surgery, Otolaryngology Department, Medical College of Georgia, Augusta University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA; Otolaryngology Department, Cairo University, ElManial, Cairo 11562, Arab Republic of Egypt
| | - David J Terris
- Otolaryngology Department, Augusta University, Thyroid and Parathyroid Center, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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