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Kakudo K, Liu Z, Jung CK, Lai CR. Lessons learned from the diversity of thyroid nodule practice. Cancer Cytopathol 2023; 131:741-746. [PMID: 37278105 DOI: 10.1002/cncy.22728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 04/28/2023] [Accepted: 05/08/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Cancer Genome Center and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Zhiyan Liu
- Department of Pathology, Shanghai Sixth People's Hospital Affiliated With Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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2
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Li Y, Che W, Yu Z, Zheng S, Xie S, Chen C, Qiao M, Lyu J. The Incidence Trend of Papillary Thyroid Carcinoma in the United States During 2003-2017. Cancer Control 2022; 29:10732748221135447. [PMID: 36256588 PMCID: PMC9583193 DOI: 10.1177/10732748221135447] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The rapid increase in the detection rate of thyroid cancer over the past few
decades has caused some unexpected economic burdens. However, that of
papillary thyroid carcinoma (PTC) seems to have had the opposite trend,
which is worthy of further comprehensive exploration. Methods The Surveillance, Epidemiology, and End Results 18 database was used to
identify patients with PTC diagnosed during 2003-2017. The incidence trends
were analyzed using joinpoint analysis and an age-period-cohort model. Results The overall PTC incidence rate increased from 9.9 to 16.1 per 100 000 between
2003 and 2017. The joinpoint analysis indicated that the incidence growth
rate began to slow down in 2009 (annual percentage change [APC] = 3.1%, 95%
confidence interval [CI] = 1.9%–4.4%). After reaching its peak in 2015, it
began to decrease by 2.8% (95% CI = −4.6% to −1.0%) per year. The stratified
analysis indicated that the incidence patterns of different sexes, age
groups, races, and tumor stages and sizes had similar downward trends,
including for the localized (APC = −4.5%, 95% CI = −7% to −1.9%) and distant
(APC = −1.3%, 95% CI = −2.7% to −.1%) stages, and larger tumors (APC = −4%,
95% CI = −12% to 4.7%). The age-period-cohort model indicated a significant
period effect on PTC, which gradually weakened after 2008-2012. The cohort
effect indicates that the risk of late birth cohorts is gradually
stabilizing and lower than that of early birth cohorts. Conclusion The analysis results of the recent downward trend and period effect for the
incidence of each subgroup further support the important role of correcting
overdiagnosis in reducing the prevalence of PTC. Future research needs to
analyze more-recent data to verify these downward trends.
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Affiliation(s)
- Yunmei Li
- Department of Clinical Research, The First Affiliated Hospital of
Jinan University, Guangzhou, China,School of Basic Medicine and Public
Health, Jinan University, Guangzhou, China
| | - Wenqiang Che
- Department of Neurosurgery, The First Affiliated Hospital of
Jinan University, Guangzhou, China
| | - Zhong Yu
- School of Public Health, Shannxi University of Chinese
Medicine, Xianyang, China
| | - Shuai Zheng
- School of Public Health, Shannxi University of Chinese
Medicine, Xianyang, China
| | - Shuping Xie
- Department of Clinical Research, The First Affiliated Hospital of
Jinan University, Guangzhou, China,School of Basic Medicine and Public
Health, Jinan University, Guangzhou, China
| | - Chong Chen
- School of Public Health, Shannxi University of Chinese
Medicine, Xianyang, China
| | - Mengmeng Qiao
- School of Public Health, Shannxi University of Chinese
Medicine, Xianyang, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of
Jinan University, Guangzhou, China,Guangdong Provincial Key Laboratory
of Traditional Chinese Medicine Informatization, Guangzhou, China,Jun Lyu, Department of Clinical Research,
The First Affiliated Hospital of Jinan University, 613 W.Huangpu Avenue,
Guangzhou 510630, People’s Republic of China.
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3
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Kurtulmuş N, Tokat F, Düren M, Kaya H, Ertaş B, İnce Ü. Expression of vascular endothelial growth factor in follicular cell-derived lesions of the thyroid: Is NIFTP benign or precancerous? Turk J Surg 2022; 38:60-66. [DOI: 10.47717/turkjsurg.2022.5318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022]
Abstract
Objective: Vascular endothelial growth factor (VEGF) is an angiogenic factor that plays an important role in physiological and pathological angiogenesis of the thyroid. The aim of the current study was to determine the expression characteristics of VEGF in follicular cell-derived lesions of the thyroid and to assess whether a new entity noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is precancerous.
Material and Methods: Patients diagnosed with 33 follicular adenomas (FA), 41 invasive follicular variant papillary thyroid cancer (IN-FVPTC), and 40 NIFTP in surgical resection materials were evaluated retrospectively. Immunostaining was performed on 5-μm paraffin tissue sections. The percentages of immunostaing for VEGF were evaluated on pathological materials. We used a percentage of labeled thyrocytes score (0, no labeling; 1, <30%; 2, 31-60%; 3, >60%) and an intensity score (0, no staining; 1, weak; 2, intermediate; 3, strong). The sum of two scores were accepted as the total score.
Results: Mean ages of the FA, IN-FVPTC, and NIFTP groups were 44.7 ± 11.7 years, 46.9 ± 13.6 years, 43.2 ± 15.4 years, respectively and the mean VEGF immunostaining scores were 44.7 ± 29.3, 50.2 ± 32.54, 4 ± 26.3 respectively. Although there was no statistically significant difference (p= 0.347), the total score of the NIFTPs was higher than the scores of the FA (mean= 3.9 ± 1.8) and IN-FVPTC(mean= 4.3 ± 1.9) groups with a mean value of 4.6 ± 1.7. This result was remarkable. There was no statistically significant difference between tumor diameters and staining percentages (p= 0.750).
Conclusion: Even if there were no statistical differences for VEGF immunostaining, it was high in NIFTPs. Since we know the role of VEGF in tumorigenesis, we can hypothesize that NIPTP can be precancerous. Our argue should be corroborated by a large prospective study.
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4
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Paja M, Zafón C, Iglesias C, Ugalde A, Cameselle-Teijeiro JM, Rodríguez-Carnero G, Fernández-Seara P, Anda E, Povoa A, Quiceno H, Sánchez-Gómez NM, González C, García-Pascual L, Gómez de la Riva I, Blanco C, Meizoso T, Riesco-Eizaguirre G, Capel I, Ortega MV, Mancha I, Chao M, Alcázar V, Roselló E, Maravall J, López-Agulló S, Pérez-Lázaro A, Meseguer P, Sanz J, Paricio JJ, Echeverría S, Castaño Á, Bella RM. Rate of non-invasive follicular thyroid neoplasms with papillary-like nuclear features depends on pathologist's criteria: a multicentre retrospective Southern European study with prolonged follow-up. Endocrine 2021; 73:131-140. [PMID: 33484411 DOI: 10.1007/s12020-021-02610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the rate of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in a multi-institutional series from the Iberian Peninsula and describing this NIFTP cohort. METHODS Retrospective study of papillary thyroid carcinoma (PTC) or well-differentiated tumours of uncertain malignant potential (WDT-UMP) diagnosed between 2005 and 2015 and measuring ≥5 mm in adult patients from 17 hospitals. Pathological reports were reviewed to determine the cases that fulfil the original criteria of NIFTP and histology was reassessed. Rates were correlated with the number of PTC and its follicular variant (FVPTC) of each institution. Demographic data, histology, management, and follow-up of the reclassified NIFTP cohort were recorded. RESULTS A total of 182 cases with NIFTP criteria were identified: 174/3372 PTC (rate: 5.2%; range: 0-12.1%) and 8/19 WDT-UMP (42.1%). NIFTP rate showed linear correlation with total PTC (p: 0.03) and FVPTC (p: 0.007) identified at each centre. Ultrasound findings were non-suspicious in 60.1%. Fine-needle cytology or core biopsy diagnoses were undetermined in 49.7%. Most patients were treated with total thyroidectomy. No case had nodal disease. Among patients with total thyroidectomy, 89.7% had an excellent response evaluated 1 year after surgery. There were no structural persistence or relapses. Five patients showed residual thyroglobulin after 90 months of mean follow-up. CONCLUSIONS NIFTP rate is low but highly variable in neighbouring institutions of the Iberian Peninsula. This study suggests pathologist's interpretation of nuclear alterations as the main cause of these differences. Patients disclosed an excellent outcome, even without using the strictest criteria.
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Affiliation(s)
- Miguel Paja
- Department of Endocrinology, Hospital Universitario Basurto, Bilbao, Spain.
| | - Carles Zafón
- Department of Endocrinology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmela Iglesias
- Department of Pathology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Aitziber Ugalde
- Department of Pathology, Hospital Universitario Basurto, Bilbao, Spain
| | | | - Gemma Rodríguez-Carnero
- Department of Endocrinology, Complejo Hospitalario Universitario Santiago de Compostela, La Coruña, Spain
| | | | - Emma Anda
- Department of Endocrinology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Antónia Povoa
- Department of Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Hernán Quiceno
- Department of Pathology, Fundación Jiménez Díaz, Madrid, Spain
| | | | - Clarisa González
- Department of Pathology, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | - Luis García-Pascual
- Department of Endocrinology, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | | | - Concha Blanco
- Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Telma Meizoso
- Department of Pathology, Hospital General de Móstoles, Madrid, Spain
| | | | - Ismael Capel
- Department of Endocrinology, Corporació Parc Taulí, Sabadell, Spain
| | - María Victoria Ortega
- Department of Pathology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Isabel Mancha
- Department of Endocrinology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Montserrat Chao
- Department of Pathology, Hospital Universitario Severo Ochoa, Leganés, Spain
| | - Victoria Alcázar
- Department of Endocrinology, Hospital Universitario Severo Ochoa, Leganés, Spain
| | - Esther Roselló
- Department of Pathology, Hospital General Universitario de Castellón, Castellón, Spain
| | - Javier Maravall
- Department of Endocrinology, Hospital General Universitario de Castellón, Castellón, Spain
| | | | | | | | - Javier Sanz
- Department of Endocrinology, Hospital Lluís Alcanyís, Xàtiva, Spain
| | - Jose J Paricio
- Department of Pathology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Saioa Echeverría
- Department of Endocrinology, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Ángel Castaño
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Rosa M Bella
- Department of Pathology, Corporació Parc Taulí, Sabadell, Spain
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5
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Kakudo K, Bychkov A, Bai Y, Li Y, Liu Z, Jung CK. The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives. Pathol Int 2018; 68:641-664. [PMID: 30537125 DOI: 10.1111/pin.12737] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kennichi Kakudo
- Faculty of Medicine, Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University, Ikoma-city, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kawagoe, Chiba, Japan.,Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yaqiong Li
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Zhiyan Liu
- Department of Pathology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Shandong, China
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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6
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Brandler TC, Liu CZ, Cho M, Zhou F, Cangiarella J, Yee-Chang M, Shi Y, Simsir A, Sun W. Does Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features (NIFTP) Have a Unique Molecular Profile? Am J Clin Pathol 2018; 150:451-460. [PMID: 30052723 DOI: 10.1093/ajcp/aqy075] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Recognizing preoperative characteristics of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is important for clinical management. Therefore, we assessed presurgical NIFTP molecular profiles using fine-needle aspiration (FNA) material. METHODS Presurgical FNA reports of 39 surgically confirmed NIFTP cases from January 2013 through May 2017 were assessed for Afirma and ThyroSeq results. RESULTS Twenty-one of 39 NIFTP nodules were preoperatively tested with Afirma with two benign and 19 suspicious results. Twenty-seven of 39 nodules were tested with ThyroSeq (nine of 39 had both Afirma and Thyroseq): 18 (67%) had RAS mutations (13 NRAS, four HRAS, one KRAS), and three of 18 had multiple alterations (NRAS + TP53, n = 1; NRAS + PTEN, n = 2). BRAF T599_R603 + EIF1AX mutation (n = 1), PTEN mutation (n = 1), MET overexpression (n = 1), PAX8/PPARG fusion (n = 3), and THADA/IGF2BP3 fusion (n = 3) comprised the remainder. CONCLUSIONS NIFTP cases most commonly displayed suspicious Afirma results and RAS mutations on ThyroSeq, lacking aggressive/BRAF-V600E-like mutations. While NIFTP remains a surgical entity, the lack of aggressive/BRAF-V600E-like mutations can aid in determining the extent of surgery.
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Affiliation(s)
- Tamar C Brandler
- Department of Pathology, New York University Langone Medical Center, New York
| | - Cheng Z Liu
- Department of Pathology, New York University Langone Medical Center, New York
| | - Margaret Cho
- Department of Pathology, New York University Langone Medical Center, New York
| | - Fang Zhou
- Department of Pathology, New York University Langone Medical Center, New York
| | - Joan Cangiarella
- Department of Pathology, New York University Langone Medical Center, New York
| | - Melissa Yee-Chang
- Department of Pathology, New York University Langone Medical Center, New York
| | - Yan Shi
- Department of Pathology, New York University Langone Medical Center, New York
| | - Aylin Simsir
- Department of Pathology, New York University Langone Medical Center, New York
| | - Wei Sun
- Department of Pathology, New York University Langone Medical Center, New York
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7
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Bychkov A, Jung CK, Liu Z, Kakudo K. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features in Asian Practice: Perspectives for Surgical Pathology and Cytopathology. Endocr Pathol 2018; 29:276-288. [PMID: 29476382 PMCID: PMC6097061 DOI: 10.1007/s12022-018-9519-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was initiated and promoted by pathologists. Recent Asian studies added new knowledge to the existing literature to aid a better understanding of NIFTP. Our original data and the results of a meta-analysis suggest that the initial rate of NIFTP has been overestimated, averaging 9.1% (95% confidence interval [CI] 6.0-12.7%) of all papillary thyroid cancers worldwide. The incidence of NIFTP in the Asian population (1.6%, 95% CI 0.9-2.5%; 7 studies) is significantly lower than that reported in the non-Asian series (13.3%, 95% CI 9.0-18.3%; 18 studies). Such difference could be attributed to various perceptions of histological diagnostic thresholds, different nature of papillary thyroid carcinoma, and different approaches in the management of thyroid nodules. The active surveillance for indeterminate nodules and NIFTP, largely represented in the indeterminate cytologic categories, promoted by Japanese institutions establishes a new paradigm to reduce overtreatment of these patients. The lower prevalence of NIFTP in the Asian series indicates a low impact on the risk of malignancy in cytopathology, as it was demonstrated in our original multi-institutional cohort of thyroid nodules, and may predict a low impact on the performance of commercial molecular tests. Several Korean studies addressed the issue of BRAF mutation in NIFTP, which prompted the current refinement of the diagnostic criteria for NIFTP. Our survey of Asian pathologists found that the term NIFTP has not been universally adopted in the local practice. Endocrine pathologists must promote the new entity through provision of educational activities.
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Affiliation(s)
- Andrey Bychkov
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, 06591, South Korea
| | - Zhiyan Liu
- Department of Pathology, Shandong University School of Basic Medical Sciences, Jinan, Shandong, 250012, China
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kindai University Faculty of Medicine, Nara, 630-0293, Japan.
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Kakudo K. How to handle borderline/precursor thyroid tumors in management of patients with thyroid nodules. Gland Surg 2018; 7:S8-S18. [PMID: 30175059 DOI: 10.21037/gs.2017.08.02] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Thyroid carcinomas originating from follicular cells have the prognosis of heterogeneous diseases, but pathologists classify them all as malignant disease. Epidemiologists have issued a stern warning regarding over-diagnosis and overtreatment of patients with indolent thyroid tumors that cause no harm to the patients. Review of the literature revealed that there were several proposals of borderline/precursor tumors to some indolent thyroid carcinomas. Thyroid tumor of uncertain malignant potential (UMP) was first proposed by Williams for encapsulated follicular pattern thyroid tumors to solve problems due to observer variation. Rosai et al. proposed to rename papillary microcarcinoma (PMC) to papillary micro-tumor as the overwhelming majority of them are of no clinical significance. Liu et al. proposed well-differentiated tumor with uncertain behavior (WDT-UB) which covered WDT of UMP (WDT-UMP) and non-invasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). The EFVPTC without invasion was renamed as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) by an international panel of pathologists. A new prognostic classification of thyroid tumors was proposed by Kakudo et al., in which extremely low risk tumors were grouped in a borderline tumors category. The borderline/precursor thyroid tumors included encapsulated tumors [capsular invasion only follicular carcinoma, encapsulated papillary carcinoma without invasion, WDT-UMP and follicular tumor of UMP (FT-UMP)] and non-encapsulated tumors (PMC). The UMP and NIFTP were incorporated in the 4th edition WHO classification of thyroid tumors as a new tumor entity in chapter 2-2A: other encapsulated follicular patterned thyroid tumors. Their behavior codes were decided to be 1 (borderline or uncertain behavior), and not 0 (benign), 2 (in situ carcinoma) or 3 (malignant). These borderline/precursor thyroid tumors are indolent tumors biologically and should be treated more conservatively than as previously recommended for thyroid follicular cell carcinomas [total thyroidectomy (TTX) followed by radio-active iodine (RAI) treatment] by western clinical guidelines.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Kindai University Faculty of Medicine, Nara Hospital, Nara, Japan
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9
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Dom G, Frank S, Floor S, Kehagias P, Libert F, Hoang C, Andry G, Spinette A, Craciun L, de Saint Aubin N, Tresallet C, Tissier F, Savagner F, Majjaj S, Gutierrez-Roelens I, Marbaix E, Dumont JE, Maenhaut C. Thyroid follicular adenomas and carcinomas: molecular profiling provides evidence for a continuous evolution. Oncotarget 2018; 9:10343-10359. [PMID: 29535811 PMCID: PMC5828225 DOI: 10.18632/oncotarget.23130] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/14/2017] [Indexed: 12/18/2022] Open
Abstract
Non-autonomous thyroid nodules are common in the general population with a proportion found to be cancerous. A current challenge in the field is to be able to distinguish benign adenoma (FA) from preoperatively malignant thyroid follicular carcinoma (FTC), which are very similar both histologically and genetically. One controversial issue, which is currently not understood, is whether both tumor types represent different molecular entities or rather a biological continuum. To gain a better insight into FA and FTC tumorigenesis, we defined their molecular profiles by mRNA and miRNA microarray. Expression data were analyzed, validated by qRT-PCR and compared with previously published data sets. The majority of deregulated mRNAs were common between FA and FTC and were downregulated, however FTC showed additional deregulated mRNA. Both types of tumors share deregulated pathways, molecular functions and biological processes. The additional deregulations in FTC include the lipid transport process that may be involved in tumor progression. The strongest candidate genes which may be able to discriminate follicular adenomas and carcinomas, CRABP1, FABP4 and HMGA2, were validated in independent samples by qRT-PCR and immunohistochemistry. However, they were not able to adequately classify FA or FTC, supporting the notion of continuous evolving tumors, whereby FA and FTC appear to show quantitative rather than qualitative changes. Conversely, miRNA expression profiles showed few dysregulations in FTC, and even fewer in FA, suggesting that miRNA play a minor, if any, role in tumor progression.
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Affiliation(s)
- Geneviève Dom
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Sandra Frank
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Sebastien Floor
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Pashalina Kehagias
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Frederick Libert
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Catherine Hoang
- Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | - Guy Andry
- Institut Jules Bordet, Brussels, Belgium
| | | | | | | | | | - Frederique Tissier
- Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France
| | | | | | - Ilse Gutierrez-Roelens
- Biolibrary of the King Albert II Institute, Cliniques Universitaires Saint-Luc, and Institut de Duve, Université Catholique de Louvain, Brussels, Belgium
| | - Etienne Marbaix
- Biolibrary of the King Albert II Institute, Cliniques Universitaires Saint-Luc, and Institut de Duve, Université Catholique de Louvain, Brussels, Belgium
| | - Jacques E. Dumont
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Carine Maenhaut
- Institute of Interdisciplinary Research (IRIBHM), Université libre de Bruxelles (ULB), Brussels, Belgium
- WELBIO, School of Medicine, Université libre de Bruxelles, Brussels, Belgium
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10
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Brandler TC, Yee J, Zhou F, Cho M, Cangiarella J, Wei XJ, Yee-Chang M, Sun W. Does noninvasive follicular thyroid neoplasm with papillary-like nuclear features have distinctive features on sonography? Diagn Cytopathol 2017; 46:139-147. [PMID: 29193910 DOI: 10.1002/dc.23863] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/18/2017] [Accepted: 11/06/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND The noninvasive encapsulated follicular variant of papillary carcinoma (nEFVPTC) has recently been reclassified to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP)," removing this entity from the malignant category. This re-categorization has had major implications for clinical management. NIFTP has overlapping cytohistologic features with papillary thyroid carcinoma (PTC) and with follicular adenomas (FA), but sonographic data comparing NIFTP to PTC and FA is lacking. Our study examines the sonographic features of NIFTP as compared with PTC and FA. METHODS Ultrasound scans and Doppler blood flow from subjects who had pre-surgical sonograms and fine needle aspiration biopsies with final surgical pathology diagnoses of NIFTP/nEFVPTC, classical PTC, and FA between 01/2013-08/2016 were assessed. Sonographic and Doppler features as well as Bethesda System (TBS) diagnoses were recorded and analyzed. RESULTS 40 NIFTP, 58 classical PTC, and 23 FA cases were included. The most common NIFTP pre-surgical TBS cytology diagnosis was Atypia of Undetermined Significance (AUS/FLUS) (40%). NIFTP cases predominantly displayed wider-than-tall shape (100%), smooth borders (75%), occurrence in multinodular glands (82.5%), heterogeneous echogenicity (50%), both perinodular and intranodular Doppler flow patterns (70%), minimal Doppler flow grade (62.5%), and no calcifications (90%). CONCLUSIONS Our study demonstrates that NIFTP, PTC, and FA display several distinguishing and overlapping sonographic and Doppler features. Sonographic features appear to complement cytology findings and may help raise pre-operative concern for NIFTP in the proper clinical setting, potentially leading to a more conservative management approach.
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Affiliation(s)
- Tamar C Brandler
- Department of Pathology, New York University School of Medicine, New York
| | - Joseph Yee
- Department of Radiology, New York University School of Medicine, New York
| | - Fang Zhou
- Department of Pathology, New York University School of Medicine, New York
| | - Margaret Cho
- Department of Pathology, New York University School of Medicine, New York
| | - Joan Cangiarella
- Department of Pathology, New York University School of Medicine, New York
| | - Xiao-Jun Wei
- Department of Pathology, New York University School of Medicine, New York
| | - Melissa Yee-Chang
- Department of Pathology, New York University School of Medicine, New York
| | - Wei Sun
- Department of Pathology, New York University School of Medicine, New York
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11
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Mehrzad R, Nishino M, Nucera C, Dias-Santagata D, Hennessey JV, Hasselgren PO. Invasive follicular variant of papillary thyroid cancer harboring the NRAS mutation Q61K and presenting with bone metastasis-A case report. Int J Surg Case Rep 2017; 38:180-184. [PMID: 28780248 PMCID: PMC5547242 DOI: 10.1016/j.ijscr.2017.06.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/16/2017] [Accepted: 06/17/2017] [Indexed: 12/13/2022] Open
Abstract
A patient with invasive follicular variant of papillary thyroid cancer presented with bone metastasis. The thyroid tumor harbored an isolated RAS mutation. The report challenges recent views that thyroid tumors with isolated RAS mutations may have a non-aggressive clinical course and may be candidates for conservative management.
Introduction The follicular variant of papillary thyroid cancer (FVPTC) can be noninvasive or invasive. The invasive form of FVPTC commonly harbors BRAF mutations whereas RAS mutations are more often associated with noninvasive FVPTC and a favorable clinical outcome. Case report A 47-year-old man presented with a metastasis to his right iliac bone as the initial manifestation of a 1.6 cm invasive FVPTC. After total thyroidectomy, the patient underwent additional treatment, including thyroid hormone suppressive treatment to non-detectable TSH levels, repeated courses of radioiodine treatment, external beam radiation, and treatment with the tyrosine kinase inhibitor sorafenib. Despite these therapeutic efforts, the disease progressed with growth of the iliac mass and additional metastatic spread to cervical and lumbar vertebrae causing increasing pain and disability. The patient succumbed to the disease four years after presentation. Retrospective next-generation sequencing of the primary tumor using a pan-cancer targeted mutation and gene fusion panel revealed NRAS Q61K mutation and no other oncogenic alterations. Discussion The study challenges the concept that thyroid neoplasms with isolated RAS mutations are often associated with favorable clinical behavior and may be candidates for conservative management. Conclusion An isolated RAS mutation in invasive FVPTC may be associated with an aggressive clinical behavior.
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Affiliation(s)
- Raman Mehrzad
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Carmelo Nucera
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Dora Dias-Santagata
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - James V Hennessey
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Per-Olof Hasselgren
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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12
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Cho U, Mete O, Kim MH, Bae JS, Jung CK. Molecular correlates and rate of lymph node metastasis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features and invasive follicular variant papillary thyroid carcinoma: the impact of rigid criteria to distinguish non-invasive follicular thyroid neoplasm with papillary-like nuclear features. Mod Pathol 2017; 30:810-825. [PMID: 28281551 DOI: 10.1038/modpathol.2017.9] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 12/14/2022]
Abstract
Thyroid tumors formerly classified as non-invasive encapsulated follicular variant of papillary thyroid carcinoma were recently renamed 'non-invasive follicular thyroid neoplasm with papillary-like nuclear features'. The current study investigated the frequency of lymph node metastasis and mutational profile of encapsulated follicular variant in the setting of a clinical practice where central neck dissection was the standard of practice. We defined the impact of rigid diagnostic criteria by regrouping such tumors based on the complete absence of papillae or presence of ≤1% papillae. Of a total of 6,269 papillary thyroid carcinomas, 152 tumors fulfilled the criteria for encapsulated follicular variant. The results were stratified according to two different diagnostic cutoff criteria with respect to the extent of papillae. When the cutoff of 1% papillae was used, the rates of lymph node metastasis and BRAFV600E mutation were 3% and 10% in non-invasive tumors and 9% and 4% in invasive tumors, respectively. Despite the lack of invasive growth, one patient with BRAFV600E mutant-tumor displaying predominant follicular growth and subtle papillae developed a bone metastasis. When absence of papillary structure was applied as rigid diagnostic criteria, no BRAFV600E mutation was found in all tumors. However, central lymph node micrometastasis still occurred in 3% of non-invasive tumors. Non-V600E BRAF and RAS mutations were detected in 4% and 47% of non-invasive tumors, respectively. Our findings suggest that non-invasive follicular thyroid neoplasm with papillary-like nuclear features should not be regarded as a benign thyroid neoplasm as it can present with lymph node micrometastasis and should not be diagnosed in the presence of even a single papillary structure. Our findings underscore the original American Thyroid Association recommendation that defined non-invasive encapsulated follicular variants as low risk thyroid cancers. Clinical surveillance similar to low risk differentiated thyroid cancers and capture of this diagnostic category by Cancer Registries should be considered.
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Affiliation(s)
- Uiju Cho
- Department of Hospital Pathology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ozgur Mete
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Min-Hee Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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13
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Aburjania Z, Jang S, Montemayor-Garcia C, Lloyd RV, Schneider DF, Sippel RS, Chen H, Elfenbein DM. Encapsulated follicular variant of papillary thyroid cancer: are these tumors really benign? J Surg Res 2017; 216:138-142. [PMID: 28807198 DOI: 10.1016/j.jss.2017.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 04/15/2017] [Accepted: 04/26/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recent studies suggest that the encapsulated form of follicular variant of papillary thyroid cancer (eFVPTC) behaves more similarly to benign lesions and can be treated with thyroid lobectomy alone instead of total thyroidectomy. To distinguish aggressive cancers from more benign lesions more clearly, the objective of this study was to determine if the eFVPTC behaves less aggressively than the nonencapsulated variant (neFVPTC). METHODS A prospectively collected endocrine surgery database in our institution was reviewed for all patients with FVPTC on surgical pathology from 1999 to 2012. Samples were rereviewed to determine if the tumor was eFVPTC or neFVPTC, which were correlated with patient outcomes. RESULTS Of the 68 patients, 59 (87%) had eFVPTC and 9 (13%) had neFVPTC. The mean age was 48 y and 63% were female. Fifty-four of 64 patients (84%) who had a total thyroidectomy received radioactive iodine. The eFVPTC group had lower rates of cervical LN involvement (5% versus 22%, P = 0.2504). The median follow-up time was 3 y (0-13 y) and only two patients had recurrence, one with eFVPTC and one with neFVPTC. None of the patients had distant metastasis or died of their disease. CONCLUSIONS eFVPTCs appear to have a lower rate of cervical lymph node metastases compared with neFVPTCs, but recurrent disease may be seen in both subtypes. These findings suggest eFVPTC can be managed more conservatively.
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Affiliation(s)
- Zviadi Aburjania
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Samuel Jang
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Celina Montemayor-Garcia
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ricardo V Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David F Schneider
- Department of Surgery, UW Hospital and Clinics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Rebecca S Sippel
- Department of Surgery, UW Hospital and Clinics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
| | - Dawn M Elfenbein
- Department of Surgery, University of California, Irvine, California
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14
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Brandler TC, Zhou F, Liu CZ, Cho M, Lau RP, Simsir A, Patel KN, Sun W. Can noninvasive follicular thyroid neoplasm with papillary-like nuclear features be distinguished from classic papillary thyroid carcinoma and follicular adenomas by fine-needle aspiration? Cancer Cytopathol 2017; 125:378-388. [DOI: 10.1002/cncy.21848] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Tamar C. Brandler
- Department of Pathology; New York University Langone Medical Center; New York New York
| | - Fang Zhou
- Department of Pathology; New York University Langone Medical Center; New York New York
| | - Cheng Z. Liu
- Department of Pathology; New York University Langone Medical Center; New York New York
| | - Margaret Cho
- Department of Pathology; New York University Langone Medical Center; New York New York
| | - Ryan P. Lau
- Department of Pathology; New York University Langone Medical Center; New York New York
| | - Aylin Simsir
- Department of Pathology; New York University Langone Medical Center; New York New York
| | - Kepal N. Patel
- Department of Endocrine Surgery; New York University Langone Medical Center; New York New York
| | - Wei Sun
- Department of Pathology; New York University Langone Medical Center; New York New York
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15
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Pusztaszeri M, Auger M. Update on the cytologic features of papillary thyroid carcinoma variants. Diagn Cytopathol 2017; 45:714-730. [PMID: 28262004 DOI: 10.1002/dc.23703] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/13/2022]
Abstract
Papillary thyroid cancer (PTC), which accounts for 85-90% of all thyroid cancers, is generally an indolent tumor with long term survival rates >95%. A reliable definitive diagnosis of PTC is usually straightforward in fine needle aspirates of conventional PTC whenever the characteristic papillary and/or flat honeycomb sheet-like architecture and the typical nuclear features of chromatin pallor, nuclear enlargement, crowding, grooves and pseudoinclusions are encountered. Conventional PTC, however, has diminished in relative frequency as compared to PTC variants, especially the noninvasive follicular variant of PTC, an indolent tumor which has recently been reclassified as "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP). These PTC variants are characterized by various architecture, cell type and shape, and stromal features, some of which can be recognized cytologically. Awareness of the cytomorphological spectrum and of the characteristic cytological features of these PTC variants is important to avoid diagnostic pitfalls. In this article, we review the different variants of PTC, including their cytomorphologic features, differential diagnosis, and salient molecular features. Diagn. Cytopathol. 2017;45:714-730. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Marc Pusztaszeri
- Department of Pathology, Geneva University Hospitals, Geneva, Switzerland
| | - Manon Auger
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Quebec, Canada
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16
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Rosario PW, Mourão GF, Nunes MB, Nunes MS, Calsolari MR. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Endocr Relat Cancer 2016; 23:893-897. [PMID: 27660403 DOI: 10.1530/erc-16-0379] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 11/08/2022]
Abstract
Recently, it was proposed that some papillary thyroid carcinomas (PTC) will no longer be termed 'cancer' and are christened as 'noninvasive follicular thyroid neoplasm with papillary-like nuclear features' (NIFTP). As this is a recent definition, little information is available about NIFTP. The objective of this study was to report the frequency, ultrasonographic appearance, cytology result and long-term evolution of cases of NIFTP seen at our institution. We excluded tumours ≤1 cm. The sample consisted of 129 patients. Sixty-four patients were submitted to total thyroidectomy and 65 to lobectomy. These patients with NIFTP did not receive radioiodine. NIFTP corresponded to 15% of cases diagnosed as PTC >1 cm. An ultrasonographic appearance considered to be of low suspicion for malignancy was common in NIFTP (32.5%), whereas a highly suspicious appearance was uncommon (5%). NIFTP frequently exhibited indeterminate cytology (62%), while malignant cytology was uncommon (4%). The patients were followed up for 12-146 months (median 72 months) after surgery. None of the patients developed structural disease during follow-up. Comparing the concentrations of thyroglobulin (Tg) and anti-Tg antibodies (TgAb) obtained 6-12 months after surgery and in the last assessment, none of the patients exhibited an increase in these markers.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Biopsy, Fine-Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Neoplasms, Complex and Mixed/diagnosis
- Neoplasms, Complex and Mixed/pathology
- Neoplasms, Complex and Mixed/surgery
- Retrospective Studies
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Tumor Burden
- Ultrasonography
- Young Adult
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17
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Glass R, Kahn L, Khalid K, Siddiqui MT, Cocker R. Predicting histological subtypes of follicular variant of papillary thyroid carcinoma based on cytomorphology. Can cytomorphology optimize use of molecular testing? J Am Soc Cytopathol 2016; 5:345-350. [PMID: 31042546 DOI: 10.1016/j.jasc.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Follicular variant papillary thyroid carcinoma (FVPTC) can be further subclassified into one of 3 subtypes: non-invasive encapsulated FVPTC, invasive encapsulated FVPTC, and infiltrative FVPTC. Longitudinal and molecular studies have demonstrated that, in terms of both molecular profiles and prognosis, encapsulated FVPTC is comparable to follicular adenoma, invasive FVPTC to follicular carcinoma, and infiltrative FVPTC to classic PTC. To improve triaging and prevent overtreatment of patients with FVPTC, we sought to determine cytologic features likely to occur within each subtype. METHODS A laboratory database search from 2010-2015 was conducted to identify patients with biopsy-proven FVPTC and prior fine-needle aspiration. Surgical specimens were reviewed to determine the appropriate subcategorization. Accompanying cytology reports were reviewed for features common in classic PTC and follicular neoplasms. RESULTS Encapsulated variants were more likely to be graded as Bethesda category 4 compared with invasive or infiltrative variants. In contrast, infiltrative variants were more likely to be graded as Bethesda categories 5 and 6 compared with invasive or encapsulated variants. Compared with the encapsulated variant, infiltrative FVPTC was more likely to have nuclear pseudo-inclusions (31.82% versus 8.11%, P = 0.0468) and less likely to have microfollicular architecture (22.73% versus 54.05%, P = 0.0374). CONCLUSION This study identified cytomorphologic differences between encapsulated and infiltrative FVPTC. With a higher threshold of suspicion for FVPTC, improved awareness of the differences between these subtypes and incorporation of molecular testing, it is likely that the Bethesda category can be revised and patient triaging can be significantly improved.
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Affiliation(s)
- Ryan Glass
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Leonard Kahn
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Kashan Khalid
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042
| | - Momin T Siddiqui
- Department of Pathology, Emory University Hospital, Atlanta, Georgia
| | - Rubina Cocker
- Department of Pathology, Northwell Health, 6 Ohio Drive, Lake Success, New York, 11042.
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