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Abdullah AM, Qaradakhy AJ, Saeed YA, Salih AM, Karim S, Ali OA, Hassan SH, Nasraldeen SA, Mohammed SH, Kakamad FH. Papillary thyroid carcinoma associated with non‑functioning parathyroid carcinoma with Warthin's tumor of the parotid gland: A case report and brief literature review. MEDICINE INTERNATIONAL 2023; 3:26. [PMID: 37304572 PMCID: PMC10251473 DOI: 10.3892/mi.2023.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023]
Abstract
Multiple neck pathologies occurring simultaneously are a rare condition. The present study describes an extremely rare case of papillary thyroid carcinoma, non-functioning parathyroid carcinoma (PC) and Warthin's tumor of the parotid gland. A 59-year-old male presented with a 3-month history of anterior neck swelling. The neck ultrasound revealed a left-sided thyroid nodule associated with pathological lymph nodes. There was a parotid gland mass. A fine-needle aspiration of the left parotid mass was not diagnostic, although the left thyroid nodule revealed a malignancy with metastasis to the left cervical group lymph nodes. The patient underwent total thyroidectomy, left central and left lateral cervical lymph node dissection. A superficial parotidectomy was also performed. A histopathological examination revealed three different pathologies: Papillary thyroid microcarcinoma, PC and Warthin's tumor. The simultaneous occurrence of a Warthin's tumor, papillary thyroid microcarcinoma and PC is an unusual condition. The concurrent findings of these three pathologies have not yet been reported in the literature, at least to the best of our knowledge. The synchronous findings of PTC, non-functioning PC and Warthin's tumor are extremely rare, yet possible. Surgical intervention remains the most appropriate treatment strategy.
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Affiliation(s)
- Ari M. Abdullah
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
- Department of Pathology, Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Aras J. Qaradakhy
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
- Department of Radiology, Shorsh Teaching Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Yadgar A. Saeed
- Department of Pathology, Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Abdulwahid M. Salih
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
| | - Seema Karim
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Osama A. Ali
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Shko H. Hassan
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Shalaw A. Nasraldeen
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Shvan H. Mohammed
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46000, Iraq
| | - Fahmi H. Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46000, Iraq
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Ding M, Kong YH, Gu JH, Xie RL, Fei J. Papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis and breast cancer: A case report. World J Clin Cases 2022; 10:3609-3614. [PMID: 35582057 PMCID: PMC9048559 DOI: 10.12998/wjcc.v10.i11.3609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The recognized pattern of cervical lymph node metastasis (CLNM) of papillary thyroid carcinoma involves a stepwise route. Contralateral lymph node skip metastasis is very rare. In addition, the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy, which made it difficult to distinguish the origin of the CLNM. Based on this case, we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.
CASE SUMMARY A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo. The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe, according to ultrasound and ultrasound-guided fine needle aspiration biopsy. The patient underwent total thyroidectomy and radical cervical LN dissection. Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis. Unfortunately, a breast cancer was discovered 4 mo later, which was accompanied by ipsilateral supraclavicular LN metastasis. She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment. The patient is currently receiving postoperative radiotherapy, and no local recurrence was observed in the 6-mo follow-up after surgery.
CONCLUSION We present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis and breast cancer with supraclavicular lymphatic metastasis.
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Affiliation(s)
- Min Ding
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ya-Hui Kong
- Department of General Surgery, Shanghai Changhang Hospital, Shanghai 200122, China
| | - Jian-Hua Gu
- Department of General Surgery, Shanghai Ruijin Rehabilitation Hospital, Shanghai 200023, China
| | - Rong-Li Xie
- Department of General Surgery, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Jian Fei
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Du Y, Jiang Y, Tang S, Li L. Diagnostic value of routine ultrasonography combined with ultrasound elastography for papillary thyroid microcarcinoma: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23905. [PMID: 33530187 PMCID: PMC7850692 DOI: 10.1097/md.0000000000023905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Papillary thyroid microcarcinoma is easy to be missed because of its small focus, concealed incidence and lack of clinical features. Ultrasound examination is one of the main methods for the detection and diagnosis of papillary thyroid microcarcinoma. The detection rate of conventional ultrasound is not ideal. Combined ultrasound elastography can improve the detection rate, but there is lack of evidence-based evidence. The purpose of this study was to systematically evaluate the value of conventional ultrasound combined with ultrasound elastography in the diagnosis of papillary thyroid microcarcinoma. METHODS A systematic search was performed by retrieving on English databases (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese databases (CNKI, Wanfang, Weipu (VIP), CBM). The retrieval time limit was from the establishment of the database to November 2020 and manually search for the conventional ultrasound combined with ultrasound elastography in the diagnosis of papillary thyroid microcarcinoma. Two researchers extracted and evaluated the quality of the data in the included study independently. A meta-analysis was performed using Meta Disc1.4 and RevMan5.3 software. CONCLUSIONS This study will evaluate the accuracy and practicability of conventional ultrasound combined with ultrasonic elastography in the diagnosis of papillary thyroid microcarcinoma, and provide evidence-based basis for clinicians to choose the appropriate or best diagnostic method. ETHICS AND DISSEMINATION The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. OSF REGISTRATION NUMBER DOI: 10.17605 / OSF.IO / V6HK7.
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Affiliation(s)
- Yanfei Du
- Department of Ultrasound, Liaocheng People's Hospital
| | - Yuyan Jiang
- Department of Ultrasound, Gaotang County People's Hospital, Liaocheng, Shandong Province, China
| | - Shujuan Tang
- Department of Ultrasound, Gaotang County People's Hospital, Liaocheng, Shandong Province, China
| | - Lijie Li
- Department of Ultrasound, Liaocheng People's Hospital
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Ding J, Wu W, Fang J, Zhao J, Jiang L. Male sex is associated with aggressive behaviour and poor prognosis in Chinese papillary thyroid carcinoma. Sci Rep 2020; 10:4141. [PMID: 32139703 PMCID: PMC7058033 DOI: 10.1038/s41598-020-60199-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/27/2020] [Indexed: 02/07/2023] Open
Abstract
The differences in prognosis of papillary thyroid carcinoma (PTC) by sex have been investigated in several previous studies, but the results have not been consistent. In addition, the impact of sex on the clinical and pathological characteristics, especially on central lymph node metastasis (CLNM), still remains unknown. To the best of our knowledge, the impact of sex on PTC has not been investigated in the Chinese PTC population. Therefore, our study retrospectively analysed the data of 1339 patients who were diagnosed with PTC and had received radical surgery at Ningbo Medical Center, Lihuili Hospital. In addition to cancer-specific death, structural recurrence and risk stratification, prognosis was also estimated by using three conventional prognostic systems: AMES (age, distant metastasis, extent, size), MACIS (distant metastasis, age, completeness of resection, local invasion, size) and the 8th version TNM (tumor, lymph node, metastasis) staging system. The clinical and pathological characteristics and above prognostic indexes were compared between male and female PTC patients. The results showed that there were higher rates of non-microcarcinoma PTC (nM-PTC), CLNM, lateral lymph node metastasis (LLNM), advanced disease and bilateral disease, but there was a lower rate of concurrent Hashimoto's thyroiditis (HT) in male PTC patients than in female PTC patients. Additionally, the rate of intermediate-risk, high-risk or advanced disease was higher in male PTC patients. The above findings indicate that PTC in men is a more aggressive disease and may have a worse prognosis; thus, it should be treated with more caution.
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Affiliation(s)
- Jinhua Ding
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
- Department of Breast and Thyroid Surgery, Taipei Medical University Ningbo Medical Center, Ningbo, China
| | - Weizhu Wu
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
- Department of Breast and Thyroid Surgery, Taipei Medical University Ningbo Medical Center, Ningbo, China
| | - Jianjiang Fang
- Department of Emergency, Ningbo Medical Center Lihuili Hospital, Ningbo, China
- Department of Emergency, Taipei Medical University Ningbo Medical Center, Ningbo, China
| | - Jing Zhao
- Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, China
- Department of Breast and Thyroid Surgery, Taipei Medical University Ningbo Medical Center, Ningbo, China
| | - Li Jiang
- Department of General Practice, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
- Department of General Practice, Taipei Medical University Ningbo Medical Center, Ningbo, China.
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Prognostic Value of Hyperechoic Echo Halo in cN0 Papillary Thyroid Microcarcinoma and Its Correlation with Age and Gender. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6479582. [PMID: 32190674 PMCID: PMC7064847 DOI: 10.1155/2020/6479582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 01/07/2020] [Accepted: 02/14/2020] [Indexed: 11/18/2022]
Abstract
Purpose. To investigate the pathology and prognostic value of hyperechoic echo halo in cN0 papillary thyroid microcarcinoma (PTMC) and the relationship between age, gender, and the formation of abnormal hyperechoic echo halo and cervical lymph node metastasis. Data of 97 patients who underwent surgical treatment for the first time for single PTMC between April 2016 and March 2017 were analyzed retrospectively. The boundary status of the PTMC was determined preoperatively. Grayscale values of the nodular center, hyperechoic echo halo, and normal thyroid tissue were acquired with Adobe Photoshop CS6 software. The histopathology of the boundary and status of the cervical lymph node metastasis were analyzed. Formation of abnormal hyperechoic halo and cervical lymph node metastasis in relation to age and gender were explored. The abnormal hyperechoic halo mainly represents cancer cell infiltration with reactive hyperplasia of inflammatory cells and fibrous tissue. In the hyperechoic halo group, the grayscale values for the nodular center, hyperechoic echo halo, and normal thyroid tissue were 1552.6 ± 578.6, 5792.0 ± 747.6, and 3582.7 ± 759.0, respectively (P < 0.05). The cervical lymph node metastasis rate was significantly lower in patients with hyperechoic halo (15.0%) than in those without (41.6%; P < 0.05) and significantly higher in those aged <45 years (53.3%) than in those aged ≥45 years (28.4%; P < 0.05). There were no significant correlations between gender and cervical lymph node metastasis or between age, gender, and hyperechoic halo formation (P > 0.05). cN0 PTMC patients with abnormal hyperechoic halo and age >45 years have a significantly reduced risk of cervical lymph node metastasis and relatively good prognosis.
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Abstract
BACKGROUND The incidence of papillary thyroid microcarcinoma (PTMC) has been increasing sharply, the current statement about whether PTMC patients should undergo radioactive iodine (RAI) remnant ablation is still controversial, mainly because it is uncertain whether RAI treatment can reduce the recurrence rate. OBJECTIVE To evaluate the effectiveness of RAI remnant ablation for thyroid cancer-related outcomes of PTMC patients. METHODS We comprehensively searched PubMed, Cochrane Library, Scopus and Science Direct for studies that compared the effectiveness after total-thyroidectomy or near total-thyroidectomy, with or without RAI remnant ablation treatment. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. RESULTS Twenty-two studies, which included 8724 patients, met our search criteria and were assessed. For PTMC patients treated by total thyroidectomy or near-total thyroidectomy, the locoregional recurrence rates were 1.92 and 7.36% [risk ratio (RR)=0.45; 95% confidence interval (CI)=0.18-1.11; P=0.08] for patients with or without RAI treatment respectively, the distant metastasis rates were 1.39 and 2.46% (RR=0.64; 95% CI=0.28-1.48; P=0.30), and the thyroid cancer-related mortality rates were 0.98 and 1.76% (RR=0.68; 95% CI=0.22-2.09; P=0.50). CONCLUSION For PTMC patients who have already treated by total thyroidectomy or near-total thyroidectomy, incremental RAI remnant ablation may significantly improve thyroid cancer-related outcomes.
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Gorostis S, Raguin T, Schneegans O, Takeda C, Debry C, Dupret-Bories A. Incidental thyroid papillary microcarcinoma: survival and follow-up. Laryngoscope 2019; 129:1722-1726. [DOI: 10.1002/lary.27664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/06/2018] [Accepted: 10/12/2018] [Indexed: 12/15/2022]
Affiliation(s)
| | - Thibaut Raguin
- CHU de Strasbourg, Oto-Rhino-Laryngology; Strasbourg France
| | | | - Catherine Takeda
- Service de Gériatrie de la Clinique Sainte Barbe; Strasbourg France
| | | | - Agnès Dupret-Bories
- Service d'Otorhinolaryngologie et Chirurgie Cervico-Faciale; Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole; Toulouse France
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8
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Surgical Treatment in Papillary Thyroid Microcarcinoma. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:244-248. [PMID: 32774085 PMCID: PMC7406556 DOI: 10.14744/semb.2018.45452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/18/2018] [Indexed: 11/20/2022]
Abstract
Despite the notable increasing incidence of papillary thyroid microcarcinoma (PTMC), the optimal treatment of the patients with PTMC remains controversial. Because of no consensus about its treatment, the suggested treatment varies from active surveillance alone to total thyroidectomy. Although the 2015 revised American Thyroid Association guideline recommends hemithyroidectomy as the first-line treatment, active surveillance has also been discussed and accepted as another approach for the patients with PTMC. However, the same guideline does not recommend fine needle aspiration biopsy for nodules sized <1 cm, even it is suspicious. In such situation, neither active surveillance nor hemithyroidectomy could be discussed, with a lack of objective cytologic data about the nodules sized <1 cm. In this situation, the decision to perform FNAB to the nodules <1 cm in size depends on the performer of the thyroid ultrasonography. In this invited review, we have discussed the diagnosis and prognostic factors for PTMCs. We have also discussed surgical strategies as the accepted the first-line treatment in patients with PTMC.
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Chae AW, Martinez SR. Too Much of a Good Thing: Radioactive Iodine Ablation Use for Micropapillary Thyroid Carcinoma. Am Surg 2018. [DOI: 10.1177/000313481808400513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radioactive iodine (RAI) is not routinely recommended for the adjuvant treatment of micro-papillary thyroid carcinoma (MPTC). We aimed to report on clinical and pathologic factors associated with the use of RAI in these patients. We queried the Surveillance, Epidemiology, and End Results database for patients who underwent surgery for MPTC (tumor size ≤1 cm) from 1988 to 2009. We excluded patients without a biopsy-proven diagnosis, those diagnosed at autopsy, and patients with documented extra-thyroidal extension. Multivariate logistic regression models predicted the use of RAI based on patient, tumor, and treatment-related factors. We identified 24,076 patients with MPTC that were eligible for study inclusion. Of these, 6,172 (25.6%) received RAI. Lymph node metastases were present in 23.8 per cent of those for whom lymph node status was known. On multivariate analysis, an increasing number of positive nodes, increasing tumor size, Asian race, and male gender predicted the use of RAI. RAI use was less likely in those with advancing age, an increasing number of lymph nodes examined and patients that received less than a total thyroidectomy. Among node-negative patients, Asian race and increasing tumor size predicted the use of RAI. Factors predicting decreased use of RAI were an increasing number of lymph nodes examined, unknown race, less than a total thyroidectomy, and advancing age. A significant number of MPTC patients receive potentially unnecessary RAI.
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Affiliation(s)
- Andrew W. Chae
- Department of Surgery, Kaiser Permanente Vallejo Medical Center, Vallejo, California and
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10
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Pishkari S, Paryan M, Hashemi M, Baldini E, Mohammadi-Yeganeh S. The role of microRNAs in different types of thyroid carcinoma: a comprehensive analysis to find new miRNA supplementary therapies. J Endocrinol Invest 2018; 41:269-283. [PMID: 28762013 DOI: 10.1007/s40618-017-0735-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/19/2017] [Indexed: 12/21/2022]
Abstract
The most common endocrine malignancy is thyroid cancer, and researchers have made a great deal of progress in deciphering its molecular mechanisms in the recent years. Many of molecular changes observed in thyroid cancer can be used as biomarkers for diagnosis, prognosis, and therapeutic targets for treatment. MicroRNAs (miRNAs) are important parts in biological and metabolic pathways such as regulation of developmental stages, signal transduction, cell maintenance, and differentiation. Therefore, their dysregulation can expose individuals to malignancies. It has been proved that miRNA expression is dysregulated in different types of tumors, like thyroid cancers, and can be the cause of tumor initiation and progression. In this paper, we have reviewed the available data on miRNA dysregulation in different thyroid tumors including papillary, follicular, anaplastic, and medullary thyroid carcinomas aiming to introduce the last updates in miRNAs-thyroid cancer relation.
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Affiliation(s)
- S Pishkari
- Department of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - M Paryan
- Department of Research and Development, Production and Research Complex, Pasteur Institute of Iran, Tehran, Iran
| | - M Hashemi
- Department of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - E Baldini
- Department of Surgical Sciences, University of Rome, Rome, Italy.
| | - S Mohammadi-Yeganeh
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Tam AA, Özdemir D, Çuhacı N, Başer H, Dirikoç A, Aydın C, Yazgan AK, Ersoy R, Çakır B. Can ratio of the biggest tumor diameter to total tumor diameter be a new parameter in the differential diagnosis of agressive and favorable multifocal papillary thyroid microcarcinoma? Oral Oncol 2016; 65:1-7. [PMID: 28109462 DOI: 10.1016/j.oraloncology.2016.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/08/2016] [Accepted: 12/04/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVES In this study, we aimed to evaluate the usefulness of a new parameter -ratio of the biggest tumor diameter to total tumor diameter- for the differentiation of agressive and favorable papillary thyroid microcarcinomas (PTMC). MATERIALS AND METHODS The diameter of the biggest tumor focus was taken as the primary tumor diameter. Total tumor diameter was calculated as the sum of the maximal diameter of each lesion. Ratio of primary tumor diameter to total tumor diameter was defined as tumor diameter ratio (TDR). Positive and negative predictive value, sensitivity and specificity of TDR to predict capsular invasion, extrathyroidal extension (ETE) and lymph node metastasis (LNM) were determined. RESULTS Mean TDR was significantly lower in multifocal PTMC patients with capsular invasion, ETE, lymphovascular invasion and LNM compared to patients without these features. The sensitivities of TDR for the detection of LNM, ETE and capsular invasion were 100%, 100% and 94.2%, respectively. Specificity of TDR was 86.2% for LNM, 88% for ETE and 94.7% for capsular invasion. Best cut off values of TDR that can predict capsular invasion, ETE and LNM in multifocal PTMC were 0.62, 0.57 and 0.56, respectively. Multifocal papillary thyroid carcinoma patients with capsular invasion, ETE and LNM had significantly lower mean TDR when compared to ones without these features. CONCLUSION Decreased TDR was associated with capsular invasion, ETE and LNM in patients with multifocal PTMC and PTC. This new parameter might be particularly helpful for the detection of aggressive behavior in multifocal PTMCs.
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Affiliation(s)
- Abbas Ali Tam
- Yıldırım Beyazıt University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.
| | - Didem Özdemir
- Yıldırım Beyazıt University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Neslihan Çuhacı
- Yıldırım Beyazıt University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Hüsniye Başer
- Yıldırım Beyazıt University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Ahmet Dirikoç
- Yıldırım Beyazıt University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Cevdet Aydın
- Yıldırım Beyazıt University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Aylin Kılıç Yazgan
- Ataturk Training and Research Hospital, Department of Pathology, Ankara, Turkey
| | - Reyhan Ersoy
- Yıldırım Beyazıt University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Bekir Çakır
- Yıldırım Beyazıt University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey
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Pyo JS, Sohn JH, Kang G. Detection of Tumor Multifocality Is Important for Prediction of Tumor Recurrence in Papillary Thyroid Microcarcinoma: A Retrospective Study and Meta-Analysis. J Pathol Transl Med 2016; 50:278-86. [PMID: 27271109 PMCID: PMC4963970 DOI: 10.4132/jptm.2016.03.29] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background: The clinicopathological characteristics and conclusive treatment modality for multifocal papillary thyroid microcarcinoma (mPTMC) have not been fully established. Methods: A retrospective study, systematic review, and meta-analysis were conducted to elucidate the clinicopathological significance of mPTMC. We investigated the multiplicity of 383 classical papillary thyroid microcarcinomas (PTMCs) and the clinicopathological significance of incidental mPTMCs. Correlation between tumor recurrence and multifocality in PTMCs was evaluated through a systematic review and meta-analysis. Results: Tumor multifocality was identified in 103 of 383 PTMCs (26.9%). On linear regression analysis, primary tumor diameter was significantly correlated with tumor number (R2=0.014, p=.021) and supplemental tumor diameter (R2=0.117, p=.023). Of 103 mPTMCs, 61 (59.2%) were non-incidental, with tumor detected on preoperative ultrasonography, and 42 (40.8%) were diagnosed (incidental mPTMCs) on pathological examination. Lymph node metastasis and higher tumor stage were significantly correlated with tumor multifocality. However, there was no difference in nodal metastasis or tumor stage between incidental and non-incidental mPTMCs. On meta-analysis, tumor multifocality was significantly correlated with tumor recurrence in PTMCs (odds ratio, 2.002; 95% confidence interval, 1.475 to 2.719, p<.001). Conclusions: Our results show that tumor multifocality in PTMC, regardless of manner of detection, is significantly correlated with aggressive tumor behavior.
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Affiliation(s)
- Jung-Soo Pyo
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Guhyun Kang
- Department of Pathology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Koo DH, Song K, Kwon H, Bae DS, Kim JH, Min HS, Lee KE, Youn YK. Does Tumor Size Influence the Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules? Int J Endocrinol 2016; 2016:3803647. [PMID: 27774103 PMCID: PMC5059591 DOI: 10.1155/2016/3803647] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/12/2016] [Accepted: 08/30/2016] [Indexed: 01/21/2023] Open
Abstract
Background. Fine-needle aspiration cytology (FNAC) is diagnostic standard for thyroid nodules. However, the influence of size on FNAC accuracy remains unclear especially in too small or too large thyroid nodules. The objective of this retrospective cohort study was to investigate the effect of nodule size on FNAC accuracy. Methods. All consecutive patients who underwent thyroidectomy for nodules in 2010 were enrolled. FNAC results (according to the Bethesda system) were compared to pathological diagnosis. The nodules were categorized into groups A-E on the basis of maximal diameter on ultrasound (≤0.5, >0.5-1, >1-2, >2-4, and >4 cm, resp.). Results. There were 502 cases with 690 nodules. Overall FNAC sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.4%, 98.2%, 99.4%, 86.4%, and 96.0%, respectively. False-negative rates (FNRs) of groups A-E were 3.2%, 5.1%, 1.3%, 13.3%, and 50%, respectively. Accuracy rates of groups A-E were 96.8%, 94.8%, 99%, 94.7%, and 87.5%, respectively. Conclusion. Although accuracy rates of FNAC in thyroid nodules smaller than 0.5 cm are comparable to the other group, thyroid nodules larger than 4 cm with benign cytology carry a higher risk of malignancy, which suggest that those should be considered for intensive follow-up or repeated biopsy.
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Affiliation(s)
- Do Hoon Koo
- Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-70, Republic of Korea
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeundae-ro, Haeundae-gu, Busan 612-030, Republic of Korea
| | - KwangSeop Song
- Department of Surgery, Seoul National University Hospital, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Hyungju Kwon
- Department of Surgery, Seoul National University Hospital, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Cancer Research Institute, Seoul National University, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Dong Sik Bae
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeundae-ro, Haeundae-gu, Busan 612-030, Republic of Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University Hospital, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Cancer Research Institute, Seoul National University, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- *Kyu Eun Lee:
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University Hospital, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Cancer Research Institute, Seoul National University, College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
- Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
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14
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Ma YJ, Deng XL, Li HQ. BRAF(V⁶⁰⁰E) mutation and its association with clinicopathological features of papillary thyroid microcarcinoma: A meta-analysis. ACTA ACUST UNITED AC 2015. [PMID: 26223933 DOI: 10.1007/s11596-015-1476-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Recent studies have demonstrated that the BRAF(V600E) mutation is associated with aggressive clinicopathological features of papillary thyroid carcinoma (PTC). However, the BRAF mutation as a prognostic biomarker in papillary thyroid microcarcinoma (PTMC) is unclear. A systematic search of the electronic databases, including Medline, Scopus, CNKI and the Cochrane Library was performed up to July 1, 2014. Outcomes of interest included age, gender, concomitant hashimoto thyroiditis or nodular goiter, tumor size, pathological stage, tall cell variant of PTMC (TCVPTMC), multifocality, extrathyroidal extension (ETE) and lymph node metastasis (LNM). A total of 19 studies published from 2008 to 2014 comprising 2253 patients fulfilled the inclusion criteria and were included in the meta-analysis, and 1143 (50.7%) of these patients were BRAF mutation positive. BRAF mutation was associated with larger tumor size (OR: 1.64; 95% CI: 1.16-2.32), multifocality (OR: 1.58; 95% CI: 1.25-2.00), ETE (OR: 2.59; 95% CI: 2.03-3.29), LNM (OR: 1.73; 95% CI: 1.14-2.62), advanced stage (OR: 2.03; 95% CI: 1.14-3.64) and TCVPTMC (OR: 5.07; 95% CI: 1.49-17.27; P=0.009). Additionally, the BRAF mutation was found to be not associated with age, gender, concomitant hashimoto thyroiditis or nodular goiter (P>0.05 for all). This meta-analysis revealed that in patients with PTMC, BRAF mutation is associated with tumor size, multifocality, ETE, LNM, advanced stage and TCVPTMC, and it may be used as a predictive factor for prognosis of PTMC.
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Affiliation(s)
- Yu-Jia Ma
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiu-Ling Deng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hui-Qing Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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15
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Jin ZQ, Lin MY, Hu WH, Li WY, Bai SJ. Gray-scale ultrasonography combined with elastography imaging for the evaluation of papillary thyroid microcarcinoma: as a prognostic clinicopathology factor. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1769-1777. [PMID: 24768485 DOI: 10.1016/j.ultrasmedbio.2014.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 06/03/2023]
Abstract
Ultrasonography (US) is the preferred imaging modality for papillary thyroid microcarcinoma (PTMC). The aim of this study was to evaluate the importance of gray-scale ultrasound combined with elastography to predict extrathyroidal extension and cervical lymph node (LN) metastasis in patients with PTMC. We retrospectively evaluated gray-scale ultrasonic and elastographic results from 119 consecutive cases of PTMC with 138 nodules and correlated the histopathological findings. The results indicated that pathological extrathyroidal extension was significantly associated with T staging on US, extrathyroidal extension on US, bilaterality on US, boundary, strain ratio and hard malignancy as measured with the Rago score. Central LN metastasis on pathology was significantly associated with central LN metastasis on US, lateral LN metastasis on US, multifocality on US and bilaterality on US. Lateral LN metastasis on US was significantly associated with lateral LN metastasis on pathology. On multivariate analysis, T staging on US, extrathyroidal extension on US and hard malignancy as measured with the Rago score were significantly associated with pathological extrathyroidal extension. Lateral LN metastasis on US and bilaterality on US were independent factors in predicting central LN metastasis on pathology. Lateral LN metastasis on US was the predictive factor for lateral LN metastasis on pathology. US should be helpful in the diagnosis of PTMC and in the evaluation of possible PTMC recurrence on US in routine clinical practice.
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Affiliation(s)
- Zhan-Qiang Jin
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China.
| | - Mei-Ying Lin
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
| | - Wen-Hua Hu
- Department of Pathology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, China
| | - Wei-Yong Li
- Department of Ultrasound, Affiliated Hospital of Ningxia Medical University, Yinchuan, China
| | - Shao-Jun Bai
- Department of Pathology, Affiliated Hospital of Ningxia Medical University, Yinchuan, China
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16
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An update on molecular biology of thyroid cancers. Crit Rev Oncol Hematol 2014; 90:233-52. [DOI: 10.1016/j.critrevonc.2013.12.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/27/2013] [Accepted: 12/06/2013] [Indexed: 12/31/2022] Open
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