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Fu J, Liu J, Wang Z, Qian L. Predictive Values of Clinical Features and Multimodal Ultrasound for Central Lymph Node Metastases in Papillary Thyroid Carcinoma. Diagnostics (Basel) 2024; 14:1770. [PMID: 39202260 PMCID: PMC11353660 DOI: 10.3390/diagnostics14161770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024] Open
Abstract
Papillary thyroid carcinoma (PTC), the predominant pathological type among thyroid malignancies, is responsible for the sharp increase in thyroid cancer. Although PTC is an indolent tumor with good prognosis, 60-70% of patients still have early cervical lymph node metastasis, typically in the central compartment. Whether there is central lymph node metastasis (CLNM) or not directly affects the formulation of preoperative surgical procedures, given that such metastases have been tied to compromised overall survival and local recurrence. However, detecting CLNM before operation can be challenging due to the limited sensitivity of preoperative approaches. Prophylactic central lymph node dissection (PCLND) in the absence of clinical evidence of CLNM poses additional surgical risks. This study aims to provide a comprehensive review of the risk factors related to CLNM in PTC patients. A key focus is on utilizing multimodal ultrasound (US) for accurate prognosis of preoperative CLNM and to highlight the distinctive role of US-based characteristics for predicting CLNM.
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Affiliation(s)
- Jiarong Fu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.F.); (Z.W.)
| | - Jinfeng Liu
- Department of Interventional Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China;
| | - Zhixiang Wang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.F.); (Z.W.)
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; (J.F.); (Z.W.)
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Liu L, Jia C, Li G, Shi Q, Du L, Wu R. Can pre-operative ultrasound elastography predict aggressive features of solitary papillary thyroid carcinoma? Br J Radiol 2023; 96:20220820. [PMID: 37171910 PMCID: PMC10461290 DOI: 10.1259/bjr.20220820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 03/16/2023] [Accepted: 04/17/2023] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVE To investigate whether pre-operative ultrasound elastography (USE) can be used to predict aggressive features of solitary papillary thyroid carcinomas (PTCs). METHODS Clinical and USE indices were retrospectively analyzed in 487 patients with surgically confirmed solitary PTCs. The patients were grouped per aggressive features on pathologic testing. Univariate and binary logistic regression analyses were performed to explore independent risk factors of aggressive features. RESULTS Univariate analysis revealed standard deviation (SD) values of the tumor shear-wave velocity (SWV) were associated with capsular invasion (p < 0.05). Further, shear-wave elasticity and SWV ratios correlated with extrathyroidal extension (all p < 0.05). The tumor shear-wave elasticity and SWV SD values were associated with cervical lymph node metastasis (CLNM) (all p < 0.05). Binary logistic regression analysis identified location and capsule contact as independent predictive risk factors for capsular invasion (all p < 0.05); size for extrathyroidal extension (all p < 0.05); and sex, age, margin, and suspected CLNM for CLNM (all p < 0.05). However, pre-operational USE indexes were not independent predictors of aggressive features (all p > 0.05). CONCLUSION Pre-operative USE indices were not independent risk factors of aggressive features of solitary PTCs. Thus, USE may have a limited value for predicting the aggressive features of PTC. ADVANCES IN KNOWLEDGE Pre-operative USE indices may have a limited value for predicting the aggressive features of PTC.
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Affiliation(s)
| | - Chao Jia
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiusheng Shi
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lianfang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chen Q, Liu Y, Liu J, Su Y, Qian L, Hu X. Development and validation of a dynamic nomogram based on conventional ultrasound and contrast-enhanced ultrasound for stratifying the risk of central lymph node metastasis in papillary thyroid carcinoma preoperatively. Front Endocrinol (Lausanne) 2023; 14:1186381. [PMID: 37409231 PMCID: PMC10319155 DOI: 10.3389/fendo.2023.1186381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/05/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The aim of this study was to develop and validate a dynamic nomogram by combining conventional ultrasound (US) and contrast-enhanced US (CEUS) to preoperatively evaluate the probability of central lymph node metastases (CLNMs) for patients with papillary thyroid carcinoma (PTC). Methods A total of 216 patients with PTC confirmed pathologically were included in this retrospective and prospective study, and they were divided into the training and validation cohorts, respectively. Each cohort was divided into the CLNM (+) and CLNM (-) groups. The least absolute shrinkage and selection operator (LASSO) regression method was applied to select the most useful predictive features for CLNM in the training cohort, and these features were incorporated into a multivariate logistic regression analysis to develop the nomogram. The nomogram's discrimination, calibration, and clinical usefulness were assessed in the training and validation cohorts. Results In the training and validation cohorts, the dynamic nomogram (https://clnmpredictionmodel.shinyapps.io/PTCCLNM/) had an area under the receiver operator characteristic curve (AUC) of 0.844 (95% CI, 0.755-0.905) and 0.827 (95% CI, 0.747-0.906), respectively. The Hosmer-Lemeshow test and calibration curve showed that the nomogram had good calibration (p = 0.385, p = 0.285). Decision curve analysis (DCA) showed that the nomogram has more predictive value of CLNM than US or CEUS features alone in a wide range of high-risk threshold. A Nomo-score of 0.428 as the cutoff value had a good performance to stratify high-risk and low-risk groups. Conclusion A dynamic nomogram combining US and CEUS features can be applied to risk stratification of CLNM in patients with PTC in clinical practice.
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Xue J, Li S, Qu N, Wang G, Chen H, Wu Z, Cao X. Value of clinical features combined with multimodal ultrasound in predicting lymph node metastasis in cervical central area of papillary thyroid carcinoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:908-918. [PMID: 37058552 DOI: 10.1002/jcu.23465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the clinical features, multimodal ultrasound features and multimodal ultrasound imaging features in predicting lymph node metastasis in the central cervical region of papillary thyroid carcinoma. METHODS A total of 129 patients with papillary thyroid carcinoma (PTC) confirmed by pathology were selected from our hospital from September 2020 to December 2022. According to the pathological results of cervical central lymph nodes, these patients were divided into metastatic group and non-metastatic group. Patients were randomly sampled and divided into training group (n = 90) and verification group (n = 39) according to the ratio of 7:3. The independent risk factors for central lymph node metastasis (CLNM) were determined by least absolute shrinkage and selection operator and multivariate logistic regression. Based on independent risk factors to build a prediction model, select the best diagnostic effectiveness of the prediction model sketch line chart, and finally, the line chart calibration and clinical benefits were evaluated. RESULTS A total of 8, 11 and 17 features were selected from conventional ultrasound images, shear wave elastography (SWE) images and contrast-enhanced ultrasound (CEUS) images to construct the Radscore of conventional ultrasound, SWE and CEUS, respectively. After univariate and multivariate logistic regression analysis, male, multifocal, encapsulation, iso-high enhancement and multimodal ultrasound imaging score were independent risk factors for cervical CLNM in PTC patients (p < 0.05). Based on independent risk factors, a clinical combined with multimodal ultrasound feature model was constructed, and multimodal ultrasound Radscore were added to the clinical combined with multimodal ultrasound feature model to form a joint prediction model. In the training group, the diagnostic efficacy of combined model (AUC = 0.934) was better than that of clinical combined with multimodal ultrasound feature model (AUC = 0.841) and multimodal ultrasound radiomics model (AUC = 0.829). In training group and validation group, calibration curves show that the joint model has good predictive ability for cervical CLNM of PTC patients; The decision curve shows that most of the net benefits of the nematic chart are higher than those of clinical + multimodal ultrasound feature model and multimodal ultrasound radiomics model within a reasonable risk threshold range. CONCLUSION Male, multifocal, capsular invasion and iso-high enhancement are independent risk factors of CLNM in PTC patients, and the clinical plus multimodal ultrasound model based on these four factors has good diagnostic efficiency. The joint prediction model after adding multimodal ultrasound Radscore to clinical and multimodal ultrasound features has the best diagnostic efficiency, high sensitivity and specificity, which is expected to provide objective basis for accurately formulating individualized treatment plans and evaluating prognosis.
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Affiliation(s)
- Jie Xue
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Siyao Li
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Nina Qu
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Guoyun Wang
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Huangzhuonan Chen
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, China
| | - Zhihui Wu
- School of Medical Imaging, Binzhou Medical University, Binzhou, Shandong, China
| | - Xiaoli Cao
- Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Li Z, Wei J, Chen B, Wang Y, Yang S, Wu K, Meng X. The Role of MMP-9 and MMP-9 Inhibition in Different Types of Thyroid Carcinoma. Molecules 2023; 28:molecules28093705. [PMID: 37175113 PMCID: PMC10180081 DOI: 10.3390/molecules28093705] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023] Open
Abstract
Matrix metalloproteinase-9 (MMP-9), one of the most investigated and studied biomarkers of the MMPs family, is a zinc-dependent proteolytic metalloenzyme whose primary function is degrading the extracellular matrix (ECM). It has been proved that MMP-9 expression elevates in multiple pathological conditions, including thyroid carcinoma. MMP-9 has a detectable higher level in malignant or metastatic thyroid tumor tissues than in normal or benign tissues and acts as an additional marker to distinguish different tumor stages because of its close correlations with clinical features, such as lymph node metastasis, TNM stage, tumor size and so on. Natural and non-natural MMP-9 inhibitors suppress its expression, block the progression of diseases, and play a role in therapy consequently. MMP-9 inhibitory molecules also assist in treating thyroid tumors by suppressing the proliferation, invasion, migration, metastasis, viability, adhesion, motility, epithelial-mesenchymal transition (EMT), and other risk factors of different thyroid cancer cells. In a word, discovering and designing MMP-9 inhibitors provide great therapeutic effects and promising clinical values in various types of thyroid carcinoma.
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Affiliation(s)
- Zhenshengnan Li
- Department of Thyroid Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Jia Wei
- Department of Thyroid Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Bowen Chen
- Department of Thyroid Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Yaoqi Wang
- Department of Thyroid Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Shuai Yang
- Department of Thyroid Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Kehui Wu
- Department of Thyroid Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, China
| | - Xianying Meng
- Department of Thyroid Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, China
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Shen H, Lv G, Li T, Wang Y, Chen K, Wang K, Li L, Zheng X, Yang S. Construction and Validation of a Predictive Nomogram Based on Ultrasound for Lymph Node Metastasis of Papillary Thyroid Carcinoma in the Cervical Central Region. Ultrasound Q 2023; 39:47-52. [PMID: 34743152 DOI: 10.1097/ruq.0000000000000583] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ABSTRACT To establish and validate a nomogram for predicting lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) in the cervical central region. This retrospective study included 287 PTC patients with 309 nodules treated from December 2018 to May 2020 at our hospital. The cohort was divided randomly into a training set and a testing set according to a 7:3 ratio. The training set contained 216 nodules, and the testing set contained 93 nodules. The nomogram was developed using the training set, and the data of the testing set were used to validate the performance of nomogram. The predictive accuracy and discriminative ability of the nomogram were determined by concordance index (C-index) and calibration curve. The study showed multifocality, thyroid lesion size, and American College of Radiology Thyroid Imaging, Reporting and Data System (TI-RADS) score were significantly independently associated with LNM in the cervical central region. In the testing set, the calibration curve showed that the nomogram had good discrimination with a C-index of 0.775 (95% confidence interval, 0.680-0.869) and adequate calibration ( P = 0.808). By decision curve analysis and clinical impact curve analysis, the nomogram was shown to have a satisfactory net benefit between thresholds of 0.40 and 0.75. The nomogram can be used for predicting LNM of PTC in the cervical central region and may provide valuable guidance for planning the surgical treatment of PTC patients.
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Affiliation(s)
- Haolin Shen
- Department of Ultrasound, Zhangzhou Hospital affiliated to Fujian Medical University, Zhangzhou
| | - Guorong Lv
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Tingting Li
- Department of Ultrasound, Zhangzhou Hospital affiliated to Fujian Medical University, Zhangzhou
| | - Yuegui Wang
- Department of Ultrasound, Zhangzhou Hospital affiliated to Fujian Medical University, Zhangzhou
| | - Keyue Chen
- Department of Ultrasound, Zhangzhou Hospital affiliated to Fujian Medical University, Zhangzhou
| | - Kangjian Wang
- Department of Ultrasound, Zhangzhou Hospital affiliated to Fujian Medical University, Zhangzhou
| | - Ling Li
- Department of Ultrasound, Zhangzhou Hospital affiliated to Fujian Medical University, Zhangzhou
| | - Xiaoyun Zheng
- Department of Ultrasound, Zhangzhou Hospital affiliated to Fujian Medical University, Zhangzhou
| | - Shuping Yang
- Department of Ultrasound, Zhangzhou Hospital affiliated to Fujian Medical University, Zhangzhou
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Zhou X, Zhang M, Jin L, Tang X, Hu Q, Cheng G, Xiao Y. Quantitative analysis of contrast-enhanced ultrasound combined with ultrasound in the unifocal papillary thyroid micro-carcinoma. Med Eng Phys 2022; 110:103840. [PMID: 35811229 DOI: 10.1016/j.medengphy.2022.103840] [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: 04/12/2022] [Revised: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate diagnostic value of ultrasound (US) combined with contrast-enhanced ultrasound (CEUS) in the invasiveness of unifocal papillary thyroid micro-carcinoma (UPTMC) without capsule-invasion. METHODS This retrospective study included data from patients with UPTMC who received US and CEUS examinations in the Ultrasound Department of the Central Hospital of Changsha, China between June 2019 and September 2021. Univariate and multivariate logistic regression analysis were used to evaluate the risk of US and CEUS parameters for UPTMC. Diagnostic performance was estimated by ROC analysis. RESULTS A total of 136 cases were enrolled, including invasive UPTMC (n = 47) and non-invasive UPTMC (n = 89), which were divided into test set (n = 109) and validation set (n = 27). The occurrence of microcalcification and the ratios (R) of each time-intensity curve (TIC) of CEUS parameter were significantly higher in patients with invasive UTPMC than non-invasive UPTMC (all P < 0.05). Additionally, nodular diameter was significantly longer in the invasive group (P < 0.05). Multivariate analysis showed that microcalcification (OR = 2.917, 95% CI: 1.002-8.491, P = 0.050), R-TTP > 1 (OR = 3.376, 95%CI: 1.267-8.994, P = 0.015), R-DS > 1 (OR = 6.558, 95% CI: 2.358-18.243, P < 0.010) were independently associated with invasive UPTMC. The sensitivities of US, CEUS and their combined application were 82.1%, 46.2% and 79.5%, respectively, and their specificities were 37.1%, 88.6% and 61.4%, respectively. The combination of the two methods had the best diagnostic efficiency (AUC=0.775)compared to US (AUC = 0.596) and CEUS (AUC = 0.750). CONCLUSION The combination of US and CEUS might have good diagnostic value for UPTMC with capsule non-invasion.
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Affiliation(s)
- Xiaohui Zhou
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Min Zhang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Linyuan Jin
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Xianpeng Tang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Qiang Hu
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Guanghui Cheng
- Department of Breast and Thyroid Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161, Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Yaocheng Xiao
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China.
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Spiesecke P, Neumann K, Wakonig K, Lerchbaumer MH. Contrast-enhanced ultrasound (CEUS) in characterization of inconclusive cervical lymph nodes: a meta-analysis and systematic review. Sci Rep 2022; 12:7804. [PMID: 35551228 PMCID: PMC9098903 DOI: 10.1038/s41598-022-11542-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/25/2022] [Indexed: 01/02/2023] Open
Abstract
Lymph node metastases are common in malignant neoplasms of head and neck. Since cervical lymph nodes (cLN) are localized superficially, ultrasound (US) represents the primary imaging modality. The aim of the study is to report the value of US and contrast-enhanced ultrasound (CEUS) and their diagnostic confidence in the characterization of inconclusive cLN. A systematic review was performed using the literature data base PubMed. Results were filtered (published in a peer-reviewed journal, full-text available, published within the last ten years, species human, English or German full-text) and inclusion criteria were clearly defined (cohort with lymphadenopathy or malignancy in head and neck ≥ 50 patients, histological confirmation of malignant imaging findings, performance of CEUS as outcome variable). The results were quantified in a meta-analysis using a random-effects model. Overall, five studies were included in qualitative and quantitative analysis. The combination of non-enhanced US and CEUS enlarges the diagnostic confidence in the characterization of lymph nodes of unclear dignity. The pooled values for sensitivity and specificity in the characterization of a malignant cervical lymph node using US are 76% (95%-CI 66-83%, I2 = 63%, p < 0.01) and 80% (95%-CI 45-95%, I2 = 92%, p < 0.01), compared to 92% (95%-CI 89-95%, I2 = 0%, p = 0.65) and 91% (95%-CI 87-94%, I2 = 0%, p = 0.40) for the combination of US and CEUS, respectively. Consistent results of the included studies show improved diagnostic performance by additional CEUS. Nevertheless, more prospective studies are needed to implement CEUS in the diagnostic pathway of cLN.
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Affiliation(s)
- Paul Spiesecke
- Department of Radiology, Interdisciplinary Ultrasound Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité -Universitätsmedizin Berlin Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Katharina Wakonig
- Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus H Lerchbaumer
- Department of Radiology, Interdisciplinary Ultrasound Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité -Universitätsmedizin Berlin Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Dobrescu R, Schipor S, Manda D, Caragheorgheopol A, Badiu C. Matrix metalloproteinase-9 (MMP-9) promoter -1562C/T functional polymorphism is associated with an increased risk to develop micropapillary thyroid carcinoma. Cancer Biomark 2022; 34:555-562. [PMID: 35275517 DOI: 10.3233/cbm-203119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Matrix metalloproteinase-9 (MMP-9) is an important mediator of tumor initiation and progression. The MMP-9 promoter -1562C/T functional polymorphism increases gene expression and was identified as a susceptibility factor for various cancers. OBJECTIVE To evaluate the influence of the MMP-9 promoter genotype on the risk of developing papillary thyroid cancer (PTC) and to correlate cancer patient genotype with the clinical and pathological phenotype. METHODS We evaluated 236 patients with nodular thyroid disease pre-thyroidectomy (119 benign disease, 117 PTC). Genomic DNA was isolated from whole blood and the MMP-9 -1562C/T genotype was evaluated by PCR-RFLP analysis. RESULTS Genotype frequencies were in Hardy-Weinberg equilibrium for all groups. The T allele was significantly more frequent in cancer compared to benign disease (17.5% vs 10.1%), p= 0.019. Patients with the CT or CT+TT genotype had an increased risk of developing PTC, specifically micropapillary thyroid carcinoma (MPTC) (CT genotype: OR = 6.467, p= 0.00006; CT+TT: OR = 6.859, p= 0.00002), but not more advanced stages (CT: p= 0.094; CT+TT: p= 0.157). The -1562C/T genotype did not significantly correlate with tumor histological subtype, invasion or TNM stage. CONCLUSION The MMP-9 -1562C/T functional polymorphism may indicate susceptibility to develop thyroid cancer, specifically intrathyroidal clinically non-relevant MPTC. This suggests that although this genotype might be a predisposing factor, other genetic/epigenetic events are needed for cancer progression.
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Affiliation(s)
- Ruxandra Dobrescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Sorina Schipor
- "CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Dana Manda
- "CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | | | - Corin Badiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"CI Parhon" National Institute of Endocrinology, Bucharest, Romania
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Niciporuka R, Nazarovs J, Ozolins A, Narbuts Z, Miklasevics E, Gardovskis J. Can We Predict Differentiated Thyroid Cancer Behavior? Role of Genetic and Molecular Markers. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1131. [PMID: 34684168 PMCID: PMC8540789 DOI: 10.3390/medicina57101131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 12/27/2022]
Abstract
Thyroid cancer is ranked in ninth place among all the newly diagnosed cancer cases in 2020. Differentiated thyroid cancer behavior can vary from indolent to extremely aggressive. Currently, predictions of cancer prognosis are mainly based on clinicopathological features, which are direct consequences of cell and tissue microenvironment alterations. These alterations include genetic changes, cell cycle disorders, estrogen receptor expression abnormalities, enhanced epithelial-mesenchymal transition, extracellular matrix degradation, increased hypoxia, and consecutive neovascularization. All these processes are represented by specific genetic and molecular markers, which can further predict thyroid cancer development, progression, and prognosis. In conclusion, evaluation of cancer genetic and molecular patterns, in addition to clinicopathological features, can contribute to the identification of patients with a potentially worse prognosis. It is essential since it plays a crucial role in decision-making regarding initial surgery, postoperative treatment, and follow-up. To date, there is a large diversity in methodologies used in different studies, frequently leading to contradictory results. To evaluate the true significance of predictive markers, more comparable studies should be conducted.
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Affiliation(s)
- Rita Niciporuka
- Department of Surgery, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia; (A.O.); (Z.N.); (J.G.)
- Department of Surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Jurijs Nazarovs
- Department of Pathology, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia;
| | - Arturs Ozolins
- Department of Surgery, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia; (A.O.); (Z.N.); (J.G.)
- Department of Surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Zenons Narbuts
- Department of Surgery, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia; (A.O.); (Z.N.); (J.G.)
- Department of Surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Edvins Miklasevics
- Institute of Oncology, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia;
| | - Janis Gardovskis
- Department of Surgery, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia; (A.O.); (Z.N.); (J.G.)
- Department of Surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
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Dobrescu R, Picu C, Caragheorgheopol A, Manda D, Ioachim D, Goldstein A, Badiu C. Serum Matrix metalloproteinase-9 (MMP-9) can help identify patients with papillary thyroid cancer at high risk of persistent disease: Value and limitations of a potential marker of neoplasia. Cancer Biomark 2021; 29:337-346. [PMID: 32716342 DOI: 10.3233/cbm-190609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Matrix metalloproteinase-9 (MMP-9) is an important mediator of invasion and metastasis in neoplasia. In thyroid cancer expression levels correlate with aggressiveness but data on peripheral MMP-9 levels are less definitive. OBJECTIVE Prospective study evaluating serum MMP-9 in the diagnosis and prognosis of papillary thyroid cancer. METHODS Serum samples of MMP-9 were drawn before surgery in 185 consecutively enrolled patients with nodular thyroid disease, stratified on pathology as benign disease (N= 88) and papillary thyroid cancer (N= 97). Serum MMP-9 was measured by an immunometric assay. RESULTS MMP-9 levels were not different between benign vs malignant pathology (p= 0.3). In papillary thyroid cancer there was no significant difference in MMP-9 levels between histologies, TNM stage and invasive/non-invasive cancers. High-risk patients with multiple features of aggressiveness had significantly higher MMP-9 levels compared to low-intermediate risk patients (767.5 ± 269.2 ng/ml vs 563.7 ± 228.4 ng/ml, p= 0.019). A cut-off of 806 ng/ml distinguished high from low-intermediate risk patients with a sensitivity of 60% and a specificity of 87.36%, p= 0.018. In patients with available follow-up data (N= 78), MMP-9 was higher in patients who required ⩾ 2 doses of 131I therapy (p= 0.009) and in those with biochemical evidence of persistent disease/who required additional therapy to achieve disease-free status (p= 0.017). CONCLUSION Serum MMP-9 is not useful in the diagnosis of PTC, but preliminary data shows that high pre-surgical serum MMP-9 levels may identify patients at higher risk of persistent disease who require intensive treatment. Large volume prospective studies are required to confirm this observation.
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Affiliation(s)
- Ruxandra Dobrescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Catalina Picu
- "CI Parhon" National Institute of Endocrinology, Bucharest, Romania.,Faculty of Biology, University of Bucharest, Bucharest, Romania
| | | | - Dana Manda
- "CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Dumitru Ioachim
- "CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Andrei Goldstein
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Corin Badiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"CI Parhon" National Institute of Endocrinology, Bucharest, Romania
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12
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Tong Y, Sun P, Yong J, Zhang H, Huang Y, Guo Y, Yu J, Zhou S, Wang Y, Wang Y, Ji Q, Wang Y, Chang C. Radiogenomic Analysis of Papillary Thyroid Carcinoma for Prediction of Cervical Lymph Node Metastasis: A Preliminary Study. Front Oncol 2021; 11:682998. [PMID: 34268116 PMCID: PMC8276635 DOI: 10.3389/fonc.2021.682998] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Papillary thyroid carcinoma (PTC) is characterized by frequent metastases to cervical lymph nodes (CLNs), and the presence of lymph node metastasis at diagnosis has a significant impact on the surgical approach. Therefore, we established a radiomic signature to predict the CLN status of PTC patients using preoperative thyroid ultrasound, and investigated the association between the radiomic features and underlying molecular characteristics of PTC tumors. Methods In total, 270 patients were enrolled in this prospective study, and radiomic features were extracted according to multiple guidelines. A radiomic signature was built with selected features in the training cohort and validated in the validation cohort. The total protein extracted from tumor samples was analyzed with LC/MS and iTRAQ technology. Gene modules acquired by clustering were chosen for their diagnostic significance. A radiogenomic map linking radiomic features to gene modules was constructed with the Spearman correlation matrix. Genes in modules related to metastasis were extracted for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, and a protein-protein interaction (PPI) network was built to identify the hub genes in the modules. Finally, the screened hub genes were validated by immunohistochemistry analysis. Results The radiomic signature showed good performance for predicting CLN status in training and validation cohorts, with area under curve of 0.873 and 0.831 respectively. A radiogenomic map was created with nine significant correlations between radiomic features and gene modules, and two of them had higher correlation coefficient. Among these, MEmeganta representing the upregulation of telomere maintenance via telomerase and cell-cell adhesion was correlated with ‘Rectlike’ and ‘deviation ratio of tumor tissue and normal thyroid gland’ which reflect the margin and the internal echogenicity of the tumor, respectively. MEblue capturing cell-cell adhesion and glycolysis was associated with feature ‘minimum calcification area’ which measures the punctate calcification. The hub genes of the two modules were identified by protein-protein interaction network. Immunohistochemistry validated that LAMC1 and THBS1 were differently expressed in metastatic and non-metastatic tissues (p=0.003; p=0.002). And LAMC1 was associated with feature ‘Rectlike’ and ‘deviation ratio of tumor and normal thyroid gland’ (p<0.001; p<0.001); THBS1 was correlated with ‘minimum calcification area’ (p<0.001). Conclusions The radiomic signature proposed here has the potential to noninvasively predict the CLN status in PTC patients. Merging imaging phenotypes with genomic data could allow noninvasive identification of the molecular properties of PTC tumors, which might support clinical decision making and personalized management.
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Affiliation(s)
- Yuyang Tong
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Surgical Oncology, The Ohio State University, Columbus, OH, United States
| | - Peixuan Sun
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanjuan Yong
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongbo Zhang
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, Finland.,Turku Biosciences Center, University of Turku and Åbo Akademi University, Turku, Finland
| | - Yunxia Huang
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi Guo
- Department of Electronic Engineering, Fudan University and Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China
| | - Jinhua Yu
- Department of Electronic Engineering, Fudan University and Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China
| | - Shichong Zhou
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yulong Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qinghai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University and Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China
| | - Cai Chang
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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13
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Zhang Y, Zhang X, Li J, Cai Q, Qiao Z, Luo YK. Contrast-enhanced ultrasound: a valuable modality for extracapsular extension assessment in papillary thyroid cancer. Eur Radiol 2021; 31:4568-4575. [PMID: 33411051 DOI: 10.1007/s00330-020-07516-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of preoperative contrast-enhanced ultrasound (CEUS) to detect extracapsular extension (ECE) and identify the relationship between ECE and nodule enhancement patterns in patients with papillary thyroid cancer (PTC). METHODS Patients with suspected thyroid cancer underwent ultrasound (US) and CEUS examinations. The US and CEUS features of the PTC nodules and thyroid capsule were recorded and classified individually. The accuracy of US and CEUS in detecting ECE was compared individually, and its relationship with various tumour enhancement patterns was analysed. The presence or absence of ECE and cervical lymph node metastasis (LNM) was confirmed pathologically. RESULTS The final dataset included 119 patients with 124 PTC nodules. Seventy-two (60.5%) of these patients with PTC had no ECE (including 38 patients with single capsule invasion), while the remaining 52 had ECE. A significant difference was found in nodules with non-capsule invasion, single capsule invasion, and ECE between the cervical LNM and non-LNM groups (p < 0.01). Receiver operating characteristic curve analysis demonstrated that area under the curve (AUC) of ECE for cervical LNM was higher than that of capsule invasion (71.9% vs. 49.6%). Moreover, the CEUS images acquired to detect ECE showed higher AUC values than those of US images (79.4% vs. 65.8%) (p = 0.02). Among the PTC nodules with differential enhancement, hyper-enhanced nodules had the highest incidence of capsule invasion (41.9%), while hypo-enhanced ones had a higher incidence of ECE (47.4%). CONCLUSIONS Compared with conventional US, CEUS is a more valuable and non-invasive imaging modality to detect ECE. KEY POINTS • Single capsular invasion was a poor predictor of cervical lymph node metastasis, while extracapsular extension assessments were clinically significant for predicting cervical lymph node metastasis. • CEUS is better than conventional US in detecting extracapsular extension in papillary thyroid carcinoma (AUC: 79.4% vs. 65.8%) (p = 0.02). • Among the thyroid papillary carcinoma nodules with differential enhancement, hyper-enhanced nodules had the highest incidence of single capsule invasion (41.9%), while hypo-enhanced ones had a higher incidence of ECE (47.4%).
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Affiliation(s)
- Yan Zhang
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xia Zhang
- Department of Oncology, Division of First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Li
- Department of Pathology, Division of First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qian Cai
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi Qiao
- Department of Surgery, Division of First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Kun Luo
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Zhan J, Zhang LH, Yu Q, Li CL, Chen Y, Wang WP, Ding H. Prediction of cervical lymph node metastasis with contrast-enhanced ultrasound and association between presence of BRAF V600E and extrathyroidal extension in papillary thyroid carcinoma. Ther Adv Med Oncol 2020; 12:1758835920942367. [PMID: 32843902 PMCID: PMC7418479 DOI: 10.1177/1758835920942367] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/19/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: This study aimed to evaluate the correlation between cervical lymph node metastasis (CLNM) and each of the ultrasound features, immunohistochemical factors, and B-type Raf (BRAFV600E) mutation. Methods: A retrospective analysis was performed on 405 patients with single papillary thyroid carcinoma (PTC) nodules, all of whom underwent preoperative sonographic examinations, including gray-scale ultrasound, color Doppler ultrasound, and contrast-enhanced ultrasound (CEUS). All PTC patients were evaluated using 14 clinical and sonographic features, eight immunohistochemical factors, and BRAFV600E. Multivariate analyses were performed to identify the risk factors for CLNM, and an equation for CLNM was established. The diagnostic value of each modality was compared with a receiver operating characteristic (ROC) curve. Results: Among the 405 PTC nodules removed surgically, CLNM was confirmed in 138 patients, whereas extrathyroidal extension was confirmed in 185 patients. Multivariate analyses indicated significant differences between CLNM and non-CLNM groups in three conventional ultrasound features (p < 0.05), whereas other sonographic features, eight immunohistochemical factors, and BRAFV600E did not indicate significant differences. A ROC curve of 0.757 in the equation exhibited a significant difference compared with the solo factors (p < 0.05 for all). Hyper or isoechoic enhancement at peak time on CEUS was associated with CLNM, whereas the presence of the BRAFV600E mutation was associated with extrathyroidal extensions although BRAF appeared to be uncorrelated with CLNM in the present study. Conclusion: Intensity at peak time, homogeneity, and size are the three most significant features in predicting CLNM in PTC patients, and the presence of the BRAFV600E mutation was associated with extrathyroidal extensions when PTCs showed a hyper or isoechoic enhancement at peak time in CEUS.
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Affiliation(s)
- Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai P.R. China
| | - Long-Hui Zhang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Qing Yu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Chao-Lun Li
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai P.R. China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Hong Ding
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Fenglin Road No.180, Shanghai, 200032, P.R. China
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15
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Homogeneity Parameter in Contrast-Enhanced Ultrasound Imaging Improves the Classification of Abnormal Cervical Lymph Node after Thyroidectomy in Patients with Papillary Thyroid Carcinoma. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9296010. [PMID: 31886269 PMCID: PMC6899314 DOI: 10.1155/2019/9296010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/09/2019] [Accepted: 10/04/2019] [Indexed: 02/06/2023]
Abstract
Objective To explore the conventional and contrast-enhanced ultrasound (CEUS) features of cervical lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) patients postoperatively and analyze its pathological basis. Materials and Methods Conventional and CEUS were performed in 86 abnormal cervical lymph nodes (ACLNs) from 56 PTC patients who had received thyroidectomy. Then, fine-needle aspiration (FNA) was taken to confirm pathological results, a multivariate analysis was performed to correlate the sonographic features of the CLNM, and then an equation for CLNM was established. Results Fifty-four lymph nodes were confirmed to be metastasis of PTC by FNA. Intensity at peak time, homogeneity, and color flow patterns, cystic change, or microcalcification and echogenicity were significantly associated with CLNM. Multivariate analysis showed three strongest features (homogeneity, intensity of peak, and cystic change or calcification) to be significantly associated with the evidence of CLNM. Then, the equation was established with the following significant predictive factors: P = 1/1 + exp∑[−3.213 + 2.77 ∗ cystic or calcification + 0.13 ∗ CDFI patterns + 3.65 ∗ homogeneity + 2.43 ∗ intensity at peak time]. Conclusion Depiction of a heterogeneous hyperenhancement of cervical lymph nodes within CEUS studies and cystic change or microcalcification in conventional ultrasound were identified as predictive for metastatic lymph node invasion, and the equation was more accurate for predicting CLNM compared to single B-mode ultrasound and CEUS feature.
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16
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Bumber B, Marjanovic Kavanagh M, Jakovcevic A, Sincic N, Prstacic R, Prgomet D. Role of matrix metalloproteinases and their inhibitors in the development of cervical metastases in papillary thyroid cancer. Clin Otolaryngol 2019; 45:55-62. [PMID: 31646745 DOI: 10.1111/coa.13466] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 10/04/2019] [Accepted: 10/21/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in the development of cervical metastases in papillary thyroid cancer. Our hypothesis is that level of expression of MMPs and TIMPs is associated with the development of cervical metastases and the pattern of metastatic process in papillary thyroid cancer. DESIGN This research retrospectively investigates the expression of MMP-1, -2 and -9 as well as TIMP-1 and -2 in papillary thyroid carcinoma tissue. Tissue specimens were immunohistochemically treated with primary monoclonal antibodies against MMP-1, MMP-2, MMP-9, TIMP-1 and TIMP-2. SETTING Single-centre study. PARTICIPANTS In total, samples of 159 patients were analysed. In all patients, total thyroidectomy was performed, whereas 102 patients underwent selective neck dissection of either central (level VI) or lateral neck (level II-V). Subjects were divided into four groups. MAIN OUTCOME MEASURES Matrix metalloproteinases and TIMPs expression values were analysed in each group, and groups were compared to each other. RESULTS Total number of patients was 159, of which 125 were women and 34 men. Comparing expression levels of MMPs and TIMPs in metastatic (study groups) and non-metastatic (control group), papillary thyroid carcinomas yielded significant differences in MMP-1 and TIMP-1 expression levels, where the highest expression values were found in the group with metastasis in lateral neck. Expression levels of MMP-2, MMP-9 and TIMP-2 did not differ statistically significant among the groups. CONCLUSION Elevated expression of MMP-1 and TIMP-1 in tumour tissue can be considered a predictive factor for the development of metastases.
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Affiliation(s)
- Boris Bumber
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marcel Marjanovic Kavanagh
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Antonia Jakovcevic
- Department of Diagnostic Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Nino Sincic
- School of Medicine, Institute of Biology, University of Zagreb, Zagreb, Croatia
| | - Ratko Prstacic
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Drago Prgomet
- Department of Otorhinolaryngology-Head & Neck Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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17
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Zhang Y, Zhang MB, Luo YK, Li J, Zhang Y, Tang J. Effect of chronic lymphocytic thyroiditis on the efficacy and safety of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma. Cancer Med 2019; 8:5450-5458. [PMID: 31359613 PMCID: PMC6746112 DOI: 10.1002/cam4.2406] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/05/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic lymphocytic thyroiditis (CLT) is an autoimmune disease commonly associated with papillary thyroid carcinoma characterized by a smaller primary tumor size at presentation. The efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) coexisting with CLT is still unknown. METHODS Sixty patients with unifocal PTMC were enrolled and classified into PTMC and PTMC+CLT groups (n = 30/group). CLT was diagnosed histopathologically. The ablation area exceeded the tumor margins, and was evaluated by US and contrast-enhanced US (CEUS) for residual tumor to prevent recurrence. Three months after ablation, US-guided core-needle biopsy was performed to assess the presence of residual and recurrent cancer. Preoperative and postoperative data on patients and tumors were recorded and analyzed. RESULTS There were no differences between groups in age, sex, preoperative tumor volume, ablation time, or ablation power (P > 0.05). There was also no significant difference in postoperative ablation zone volume between the groups at the 1-, 3-, 6-, 12-, and 18-month follow-ups (P > 0.05). The volume reduction rate significantly differed between the two groups at month 3 (P = 0.03). The ablation area could not be identified on US and CEUS at 9.8 ± 5.0 and 10.0 ± 4.8 months in the PTMC and PTMC + CLT groups, respectively (P = 0.197). No serious complications occurred during and after ablation. No residual cancer cells were found on biopsy after ablation. CONCLUSIONS RFA was effective in patients with PTMC+CLT, and its therapeutic efficacy and safety were similar to those in patients with PTMC without CLT.
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Affiliation(s)
- Yan Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ming-Bo Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu-Kun Luo
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Li
- Department of Pathology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Ying Zhang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
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18
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Xu D, Su C, Guo L, Yan H, Wang S, Yuan C, Chen G, Pang L, Zhang N. Predictive Significance of Serum MMP-9 in Papillary Thyroid Carcinoma. Open Life Sci 2019; 14:275-287. [PMID: 33817161 PMCID: PMC7874766 DOI: 10.1515/biol-2019-0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/22/2019] [Indexed: 01/13/2023] Open
Abstract
Objective The incidence of papillary thyroid carcinoma (PTC) is increasing, and there are no reliable serum biomarkers for the diagnosis and prognosis of PTC. This study aimed to assess whether serum matrix metalloproteinase-9 (MMP-9) could serve as an auxiliary diagnostic/prognostic marker for PTC after total and partial thyroidectomy. Material and Methods Postoperative serum MMP-9 concentrations were measured in 182 male patients with PTC, 86 male patients with benign thyroid nodule (BTN), and 62 male healthy controls (HCs). Multivariate logistic regression and Cox regression were applied to evaluate the correlation between variables. The performance of serum MMP-9 in diagnosing PTC and predicting structural persistent/recurrent disease (SPRD) during 48 months of follow-up after initial surgery was evaluated by receiving operating characteristic curve analysis. Results The median serum MMP-9 concentration in the PTC group (79.45 ng/ml) was significantly higher than those in the BTN group (47.35 ng/ml) and HC group (47.71 ng/ml). The area under the curve (AUC) for predicting PTC from BTN was 0.852 at a cut-off value of 60.59 ng/ml. Serum MMP-9 was negatively correlated with disease-free survival (OR 1.026, P=0.001). Serum MMP-9 exhibited good performance in predicting SPRD at a cutoff value of 99.25 ng/ml with an AUC of 0.818. Advanced TNM stage (OR 31.371, P=0.019) and serum MMP-9 ≥99.25 ng/ml (OR 4.103, P=0.022) were independent risk factors for SPRD. Conclusions Serum MMP-9 potentially represents a good predictive biomarker for PTC diagnosis and prognosis after thyroidectomy in Chinese male patients for whom radio-imaging indicates suspected PTC.
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Affiliation(s)
- Dahai Xu
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021,China
| | - Chang Su
- Department of Thyroid Surgery, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Liang Guo
- Department of Pathology, the First Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - He Yan
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021,China
| | - Shaokun Wang
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021,China
| | - Congwang Yuan
- Department of Pain, Yancheng First People’s Hospital, Yancheng, Jiangsu, 224000, China
| | - Guohui Chen
- Department of Pathology, Jilin City People’s Hospital, Jilin, 132000, China
| | - Li Pang
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021,China
- E-mail:
| | - Nan Zhang
- Department of Emergency, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin, 130021,China
- E-mail:
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19
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Liu X, Su C, Xu J, Zhou D, Yan H, Li W, Chen G, Zhang N, Xu D, Hu H. Immunohistochemical analysis of matrix metalloproteinase-9 predicts papillary thyroid carcinoma prognosis. Oncol Lett 2019; 17:2308-2316. [PMID: 30675296 PMCID: PMC6341782 DOI: 10.3892/ol.2018.9850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023] Open
Abstract
The present study aimed to explore the association between immunohistochemical matrix metalloproteinase-9 (MMP-9) expression and the clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC), and to determine whether it may be used as a diagnostic or prognostic tool for PTC. Immunohistochemical staining of MMP-9 was performed in thyroid tissues obtained from 112 patients with PTC and 42 subjects with benign thyroid nodules (BTNs). The receiver operating characteristic curve was used to evaluate the legitimacy of MMP-9 as a diagnostic tool for PTC, and a predictor for structurally persistent/recurrent disease (SPRD) and disease status. Cox regression was applied to identify the risk factors of disease status and SPRD. The present study revealed that MMP-9 was overexpressed in PTC tissues, compared with in BTN tissues. Furthermore, MMP-9 scores yielded an area under the curve (AUC) of 0.842 (95% CI, 0.776-0.908) for differentially diagnosing PTC from BTN. In addition, the MMP-9 score was greater if patients previously had central lymph node metastasis, lateral lymph node metastasis or an advanced tumor-node-metastasis stage (III+IV). When MMP-9 was employed to predict disease status and SPRD, an AUC of 0.811 (95% CI, 0.706-0.917) and 0.806 (95% CI, 0.620-0.992) was obtained, respectively. A tumor size of >2 cm and an MMP-9 staining score of ≥6 were independent risk factors for predicting disease status, whereas vascular invasion and an MMP-9 staining score of ≥8 were risk factors for predicting SPRD. Furthermore, an MMP-9 staining score of ≥6 and ≥8 indicated shortened disease-free survival and survival without SPRD, respectively. In conclusion, the assessment of MMP-9 expression in thyroid carcinoma samples may represent a potential and supplementary tool for the diagnosis and prognostic prediction of PTC.
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Affiliation(s)
- Xingkai Liu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Chang Su
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jing Xu
- Cardiovascular Disease Center, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Dan Zhou
- Department of Pediatrics, The Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - He Yan
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Wei Li
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Guihui Chen
- Department of Pathology, Jilin City People's Hospital, Jilin, Jilin 132000, P.R. China
| | - Nan Zhang
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Dahai Xu
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Haixia Hu
- Department of Emergency, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Zarkesh M, Zadeh-Vakili A, Akbarzadeh M, Fanaei SA, Hedayati M, Azizi F. The role of matrix metalloproteinase-9 as a prognostic biomarker in papillary thyroid cancer. BMC Cancer 2018; 18:1199. [PMID: 30509240 PMCID: PMC6276227 DOI: 10.1186/s12885-018-5112-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the association between matrix metalloproteinase-9 (MMP-9) expression with BRAF V600E mutation and clinicopathological features, in Iranian papillary thyroid cancer (PTC) patients. METHODS In total, 90 participants including 60 PTC patients (15 males and 45 females) and 30 individuals with benign multinodular goiter (MNG) (5 males and 25 females) which were confirmed by surgical pathology, were investigated. MMP-9 was evaluated at both mRNA and protein levels, using SYBR-Green Real-Time PCR and enzyme-linked immune sorbent assay (ELISA), respectively. BRAF V600E mutation was detected by sequencing. RESULTS Mean age of PTC and MNG patients was 37.6 ± 12.6 and 48.1 ± 13.3 years, respectively (P = 0.001). BRAF V600E mutation was found in 24 of the 60 (40%) PTC cases, with mean tumor size of 1.59 ± 1.20 cm. MMP-9 mRNA levels were elevated in tumoral compared to the adjacent non-tumoral tissues (P = 0.039); moreover, this rise was also observed in PTC patients compared to MNG patients (P = 0.001). The mRNA levels of MMP-9 increased in patients aged≥45 years (P = 0.015), those with lymphovascular invasion (P = 0.003), and higher tumor stages (III and IV) (P = 0.011). The protein level of MMP-9 increased in tumoral compared to adjacent non-tumoral tissues (P < 0.001); this increase was also found in PTC patients compared to MNG participants (P = 0.004). MMP-9 protein level was higher in patients aged≥45 years (P = 0.001), those with lymphovascular invasion (P = 0.036) and higher TNM stages (III and IV) (P = 0.001). Area under the ROC curve (AUC) was 0.70 (95%CI: 0.57-0.83, P = 0.003), with 91.4% sensitivity and 51.9% specificity at the cutoff value of 0.50. CONCLUSION The mRNA and protein levels of MMP-9 had no association with BRAF V600E mutation in Iranian PTC patients. These levels were associated with age, TNM stages, and lymphovascular invasion, being defined as malignant factors. Thus, elevated levels of MMP-9 in PTC patients compared to MNG participants illustrated that it can be used as a potential biomarker to differentiate PTC patients from those with MNG.
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Affiliation(s)
- Maryam Zarkesh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Po Box: 19395-4763, Tehran, Iran
| | - Azita Zadeh-Vakili
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Po Box: 19395-4763, Tehran, Iran.
| | - Mahdi Akbarzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Ahmad Fanaei
- Association Professor of General Surgery, Erfan Hospital, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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