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Febrero B, Ruiz-Manzanera JJ, Ros-Madrid I, Hernández AM, Orenes-Piñero E, Rodríguez JM. Tumor microenvironment in thyroid cancer: Immune cells, patterns, and novel treatments. Head Neck 2024; 46:1486-1499. [PMID: 38380767 DOI: 10.1002/hed.27695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
The tumor immune microenvironment of thyroid cancer is the heterogeneous histological space in which tumor cells coexist with host cells. Published data from this review were identified by search and selection database of Pubmed, Elsevier, and Science Direct. Searching was made in two steps using different keywords. In thyroid pathology, the inflammatory response is very important, and might have a key role finding new diagnostic and therapeutic methods, particularly in thyroid cancer. Different immune cells may be more or less present in different types of thyroid cancer and may even have different functions, hence the importance of knowing their presence in different thyroid tumor pathologies. Cancer-related inflammation could be a useful target for new diagnostic and therapeutic strategies by analyzing peritumoral and intratumoral immune cells in different types of thyroid tumors. Moreover, novel strategies for thyroid cancer treatments, such as monoclonal antibodies targeting checkpoint inhibitors, are emerging as promising alternatives.
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Affiliation(s)
- Beatriz Febrero
- Department of Endocrine Surgery, General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
| | - Juan José Ruiz-Manzanera
- Department of Endocrine Surgery, General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
| | - Inmaculada Ros-Madrid
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Antonio Miguel Hernández
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Biochemistry and Molecular Biology-A, University of Murcia, Murcia, Spain
| | - José Manuel Rodríguez
- Department of Endocrine Surgery, General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), Murcia, Spain
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Girardi FM, Wagner VP, Martins MD. Thyroid Incidentalomas: Scrutinizing the Mode of Detection and Evaluating its Contribution to Thyroid Cancer Diagnosis. Indian J Otolaryngol Head Neck Surg 2024; 76:1733-1740. [PMID: 38566651 PMCID: PMC10982254 DOI: 10.1007/s12070-023-04392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
There is an ongoing debate about the reasons behind the increasing incidence of thyroid cancer in the last two to three decades. Here, we investigate how thyroid nodules were detected in a large series of consultations for thyroid nodular pathology. METHODS In total, 576 patients were analyzed, with a total of 1014 nodules described. RESULTS In 347 (60.2%) cases, the diagnosis of a thyroid nodule was incidental, mostly during imaging tests for other reasons. Incidental diagnosis occurred among all ranges of nodule diameter and between palpable and non-palpable cases, even within a small proportion of symptomatic cases. In univariate analysis, incidental diagnosis was associated with smaller nodule diameter, non-palpable nodules, asymptomatic cases, older patient age, less advanced stages (T1-2), and conservative management. After multivariate analysis, older age, euthyroidism, and smaller diameter were statistically significant. Incidental diagnosis contributed to the diagnosis of 53.8% of the cases of cancer. Advanced T stages (T3-4) were more common in non-incidental diagnoses. CONCLUSION Our results indicate that incidental diagnosis of thyroid nodules is a significant contributor to thyroid cancer diagnosis in all ranges of nodule diameter, especially at earlier stages.
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Affiliation(s)
- Fábio Muradás Girardi
- Integrated Oncology Center of Ana Nery Hospital, Borges de Medeiros Street, 274, 503, Santa Cruz do Sul, RS 96810-034 Brazil
| | - Vivian P. Wagner
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS Brazil
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3
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Xu Z, Mao Z, Chen S, Mo Z, Zhou J, Chen Z, Zarnegar R, Fahey Iii TJ, Wang W, Teng L. Long-term impact of prophylactic central neck dissection in non-invasive classic papillary thyroid carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107305. [PMID: 38070466 DOI: 10.1016/j.ejso.2023.107305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The utilization of prophylactic central neck dissection (pCND) in cases of non-invasive clinical node-negative (cN0) papillary thyroid carcinoma (PTC) remains a topic of debate, with a dearth of long-term evidence. MATERIALS AND METHODS We retrospectively reviewed 1181 cN0 PTC patients from 1997 to 2011. Of these, 641 underwent pCND (pCND + group) and 540 did not (pCND-group). Propensity score matching (PSM) was used to identify similar patients. Event-free survival and long-term complications including permanent hyperparathyroidism and permanent recurrent laryngeal nerve (RLN) paralysis were analyzed after PSM. RESULTS The pCND + group had more aggressive characteristics. In the matched cohort after PSM, the 5-year, 10-year, and 15-year EFS rates were 98.9 %, 98.2 %, and 97.1 % for the pCND + group, and 97.7 %, 97.1 %, and 97.1 % for the pCND-group, respectively. There was no statistically significant difference in EFS rates between the two groups (Log Rank P = 0.38). There was no statistically significant difference in the incidence of permanent hyperparathyroidism (3.3 % vs. 1.5 %, P = 0.08) and permanent RLN paralysis (1.7 % vs. 0.9 %, P = 0.13) between the pCND+ and pCND- groups. CONCLUSION Our study, with a median follow-up duration of 107 months, indicates that pCND does not lead to a significant reduction in nodal recurrence among non-invasive cN0 PTC patients.
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Affiliation(s)
- Zehang Xu
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Zhuochao Mao
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Shitu Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Zhe Mo
- Department of Environmental and Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China.
| | - Jie Zhou
- Department of Pathology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Zhendong Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital, and Weill Medical College of Cornell University, 525 East 68th Street, Room F-2024, New York, 10065, NY, USA.
| | - Thomas J Fahey Iii
- Department of Surgery, New York Presbyterian Hospital, and Weill Medical College of Cornell University, 525 East 68th Street, Room F-2024, New York, 10065, NY, USA.
| | - Weibin Wang
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Lisong Teng
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Alsaud JS, Alharbi MS, Aldekhail AI, Almesned RA, Alsultan FS, Alharbi M, Alshubrumi H. Quality of Life in Thyroid Cancer Patients. Cureus 2023; 15:e45222. [PMID: 37842476 PMCID: PMC10576537 DOI: 10.7759/cureus.45222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Thyroid cancer ranks as the ninth most common cancer worldwide and third in Saudi Arabia. Given thyroid cancer's high incidence, thyroid cancer patients' quality of life (QoL) has been a concern for many years. However, no study has been dedicated to assessing thyroid cancer patients' QoL in Saudi Arabia. Thus, we aimed to fill this gap by assessing thyroid cancer patients' QoL in Saudi Arabia. This cross-sectional study was conducted among thyroid cancer patients attending outpatient clinics at the Diabetes and Endocrinology Centre, King Fahad Specialist Hospital, Qassim region, Saudi Arabia, from 2017 to 2023. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) assessed the patients' QoL through an individual interviewer-administered technique. We used RStudio to perform statistical analysis. Statistical differences between groups based on QoL scores were assessed using the Wilcoxon and Kruskal-Wallis rank-sum tests. Our results showed that for QoL scores of functional domains, the lowest was in social functioning, and the highest was in cognitive functioning. Regarding the subscales of symptoms, the highest scores were fatigue and insomnia. In conclusion, numerous factors affect thyroid cancer patients' QoL. Recognition and appropriate management of these factors will improve the overall QoL; there is a need to understand what is driving these factors in further clinical studies.
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Affiliation(s)
| | | | | | | | | | | | - Hamad Alshubrumi
- Endocrinology and Diabetes Center, King Fahad Specialist Hospital, Buraydah, SAU
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Nasiri S, Yazd SMM, Gholami M, Shahriarirad S, Sharghi S, Shahriarirad R. The evaluation of locoregional tumoral involvement in the cooccurrence of hashimoto thyroiditis with papillary thyroid cancer: a case controlled study. BMC Endocr Disord 2023; 23:66. [PMID: 36964545 PMCID: PMC10037788 DOI: 10.1186/s12902-023-01322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/13/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma PTC is the most prevalent of all thyroid carcinomas. On the other hand, Hashimoto's thyroiditis (HT), as part of the spectrum of autoimmune thyroid diseases, is a major cause of thyroid hypofunction worldwide. Several studies have aimed to indicate a possible correlation between PTC and HT over the years. This study aims to investigate the correlation between HT disease and PTC tumor invasion rate. METHOD In the present cross-sectional study, PTC patients with HT were selected among patients referred to the surgical ward of Shariati hospital from 2016 to 2019 and compared in terms of tumor invasion and central LN dissection. Also, a similar group of PTC patients without HT undergoing total thyroidectomy was selected for comparison. The tumor invasion rate was assessed based on invasion indices obtained from postoperative permanent pathology specimens. These indices included tumor type and size, number of involved LNs, lymphovascular involvement, perineural involvement, thyroid capsule involvement, multifocal or unifocal tumor, extrathyroidal proliferation, marginal status, and necrosis. Data were obtained and compared in the two groups with SPSS version 22.0 software. RESULTS Based on the postoperative pathology reports, 50 (56.2%) PTC patients with Hashimoto thyroiditis were compared against 39 PTC patients without Hashimoto thyroiditis. No significant difference was found between the two groups regarding tumor invasion factors such as multifocality, lymphovascular invasion, marginal invasion, extrathyroidal invasion, capsular invasion, and necrosis. CONCLUSION HT could not be mentioned as an aggravating factor of PTC invasion based on the invasion factors evaluated in pathology specimens.
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Affiliation(s)
- Shirzad Nasiri
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahsa Gholami
- Student research committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepehr Shahriarirad
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 77030, USA
| | - Sina Sharghi
- Department of General Surgery, Alborz University of Medical Sciences, Alborz, Iran
| | - Reza Shahriarirad
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
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Huang Y, Huang Z, Cai H, Zhuge L, Wang S, Yan D, Zhang X, An C, Niu L, Li Z. Evaluation of serum B7-H3 expression, ultrasound and clinical characteristics to predict the risk of cervical lymph node metastases in papillary thyroid carcinoma by nomogram. J Clin Lab Anal 2022; 37:e24811. [PMID: 36525343 PMCID: PMC9833969 DOI: 10.1002/jcla.24811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Improving the preoperative diagnosis of cervical lymph node metastasis (LNM) will help improve the clinical outcomes of papillary thyroid carcinoma (PTC) patients. B7-H3, as an immune checkpoint of the B7 family, is highly expressed in PTC tissues and related to LNM and prognosis. We aimed to explore the clinical values of serum B7-H3 (sB7-H3) in predicting LNM in PTC by a nomogram prediction model. METHODS From September 2019 to May 2021, a total of 344 PTC patients with primary surgery in our hospital were enrolled in this research. Enzyme-linked Immunosorbent Assay (ELISA) was used to detect sB7-H3 from the peripheral blood of PTC patients and normal controls. We created a nomogram prediction model in combination with sB7-H3 expression, clinical and ultrasound characteristics to predict LNM in the early stage. RESULTS Gender (p = 0.001), age (p = 0.015), tumor size (p < 0.001), number of tumors (p = 0.021) and sB7-H3 expression (p = 0.003) were independent risk factors for LNM in PTC. All the factors were included in the nomogram. The area under the curve (AUC) was 73.9% (95% CI, 68.12%-79.69%). CONCLUSION The nomogram is helpful in assessing the risk of LNM in PTC. sB7-H3 has excellent potential in predicting LNM in patients with PTC as an adjunctive ultrasound tool.
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Affiliation(s)
- Yingcheng Huang
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zehao Huang
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Huizhu Cai
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lingdun Zhuge
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shixu Wang
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Dangui Yan
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiwei Zhang
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Changming An
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lijuan Niu
- Department of UltrasoundNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhengjiang Li
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Jeong SY, Baek JH, Chung SR, Choi YJ, Song DE, Chung KW, Kim WW, Lee JH. Diagnostic Performance of Core Needle Biopsy for Characterizing Thyroidectomy Bed Lesions. Korean J Radiol 2022; 23:1019-1027. [PMID: 36098339 PMCID: PMC9523230 DOI: 10.3348/kjr.2021.0772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Thyroidectomy bed lesions frequently show suspicious ultrasound (US) features after thyroid surgery. Fine-needle aspiration (FNA) may not provide definitive pathological information about the lesions. Although core-needle biopsy (CNB) has excellent diagnostic performance in characterizing suspicious thyroid nodules, no published studies have evaluated the performance of CNB specifically for thyroidectomy bed lesions. Therefore, we aimed to evaluate the diagnostic performance and safety of CNB for characterizing thyroidectomy bed lesions. Materials and Methods A total of 124 thyroidectomy bed lesions in 113 patients (79 female and 34 male; age, 23–85 years) who underwent US-guided CNB between December 2008 and December 2020 were included. We reviewed the US imaging features of the target lesions and the histories of previous biopsies. The pathologic results, diagnostic performance for malignancy, and complications of CNB were analyzed. Results All samples (100%) obtained by CNB were adequate for pathological analysis. Pathological analysis revealed inconclusive results in two lesions (1.6%). According to the reference standard, 50 lesions were ultimately malignant (40.3%), and 72 were benign (58.1%), excluding the two inconclusive lesions. The performance of CNB for diagnosing malignant thyroidectomy bed lesions in the 122 lesions had a sensitivity of 98.0% (49/50), a specificity of 100% (72/72), positive predictive value of 100% (49/49), and negative predictive value of 98.6% (72/73). Eleven lesions were referred for CNB after prior inconclusive FNA results in thyroidectomy bed lesions, for all of which CNB yielded correct conclusive pathologic diagnoses. According to the pathological analysis of CNB, there were various benign lesions (58.9%, 73/124) besides recurrence, including benign postoperative lesions other than suture granuloma (32.3%, 40/124), suture granuloma (15.3%, 19/124), remnant thyroid tissue (5.6%, 7/124), parathyroid lesions (4%, 5/124), and abscesses (1.6%, 2/124). No major or minor complications were associated with the CNB procedure. Conclusion US-guided CNB is accurate and safe for characterizing thyroidectomy bed lesions.
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Affiliation(s)
- So Yeong Jeong
- Department of Radiology, Hanyang University Medical Center, Hanyang University Medical College, Seoul, Korea.,Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Woong Kim
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Ferrante M, Distefano G, Distefano C, Copat C, Grasso A, Oliveri Conti G, Cristaldi A, Fiore M. Benefits of Physical Activity during and after Thyroid Cancer Treatment on Fatigue and Quality of Life: A Systematic Review. Cancers (Basel) 2022; 14:cancers14153657. [PMID: 35954324 PMCID: PMC9367318 DOI: 10.3390/cancers14153657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 12/09/2022] Open
Abstract
Simple Summary The usefulness of physical activity in a preventive key is no longer in question, whereas sports therapy is assuming an increasingly important role in cancer rehabilitation. This review provides an overview on the effects of physical activity on fatigue, quality of life (QoL) and health-related quality of life (HRQoL) in patients with thyroid cancer diagnosis both during and after treatment, with a focus on sex. We found that the level of confidence in the available evidence is very low. Future studies are needed to understand which training programs are optimal, both in terms of beneficial effects and to avoid potential adverse responses, in addition to focusing on gender differences. Abstract Background: Several epidemiological studies have provided evidence of the usefulness of physical activity for cancer prevention, increased survival and quality of life (QoL), but no comprehensive review is available on the effects on thyroid cancer. The present systematic review provides an overview of the effects of physical activity on fatigue, QoL and health-related quality of life (HRQoL) in patients with thyroid cancer diagnosis both during and after treatment, with a focus on sex. Methods: A literature search was conducted in the PubMed and Scopus databases. We included studies investigating the impact of physical activity during and after thyroid cancer treatment, including fatigue, QoL and/or HRQoL among the outcomes. Review articles, conference papers, short communications and articles written in a language other than English articles were excluded. Study selection followed the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA). Two reviewers independently selected the studies and assessed their eligibility. The same two reviewers independently screened studies, extracted data and assessed the risk of bias. Outcomes of interest were fatigue, QoL and HRQoL. The Newcastle–Ottawa Scale was used to assess the quality of the selected studies. We compared the outcomes between groups of patients with subclinical hyperthyroidism undergoing a physical activity program and a sedentary group, evaluating the possible presence of sex differences. Results and Discussion: We found five studies eligible for inclusion in our review; only two were prospective studies including an exercise training program. One study was a quasi-experimental study with a non-equivalent control group. Three out of five studies comprised low-quality evidence with a high risk of bias. Conclusion: The level of confidence in the available evidence is very low. A close association between physical activity and fatigue, QoL and HRQoL in patients with thyroid cancer diagnosis with a focus on sex can neither be supported nor refuted. Future studies are needed to understand which training programs are optimal, both in terms of beneficial effects and to avoid potential adverse responses, in addition to focusing on gender differences. The protocol of this systematic review was registered with PROSPERO: CRD42022322519.
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Al Essa M, Doubi A, Aldosari L, Alkhaldi A, Alzahrani M, Alsadi M, Alsalem A. Risk of thyroid carcinoma in patients treated surgically with assumed benign cytology in Riyadh, Saudi Arabia. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:237-242. [PMID: 35880364 PMCID: PMC9330754 DOI: 10.14639/0392-100x-n1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
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10
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Shu X, Tang L, Hu D, Wang Y, Yu P, Yang Z, Deng C, Wang D, Su X. Prediction Model of Pathologic Central Lymph Node Negativity in cN0 Papillary Thyroid Carcinoma. Front Oncol 2021; 11:727984. [PMID: 34646771 PMCID: PMC8503674 DOI: 10.3389/fonc.2021.727984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Most patients with papillary thyroid carcinoma (PTC) have an excellent prognosis. Although central lymph node invasion is frequent, management via central lymph node dissection (CLND) remains controversial. The present study retrospectively investigated independent predictors of pathologic central lymph node negativity (pCLN-) and established a prediction model for pCLN- in clinical lymph node negativity (cN0) PTC. Methods A total of 2,687 patients underwent thyroid surgery for cN0 PTC from 2013 to 2018 at the First Affiliated Hospital of Chongqing Medical University, and lobectomy plus ipsilateral CLND was the basic surgical extent. Clinicopathological characteristics were reviewed and analyzed. Univariate and multivariate analyses were performed to identify factors related to pCLN-. A prediction model was established based on the results of multivariate analyses. Results The pCLN- rate was 51.5% (1,383/2,687). Multivariate analysis revealed that sex, age, thyroid stimulating hormone (TSH), size, location, laterality, unifocality and extrathyroidal extension negativity (ETE-) were independent predictors of pCLN-. The nomogram showed good discriminative ability (C-index: 0.784 and 0.787 in derivation and validation groups, respectively) and was well calibrated. We quantified the clinical usefulness of the nomogram by decision curve analysis. The median length of follow-up was 30 (range 12– 83) months, and 190 cases were lost, with a follow-up rate of 92.9% (2,497/2,687). Of the 2,687 patients included, 21 (0.8%) experienced recurrence. Conclusion This nomogram, which integrates available preoperative clinicopathological features and intraoperative frozen biopsy outcomes, is a reliable tool with high accuracy to predict pCLN- in cN0 PTC.
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Affiliation(s)
- Xiujie Shu
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingfeng Tang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Wang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Yu
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhixin Yang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Deng
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Denghui Wang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinliang Su
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Liu C, Zhou X, Pan Y, Liu Y, Zhang Y. Pyruvate carboxylase promotes thyroid cancer aggressiveness through fatty acid synthesis. BMC Cancer 2021; 21:722. [PMID: 34158007 PMCID: PMC8220755 DOI: 10.1186/s12885-021-08499-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background Pyruvate carboxylase (PC) is an important anaplerotic enzyme in the tricarboxylic acid cycle (TCA) in cancer cells. Although PC overexpression has been observed in thyroid cancer (TC), the mechanisms involved in the carcinogenic effects of PC are still unclear. Methods Bioinformatics analysis and clinical specimens were used to analyze the relationship of PC expression with clinicopathological variables in TC. Fatty acid synthesis was monitored by LC/MS, Nile red staining, and triglyceride analysis. Mitochondrial oxygen consumption was evaluated by the Seahorse XF Mito Cell Stress Test. The correlation of PC with FASN and SREBP1c was assessed by qRT-PCR and IHC in 38 human TC tissues. Western blotting was used to evaluate the protein expression of PC, FASN, and SREBP1c and members of the AKT/mTOR and EMT pathways in TC cell lines. Wound-healing, CCK-8, and Transwell assays and a nude mouse xenograft model were used to verify the regulatory effects of PC and SREBP1c on thyroid tumor cell proliferation, migration and invasion. Results We demonstrated that PC increased fatty acid synthesis, which then promoted TC progression and metastasis. Analysis of GEO data showed that the overexpression of PC in papillary thyroid cancer (PTC) was associated with PTC invasion and the fatty acid synthesis pathway. Analysis of clinical tissue specimens from PTC patients revealed that PC was more highly expressed in specimens from PTC patients with lymph node metastasis than in those from patients without metastasis. Multiple genes in the fatty acid synthesis signaling pathway, including FASN and SREBP1c, were downregulated in PC-knockdown TC cells compared to control cells. Lipid levels were also decreased in the PC-knockdown TC cells. Moreover, the ability of cells to grow, invade, and metastasize was also suppressed upon PC knockdown, suggesting that PC-mediated lipogenesis activation increases the aggressiveness of TC cells. In addition, PC was found to activate the AKT/mTOR pathway, thus improving FASN-mediated de novo lipogenesis in TC cells by upregulating SREBP1c expression. Studies in a nude mouse xenograft model showed that PC knockdown decreased tumor weight, but this effect was attenuated by forced expression of SREBP1c. Conclusions Our results demonstrate that PC is strongly involved in the tumor aggressiveness of TC via its stimulation of fatty acid synthesis. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08499-9.
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Affiliation(s)
- Chang Liu
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025, China
| | - Xiang Zhou
- Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Pan
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025, China
| | - Yang Liu
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025, China
| | - Yifan Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025, China.
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12
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Ye J, Feng JW, Wu WX, Hu J, Hong LZ, Qin AC, Shi WH, Jiang Y. Papillary Thyroid Microcarcinoma: A Nomogram Based on Clinical and Ultrasound Features to Improve the Prediction of Lymph Node Metastases in the Central Compartment. Front Endocrinol (Lausanne) 2021; 12:770824. [PMID: 35095755 PMCID: PMC8790095 DOI: 10.3389/fendo.2021.770824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Accurate preoperative identification of central lymph node metastasis (CLNM) is essential for surgical protocol establishment for patients with papillary thyroid microcarcinoma (PTMC). We aimed to develop a clinical and ultrasound characteristics-based nomogram for predicting CLNM. METHODS Our study included 399 patients who were pathologically diagnosed with PTMC between January 2011 and June 2018. Clinical and ultrasound features were collected for univariate and multivariate analyses to determine risk factors of CLNM. A nomogram comprising the prognostic model to predict the CLNM was established, and internal validation in the cohort was performed. The Cox regression model was used to determine the risk factors for recurrence-free survival (RFS) and cumulative hazard was calculated to predict prognosis. RESULTS Three variables of clinical and US features as potential predictors including sex (odd ratio [OR] = 1.888, 95% confidence interval [CI], 1.160-3.075; P =0.011), tumor size (OR = 1.933, 95% CI, 1.250-2.990; P =0.003) and ETE (OR = 6.829, 95% CI, 3.250-14.350; P <0.001) were taken into account. The predictive nomogram was established by involving all the factors above used for preoperative prediction of CLNM in patients with PTMC. The nomogram showed excellent calibration in predicting CLNM, with area under curves (AUC) of 0.684 (95% CI, 0.635 to 0.774). Furthermore, tumor size, multifocality, presence of ETE, vascular invasion, and CLNM were the significant factors related to the RFS. CONCLUSION Through this easy-to-use nomogram by combining clinical and US risk factor, the possibility of CLNM can be objectively quantified preoperatively. This prediction model may serve as a useful clinical tool to help clinicians determine an individual's risk of CLNM in PTMC, thus make individualized treatment plans accordingly.
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Affiliation(s)
- Jing Ye
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, China
| | - Jia-Wei Feng
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, China
| | - Wan-Xiao Wu
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, China
| | - Jun Hu
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, China
| | - Li-Zhao Hong
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, China
| | - An-Cheng Qin
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Wei-Hai Shi
- The Affiliated Hospital of Nanjing Medical University, Changzhou Second People’s Hospital, Changzhou, China
| | - Yong Jiang
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People’s Hospital, Changzhou, China
- *Correspondence: Yong Jiang,
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Li JW, Chang C, Chen JY, Shi ZT, Chen M. Nodule Size Effect on Diagnostic Performance of Ultrasonography and Computed Tomography for Papillary Thyroid Carcinoma. Curr Med Imaging 2020; 15:489-495. [PMID: 32008556 DOI: 10.2174/1573405614666180425142141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 03/12/2018] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND To compare the abilities of ultrasonography (US) and Computed Tomography (CT) to identify calcifications and to predict probability of malignancy for Papillary Thyroid Carcinoma (PTC) and Papillary Thyroid Microcarcinoma (PTMC). METHODS We reviewed 1008 cases of PTC/PTMC with calcifications reported by pre-operative US, CT, or post-operative pathology. The size of the thyroid nodule was obtained from the US report and the maximum diameter (d) was documented. According to the nodule size (d), the PTC and PTMC groups were each divided into two subgroups, as follows: large PTC group (d ≥ 2 cm), small PTC group (1 cm < d < 2 cm), large PTMC group (0.6 cm ≤ d ≤ 1 cm), and small PTMC group (d < 0.6 cm). RESULTS In the 1008 patients, the ratio of females to males was 2.29 and the mean age was 40.9 years (standard deviation: 11.7 years). Of the 1008 records, 92.8% were found to have calcifications according to the US report, while 50.4% showed calcifications according to the CT report. This difference between US and CT reports was statistically significant (p < 0.0005). The percentages of US reports showing calcifications were similar for all four PTC and PTMC subgroups (93.7%, 94.3%, 92.1%, and 85.1%, respectively; p = 0.052), while the percentages of CT reports showing calcifications were significantly different among the PTC and PTMC subgroups (62.3%, 52.2%, 45.4%, and 31.3%, respectively; p < 0.0005). As for the prediction of malignancy, US was superior to CT in all four subgroups (large PTC group: 97.1% vs. 54.1%, small PTC group: 94.8% vs. 42.9%, large PTMC group: 97.2% vs. 32.0%, small PTMC group: 95.5% vs. 14.9%; p < 0.0005 for all pairwise comparisons). No significant difference was observed in terms of the ability of US to predict the malignancy of PTC versus PTMC (p = 0.31), while CT showed significant superiority in diagnosing PTC versus PTMC (p < 0.0005). The predictive value of CT for PTC declined as the nodule size decreased (p < 0.05 for all pairwise comparisons). CONCLUSION Our results showed that US detected calcifications and predicted the malignancy of all nodule sizes of thyroid papillary carcinoma equally well, while the performance of CT declined with the reduction of nodule size.
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Affiliation(s)
- Jia-Wei Li
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Cai Chang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Jia-Ying Chen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; No 270, Dong'an Road, Xuhui District, Shanghai, China
| | - Zhao-Ting Shi
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Min Chen
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Zurikat RO, Khader M, Azzam MI, Zahid ZM, Daoud SF, Nusirat SF, Albsoul N, Al-Natsheh MA, Al-Abbadi MA. Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP): a 13-year retrospective review at Jordan University Hospital. Endocrine 2020; 69:339-346. [PMID: 32319013 DOI: 10.1007/s12020-020-02299-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) is the term to describe what was previously known as encapsulated follicular variant of papillary thyroid carcinoma. This new paradigm shift was agreed upon by experts in the field. The objective of this study is to evaluate cases previously diagnosed as follicular adenomas, follicular variant of papillary thyroid carcinoma and hyperplastic nodules to be reclassified as NIFTP according to the new criteria. Furthermore, the clinical follow-up of these NIFTP cases is evaluated. METHODS This retrospective study reviewed potential NIFTP cases over the last 13 years, at Jordan University Hospital. RESULTS A total of 811 thyroid surgery reports were identified and revised to identify the potential NIFTP cases. The review yielded 173 cases identified as potential NIFTP cases. Further pathological slide review resulted in a revised diagnosis of 32 cases of NIFTP according to the new criteria. The NIFTP cases comprised 4% of the total number of thyroidectomy cases and 16.1% of the total pool of previously diagnosed papillary thyroid carcinoma cases at our institution. While 111 cases retained their original diagnosis. Follow-up showed that all patients are alive and well with no evidence of disease. CONCLUSION Patients with NIFTP are not uncommon and the diagnosis is made only after a thorough evaluation of excision. Therefore, initial conservative management of solitary thyroid nodules suspicious for NIFTP in the form of lobectomy is recommended to avoid unnecessary total thyroidectomies. Our follow-up of NIFTP cases is similar to all previous reports.
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Affiliation(s)
- Rajai O Zurikat
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Majd Khader
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Muayad I Azzam
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Zaid M Zahid
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Samer F Daoud
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Salam F Nusirat
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Nader Albsoul
- Department of General Surgery, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Motaz A Al-Natsheh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Mousa A Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan.
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15
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Dinčić M, Todorović J, Nešović Ostojić J, Kovačević S, Dunđerović D, Lopičić S, Spasić S, Radojević-Škodrić S, Stanisavljević D, Ilić AŽ. The Fractal and GLCM Textural Parameters of Chromatin May Be Potential Biomarkers of Papillary Thyroid Carcinoma in Hashimoto's Thyroiditis Specimens. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2020; 26:717-730. [PMID: 32588793 DOI: 10.1017/s1431927620001683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Occasionally, Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) share similar nuclear features. The current study aims to quantify the differences between the investigated specimens of HT-associated PTC versus the HT alone, to reduce the subjective experience of an observer, by the use of fractal parameters as well as gray-level co-occurrence matrix (GLCM) textural parameters. We have analyzed 250 segmented nuclei per group (nn = 25 per patient and np = 10 patients per group) using the ImageJ software (NIH, Bethesda, MD, USA) as well as an in-house written code for the GLCM analysis. The mean values of parameters were calculated for each patient. The results demonstrated that the malignant cells from the HT-associated PTC specimens showed lower chromatin fractal dimension (p = 0.0321) and higher lacunarity (p = 0.0038) compared with the corresponding cells from the HT specimens. Also, there was a statistically significant difference between the investigated specimens, in the contrast, correlation, angular second moment, and homogeneity, of the GLCM corresponding to the visual texture of follicular cell chromatin. The differences in chromatin fractal and GLCM parameters could be integrated with other diagnostic methods for the improved evaluation of distinctive features of the HT-associated PTC versus the HT in cytology and surgical pathology specimens.
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Affiliation(s)
- Marko Dinčić
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Jasna Todorović
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Jelena Nešović Ostojić
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Sanjin Kovačević
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Duško Dunđerović
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Srđan Lopičić
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Svetolik Spasić
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | | | - Dejana Stanisavljević
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andjelija Ž Ilić
- Institute of Physics Belgrade, University of Belgrade, Pregrevica 118, 11080Zemun-Belgrade, Serbia
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16
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Jiwang L, Yahong L, Kai L, Bo H, Yuejiao Z, Haotian W, Tao Y. Clinicopathologic factors and preoperative ultrasonographic characteristics for predicting central lymph node metastasis in papillary thyroid microcarcinoma: a single center retrospective study. Braz J Otorhinolaryngol 2020; 88:36-45. [PMID: 32571753 PMCID: PMC9422721 DOI: 10.1016/j.bjorl.2020.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/21/2020] [Accepted: 05/03/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The treatment of papillary thyroid microcarcinoma remains controversial. Central lymph node metastasis is common in papillary thyroid microcarcinoma and it is an important consideration in treatment strategy selection. Objective The aim of this study was to investigate clinicopathologic risk factors and thyroid nodule sonographic characteristics for central lymph node metastasis in papillary thyroid microcarcinoma. Methods We retrospectively reviewed the data of 599 papillary thyroid microcarcinoma patients who underwent surgery from 2005 to 2017 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic factors and preoperative sonographic features of central lymph node metastasis. A receiver-operating characteristic, ROC curve analysis, was performed to identify the efficacy of ultrasonographic features in predicting central lymph node metastasis. A nomogram based on the risk factors was established to predict central lymph node metastasis. Results The incidence of central lymph node metastasis was 22.4%. The univariate and multivariate analyses suggested that gender, age, multifocality, extrathyroidal invasion, and lateral lymph node metastasis were independent risk factors for central lymph node metastasis. The univariate and multivariate analyses revealed that nodular shape, margin, and calcification were independently associated with central lymph node metastasis. The ROC curve analysis revealed that the combination of shape, margin and calcification had excellent accuracy in predicting central lymph node metastasis. The nomogram was developed based on the identified risk factors for predicting central lymph node metastasis, and the calibration plot analysis indicated the good performance and clinical utility of the nomogram. Conclusions Central lymph node metastasis is associated with male gender, younger age (<45 years), extrathyroidal invasion, multifocality and lateral lymph node metastasis in papillary thyroid microcarcinoma patients. The ultrasongraphic features, such as irregular shape, ill-defined margin and calcification, may improve the efficacy of predicting central lymph node metastasis. Surgeons and radiologists should pay close attention to the patients who have these risk factors. The nomogram may help guide surgical decision making in papillary thyroid microcarcinoma.
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Affiliation(s)
- Liang Jiwang
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Head and Neck Surgery, Liaoning Province, People's Republic of China
| | - Luo Yahong
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Medical Imaging, Liaoning Province, People's Republic of China
| | - Liang Kai
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Medical Imaging, Liaoning Province, People's Republic of China
| | - Huang Bo
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Pathology, Liaoning Province, People's Republic of China
| | - Zhao Yuejiao
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Head and Neck Surgery, Liaoning Province, People's Republic of China
| | - Wang Haotian
- Grade 2016 Clinical Medicine Class 5, The First Clinical College, Dalian Medical University, Liaoning Province, People's Republic of China
| | - Yu Tao
- Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Medical Imaging, Liaoning Province, People's Republic of China.
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17
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Marina M, Serra MF, Aldigeri R, Ceresini G. Incidental versus clinically diagnosed differentiated thyroid cancer in both adult and elderly subjects: histological characteristics and follow-up in a retrospective analysis from a single institution. Endocrine 2020; 68:584-591. [PMID: 31970586 DOI: 10.1007/s12020-020-02200-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Most thyroid cancer are incidentally diagnosed. However, little is known on the different modalities of incidental diagnosis in adult versus older patients. METHODS We retrospectively analyzed data from 440 patients consecutively diagnosed with differentiated thyroid cancer (DTC) in a single institution. Modalities of diagnosis were categorized as follows: (A) clinically diagnosed, nonincidental cases; (B) incidental during carotid power-duplex (CPD); (C) incidental during neck imaging other than carotid power-duplex; (D) incidental during imaging workup of thyroid dysfunction or at histological examination after thyroidectomy for benign lesions. Demographics, histology and follow-up were compared between adult (<65 years) and older (≥65 years) patients according to the different modalities of diagnosis. RESULTS A total of 363 and 67 cases were recorded in adult and older patients, respectively with incidental proportions of 79% and 85%, respectively. A P < 0.001 significant difference in the modality of diagnosis was found between adult and older subjects, the latter presenting with a higher prevalence of Group B. In the nonincidental group, papillary histotype, larger size, and extrathyroidal invasion were more frequently observed in older subjects. Disease-free survival was comparable between adult and older subjects in the incidental cases, whereas it was reduced, though not significantly, in older subjects. CONCLUSION Incidental cases of DTC are more frequently diagnosed in the old subjects and are mainly due to CPD. Disease-free survival is comparable between adult and older subjects in both incidental and nonincidental cases, although it may be slightly reduced in nonincidentally diagnosed older patients.
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Affiliation(s)
- Michela Marina
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Maria Francesca Serra
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Raffaella Aldigeri
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Graziano Ceresini
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy.
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More Y, Khalil AB, Mustafa H, Gupte M, Al-Abbadi M, Elamin D, Aziz L, Basha SI. Incidental Thyroid cancer in patients undergoing surgery for hyperthyroidism. Am J Otolaryngol 2020; 41:102187. [PMID: 31757411 DOI: 10.1016/j.amjoto.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/04/2019] [Indexed: 12/24/2022]
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Lohia S, Hanson M, Tuttle RM, Morris LGT. Active surveillance for patients with very low-risk thyroid cancer. Laryngoscope Investig Otolaryngol 2020; 5:175-182. [PMID: 32128446 PMCID: PMC7042648 DOI: 10.1002/lio2.356] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/07/2020] [Accepted: 01/25/2020] [Indexed: 01/03/2023] Open
Abstract
Over the past 30 years in the United States, increasing identification of small thyroid nodules has led to a dramatic rise in the detection of small thyroid cancers, many of which are unlikely to progress to overt clinical disease. Because autopsy studies reveal that up to 30% of people harbor clinically occult thyroid cancers, the growing use of diagnostic technologies has identified an increasing number of small, clinically low risk papillary thyroid cancers (PTCs). In recent years, clinical practice has evolved to de-intensify the treatment for PTCs, with fewer total thyroidectomy and nodal dissection procedures being performed, in favor of more limited operations. In addition, vigilant observation of selected low risk cancers has demonstrated outcomes comparable to those patients who undergo immediate surgical intervention. Active surveillance has emerged as a new option within the treatment algorithm of PTCs. There is now robust data from cancer centers in Japan and Korea which have reported excellent oncologic outcomes among patients undergoing active surveillance for PTC, as well as more recent, similar data from the United States. American Thyroid Association guidelines now include the option of active surveillance for appropriately selected patients with low-risk PTC. With active surveillance now one option within the standard of care for patients with certain thyroid cancers, surgeons have become critical to facilitating shared decision-making for patients facing this diagnosis.
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Affiliation(s)
- Shivangi Lohia
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Martin Hanson
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - R. Michael Tuttle
- Department of Medicine, Endocrine ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Luc G. T. Morris
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
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20
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Loomans-Kropp HA, Dunn BK, Kramer BS, Pinsky P. Thyroid Incidentalomas in Association With Low-Dose Computed Tomography in the National Lung Screening Trial. Am J Epidemiol 2020; 189:27-33. [PMID: 31595954 DOI: 10.1093/aje/kwz219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/18/2019] [Indexed: 02/06/2023] Open
Abstract
Advances in cancer screening methods have opened avenues for incidental findings and cancer overdiagnosis. We performed a secondary analysis of the National Lung Screening Trial (enrollment from 2002-2004), a randomized controlled trial comparing low-dose computed tomography (LDCT; n = 26,722) with chest radiography (CXR; n = 26,732) for lung cancer detection, to examine incidental findings related to thyroid cancer (ThCa). Three screening rounds were included, and median follow-up was 6.6 years for LDCT and 6.5 years for CXR. Radiologists reported lung and non-lung-related abnormalities. In the LDCT arm, 5.7%, 4.7%, and 4.5% of participants had abnormalities above the diaphragm (AADs) detected at baseline, year 1, and year 2, respectively, compared with 2.3%, 1.5%, and 1.3% in the CXR arm. In the LDCT arm, 205 AADs (7.0%) were thyroid-related. Overall, 60 ThCas were reported, 35 in the LDCT arm and 25 in the CXR arm (P = 0.2). In the LDCT arm, participants with a prior AAD had a 7.8-fold increased risk (95% confidence interval: 4.0, 15.1) of ThCa compared with those who did not have an AAD. Early and persistent excess of ThCas diagnosed earlier in the LDCT arm suggests overdiagnosis. The use of sensitive screening modalities for early detection of lung cancer might result in the discovery of thyroid incidentalomas.
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Affiliation(s)
- Holli A Loomans-Kropp
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
- Gastrointestinal and Other Cancers Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Barbara K Dunn
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Paul Pinsky
- Early Detection Research Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
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Jeong C, Kim H, Lee J, Ha J, Kim MH, Kang MI, Lim DJ. Fine-Needle Aspiration of Subcentimeter Thyroid Nodules in the Real-World Management. Cancer Manag Res 2020; 12:7611-7618. [PMID: 32943919 PMCID: PMC7468373 DOI: 10.2147/cmar.s263451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/02/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The Korea Thyroid Association published the revised guidelines for thyroid nodules in 2016. However, whether fine-needle aspiration is accurately performed based on indications and whether the results of this procedure are appropriately addressed according to clinical guidelines, particularly in subcentimeter nodules, are unclear. METHODS We retrospectively analyzed the fine-needle aspiration data of 331 thyroid nodules of patients who were referred to a tertiary hospital clinic for fine-needle aspiration. Each nodule was categorized according to ultrasonography findings based on the recommendations of the Korea Thyroid Association for fine-needle aspiration. Only nodules with a final pathological diagnosis of benign or malignant made using the Bethesda system were included. RESULTS Up to 32% of thyroid nodules that were not indicated for fine-needle aspiration were aspirated. Regarding subcentimeter nodules, only 28 of 123 (22.8%) aspirated nodules were indicated for fine-needle aspiration. Of the 49 malignant subcentimeter nodules, 33 (67.3%) underwent immediate surgery. Meanwhile, 14 (28.6%) nodules were lost to follow-up, and two (4.1%) were under active surveillance. Eighteen (36.7%) malignant subcentimeter nodules were not indicated for fine-needle aspiration but underwent surgical resection instead of active surveillance. CONCLUSION Despite the recommendations in the revised guidelines, several thyroid nodules that do not meet the indications for FNA are aspirated in real-world practice. To reduce overtreatment, a widespread knowledge of the correct indications for fine-needle aspiration is important in clinical practice, particularly for subcentimeter nodules.
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Affiliation(s)
- Chaiho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunsam Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moo Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Fiore M, Cristaldi A, Okatyeva V, Lo Bianco S, Oliveri Conti G, Zuccarello P, Copat C, Caltabiano R, Cannizzaro M, Ferrante M. Physical Activity and Thyroid Cancer Risk: A Case-Control Study in Catania (South Italy). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081428. [PMID: 31013573 PMCID: PMC6517930 DOI: 10.3390/ijerph16081428] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/10/2019] [Accepted: 04/14/2019] [Indexed: 12/24/2022]
Abstract
Background: The health benefits of physical activity are well established, but the association between physical activity and thyroid cancer remains poorly understood. The aim of the study was to investigate the relationship between physical activity and thyroid cancer in order to determine type, frequency, and duration of exercise needed to maximize prevention. Method: Cases, diagnosed from January 2009 to July 2018, and controls were enrolled at the University Hospital “Policlinico-Vittorio Emanuele” of Catania (South Italy). Logistic regression models were used to estimate the crude and adjusted odds ratios (ORs) and their 95% confidence intervals. Results: A total of 106 cases (91.2% papillary type) and 217 controls were enrolled. Physical activity was rare in Catania (32.8%) and was not correlated to risk of total thyroid cancer (OR: 0.997; 95% CI: 0.515–1.929). Conversely, walking every day for at least 60 minutes reduced the risk of thyroid cancer (OR: 0.357; 95% CI: 0.157–0.673). Conclusions: Our study showed that daily walking duration was associated with lower risk of thyroid cancer using a case-control study. Unfortunately, the frequency of physical activity often declines with age, particularly among the elderly, thus more research on physical activity adherence is needed to determine which approaches are most effective in promoting sustained physical activity participation.
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Affiliation(s)
- Maria Fiore
- Environmental and Food Hygiene Laboratory (LIAA), Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
| | - Antonio Cristaldi
- Environmental and Food Hygiene Laboratory (LIAA), Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
| | - Valeriya Okatyeva
- General Surgery, Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", 95123 Catania, Italy.
| | - Salvatore Lo Bianco
- General Surgery, Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", 95123 Catania, Italy.
| | - Gea Oliveri Conti
- Environmental and Food Hygiene Laboratory (LIAA), Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
| | - Pietro Zuccarello
- Environmental and Food Hygiene Laboratory (LIAA), Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
| | - Chiara Copat
- Environmental and Food Hygiene Laboratory (LIAA), Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", Section of Anatomic Pathology, 95123 Catania, Italy.
| | - Matteo Cannizzaro
- General Surgery, Department of Medical and Surgical Sciences and Advanced Technologies, "G.F. Ingrassia", 95123 Catania, Italy.
| | - Margherita Ferrante
- Environmental and Food Hygiene Laboratory (LIAA), Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, 95123 Catania, Italy.
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Li F, Wu Y, Chen L, Hu L, Liu X. Evaluation of clinical risk factors for predicting insidious right central and posterior right recurrent laryngeal nerve lymph node metastasis in papillary thyroid microcarcinoma patients (cN0): experience of a single center. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:8. [PMID: 30788355 DOI: 10.21037/atm.2018.12.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Papillary thyroid microcarcinoma (PTMC), one specific subtype of papillary thyroid carcinoma (PTC) which measures less than 10 mm in maximum dimension, presents with a high risk of insidious lymph node metastasis escaping from preoperative examinations (cN0). Given the complications of lymph node dissection (LND) and metastasis risk, proper stratification of PTMC for performing prophylactic LND bears great importance. Methods From June 2015 to December 2017, 338 PTMC patients undergoing thyroidectomy were included in the present study. Potential risk factors, including age, gender, maximal tumor size, etc. were collected and analyzed for association with thyroid lymph node metastasis. Results Among the 338 patients, 87 patients (25.7%) presented with right central lymph node metastasis (CLNM) and 28 patients (8.3%) had posterior right recurrent laryngeal nerve lymph node metastasis (PRRLN-LNM). The maximal tumor was prone to occur at the middle part of the lower pole (35.3%) in patients with right CLNM, while the proportion of tumors located in the middle part of the upper pole (17.2%) was highest in PRRLN-LNM patients. Ages younger than 45 years old, male gender, and a tumor size of more than 0.5 cm were correlated independently with right CLNM and PRRLN-LNM. Presence of capsular invasion also had a significant association with the occurrence of PRRLN-LNM. Conclusions Ages younger than 45, male gender, and a maximal tumor size larger than 0.5 cm, in addition to capsular invasion, were independent risk factors for stratification of PTMC patients. PTMC patients with these clinical characteristics were suggested to receive prophylactic LND in their initial thyroid surgeries.
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Affiliation(s)
- Fuqiang Li
- Thyroid Disease Diagnosis and Treatment Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Yijun Wu
- Thyroid Disease Diagnosis and Treatment Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Liang Chen
- Thyroid Disease Diagnosis and Treatment Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Liang Hu
- Thyroid Disease Diagnosis and Treatment Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Xiaosun Liu
- Thyroid Disease Diagnosis and Treatment Center, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Borges AKDM, Miranda-Filho A, Koifman S, Koifman RJ. Thyroid Cancer Incidences From Selected South America Population-Based Cancer Registries: An Age-Period-Cohort Study. J Glob Oncol 2018; 4:1-11. [PMID: 30241178 PMCID: PMC6180755 DOI: 10.1200/jgo.17.00024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The incidence of thyroid cancer (TC) has increased substantially worldwide. However, there is a lack of knowledge about age-period-cohort (APC) effects on incidence rates in South American countries. This study describes the TC incidence trends and analyzes APC effects in Cali, Colombia; Costa Rica; Goiânia, Brazil; and Quito, Ecuador. MATERIALS AND METHODS Data were obtained from the Cancer Incidence in Five Continents series, and the crude and age-standardized incidence rates were calculated. Trends were assessed using the estimated annual percentage change, and APC models were estimated using Poisson regression for individuals between age 20 and 79 years. RESULTS An increasing trend in age-standardized incidence rates was observed among women from Goiânia (9.2%), Costa Rica (5.7%), Quito (4.0%), and Cali (3.4%), and in men from Goiânia (10.0%) and Costa Rica (3.4%). The APC modeling showed that there was a period effect in all regions and for both sexes. Increasing rate ratios were observed among women over the periods. The best fit model was the APC model in women from all regions and in men from Quito, whereas the age-cohort model showed a better fit in men from Cali and Costa Rica, and the age-drift model showed a better fit among men from Goiânia. CONCLUSION These findings suggest that overdiagnosis is a possible explanation for the observed increasing pattern of TC incidence. However, some environmental exposures may also have contributed to the observed increase.
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Affiliation(s)
- Anne Karin da Mota Borges
- Anne Karin da Mota Borges, Sérgio
Koifman,† and Rosalina Jorge Koifman, National
Public Health School, Oswaldo Cruz Foundation; Anne Karin da Mota
Borges, Brazilian National Cancer Institute, Rio de Janeiro, Brazil;
and Adalberto Miranda-Filho, International Agency for Research on
Cancer, Lyon, France
| | - Adalberto Miranda-Filho
- Anne Karin da Mota Borges, Sérgio
Koifman,† and Rosalina Jorge Koifman, National
Public Health School, Oswaldo Cruz Foundation; Anne Karin da Mota
Borges, Brazilian National Cancer Institute, Rio de Janeiro, Brazil;
and Adalberto Miranda-Filho, International Agency for Research on
Cancer, Lyon, France
| | - Sérgio Koifman
- Anne Karin da Mota Borges, Sérgio
Koifman,† and Rosalina Jorge Koifman, National
Public Health School, Oswaldo Cruz Foundation; Anne Karin da Mota
Borges, Brazilian National Cancer Institute, Rio de Janeiro, Brazil;
and Adalberto Miranda-Filho, International Agency for Research on
Cancer, Lyon, France
| | - Rosalina Jorge Koifman
- Anne Karin da Mota Borges, Sérgio
Koifman,† and Rosalina Jorge Koifman, National
Public Health School, Oswaldo Cruz Foundation; Anne Karin da Mota
Borges, Brazilian National Cancer Institute, Rio de Janeiro, Brazil;
and Adalberto Miranda-Filho, International Agency for Research on
Cancer, Lyon, France
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Teng H, Mao F, Liang J, Xue M, Wei W, Li X, Zhang K, Feng D, Liu B, Sun Z. Transcriptomic signature associated with carcinogenesis and aggressiveness of papillary thyroid carcinoma. Theranostics 2018; 8:4345-4358. [PMID: 30214625 PMCID: PMC6134936 DOI: 10.7150/thno.26862] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/16/2018] [Indexed: 01/27/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the fastest-growing disease caused by numerous molecular alterations in addition to previously reported DNA mutations. There is a compelling need to identify novel transcriptomic alterations that are associated with the pathogenesis of PTC with potential diagnostic and prognostic implications. Methods: We gathered and compared 242 expression profiles between paired PTC and adjacent normal tissues and identified and validated the coding and long non-coding RNAs (lncRNAs) associated with the extrathyroidal extension (ETE) of 655 PTC patients in two independent cohorts, followed by predicting their interactions with drugs. Co-expression, RNA interaction, Kaplan-Meier survival and multivariate Cox proportional regression analyses were performed to identify dysregulated lncRNAs and genes that correlated with clinical outcomes of PTC. Alternative splicing (AS), RNA circularization, and editing were also compared between transcriptomes to expand the repertoire of molecular alterations in PTC. Results: Numerous genes related to cellular microenvironment and steroid hormone response were associated with the ETE of PTC. Drug susceptibility predictions of the expression signature revealed two highly ranked compounds, 6-bromoindirubin-3'-oxime and lovastatin. Co-expression and RNA interaction analysis revealed the essential role of lncRNAs in PTC pathogenesis by modulating extracellular matrix and cell adhesion. Eight genes and two novel lncRNAs were identified that correlated with the aggressive nature and disease-free survival of PTC. Furthermore, this study provided the transcriptome-wide landscape of circRNAs in PTC and uncovered dissimilar expression profiles among circRNAs originating from the same host gene, suggesting the functional complexity of circRNAs in PTC carcinogenesis. The newly identified AS events in the SERPINA1 and FN1 genes may improve the sensitivity and specificity of these diagnostic biomarkers. Conclusions: Our study uncovered a comprehensive transcriptomic signature associated with the carcinogenesis and aggressive behavior of PTC, as well as presents a catalog of 10 potential biomarkers, which would facilitate PTC prognosis and development of new therapeutic strategies for this cancer.
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Affiliation(s)
- Huajing Teng
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
| | - Fengbiao Mao
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
| | - Jialong Liang
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
| | - Meiying Xue
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Wenqing Wei
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Xianfeng Li
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
| | - Kun Zhang
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China
| | - Dongdong Feng
- Department of Head and Neck Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Baoguo Liu
- Department of Head and Neck Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhongsheng Sun
- Beijing Institutes of Life Science, Chinese Academy of Sciences, Beijing, China
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Wang Y, Guan Q, Xiang J. Nomogram for predicting central lymph node metastasis in papillary thyroid microcarcinoma: A retrospective cohort study of 8668 patients. Int J Surg 2018; 55:98-102. [PMID: 29803769 DOI: 10.1016/j.ijsu.2018.05.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The status of central lymph node metastasis (CLNM) is crucial to determining the surgical strategies for papillary thyroid micro carcinoma (PTMC). The objective of the study was to establish a nomogram to predict the possibility of CLNM in PTMC patients. METHODS A total of 8668 PTMC patients who underwent total thyroidectomy or lobectomy with central lymph node dissection (CLND) from 2006 to 2016 were retrospectively retrieved. Univariate and multivariate analysis were performed to examine risk factors associated with CLNM. A nomogram for predicting CLNM was established and internally validated. RESULTS Six variables significantly associated with CLNM were included in our model, these are age <55 years (odd ratio [OR] = 1.779, 95% confidence interval [CI],1.569-2.017; P < 0.001), male sex (OR = 1.718, 95%CI,1.543-1.913; P < 0.001), tumor size 0.5-1.0 cm (OR = 1.985,95%CI,1.761-2.238; P < 0.001), multifocal lesions (OR = 1.263, 95%CI,1.118-1.426; P < 0.001), extra thyroidal extension (ETE) (OR = 1.348, 95%CI,1.092-1.664; P = 0.005) and lateral lymph node metastasis (LLNM) (OR = 5.135, 95%CI, 4.236-6.225; P < 0.001). The discrimination of the prediction model was 0.711 (95%CI, 0.700-0.722; P < 0.001). CONCLUSIONS Based on the quantified risk stratification offered by our nomogram, clinicians might have a thorough discussion with PTMC patients during the both pre- and postoperative period. Prophylactic CLND and strict postoperative evaluation may be indicated when the patients have a high nomogram score.
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Affiliation(s)
- Yunjun Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Qing Guan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Jun Xiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Du L, Wang Y, Sun X, Li H, Geng X, Ge M, Zhu Y. Thyroid cancer: trends in incidence, mortality and clinical-pathological patterns in Zhejiang Province, Southeast China. BMC Cancer 2018; 18:291. [PMID: 29544469 PMCID: PMC5856225 DOI: 10.1186/s12885-018-4081-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/31/2018] [Indexed: 01/17/2023] Open
Abstract
Background Thyroid cancer is the most common malignant disease of the endocrine system. Previous studies indicate a rapid increase in the incidence of thyroid cancer in recent decades, and this increase has aroused the great public concern. The aim of this study was to analyze the trends in incidence, mortality and clinical-pathological patterns of thyroid cancer in Zhejiang province. Methods Population-based incidence and mortality rates of thyroid cancer were collected from eight cancer registries in Zhejiang from 2000 to 2012. The incidence and mortality rates were age-standardized to Segi’s world population. A Joinpoint model was used to examine secular trends in age-adjusted thyroid cancer rates with the Joinpoint Regression Program Version 4.0.0. Thyroid cancer patients were recruited from Zhejiang Cancer Hospital from 1972 to 2014. Patient demographics, tumor histology and tumor size were compared among the different periods of 1972–1985, 1986–1999 and 2000–2014. Results The age-standardized incidence rate of thyroid cancer in Zhejiang cancer registries was 2.75/105 in 2000, and increased to 19.42/105 in 2012. Additionally, we observed significantly increasing incidence rates with the Annual Percent Change (APC) of 22.86% (95%CI, 19.2%–26.7%). The age-standardized mortality of thyroid cancer in Zhejiang cancer registries was 0.23/105 in 2000 and 0.25/105 in 2012. No significant change in mortality rate was found. We observed a rapid increase in the proportions of papillary thyroid carcinoma (PTC) in 12,508 patients with thyroid carcinoma identified in the Zhejiang Cancer Hospital from 1972 to 2014 while the proportions of poorly differentiated thyroid cancer (PDTC), medullary thyroid carcinoma (MTC) and follicular thyroid carcinoma (FTC) decreased over the decades. In the PTC cases, the proportion of patients with maximum tumor diameter (MTD) < 1 cm dramatically and significantly increased from 0 in 1972–1985 to 32.1% in 2000–2014. Conclusions A rapid increase in incidence and a stable trend in mortality of thyroid cancer were found in the distribution of thyroid cancer. Most of the increased incidence was PTC, especially the papillary thyroid microcarcinoma (PTMC) with MTD < 1 cm. This increase in incidence might be due to increased diagnosis with advanced technology.
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Affiliation(s)
- Lingbin Du
- Zhejiang Cancer Center, Zhejiang Cancer Hospital, No.30 Jichang Road, Hangzhou, Zhejiang, 310004, China
| | - Youqing Wang
- Zhejiang Cancer Center, Zhejiang Cancer Hospital, No.30 Jichang Road, Hangzhou, Zhejiang, 310004, China
| | - Xiaohui Sun
- Department of Epidemiology & Biostatistics, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Zhejiang, Hangzhou, 310058, China
| | - Huizhang Li
- Zhejiang Cancer Center, Zhejiang Cancer Hospital, No.30 Jichang Road, Hangzhou, Zhejiang, 310004, China
| | - Xinwei Geng
- Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Minghua Ge
- Zhejiang Cancer Center, Zhejiang Cancer Hospital, No.30 Jichang Road, Hangzhou, Zhejiang, 310004, China. .,Head and Neck Surgery, Zhejiang Cancer Hospital, No.1 East Banshan Road, Hangzhou, Zhejiang, 310022, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Zhejiang, Hangzhou, 310058, China.
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Furuya-Kanamori L, Sedrakyan A, Onitilo AA, Bagheri N, Glasziou P, Doi SAR. Differentiated thyroid cancer: millions spent with no tangible gain? Endocr Relat Cancer 2018; 25:51-57. [PMID: 29042396 DOI: 10.1530/erc-17-0397] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/08/2022]
Abstract
The incidence of differentiated thyroid cancer (DTC) has rapidly increased worldwide over the last decades. It is unknown if the increase in diagnosis has been mirrored by an increase in thyroidectomy rates with the concomitant economic impact that this would have on the health care system. DTC and thyroidectomy incidence as well as DTC-specific mortality were modeled using Poisson regression in New South Wales (NSW), Australia per year and by sex. The incidence of 2002 was the point from which the increase in rates was assessed cumulatively over the subsequent decade. The economic burden of potentially avoidable thyroidectomies due to the increase in diagnosis was estimated as the product of the additional thyroidectomy procedures during a decade attributable to rates beyond those reported for 2002 and the national average hospital cost of an uncomplicated thyroidectomy in Australia. The following results were obtained. The incidence of both DTC and thyroidectomy doubled in NSW between 2003 and 2012, while the DTC-specific mortality rate remained unchanged over the same period. Based on the 2002 incidence, the projected increase over 10 years (2003-2012) in thyroidectomy procedures was 2196. This translates to an extra cost burden of over AUD$ 18,600,000 in surgery-related health care expenditure over one decade in NSW. Our findings suggest that, if this rise is solely attributable to overdetection, then the rising expenditure serves no additional purpose. Reducing unnecessary detection and a conservative approach to managing DTC are sensible and would lead to millions of dollars in savings and reduced harms to patients.
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Affiliation(s)
- Luis Furuya-Kanamori
- Department of Population MedicineCollege of Medicine, Qatar University, Doha, Qatar
| | - Art Sedrakyan
- Research School of Population HealthAustralian National University, Canberra, ACT, Australia
- Department of Healthcare Policy and ResearchWeill Cornell Medicine, New York, New York, USA
| | - Adedayo A Onitilo
- Department of Hematology/OncologyMarshfield Clinic Weston Center, Weston, Wisconsin, USA
| | - Nasser Bagheri
- Research School of Population HealthAustralian National University, Canberra, ACT, Australia
| | - Paul Glasziou
- Centre for Research in Evidence Based PracticeBond University, Gold Coast, QLD, Australia
| | - Suhail A R Doi
- Department of Population MedicineCollege of Medicine, Qatar University, Doha, Qatar
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Zhang L, Chen J, Xu C, Qi L, Ren Y. Effects of iodine-131 radiotherapy on Th17/Tc17 and Treg/Th17 cells of patients with differentiated thyroid carcinoma. Exp Ther Med 2017; 15:2661-2666. [PMID: 29467858 DOI: 10.3892/etm.2017.5663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/09/2017] [Indexed: 12/28/2022] Open
Abstract
T helper 17 (Th17), T cytotoxic 17 (Tc17) and regulatory T (Treg) cells serve important roles in a number of inflammatory and autoimmune diseases. The aim of the present study was to examine the distribution of Th17, Tc17 and Treg cells in patients with differentiated thyroid cancer (DTC) prior to as well as 7, 30 and 90 days following radioactive iodine-131 (131I) therapy, and to elucidate the probable effects of 131I therapy on Th17/Tc17 and Treg/Th17 cells in patients with DTC. A total of 40 patients with DTC (26 female; 14 male) between the ages of 24 and 72 years, as well as 13 age- and sex-matched healthy subjects were included in this study. The number of Th17, Tc17 and Treg cells in the peripheral blood of patients with DTC and of healthy Controls were assessed by flow cytometry. Th17 and Tc17 cells were counted as percentages of the number of CD3+ T cells; Treg cells were counted as a percentage of the number of CD4+T cells. In addition, the serum levels of interleukin (IL)-17, IL-23, IL-10 and transforming growth factor (TGF)-β1 were examined by ELISA. The frequencies of Th17, Tc17 and Treg cells, as well as the serum levels of IL-17, IL-23, IL-10 and TGF-β1 were significantly elevated in patients with DTC compared with healthy Controls, whereas 131I therapy significantly decreased them. In addition, elevated Th17/Tc17 ratio and reduced Treg/Th17 ratio were observed in patients with DTC at day 0, however, these ratios returned to normal levels following 131I therapy for 90 days as compared with healthy Controls. Notably, Th17/Tc17 and Treg/Th17 ratios varied following 131I therapy for 7 and 30 days. In addition, a strong positive correlation between Th17 and Tc17 cells was observed in the healthy Controls and patients with DTC that received 131I treatment for 90 days, whereas a weak positive correlation between Th17 and Treg cell levels was identified in the healthy Controls and no obvious correlation between Th17 and Treg cells was observed in all patients with DTC pre- and post-131I therapy during the entire treatment period. These data suggested a significant involvement of Th17, Tc17 and Treg cells in the pathology of DTC. Restoring the balance of these cells may contribute to the recovery of patients with DTC following 131I therapy.
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Affiliation(s)
- Lixia Zhang
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Jinyan Chen
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Caiyun Xu
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Lili Qi
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
| | - Yan Ren
- Department of Nuclear Medicine, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310006, P.R. China
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Arnoux G, Pusztaszeri M. "Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features" With Focal Spindle Cell Metaplasia. Int J Surg Pathol 2017; 26:261-265. [PMID: 29212393 DOI: 10.1177/1066896917741548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
"Noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) is a recent reclassification of the encapsulated follicular variant of papillary thyroid carcinoma, which is supposed to reflect its indolent clinical behavior and to prevent overtreatment of patients with this neoplasm. The diagnosis of NIFTP can only be made histologically on the surgical specimen according to specific inclusion and exclusion criteria, which requires the examination of the whole nodule and its capsule. Spindle cell proliferations, especially of follicular cell origin, arising within thyroid follicular neoplasms are very rare and may cause diagnostic difficulties. Few reports described spindle cell proliferations arising in follicular thyroid adenoma and papillary thyroid carcinoma. To the best of our knowledge, only one case has been reported in NIFTP so far. In this article, we report a unique case of NIFTP associated with a spindle cell proliferation that was characterized immunohistochemically. Specific issues related to this case are discussed.
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Affiliation(s)
| | - Marc Pusztaszeri
- 1 Geneva University Hospital, Geneva, Switzerland.,Current affiliation: Department of Pathology, Jewish General Hospital and McGill University, 3755 Côte-Sainte-Catherine Road, Montréal, Québec, Canada H3T 1E2
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31
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Sanabria A, Kowalski LP, Shah JP, Nixon IJ, Angelos P, Williams MD, Rinaldo A, Ferlito A. Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis. Head Neck 2017; 40:855-866. [PMID: 29206325 DOI: 10.1002/hed.25029] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/24/2017] [Accepted: 10/25/2017] [Indexed: 01/03/2023] Open
Abstract
There is an increasing incidence of well-differentiated thyroid cancer worldwide. Much of the increase is secondary to increased detection of small, low-risk tumors, with questionable clinical significance. This review addresses the factors that contribute to the increasing incidence and considers environmental, and patient-based and clinician-led influences. Articles addressing the causes of the increased incidence were critically reviewed. A complex interplay of environmental, medical, and social pressures has resulted in increased awareness of the thyroid disease risk, increased screening of thyroid cancers, and increased diagnosis of thyroid cancers. Although there is evidence to suggest that the true disease incidence may be changing slightly, most of the increase is related to factors that promote early diagnosis of low-risk lesions, which is resulting in a significant phenomenon of overdiagnosis. An improved understanding of these pressures at a global level will enable healthcare policymakers to react appropriately to this challenge in the future.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Clinica Vida/Instituto de Cancerología Las Americas, Medellin, Colombia, South America
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Jatin P Shah
- Department of Head and Neck Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Michelle D Williams
- Department of Pathology, Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Goepfert RP, Clayman GL. Management of the central compartment in differentiated thyroid carcinoma. Eur J Surg Oncol 2017; 44:327-331. [PMID: 28964612 DOI: 10.1016/j.ejso.2017.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 08/05/2017] [Accepted: 09/05/2017] [Indexed: 01/14/2023] Open
Abstract
Management of differentiated thyroid carcinoma (DTC) is gradually evolving with considerations of de-escalation of treatment and/or active surveillance in a significant proportion of patients on the basis of an improved understanding of the long-term disease and functional outcomes from both surgical and non-surgical approaches. This is fueled by improved risk stratification using clinicopathologic prognostic factors as determined through high resolution ultrasound and fine needle aspiration cytology. This paper discusses general recommendations for preoperative decision-making in the management of the central compartment in DTC with particular reference to micropapillary thyroid carcinoma and encapsulated follicular variant papillary thyroid carcinoma. Given the multitude of specific factors that must be considered for each patient, therapeutic decisions should occur in a multidisciplinary setting weighing the risks of treatment morbidity against the risks of disease progression or recurrence. Recurrent/persistent disease merits special attention with regard to pre-operative planning and surgical risk, and should be managed by high-volume thyroid surgeons.
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Affiliation(s)
- Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1445, Houston, TX, 77030, USA.
| | - Gary L Clayman
- The Clayman Thyroid Surgery and Thyroid Cancer Center, Tampa, FL, USA.
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Marina M, Ceda GP, Aldigeri R, Ceresini G. Causes of referral to the first endocrine visit of patients with thyroid carcinoma in a mildly iodine-deficient area. Endocrine 2017; 57:247-255. [PMID: 27738889 DOI: 10.1007/s12020-016-1140-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
To evaluate the causes of the first referral to an endocrine visit of patients with thyroid cancer in a mildly iodine-deficient area and to correlate them with prognostic features. We studied 298 consecutive patients (64 M and 234 F) with thyroid cancer. Of these, 281 had differentiated thyroid cancer. The causes of referral were categorized as follows: (Group A) clinical evidence of a neck lump; (Group B) incidental imaging in subjects without known thyroid diseases; (Group C) incidental imaging during a workup of thyroid disorders. Also, in differentiated thyroid cancer cases, clinical, histomorphologic, and prognostic parameters were compared among the three different groups of referral causes. In both total thyroid cancer and differentiated thyroid cancer cohorts, Group A, B, and C accounted for about 25, 35, and 40 % of causes, respectively. Considering the differentiated thyroid cancer, in Group B, ultrasound accounted for 94 % of cases, with 73 % resulting from screening or serendipitous study. Within a median follow-up of 5.6 [IQR: 2.7-9.5] years, disease-free survival was significantly lower in patients of Group A (Log-Rank test p = 0.030 vs. the other groups of causes). However, at the Cox multivariate analysis only male sex (p = 0.002) and stage (p = 0.005), but not referral cause, resulted independent predictors of events. In patients without known thyroid disease, unjustified thyroid ultrasound represents the main cause of referral of thyroid cancer patients to the first endocrine visit. The fact that this is not related to the disease-free survival strengthens the concept of the uselessness of thyroid cancer screening.
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Affiliation(s)
- Michela Marina
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Gian Paolo Ceda
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Raffaella Aldigeri
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
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Papaleontiou M, Hughes DT, Guo C, Banerjee M, Haymart MR. Population-Based Assessment of Complications Following Surgery for Thyroid Cancer. J Clin Endocrinol Metab 2017; 102:2543-2551. [PMID: 28460061 PMCID: PMC5505192 DOI: 10.1210/jc.2017-00255] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/25/2017] [Indexed: 01/22/2023]
Abstract
CONTEXT As thyroid cancer incidence rises, more patients undergo thyroid surgery. Although postoperative complication rates have been reported in single institution studies, population-based data are limited. OBJECTIVE To determine thyroid cancer surgery complication rates and identify at-risk populations. DESIGN/SETTING/PATIENTS Using the Surveillance, Epidemiology, and End Results-Medicare database, we evaluated general complications within 30 days and thyroid surgery-specific complications within 1 year in 27,912 patients who underwent surgery for differentiated or medullary thyroid cancer between 1998 and 2011. Multivariable analyses of patient characteristics associated with postoperative complications were performed. MAIN OUTCOME MEASURES General and thyroid surgery-specific complications. RESULTS Overall, 1820 (6.5%) patients developed general postoperative complications and 3427 (12.3%) developed thyroid surgery-specific complications. In multivariable analyses, general and thyroid surgery-specific complications were significantly higher in patients >65 years [odds ratio (OR), 2.61; 95% confidence interval (CI), 2.31 to 2.95; OR, 3.12; 95% CI, 2.85 to 3.42], those with a Charlson/Deyo comorbidity score of 1 (OR, 2.40; 95% CI, 1.66 to 3.49; OR, 1.88; 95% CI, 1.53 to 2.31) and ≥2 (OR, 7.05; 95% CI, 5.33 to 9.56; OR, 3.62; 95% CI, 3.11 to 4.25), and those with regional (OR, 1.18; 95% CI, 1.03 to 1.35; OR, 1.31; 95% CI, 1.19 to 1.45) or distant disease (OR, 2.83; 95% CI, 2.30 to 3.47; OR, 1.85; 95% CI, 1.54 to 2.21), respectively. CONCLUSIONS The rates of thyroid cancer surgery complications are higher than predicted, and patients with older age, more comorbidities, and advanced disease are at greatest risk. Efforts to reduce complications are needed.
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Affiliation(s)
- Maria Papaleontiou
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48106
| | - David T. Hughes
- Division of Endocrine Surgery, Department of General Surgery, University of Michigan, Ann Arbor, Michigan 48109
| | - Cui Guo
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109
| | - Mousumi Banerjee
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, Michigan 48109
| | - Megan R. Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48106
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Abstract
Thyroid neoplasms encompass a variety of lesions that range from benign adenomas to malignancies. These latter can be well-differentiated, poorly differentiated or undifferentiated (anaplastic) carcinomas. More than 95% of thyroid cancers are derived from thyroid follicular cells, while 2-3% (medullary thyroid cancers, MTC) originate from calcitonin producing C-cells. Over the last decade, investigators have developed a clearer understanding of genetic alterations underlying thyroid carcinogenesis. A number of point mutations and translocations are involved, not only in its tumorigenesis, but also as have potential use as diagnostic and prognostic indicators and therapeutic targets. Many occur in genes for several important signaling pathways, in particular the mitogen-activated protein kinase (MAPK) pathway. Sporadic (isolated) lesions account for 75% of MTC cases, while inherited MTC, often in association with multiple endocrine neoplasia (MEN) type 2A and 2B syndromes, constitute the remainder. However, non-MEN familial MTC may also occur. Advances in genetic testing have revolutionized the management of MTC, with prospects of genetic screening, testing and early prophylactic thyroidectomy. Ethical concerns of these advances are addressed.
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Affiliation(s)
- Enas Younis
- King Hussein Cancer center (KHCC), Amman, Jordan.
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36
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Dankner R, Boffetta P, Balicer RD, Boker LK, Sadeh M, Berlin A, Olmer L, Goldfracht M, Freedman LS. Time-Dependent Risk of Cancer After a Diabetes Diagnosis in a Cohort of 2.3 Million Adults. Am J Epidemiol 2016; 183:1098-106. [PMID: 27257115 DOI: 10.1093/aje/kwv290] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/17/2015] [Indexed: 12/14/2022] Open
Abstract
Using a time-dependent approach, we investigated all-site and site-specific cancer incidence in a large population stratified by diabetes status. The study analyzed a closed cohort comprised of Israelis aged 21-89 years, enrolled in a health fund, and followed from 2002 to 2012. Adjusting for age, ethnicity, and socioeconomic status, we calculated hazard ratios for cancer incidence using Cox regression separately for participants with prevalent and incident diabetes; the latter was further divided by time since diabetes diagnosis. Of the 2,186,196 individuals included in the analysis, 159,104 were classified as having prevalent diabetes, 408,243 as having incident diabetes, and 1,618,849 as free of diabetes. In both men and women, diabetes posed an increased risk of cancers of the liver, pancreas, gallbladder, endometrium, stomach, kidney, brain (benign), brain (malignant), colon/rectum, lung (all, adenocarcinoma, and squamous cell carcinoma), ovary, and bladder, as well as leukemia, multiple myeloma, non-Hodgkin lymphoma, and breast cancer in postmenopausal women. No excess risk was observed for breast cancer in premenopausal women or for thyroid cancer. Diabetes was associated with a reduced risk of prostate cancer. Hazard ratios for all-site and site-specific cancers were particularly elevated during the first year following diabetes diagnosis. The findings of this large study with a time-dependent approach are consistent with those of previous studies that have observed associations between diabetes and cancer incidence.
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Souza MCD, Momesso DP, Vaisman F, Vieira Neto L, Martins RAG, Corbo R, Vaisman M. Is radioactive iodine- 131 treatment related to the occurrence of non-synchronous second primary malignancy in patients with differentiated thyroid cancer? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:9-15. [PMID: 26222230 PMCID: PMC10118921 DOI: 10.1590/2359-3997000000078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Much controversy relates to the risk of non-synchronous second primary malignancies (NSSPM) after radioactive iodine treatment (RAI-131) in differentiated thyroid cancer (DTC) patients. This study evaluated the relationship between RAI-131 and NSSPM in DTC survivors with long-term follow-up. MATERIALS AND METHODS Retrospective analysis of 413 DTC cases was performed; 252 received RAI-131 and 161 were treated with thyroidectomy alone. Exclusion criteria were: prior or synchronous non-thyroidal malignancies (within the first year), familial syndromes associated to multiple neoplasms, ionizing radiation exposure or second tumors with unknown histopathology. RESULTS During a mean follow-up of 11.0 ± 7.5 years, 17 (4.1%) patients developed solid NSSPM. Patients with NSSPM were older than those without (p = 0.02). RAI-131 and I-131 cumulative activity were similar in patients with and without NSSPM (p = 0.18 and p = 0.78, respectively). Incidence of NSSPM was 5.2% in patients with RAI-131 treatment and 2.5% in those without RAI-131 (p = 0.18). Using multivariate analysis, RAI-131 was not significantly associated with NSSPM occurrence (p = 0.35); age was the only independent predictor (p = 0.04). Under log rank statistical analysis, after 10 years of follow-up, it was observed a tendency of lower NSSPM-free survival among patients that received RAI-131 treatment (0.96 vs . 0.87; p = 0.06), what was not affected by age at DTC diagnosis. CONCLUSION In our cohort of DTC survivors, with a long-term follow-up period, RAI-131 treatment and I-131 cumulative dose were not significantly associated with NSSPM occurrence. A tendency of premature NSSPM occurrence among patients treated with RAI-131 was observed, suggesting an anticipating oncogenic effect by interaction with other risk factors.
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Affiliation(s)
| | | | - Fernanda Vaisman
- Universidade Federal do Rio de Janeiro, Brazil; Instituto Nacional do Cancer, Brazil
| | | | | | - Rossana Corbo
- Universidade Federal do Rio de Janeiro, Brazil; Instituto Nacional do Cancer, Brazil
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Pandeya N, McLeod DS, Balasubramaniam K, Baade PD, Youl PH, Bain CJ, Allison R, Jordan SJ. Increasing thyroid cancer incidence in Queensland, Australia 1982-2008 - true increase or overdiagnosis? Clin Endocrinol (Oxf) 2016; 84:257-264. [PMID: 25597380 DOI: 10.1111/cen.12724] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 12/15/2014] [Accepted: 01/13/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thyroid cancer incidence has been increasing worldwide. Some suggest greater ascertainment of indolent tumours is the only driver, but others suggest there has been a true increase. Increases in Australia appear to have been among the largest in the world, so we investigated incidence trends in the Australian state of Queensland to help understand reasons for the rise. METHODS Thyroid cancers diagnoses in Queensland 1982-2008 were ascertained from the Queensland Cancer Registry. We calculated age-standardized incidence rates (ASR) and used Poisson regression to estimate annual percentage change (APC) in thyroid cancer incidence by socio-demographic and tumour-related factors. RESULTS Thyroid cancer ASR in Queensland increased from 2·2 to 10·6/100 000 between 1982 and 2008 equating to an APC of 5·5% [95% confidence interval (CI) 4·7-6·4] in men and 6·1% (95% CI 5·5-6·6) in women. The rise was evident, and did not significantly differ, across socio-economic and remoteness-of-residence categories. The largest increase seen was in the papillary subtype in women (APC 7·9%, 95% CI 7·3-8·5). Incidence of localized and more advanced-stage cancers rose over time although the increase was greater for early-stage cancers. CONCLUSION There has been a marked increase in thyroid cancer incidence in Queensland. The increase is evident in men and women across all adult age groups, socio-economic strata and remoteness-of-residence categories as well as in localized and more advanced-stage cancers. Our results suggest 'overdiagnosis' may not entirely explain rising incidence. Contemporary aetiological data and individual-level information about diagnostic circumstances are required to further understand reasons for rising thyroid cancer incidence.
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Affiliation(s)
- N Pandeya
- School of Population Health, The University of Queensland, Herston, Brisbane, Qld, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Qld, Australia
| | - D S McLeod
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Qld, Australia
- Department of Endocrinology and Diabetes, Royal Brisbane & Women Hospital, Brisbane, Qld, Australia
| | - K Balasubramaniam
- School of Population Health, The University of Queensland, Herston, Brisbane, Qld, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Qld, Australia
| | - P D Baade
- Cancer Council Queensland, Brisbane, Qld, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
- Griffith Health Institute, Griffith University, Gold Coast, Qld, Australia
| | - P H Youl
- Cancer Council Queensland, Brisbane, Qld, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
- Griffith Health Institute, Griffith University, Gold Coast, Qld, Australia
| | - C J Bain
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Qld, Australia
| | - R Allison
- Cancer Care Services, Royal Brisbane & Women Hospital, Brisbane, Qld, Australia
| | - S J Jordan
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Qld, Australia
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Abstract
OBJECTIVES Thyroid cancer incidence is increasing worldwide, while mortality from thyroid cancer is stable or decreasing. Consequently, survival rates are rising. We describe time trends in the incidence, mortality, and 5-year survival of thyroid cancer in Israel in 1980-2012, in light of the global trends. METHODS Israel National Cancer Registry database provided information regarding thyroid cancer incidence and vital status, which enabled computation of survival rates. The Central Bureau of Statistics database provided information on thyroid cancer mortality. Incidence and mortality rates were age-adjusted and presented by population group (Jews/Arabs) and gender. Relative 5-year survival rates which account for the general population survival in the corresponding time period were presented by population group and gender. Joinpoint analyses were used to assess incidence trends over time. RESULTS In 1980-2012 significant increases in the incidence of thyroid cancer were observed, with an annual percent change (APC) range of 3.98-6.93, driven almost entirely by papillary carcinoma (APCs 5.75-8.86), while rates of other types of thyroid cancer remained stable or decreased. Furthermore, higher rates of early detection were noted. In 1980-2012, a modest reduction in thyroid cancer mortality was observed in Jewish women (APC -1.07) with no substantial change in Jewish men. The 5-year relative survival after thyroid cancer diagnosis has increased to ≥90% in both population groups and both genders. CONCLUSIONS The Israeli secular trends of thyroid cancer incidence (increasing), mortality (mostly stable), and survival (modestly increasing) closely follow reported global trends.
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Affiliation(s)
- Lital Keinan-Boker
- Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel; School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Barbara G Silverman
- Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel; School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gao Y, Qu N, Zhang L, Chen JY, Ji QH. Preoperative ultrasonography and serum thyroid-stimulating hormone on predicting central lymph node metastasis in thyroid nodules as or suspicious for papillary thyroid microcarcinoma. Tumour Biol 2015; 37:7453-9. [DOI: 10.1007/s13277-015-4535-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 11/28/2014] [Indexed: 12/23/2022] Open
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Xu JM, Xu XH, Xu HX, Zhang YF, Guo LH, Liu LN, Liu C, Bo XW, Qu S, Xing M, Li XL. Prediction of cervical lymph node metastasis in patients with papillary thyroid cancer using combined conventional ultrasound, strain elastography, and acoustic radiation force impulse (ARFI) elastography. Eur Radiol 2015; 26:2611-22. [PMID: 26560715 DOI: 10.1007/s00330-015-4088-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the value of combined conventional ultrasound (US), strain elastography (SE) and acoustic radiation force impulse (ARFI) elastography for prediction of cervical lymph node metastasis (CLNM) in papillary thyroid cancer (PTC). METHODS A consecutive series of 203 patients with 222 PTCs were preoperatively evaluated by US, SE, and ARFI including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ). A multivariate analysis was performed to predict CLNM by 22 independent variables. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance. RESULTS Multivariate analysis demonstrated that VTI area ratio (VAR) > 1 was the best predictor for CLNM, followed by abnormal cervical lymph node (ACLN), capsule contact, microcalcification, capsule involvement, and multiple nodules (all P < 0.05). ROC analyses of these characteristics showed the areas under the curve (Az), sensitivity, and specificity were 0.600-0.630, 47.7 %-93.2 %, and 26.9 %-78.4 % for US, respectively; and they were 0.784, 83.0 %, and 73.9 %, respectively, for VAR > 1. As combination of US characteristics with and without VAR, the Az, sensitivity, and specificity were 0.803 and 0.556, 83.0 % and 100.0 %, and 77.6 % and 11.2 %, respectively (P < 0.001). CONCLUSIONS ARFI elastography shows superior performance over conventional US, particularly when combined with US, in predicting CLNM in PTC patients. KEY POINTS • Conventional ultrasound is useful in predicting cervical lymph node metastasis preoperatively. • Virtual touch tissue imaging area ratio is the strongest predicting factor. • Predictive performance is markedly improved by combining ultrasound characteristics with VAR. • Acoustic radiation force impulse elastography may be a promising complementary tool.
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Affiliation(s)
- Jun-Mei Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiao-Hong Xu
- Department of Ultrasound, Guangdong Medical College Affiliated Hospital, 524001, Zhanjiang, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Department of Ultrasound, Guangdong Medical College Affiliated Hospital, 524001, Zhanjiang, China.
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301, Yanchangzhong Road, Shanghai, 200072, China.
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
| | - Lin-Na Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
| | - Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiao-Wan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shen Qu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Mingzhao Xing
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Department of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
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Zhou L, Patel KN. The management of thyroid nodules and cancer in the molecular era. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2015. [DOI: 10.2217/ije.15.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The incidence of thyroid cancer is increasing worldwide. Current standards in the diagnosis and management of thyroid cancer are limited by the uncertainty of fine-needle aspiration samples that are indeterminate in nature. Molecular markers have the potential to improve the accuracy of thyroid fine-needle aspiration and to aid the physician in giving a more accurate diagnosis and prognosis. This paper summarizes the various molecular markers currently available.
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Affiliation(s)
- Ling Zhou
- Division of Endocrine Surgery, Department of Surgery, Biochemistry & Otolaryngology, Thyroid Cancer Interdisciplinary Program, NYU Langone Medical Center, 530 First Avenue, Suite 6H, NY 10016, USA
| | - Kepal N Patel
- Division of Endocrine Surgery, Department of Surgery, Biochemistry & Otolaryngology, Thyroid Cancer Interdisciplinary Program, NYU Langone Medical Center, 530 First Avenue, Suite 6H, NY 10016, USA
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Yin Y, Mao Q, Chen S, Li N, Li X, Li Y. A Clinical Trial of Optimal Time Interval Between Ablation and Diagnostic Activity When a Pretherapy RAI Scanning Is Performed on Patients With Differentiated Thyroid Carcinoma. Medicine (Baltimore) 2015; 94:e1308. [PMID: 26252311 PMCID: PMC4616613 DOI: 10.1097/md.0000000000001308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This article investigates the association of the time interval between the diagnostic dose and ablation with the stunning effect, when a 74 MBq I pretherapy scanning was performed on patients with differentiated thyroid carcinoma (DTC); the patients who were diagnosed as DTC and would be performed radioiodine (RAI) ablation of thyroid remnants or metastases were recruited during January 2011 and May 2012 in our hospital.Thirty-seven patients with DTC who had the RAI ablation of thyroid remnants or metastases for the first time were recruited. All the patients received a dose of 1850 to 7400 MBq of I for ablation and a diagnostic scan was performed 24 hours after the administration of 74 MBq I before ablation. A posttherapy scan was performed 2 to 7 days after the ablation. The patients were broken down into 3 groups (G1, G2, and G3) according to the interval time between the diagnostic dose and therapy (1-3, 4-7, and >7 days). The fractional concentrations of I in remnants or functional metastases were quantified and expressed as therapeutic/diagnostic (Rx/Dx). The level of significance was set at 0.05.Sixty-seven foci were found both on pretherapy and posttherapy scans, the mean ratio of Rx/Dx was 0.43 ± 0.29, and the ratio of 49 foci (73.13%) was <0.6. The ratios in G1, G2, and G3 were 0.46 ± 0.29, 0.29 ± 0.18, and 0.55 ± 0.33, respectively. The differences between G1 and G2, and G2 and G3 were statistically significant (t = 2.40, P = 0.021 and t = 3.28, P = 0.002), whereas the difference between G1 and G3 was not significant (t = 1.01, P = 0.319).By a diagnostic scan of 74 MBq I, stunning prominently occurs with a time of 4 to 7 days between the diagnostic dose and ablation. We recommend that for less stunning effect, RAI ablation should be performed within 3 days or postponed until 1 week after the diagnostic dose administrated.
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Affiliation(s)
- Yafu Yin
- From the Department of Nuclear Medicine, The First Hospital of China Medical University, China Medical University, Shenyang, China
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O'Grady TJ, Gates MA, Boscoe FP. Thyroid cancer incidence attributable to overdiagnosis in the United States 1981-2011. Int J Cancer 2015; 137:2664-73. [DOI: 10.1002/ijc.29634] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Thomas J. O'Grady
- Department of Epidemiology and Biostatistics; School of Public Health, University at Albany; NY
- Department of Basic and Social Sciences; School of Arts and Sciences, Albany College of Pharmacy and Health Sciences; NY
| | - Margaret A. Gates
- Department of Epidemiology and Biostatistics; School of Public Health, University at Albany; NY
| | - Francis P. Boscoe
- New York State Department of Health, New York State Cancer Registry; NY
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Girardi FM, Barra MB, Zettler CG. Analysis of pattern of occurrence of thyroid carcinoma between 2001 and 2010. Braz J Otorhinolaryngol 2015; 81:541-8. [PMID: 26277590 PMCID: PMC9449006 DOI: 10.1016/j.bjorl.2015.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/21/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION An ongoing discussion is found in medical literature about the reasons for changes in thyroid carcinoma incidence patterns over the last decades. OBJECTIVE To analyze the clinical and pathological characteristics of thyroid carcinoma cases over a decade. METHODS Cross-sectional study over an historical cohort. Medical records of 628 thyroid cancer cases in a single center were reviewed. 597 patients were included. Microcarcinoma cases were selected for a qualitative analysis phase, in which medical records were reviewed for better understanding of thyroid nodule and thyroid cancer diagnosis process. RESULTS An increase in the proportion of cases with thyroid cancer diagnosis was observed throughout the decade; new cases were predominantly tumors of less than 2 cm, with histopathological signs of low aggressiveness. There was an increase in proportion of cases with malignant cytological results among microcarcinomas. CONCLUSION There is a trend for increase in thyroidectomies due to cancer in this institution, with proportional increment of cases with histopathological characteristics indicative of early disease. Among microcarcinomas, there is an increasing group represented by cancer cases that were not incidentally diagnosed, related to an enhancement in preoperative diagnostic methods.
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Affiliation(s)
- Fábio Muradás Girardi
- Head and Neck Surgery Department, Hospital Santa Rita, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil.
| | - Marinez Bizarro Barra
- Pathology Department, Hospital Santa Rita, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil
| | - Cláudio Galleano Zettler
- Pathology Department, Hospital Santa Rita, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil
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Colonna M, Uhry Z, Guizard AV, Delafosse P, Schvartz C, Belot A, Grosclaude P. Recent trends in incidence, geographical distribution, and survival of papillary thyroid cancer in France. Cancer Epidemiol 2015; 39:511-8. [PMID: 26003877 DOI: 10.1016/j.canep.2015.04.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/23/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Over the past few decades, the incidence of thyroid cancer has dramatically increased in many countries. This increase was mainly seen in papillary cancer. The role of diagnostic practices and the effects of other risk factors were suggested to explain this increase. We provide a descriptive analysis in terms of changes in incidence, geographical distribution, and survival to check the relevance of assumptions about the increase. METHODS A detailed analysis of changes in incidence recorded in French cancer registries between 1982 and 2010 was performed taking into account age, period, and birth cohort. The geographical distribution of the incidence in the 2006-2010 period was estimated from the standardized incidence ratios. The net survival was estimated to evaluate the effects of sex, age, and period of diagnosis in patients diagnosed between 1989 and 2004 and followed-up until 2013. RESULTS The incidence of papillary cancer has increased sharply over the 1982-2010 period; the average annual rate of increase was 7.8% in men and 7.2% in women. The increase has slowed in the recent period in people aged less than 50 at the time of diagnosis. It has also slowed in the cohorts born 1945 and after. There was a strong geographic disparity in incidence between areas covered by cancer registries. Finally, the net survival was very high; the 10-year net survival was 96% and improved progressively from 82% in patients diagnosed between 1989 and 1993 to 95% in those diagnosed between 1999 and 2004. CONCLUSION The increased incidence results most probably from the effect of medical practice, although other risk factors seem also involved, but to a lesser extent. The increase seems to have slowed down in the recent years, especially in the youngest age groups. This observation suggests a recent trend towards saturation of the effects of medical practices in post-1945 cohorts associated with an effect of the gradual dissemination of the recommendations relative to the management of thyroid nodules.
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Affiliation(s)
- M Colonna
- Registre du cancer de l'Isère, CHU Grenoble, F-38043, Grenoble, France; FRANCIM, F-31073, Toulouse, France.
| | - Z Uhry
- Institut de Veille Sanitaire, Département des Maladies Chroniques et Traumatismes, F-94410, Saint-Maurice, France; Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, CNRS UMR5558, F-69100, Villeurbanne France
| | - A V Guizard
- Registre des tumeurs du Calvados, Centre François Baclesse, F-14076, Caen, France; FRANCIM, F-31073, Toulouse, France
| | - P Delafosse
- Registre du cancer de l'Isère, CHU Grenoble, F-38043, Grenoble, France; FRANCIM, F-31073, Toulouse, France
| | - C Schvartz
- Registre des cancers de la thyroïde de Marne-Ardennes, CLCC Jean Godinot, F-51100, Reims, France; FRANCIM, F-31073, Toulouse, France
| | - A Belot
- Institut de Veille Sanitaire, Département des Maladies Chroniques et Traumatismes, F-94410, Saint-Maurice, France; Hospices Civils de Lyon, Service de Biostatistique, F-69495, Pierre-Bénite, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, CNRS UMR5558, F-69100, Villeurbanne France; Cancer Research UK Cancer Survival Group, Faculty of Epidemiology and Population Health, London, UK
| | - P Grosclaude
- Registre des Cancer du Tarn, Centre Hospitalier spécialisé, F-81000, Albi, France; FRANCIM, F-31073, Toulouse, France
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Lin JD. Discovering Incidental Thyroid Disease by Imaging Studies. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zhan XX, Zhao B, Diao C, Cao Y, Cheng RC. Expression of MUC1 and CD176 (Thomsen-Friedenreich antigen) in papillary thyroid carcinomas. Endocr Pathol 2015; 26:21-6. [PMID: 25614211 DOI: 10.1007/s12022-015-9356-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incidence of thyroid cancer has appeared as an increasing trend globally, especially in Asian countries. In this study, the expression of mucin-1 (MUC1) and Thomsen-Friedenreich antigen, Galβ1-3GalNAcα1-R (CD176) was investigated by immunohistochemistry in papillary thyroid carcinomas (PTCs), which accounts for approximately 80 % of all thyroid cancer. We found that 78 % of PTC overexpressed MUC1. Importantly, we observed firstly that CD176 was expressed in 63 % of PTC, but was faintly or not expressed in normal thyroid tissues and benign thyroid disease tissues, indicating that CD176 is also a tumour-associated antigen for PTCs. Moreover, expression of CD176 was strongly correlated with MUC1 by immunohistochemical staining in PTCs. Furthermore, we used the immunochemical method to confirm that MUC1 is a common and main carrier of CD176 in PTCs. Our data demonstrated that MUC1 and CD176 might be promising biomarkers for thyroid cancer.
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Affiliation(s)
- Xiang-xiang Zhan
- Thyroid Disease Diagnosis and Treatment Center, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming, 650031, Yunnan, China
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Monti E, Bovero M, Mortara L, Pera G, Zupo S, Gugiatti E, Dono M, Massa B, Ansaldo GL, Massimo G. BRAF Mutations in an Italian Regional Population: Implications for the Therapy of Thyroid Cancer. Int J Endocrinol 2015; 2015:138734. [PMID: 26693224 PMCID: PMC4674605 DOI: 10.1155/2015/138734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/27/2015] [Accepted: 10/28/2015] [Indexed: 01/21/2023] Open
Abstract
Background. Molecular diagnostics has offered new techniques for searching for mutations in thyroid indeterminate lesions. The study's aim was to evaluate the BRAF mutations' incidence in an Italian regional population. Subjects and Methods. 70 Caucasian patients born in Liguria with indeterminate or suspicious cytological diagnoses. Results. A BRAF gene mutation was successfully analyzed in 56/70 patients. The mutation was BRAF V600E in 12/56 cases (21%) and BRAF K601E in 2/56 (4%). Of the BRAF mutated samples on cytological diagnosis (14/56 cases), 2/14 cases (14%) were benign on final histology and 12/14 (86%) were malignant. All BRAF-mutated cases on cytology that were found to be benign on histological examination carried the K601E mutation. Of the nonmutated BRAF cases (42/56, 75%) which were later found to be malignant on definitive histology, 5 cases were follicular carcinomas (36%), 3 cases were incidentally found to be papillary microcarcinomas (22%), 2 were cases papillary carcinomas (14%), 1 was case follicular variant of papillary carcinoma (7%), 1 was case medullary carcinoma (7%), 1 case was Hurtle cell tumor (7%), and 1 case was combined cell carcinoma and papillary oncocytic carcinoma (7%). Conclusions. The presence of the BRAF V600E mutation may suggest a more aggressive surgical approach. BRAF K601E mutation did not correlate with malignancy indexes.
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Affiliation(s)
- Eleonora Monti
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
- *Eleonora Monti:
| | - Michela Bovero
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Lorenzo Mortara
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Giorgia Pera
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Simonetta Zupo
- Department of Pathology, Molecular Diagnostic Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Elena Gugiatti
- Department of Pathology, Molecular Diagnostic Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Mariella Dono
- Department of Pathology, Molecular Diagnostic Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Barbara Massa
- Department of Pathology, Molecular Diagnostic Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Gian Luca Ansaldo
- Department of Surgery, Endocrinology Surgery Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
| | - Giusti Massimo
- Department of Internal Medicine, Endocrinology Unit, IRCCS IST Azienda Ospedaliera Universitaria “San Martino”, Largo R. Benzi, No. 10, 16132 Genoa, Italy
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Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia. Surgery 2015; 157:111-8. [DOI: 10.1016/j.surg.2014.05.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 05/30/2014] [Indexed: 01/10/2023]
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