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Hekimsoy İ, Ertan Y, Serin G, Karabulut AK, Özbek SS. Comparison of ultrasound findings of papillary thyroid carcinoma subtypes based on the 2022 WHO classification of thyroid neoplasms. Front Endocrinol (Lausanne) 2024; 15:1434787. [PMID: 39205684 PMCID: PMC11349574 DOI: 10.3389/fendo.2024.1434787] [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: 05/18/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose The present study aimed to analyze and compare sonographic features of papillary thyroid carcinoma (PTC) subtypes to determine whether ultrasound (US) may aid in differentiating particular subtypes. Methods This retrospective study enrolled 133 patients diagnosed with 142 histopathologically proven PTCs as per the fifth edition of the World Health Organization classification of thyroid neoplasms between January 2013 and May 2023. US features based on the American College of Radiology and European Thyroid Imaging and Reporting Data Systems (TIRADS), and histopathological characteristics of nodules were assessed and compared. Results Histopathological analysis yielded 55 (38.7%) classic PTC, 32 (22.5%) invasive encapsulated follicular variant (IEFV) PTC, 20 (14.1%) oncocytic subtype, 14 (9.9%) non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), 11 (7.8%) infiltrative follicular subtype, 7 (4.9%) tall cell subtype, 2 (1.4%) solid subtype, and 1 (0.7%) diffuse sclerosing subtype. The US findings indicating malignancy, such as taller-than-wide shape, irregular margins, echogenic foci, and higher TIRADS categories, were more frequently demonstrated in nodules with classic PTC and the tall cell subtype, in line with their histopathological features. Conversely, IEFV-PTC and NIFTP rarely exhibited these high-risk sonographic features. US appearance of the oncocytic subtype more frequently overlapped with IEFV-PTC, yet hypo/very hypoechoic nodules with larger nodular diameters and higher TIRADS scores may favor the diagnosis of this subtype. Conclusion US features of certain subtypes may guide the differential diagnosis regarding shape, margin, echogenic foci, and TIRADS category of nodules; however, definitive subtyping is not yet possible using US images alone.
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Affiliation(s)
- İlhan Hekimsoy
- Department of Radiology, İzmir Torbalı State Hospital, Izmir, Türkiye
| | - Yeşim Ertan
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Gürdeniz Serin
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Türkiye
| | | | - Süha Süreyya Özbek
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Türkiye
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Ben Thayer M, Khanchel F, Helal I, Chiboub D, Raoueh H, Ben Brahim E, Jouini R, Chadli-Debbiche A. Epidemiological and histopathological characteristics of thyroid carcinoma in a Tunisian health care center. World J Otorhinolaryngol Head Neck Surg 2024; 10:37-42. [PMID: 38560041 PMCID: PMC10979045 DOI: 10.1002/wjo2.147] [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: 09/07/2022] [Revised: 08/10/2023] [Accepted: 09/19/2023] [Indexed: 04/04/2024] Open
Abstract
Background Thyroid carcinoma (TC) accounts for almost 0.5%-1% of total malignancies. Its incidence is increasing rapidly worldwide. Several studies have drawn up the epidemiological profile of TC and its clinical and pathological features. However, to date, no similar studies have been conducted in Tunisia. Aims To establish an epidemiological profile of TC in a Tunisian health care institute and to analyze its clinical and histopathological characteristics in our institute. Materials and Methods We present a retrospective study reviewing the cases of TC diagnosed in our institution in a 4-year period. Results We collected a sample of 192 cases of TC. It consisted of 31 males and 161 females (83.8%) with a sex-ratio M/F of 0.19. The mean age was 46.4 years. Papillary thyroid carcinoma was the most frequent histological subtype. The multifocality rate was 33.8%. The mean size of TC was 2.2 ± 1.9 cm. 60.9% of TC were staged pT1 and 20.3% had nodal involvement. Papillary thyroid microcarcinomas were noted in 37.5% of cases. Conclusion Our results were consistent with those of the literature. A high proportion of pT1 and pN0 tumors were noted in our series, suggesting that TC's diagnosis and management was performed at an early stage of the disease in our institution. In addition, our study enabled us to notice the impact of the Coronavirus disease 19 crisis on the management of TC in our institution. Further studies are needed to establish the epidemiological profile of TC in Tunisia and to assess its clinical and pathological features.
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Affiliation(s)
- Maissa Ben Thayer
- Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia
- Depatment of Pathology Habib Thameur's Hospital Tunis Tunisia
| | - Fatma Khanchel
- Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia
- Depatment of Pathology Habib Thameur's Hospital Tunis Tunisia
| | - Imen Helal
- Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia
- Depatment of Pathology Habib Thameur's Hospital Tunis Tunisia
| | - Dorra Chiboub
- Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia
- Department of Otorhinolaryngology-Head and Neck surgery Habib Thameur's Hospital Tunis Tunisia
| | - Hedhli Raoueh
- Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia
- Depatment of Pathology Habib Thameur's Hospital Tunis Tunisia
| | - Ehsen Ben Brahim
- Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia
- Depatment of Pathology Habib Thameur's Hospital Tunis Tunisia
| | - Raja Jouini
- Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia
- Depatment of Pathology Habib Thameur's Hospital Tunis Tunisia
| | - Aschraf Chadli-Debbiche
- Faculty of Medicine of Tunis Tunis El Manar University Tunis Tunisia
- Depatment of Pathology Habib Thameur's Hospital Tunis Tunisia
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Buczyńska A, Kościuszko M, Krętowski AJ, Popławska-Kita A. Exploring the clinical utility of DPP-IV and SGLT2 inhibitors in papillary thyroid cancer: a literature review. Front Pharmacol 2024; 15:1323083. [PMID: 38292938 PMCID: PMC10824900 DOI: 10.3389/fphar.2024.1323083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
In the realm of clinical management, Papillary Thyroid Cancer (PTC) stands out as a prevalent thyroid malignancy, characterized by significant metabolic challenges, particularly in the context of carbohydrate metabolism. Recent studies have unveiled promising applications of Dipeptidyl Peptidase-IV (DPP-IV) and Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors, which are conventionally employed in the treatment of type 2 diabetes mellitus (T2DM), as potential adjuncts in anticancer therapy. DPP-IV and SGLT2 inhibitors can be imply to counteract the Warburg effect in cancer, with a specific focus on PTC, owing to their potential metabolic advantages and their influence on the tumor microenvironment, achieved by imposing restrictions on glucose accessibility. Consequently, a comprehensive review has been undertaken, involving meticulous examination of the existing body of evidence pertaining to the utilization of DPP-IV and SGLT2 inhibitors in the context of PTC. The mechanisms of action inherent to these inhibitors have been thoroughly explored, drawing upon insights derived from preclinical investigations. Furthermore, this review initiates discussions concerning the implications for future research directions and the formulation of innovative therapeutic strategies for PTC. As the intricate interplay between carbohydrate metabolism, the Warburg effect, and cancer progression garners increasing attention, attaining a comprehensive understanding of the roles played by DPP-IV and SGLT2 inhibitors in PTC management may serve as the cornerstone for novel approaches aimed at enhancing patient care and broadening the spectrum of available therapeutic modalities.
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Affiliation(s)
- Angelika Buczyńska
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Maria Kościuszko
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Adam Jacek Krętowski
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Anna Popławska-Kita
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
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Qusty NF, Albarakati AJA, Almasary M, Alsalamah S, Alharbi L, Alharthi A, Al Sulaiman IN, Baokbah TAS, Taha M. Thyroid Cancer Knowledge and Awareness in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e47888. [PMID: 38034267 PMCID: PMC10681848 DOI: 10.7759/cureus.47888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2023] [Indexed: 12/02/2023] Open
Abstract
Background Thyroid cancer incidence has been increasing worldwide over the last few decades. It is the most common endocrine cancer and is most common among females. The study contributes to filling the knowledge gap among Saudi people regarding thyroid cancer. Objectives This research aims to investigate the level of thyroid cancer knowledge and awareness in Saudi Arabia, identify potential knowledge gaps, and develop targeted strategies for enhancing public awareness and education. Methods A cross-sectional, voluntary online survey was conducted from 1st August 2023 to 1st October 2023 among residents living in Saudi Arabia over 18 years of age. The participants included were 2030 respondents. Data analysis was performed using RStudio (R version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria). Results Among the participants, the majority were female (60.4%). A total of 49.7% of the individuals reported having a moderate to high level of knowledge about thyroid cancer. While 63.9% knew the association of a lump in the neck to thyroid cancer, 82.6% affirmed to consult a doctor upon discovering a lump, 72.1% knew that regular monitoring of neck lumps is crucial for early diagnosis and treatment of precancerous conditions, 38.7% were aware of females being prone to thyroid cancer, and 59.2% were aware of the link between lifestyle and increased risk. Higher awareness scores were positively associated with female gender, previously having thyroid function tests done, and previously undergoing a US scan of the thyroid. Conclusion In this study, Saudi individuals are reported to lack some aspects of knowledge and perception of thyroid cancer. This study emphasizes filling the existing knowledge gap in thyroid cancer awareness in the Saudi population.
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Affiliation(s)
- Naeem F Qusty
- Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | | | - Manal Almasary
- Medicine, Faculty of Medicine, Umm Al-Qura University, Al-Qunfudah, SAU
| | - Seham Alsalamah
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Lama Alharbi
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Amnah Alharthi
- Medicine, College of Medicine, King Khalid University, Abha, SAU
| | | | - Tourki A S Baokbah
- Medical Emergency Services, College of Health Sciences, Umm Al-Qura University, Al-Qunfudah, SAU
| | - Medhat Taha
- Anatomy, College of Medicine, Umm Al-Qura University, Al-Qunfudah, SAU
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Bukasa-Kakamba J, Bangolo AI, Bayauli P, Mbunga B, Iyese F, Nkodila A, Atoot A, Anand G, Lee SH, Chaudhary M, Fernandes PQ, Mannam HPSS, Polavarapu A, Merajunnissa M, Azhar A, Alichetty MN, Singh G, Arana Jr GV, Sekhon I, Singh M, Rodriguez-Castro JD, Atoot A, Weissman S, M’buyamba JR. Proportion of thyroid cancer and other cancers in the democratic republic of Congo. World J Exp Med 2023; 13:17-27. [PMID: 37396884 PMCID: PMC10308319 DOI: 10.5493/wjem.v13.i3.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo (DRC). The proportion of thyroid cancer has increased over the past three decades. There are very few studies on cancer epidemiology, and in particular on thyroid cancer in the DRC.
AIM To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers.
METHODS This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa. This study included all cancer cases recorded in the registers between 2005 and 2019.
RESULTS From a sample of 6106 patients, including all cancer types, 68.3% cases were female and 31.7% were male. Breast and cervical cancer were the most common types of cancer in women and, prostate and skin cancer were the most common types in men. Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers. Papillary carcinoma was the most common of thyroid cancers. Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7% and 2%, respectively.
CONCLUSION Newer diagnostic tools led to a surge in cancer diagnoses in the DRC. Thyroid cancer has more than doubled its proportion over the last several decades in the country.
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Affiliation(s)
- John Bukasa-Kakamba
- Endocrine and Metabolic Disorders Department, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Ayrton I Bangolo
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pascal Bayauli
- Endocrine and Metabolic Disorders Department, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Branly Mbunga
- School of Public Health, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Francis Iyese
- Endocrine and Metabolic Disorders Department, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Aliocha Nkodila
- Family Medicine, Protestant University of Congo, Kinshasa Kinshasa, Congo
| | - Ali Atoot
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gaurav Anand
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Stacy H Lee
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Maimona Chaudhary
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pamela Q Fernandes
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hari PSS Mannam
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Adithya Polavarapu
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Merajunissa Merajunnissa
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Abdullah Azhar
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mohan N Alichetty
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gauravdeep Singh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Georgemar V Arana Jr
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Imranjot Sekhon
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Manbir Singh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - José D Rodriguez-Castro
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Adam Atoot
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Simcha Weissman
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jean Rene M’buyamba
- Endocrine and Metabolic Disorders Department, University of Kinshasa, Kinshasa Kinshasa, Congo
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Alibrahim IS, Alnafei KH, Atwah RH, Altwyjri OA, Bassas RB, Alqurashi RO, Alsairafi RA. Thyroid Cancer Knowledge and Awareness Among Women in Makkah Region, Saudi Arabia. Cureus 2023; 15:e37739. [PMID: 37213993 PMCID: PMC10192656 DOI: 10.7759/cureus.37739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Thyroid cancer (TC) is the most prevalent endocrine cancer, and it has shown a rapid rise in incidence across the globe in recent decades. This study aimed to evaluate the level of knowledge about TC among women in the Makkah Region, Saudi Arabia. METHODS A cross-sectional study was conducted between 28 December 2022 and 20 January 2023 among women in the Makkah Region via a self-administrated online questionnaire using Google Forms. Our inclusion criteria were women aged 18 years and older from the Makkah Region, and we excluded healthcare professionals and women who declined to participate in the study. The collected data were analyzed using the SPSS program. RESULTS The sample included 1219 participants. The majority (64%, n = 784) were 18 to 35. Of the participants, 362 (29.7%) had poor knowledge of TC, and only 94 (7.7%) possessed good knowledge. Forty-four percent of the participants (n = 541) believed that TC was incurable, and 86% (n = 1050) did not watch or participate in TC campaigns. Age, marital status, and family members or friends working in the medical field all significantly impacted the participants' knowledge scores. CONCLUSION According to our study, women in the Makkah Region in Saudi Arabia do not fully comprehend the risk factors and symptoms of TC or the diagnostic methods and treatment for it. The results emphasize the value of health campaigns focused on women-in public places and on social media platforms to increase awareness of TC.
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Kong M, Guo Q, Zhou S, Li M, Kuang K, Huang Z, Wu F, Chen X, Zhu Q. Attribute-aware interpretation learning for thyroid ultrasound diagnosis. Artif Intell Med 2022; 131:102344. [DOI: 10.1016/j.artmed.2022.102344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/02/2022]
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de Carlos J, Ernaga A, Irigaray A, Pineda JJ, Echegoyen A, Salvador P, Anda E. Incidentally discovered papillary thyroid microcarcinoma in patients undergoing thyroid surgery for benign disease. Endocrine 2022; 77:325-332. [PMID: 35639243 DOI: 10.1007/s12020-022-03089-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The incidence of thyroid carcinoma has grown significantly over the last few decades. A possible explanation is the increased diagnosis of small thyroid microcarcinoma (TMc). TMc reach a maximum diameter of ≤1 cm, identified during histopathology examination following a thyroidectomy performed for reasons not pertaining to malignancy. This study aims to investigate the prevalence of papillary thyroid microcarcinoma (PTMc) according to the benign pathology that refers patients to surgery and its trend evolution. METHODS Retrospective cohort analysis of 1815 patients who underwent total thyroidectomy for non-malignant diseases in the 2005-2020 period. RESULTS The mean age of the subjects was 53.5 years, with a higher proportion of women (1481, 82.1%). A total of 167 PTMc (9.3%) were incidentally discovered. A multivariate logistic regression analysis was performed, showing no differences in prevalence according to sex or age in patients with PTMc compared to final benign histology. Multinodular goiter increases the risk of PTMc with an odds ratio of 2.2 (p = 0.001) compared to Hashimoto's thyroiditis and Graves' disease (GD). There is a statistically significant increase in the incidence of PTMc in the group operated in the 2017-2020 vs. 2005-2008 period (p = 0.005). CONCLUSION The overall prevalence of PTMc in patients who underwent thyroid surgery for the benign disease was 9.3%. Thyroid nodular hyperplasia was the most frequent benign pathology associated with PTMc compared to Hashimoto's or GD. Gender and age were not correlated with the prevalence of TMc. Over the years, surgical findings of PTMc have grown, particularly in the 2017-2020 period.
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Affiliation(s)
- Joaquín de Carlos
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | - Ander Ernaga
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Ana Irigaray
- Section of Endocrinology, Hospital García Orcoyen, Estella, Navarra, Spain
| | - Jose Javier Pineda
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Ana Echegoyen
- Pathology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Pilar Salvador
- General Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Emma Anda
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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Navarro P, Rocher S, Miró-Martínez P, Oltra-Crespo S. Radioactive iodine and female fertility. Sci Rep 2022; 12:3704. [PMID: 35260614 PMCID: PMC8904766 DOI: 10.1038/s41598-022-07592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/04/2022] [Indexed: 11/17/2022] Open
Abstract
Radioactive iodine (I131) is used after surgery in the treatment of Differentiated Thyroid Carcinoma (DTC). There is no solid evidence about the potential deleterious effect of I131 on women fertility. The objective of this study is to assess the impact that I131 may have on fertility in women. All women followed by DTC in our department have been analyzed and women younger than 45 years old at the time of diagnosis and initial treatment were included. There were 40 women exposed to I131 (study group) and 11 women who were only treated with thyroidectomy (control group). Of the women exposed to I131, 40% went through early menopause, while no cases were reported among their controls. Furthermore, 29.2% of women exposed to I131 had decreased Antimüllerian Hormone (AMH), compared to the only 11% of unexposed women (not significant). Regarding the fertility impairment "perceived" by patients, in the group of women exposed to iodine, 17.9% described being unable to complete their genesic desire whereas, none was registered in the control group. We conclude that radioactive iodine can affect a woman's fertility and shorten her reproductive life, so this is an aspect that should be taken into consideration.
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Affiliation(s)
- Pino Navarro
- Department of Endocrinology, Hospital Virgen de los Lirios Alcoy, 03804, Alicante, Spain.
- Department of Endocrinology, Bernabéu Institute of Reproductive Medicine, 03016, Alicante, Spain.
| | - Sandra Rocher
- Department of Gynaecology and Obstetrics, Hospital Reina Sofía, 30003, Murcia, Spain.
- Department of Gynaecology and Obstetrics, Hospital Universitario Virgen de la Arrixaca, 30120, Murcia, Spain.
| | - Pau Miró-Martínez
- Department of Applied Statistics and Operational Research and Quality, Universitat Politècnica de València, Valencia, Spain
| | - Sandra Oltra-Crespo
- Department of Applied Mathematics, Universitat Politècnica de València, Valencia, Spain
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Baloch ZW, Asa SL, Barletta JA, Ghossein RA, Juhlin CC, Jung CK, LiVolsi VA, Papotti MG, Sobrinho-Simões M, Tallini G, Mete O. Overview of the 2022 WHO Classification of Thyroid Neoplasms. Endocr Pathol 2022; 33:27-63. [PMID: 35288841 DOI: 10.1007/s12022-022-09707-3] [Citation(s) in RCA: 394] [Impact Index Per Article: 197.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
This review summarizes the changes in the 5th edition of the WHO Classification of Endocrine and Neuroendocrine Tumors that relate to the thyroid gland. The new classification has divided thyroid tumors into several new categories that allow for a clearer understanding of the cell of origin, pathologic features (cytopathology and histopathology), molecular classification, and biological behavior. Follicular cell-derived tumors constitute the majority of thyroid neoplasms. In this new classification, they are divided into benign, low-risk, and malignant neoplasms. Benign tumors include not only follicular adenoma but also variants of adenoma that are of diagnostic and clinical significance, including the ones with papillary architecture, which are often hyperfunctional and oncocytic adenomas. For the first time, there is a detailed account of the multifocal hyperplastic/neoplastic lesions that commonly occur in the clinical setting of multinodular goiter; the term thyroid follicular nodular disease (FND) achieved consensus as the best to describe this enigmatic entity. Low-risk follicular cell-derived neoplasms include non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), thyroid tumors of uncertain malignant potential, and hyalinizing trabecular tumor. Malignant follicular cell-derived neoplasms are stratified based on molecular profiles and aggressiveness. Papillary thyroid carcinomas (PTCs), with many morphological subtypes, represent the BRAF-like malignancies, whereas invasive encapsulated follicular variant PTC and follicular thyroid carcinoma represent the RAS-like malignancies. This new classification requires detailed subtyping of papillary microcarcinomas similar to their counterparts that exceed 1.0 cm and recommends not designating them as a subtype of PTC. The criteria of the tall cell subtype of PTC have been revisited. Cribriform-morular thyroid carcinoma is no longer classified as a subtype of PTC. The term "Hürthle cell" is discouraged, since it is a misnomer. Oncocytic carcinoma is discussed as a distinct entity with the clear recognition that it refers to oncocytic follicular cell-derived neoplasms (composed of > 75% oncocytic cells) that lack characteristic nuclear features of PTC (those would be oncocytic PTCs) and high-grade features (necrosis and ≥ 5 mitoses per 2 mm2). High-grade follicular cell-derived malignancies now include both the traditional poorly differentiated carcinoma as well as high-grade differentiated thyroid carcinomas, since both are characterized by increased mitotic activity and tumor necrosis without anaplastic histology and clinically behave in a similar manner. Anaplastic thyroid carcinoma remains the most undifferentiated form; squamous cell carcinoma of the thyroid is now considered as a subtype of anaplastic carcinoma. Medullary thyroid carcinomas derived from thyroid C cells retain their distinct section, and there is a separate section for mixed tumors composed of both C cells and any follicular cell-derived malignancy. A grading system for medullary thyroid carcinomas is also introduced based on mitotic count, tumor necrosis, and Ki67 labeling index. A number of unusual neoplasms that occur in the thyroid have been placed into new sections based on their cytogenesis. Mucoepidermoid carcinoma and secretory carcinoma of the salivary gland type are now included in one section classified as "salivary gland-type carcinomas of the thyroid." Thymomas, thymic carcinomas and spindle epithelial tumor with thymus-like elements are classified as "thymic tumors within the thyroid." There remain several tumors whose cell lineage is unclear, and they are listed as such; these include sclerosing mucoepidermoid carcinoma with eosinophilia and cribriform-morular thyroid carcinoma. Another important addition is thyroblastoma, an unusual embryonal tumor associated with DICER1 mutations. As in all the WHO books in the 5th edition, mesenchymal and stromal tumors, hematolymphoid neoplasms, germ cell tumors, and metastatic malignancies are discussed separately. The current classification also emphasizes the value of biomarkers that may aid diagnosis and provide prognostic information.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald A Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Virginia A LiVolsi
- Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Manuel Sobrinho-Simões
- Department of Pathology, Institute of Molecular Pathology and Immunology, IPATIMUP, University of Porto, Porto, Portugal
| | - Giovanni Tallini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Ozgur Mete
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
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11
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Zha X, Miao Z, Huang X, Wang X, Xie R, Jin J, Zou D, Yang P, Huang Y. The Risk Stratification of Papillary Thyroid Cancer With Bethesda Category III (Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance) by Thyroid Fine-Needle Aspiration Could Be Assisted by Tumor Size for Precision Treatment. Front Endocrinol (Lausanne) 2022; 13:822423. [PMID: 35197932 PMCID: PMC8859163 DOI: 10.3389/fendo.2022.822423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the clinical characteristics of papillary thyroid cancer (PTC) classified as Bethesda category III [atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS)] by fine-needle aspiration (FNA) for precision treatment. METHODS A total of 1,739 patients diagnosed with Bethesda category III (AUS/FLUS) by FNA were investigated, and 290 patients diagnosed with PTC were analyzed. RESULTS The rate of papillary thyroid microcarcinoma (PTMC) was 82.1% (238/290). The rates of lymph node metastases were 44.9% (22/49) and 25.2% (56/222) for PTC and PTMC, respectively (p = 0.006). The rates of extra-thyroid extension were 46.2% (24/52) and 19.8% (47/237) (p < 0.001). Compared with PTMC, PTC had significantly higher odds ratios (ORs) of 3.41 (1.81-6.44, p < 0.001), 2.19 (1.16-4.13, p = 0.016), and 2.51 (1.29-4.88, p = 0.007) for extra-thyroid extension, multifocality, and lymph node metastases, respectively, after adjustment for age and gender. The larger size and BRAF V600E mutation had a robust synergistic effect for invasive features. The rates of lymph node metastases, multifocality, and extra-thyroid extension were significantly increased with larger sizes harboring BRAF V600E mutation. Compared with PTMC harboring wild type (WT)-BRAF, PTC harboring BRAF V600E mutation had adjusted higher ORs of 3.01 (1.26-8.68, p = 0.015), 3.20 (1.22-8.42, p = 0.018), and 5.62 (2.25-14.01, p < 0.001) for lymph node metastases, multifocality, and extra-thyroid extension, respectively. CONCLUSIONS In this study, risk stratification was recommended for patients with Bethesda category III (AUS/FLUS) nodules with a size under 1 cm harboring WT-BRAF being regarded as low risk and should be recommended for active surveillance. Nodules with a size over 1 cm harboring WT-BRAF or those under 1 cm harboring BRAF V600E mutation could be regarded as moderate risk, and molecular testing should be recommended. However, those with a size over 1 cm harboring BRAF V600E mutation should be regarded as high risk, and a diagnostic surgery should be recommended.
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Affiliation(s)
- Xiaojuan Zha
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhenchun Miao
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiu Huang
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xingchun Wang
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruting Xie
- Department of Pathology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiaoying Jin
- Department of Pathology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dajin Zou
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Peng Yang
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yueye Huang
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Yueye Huang,
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12
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Horiguchi K, Yoshida Y, Iwaku K, Emoto N, Kasahara T, Sato J, Shimura H, Shindo H, Suzuki S, Nagano H, Furuya F, Makita N, Matsumoto F, Manaka K, Mitsutake N, Miyakawa M, Yokoya S, Sugitani I. Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults. Endocr J 2021; 68:763-780. [PMID: 33762511 DOI: 10.1507/endocrj.ej20-0692] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The incidence of thyroid carcinoma has been increasing worldwide. This is interpreted as an increase in the incidental detection of papillary thyroid microcarcinomas (PTMCs). However, mortality has not changed, suggesting overdiagnosis and overtreatment. Prospective clinical trials of active surveillance for low-risk PTMC (T1aN0M0) have been conducted in two Japanese institutions since the 1990s. Based on the favorable outcomes of these trials, active surveillance has been gradually adopted worldwide. A task force on the management of PTMC in adults organized by the Japan Thyroid Association therefore conducted a systematic review and has produced the present position paper based on the scientific evidence concerning active surveillance. This paper indicates evidence for the increased incidence of PTMC, favorable surgical outcomes for low-risk PTMC, recommended criteria for diagnosis using fine needle aspiration cytology, and evaluation of lymph node metastasis (LNM), extrathyroidal extension (ETE) and distant metastasis. Active surveillance has also been reported with a low incidence of disease progression and no subsequent recurrence or adverse events on survival if conversion surgery was performed at a slightly advanced stage. Active surveillance is a safe and valid strategy for PTMC, because it might preserve physical quality of life and reduce 10-year medical costs. However, some points should be noted when performing active surveillance. Immediate surgery is needed for PTMC showing high-risk features, such as clinical LNM, ETE or distant metastasis. Active surveillance should be performed under an appropriate medical team and should be continued for life.
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Affiliation(s)
- Kazuhiko Horiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kenji Iwaku
- Sapporo Thyroid Clinic (Ito Hospital), Sapporo 060-0042, Japan
| | - Naoya Emoto
- Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Sakura 285-0014, Japan
| | | | - Junichiro Sato
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroki Shimura
- Department of Laboratory Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan
| | - Satoru Suzuki
- Department of Thyroid and Endocrinology, Division of Internal Medicine, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Hidekazu Nagano
- Department of Molecular Diagnosis, Graduate school of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Fumihiko Furuya
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi 409-3998, Japan
| | - Noriko Makita
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Katsunori Manaka
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Norisato Mitsutake
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
| | - Megumi Miyakawa
- Department of Internal Medicine, Miyakawa Hospital, Kawasaki 210-0802, Japan
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo 113-8603, Japan
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13
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Zeng Z, Li K, Wang X, Ouyang S, Zhang Z, Liu Z, Sun J, Ye X, Kang W, Yu J. Low urinary iodine is a protective factor of central lymph node metastasis in papillary thyroid cancer: a cross-sectional study. World J Surg Oncol 2021; 19:208. [PMID: 34253203 PMCID: PMC8276512 DOI: 10.1186/s12957-021-02302-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background An abrupt increase of thyroid cancer has been witnessed paralleling the supplemented iodine intake in formerly iodine-deficient countries. And increased iodine intake has been linked to the rising incidence rate of papillary thyroid cancer (PTC). However, the correlation between iodine and clinicopathological features of PTC has not been well-characterized. This study aimed to investigate the associations between iodine intake and the clinicopathological features of PTC patients. Methods Three hundred and fifty-nine PTC patients who received surgical treatment in Peking Union Medical College Hospital from May 2015 to November 2020 were retrospectively reviewed. The associations between urinary iodine (UI), urinary iodine/creatinine ratio (UI/U-Cr), and the clinicopathological features of PTC were analyzed. Univariate and multivariate analysis were performed to investigate the relationship between UI level and central lymph node metastasis (CLNM). Results There were no significant differences in UI in different groups according to the variables studied, except that patients with CLNM had higher UI level than CLNM(−) patients. No associations were found between UI/U-Cr and clinicopathological features except variant subtypes (classic/follicular). After dividing patients into high-iodine group and low-iodine group, more patients were found to have CLNM in the high-iodine group (p = 0.02). In addition, younger age, larger tumor size, and classic variant were positively correlated with CLNM (p < 0.05). Univariate analysis showed that insufficient iodine intake (≤ 99 μg/L) was associated with decreased CLNM risk in PTC. And after defining insufficient iodine intake as ≤ 109 μg/L and above requirements as ≥ 190 μg/L, multivariate analysis showed that lower iodine was associated with CLNM in total population of PTC (OR 0.53, 95% CI 0.31–0.91) and in PTC < 1 cm (papillary thyroid microcarcinoma, PTMC) (OR 0.43, 95% CI 0.21–0.87). Conclusions Low iodine was a protective factor for CLNM in papillary thyroid cancer, particularly in those < 1 cm. These results indicated that iodine may not only be an initiator of tumorigenesis, but also a promoter of the development of PTC. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02302-6.
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Affiliation(s)
- Ziyang Zeng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianze Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Siwen Ouyang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zimu Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Zhen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Juan Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Xin Ye
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
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14
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Soares P, Póvoa AA, Melo M, Vinagre J, Máximo V, Eloy C, Cameselle-Teijeiro JM, Sobrinho-Simões M. Molecular Pathology of Non-familial Follicular Epithelial-Derived Thyroid Cancer in Adults: From RAS/BRAF-like Tumor Designations to Molecular Risk Stratification. Endocr Pathol 2021; 32:44-62. [PMID: 33651322 DOI: 10.1007/s12022-021-09666-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
This review addresses the impact of molecular alterations on the diagnosis and prognosis of differentiated thyroid carcinoma (DTC), including papillary, follicular, and well-differentiated carcinoma NOS, as well as oncocytic neoplasms. The molecular characterization of DTC is based upon the well-established dichotomy of BRAF-like and RAS-like designations, together with a remaining third group, less homogeneous, composed of non-BRAF-/non-RAS-like tumors. The role of BRAF V600E mutation in risk stratification is discussed in the clinico-pathological context, namely, staging and invasive features of classic papillary thyroid carcinoma (PTC) and histopathological variants carrying an excellent prognosis (microPTC) or a guarded prognosis, including the aggressive variants tall cell and hobnail cell PTCs. In follicular patterned tumors, namely, follicular thyroid carcinoma (FTC), with or without oncocytic features, the most prevalent molecular alteration are RAS mutations that do not carry prognostic significance. The only genetic alteration that has been proven to play a role in risk stratification of PTC and FTC is TERT promoter (TERTp) mutation.
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Affiliation(s)
- Paula Soares
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal.
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal.
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal.
| | - Antónia Afonso Póvoa
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4400-129, Vila Nova de Gaia, Portugal
| | - Miguel Melo
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar Universitário de Coimbra, 3004-561, Coimbra, Portugal
| | - João Vinagre
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
| | - Valdemar Máximo
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
| | - Catarina Eloy
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
| | - José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), University of Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Manuel Sobrinho-Simões
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar E Universitário São João, 4200-139, Porto, Portugal
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15
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Zhang D, Jones RR, James P, Kitahara CM, Xiao Q. Associations between artificial light at night and risk for thyroid cancer: A large US cohort study. Cancer 2021; 127:1448-1458. [PMID: 33554351 DOI: 10.1002/cncr.33392] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Light at night (LAN) inhibits nighttime secretion of melatonin and may cause circadian disruption, which may be a risk factor for cancer. Recent studies have linked high LAN exposure with elevated breast cancer risk. Given that breast cancer may share a common hormone-dependent etiology with thyroid cancer and that circadian rhythms play a role in regulating thyroid function, the authors hypothesized that exposure to LAN is positively associated with thyroid cancer incidence. METHODS This study examined the association between LAN and thyroid cancer incidence in the National Institutes of Health-American Association of Retired Persons Diet and Health Study. LAN exposure was estimated from satellite data and was linked to residential addresses at the baseline. Incident thyroid cancer cases were ascertained via linkage to state cancer registries. Cox regression was used to determine the relationship between LAN and thyroid cancer risk, with adjustments made for sociodemographic, lifestyle, and other environmental factors. RESULTS Among 464,371 participants, a positive association was found between LAN and thyroid cancer risk. Specifically, in comparison with the lowest quintile of LAN, the highest quintile was associated with a 55% increase in risk (hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.18-2.02). The association was primarily driven by papillary thyroid cancer and was stronger in women (HR, 1.81; 95% CI, 1.26-2.60) than men (HR, 1.29; 95% CI, 0.86-1.94). In women, the association was stronger for localized cancer, whereas in men, the association was stronger for a more advanced stage. Results were consistent across different tumor sizes. CONCLUSIONS LAN was positively associated with thyroid cancer risk. Future studies are needed to confirm this association and identify underlying biological mechanisms.
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Affiliation(s)
- Dong Zhang
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Peter James
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Qian Xiao
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
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16
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Youssef A, Abd-Elmonem MH, Ghazy RAM, El Shafei MM, Zahran M. The diagnostic value of ultrasonography in detection of different types of thyroid nodules. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2020; 36:23. [DOI: 10.1186/s43163-020-00025-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/22/2020] [Indexed: 09/02/2023]
Abstract
Abstract
Background
This article discusses the importance of high frequency ultrasonography in detection of different types of thyroid nodules considering only the histopathological examination of the surgical specimens as the final diagnosis. We studied 50 patients referred to ENT clinic with a thyroid nodule. Ultrasonography and ultrasound-guided fine-needle aspiration biopsy were done to all the patients. Thyroid surgery was done according to FNAB results.
Result
From 50 thyroid specimens, the US could predict the malignancy in 18 specimens. By histopathology, only 16 specimens were malignant, and 34 were benign thyroid disease. The sensitivity, specificity, and accuracy of US were 100%, 94.12%, and 96% respectively. The most suspicious ultrasongraphic feature was microcalcification followed by taller than wider (T ˃ W).
Conclusion
High frequency ultrasound is a very important tool to predict the malignant possibility during thyroid nodule evaluation.
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17
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Zeng Z, Li K, Kang W, Yu J, Wang X, Zhang Z, Sun J, Ouyang S. Changing patterns of thyroid cancer in different stages of Universal Salt Iodization in Peking Union Medical College Hospital, 1986-2018. Gland Surg 2020; 9:1338-1345. [PMID: 33224808 DOI: 10.21037/gs-20-346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Backgrounds Iodine intake may be associated with increased thyroid cancer, but its effect varied from places to places. Universal salt iodization (USI) has been introduced in China from 1996 to 2012. The effects of increased iodine intake on thyroid cancer needs to be investigated in China. Methods From 1986 to 2018, patients who had thyroidectomies in Peking Union Medical College Hospital (PUMCH) were retrospectively studied. The detection rate, constituent ratio, mean age, sex distribution of thyroid cancer and the pattern of papillary thyroid microcarcinoma (PTMC) were compared between different historical periods. Results The detection rate of thyroid cancer in thyroid surgery significantly increased from 6.77% to 75.78% post-USI, with papillary thyroid cancer (PTC) being the majority, and that of follicular thyroid cancer (FTC) and medullary thyroid cancer (MTC) showed only minor changes. There was a descending trend of female/male ratio in PTC from 3.7 to 2.8, and a slight decrease of mean age observed in PTC after USI compared with during USI. The percentage of PTMC in PTC decreased from 13.99% to 8.64%, with a lower mean age after USI (44.88±10.37 vs. 46.44±10.42). Prevalence of goiter coexisting with PTMC was also lower after USI than during USI (31% vs. 41%). Conclusions With the popularization of iodized salt, PTC has become the major type in surgery for thyroid cancer, and trends in other histological subtypes remained mostly stable over the periods. The increase in PTC cannot be attributed to the increase of PTMC which is smaller than 1 cm, indicating that contributing factors other than diagnostic activities, may play a role in the increase of PTC.
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Affiliation(s)
- Ziyang Zeng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weiming Kang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchun Yu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianze Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zimu Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Sun
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siwen Ouyang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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18
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Thyroid Papillary Microtumor: Validation of the (Updated) Porto Proposal Assessing Sex Hormone Receptor Expression and Mutational BRAF Gene Status. Am J Surg Pathol 2020; 44:1161-1172. [PMID: 32804453 DOI: 10.1097/pas.0000000000001522] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Given the high incidence and excellent prognosis of many papillary thyroid microcarcinomas, the Porto proposal uses the designation papillary microtumor (PMT) for papillary microcarcinomas (PMCs) without risk factors to minimize overtreatment and patients' stress. To validate Porto proposal criteria, we examined a series of 190 PMC series, also studying sex hormone receptors and BRAF mutation. Our updated Porto proposal (uPp) reclassifies as PMT incidental PMCs found at thyroidectomy lacking the following criteria: (a) detected under the age of 19 years; (b) with multiple tumors measuring >1 cm adding up all diameters; and (c) with aggressive morphologic features (extrathyroidal extension, angioinvasion, tall, and/or hobnail cells). PMCs not fulfilling uPp criteria were considered "true" PMCs. A total of 102 PMCs were subclassified as PMT, 88 as PMC, with no age or sex differences between subgroups. Total thyroidectomy and iodine-131 therapy were significantly more common in PMC. After a median follow-up of 9.6 years, lymph node metastases, distant metastases, and mortality were only found in the PMC subgroup. No subgroup differences were found in calcifications or desmoplasia. Expression of estrogen receptor-α and estrogen receptor-β, progesterone receptor, and androgen receptor was higher in PMC than in nontumorous thyroid tissue. BRAF mutations were detected in 44.7% of PMC, with no differences between subgroups. In surgical specimens, the uPp is a safe pathology tool to identify those PMC with extremely low malignant potential. This terminology could reduce psychological stress associated with cancer diagnosis, avoid overtreatment, and be incorporated into daily pathologic practice.
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19
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Changes in the Demographic and Clinicopathological Characteristics of Thyroid Cancer: A Population-Based Investigation in Algeria, 1993-2013. J Cancer Epidemiol 2020; 2020:7812791. [PMID: 33029144 PMCID: PMC7528096 DOI: 10.1155/2020/7812791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/19/2020] [Accepted: 09/14/2020] [Indexed: 01/09/2023] Open
Abstract
Over the last three decades, the incidence of thyroid cancer has increased worldwide. The reasons for this increase remain controversial. In Algeria, however, to date, information on thyroid cancer has been limited to a hospital-based case series. We analyzed data from a population-based cohort study in Oran District, Algeria, to describe demographic and clinicopathological characteristics of patients diagnosed with thyroid cancer between 1993 and 2013. Medical records and pathology reports of thyroid cancer patients who had surgery were reviewed. Changes in demographic and clinicopathological features over the 21-year period are described. During the study period, thyroid cancer was diagnosed in 1248 women (86.5%, mean age 43.7 ± 15.2 years) and 195 men (23.4%, mean age 48.1 ± 15.9 years). Most cases (83.1% for women and 69.8% for men) sought a diagnosis following a self-neck check. The most common histologic types were papillary (58.3%), follicular (29.7%), anaplastic (4.1%), and medullary (0.8%) carcinomas. The incidence of papillary carcinomas significantly increased (p < 0.001) while the incidence of other histologic types significantly decreased over time. Tumor size overall significantly decreased (p < 0.001) while the frequency of small (≤20 mm) and larger (>20 mm) carcinomas significantly increased (p < 0.05). The frequency of thyroid cancers with capsular effractions and angioinvasions also decreased over time. Thyroid cancer incidence in Algeria has increased substantially in line with international trends with changes in clinical practice being a possible contributing factor. However, the increasing papillary-to-follicular cancer ratio may be due to changes in iodine nutrition status in Algeria. Further research, including exploration of biological and molecular features of thyroid cancer, will enable a better understanding of risk factors and etiopathogenetic mechanisms.
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Zhou SC, Liu TT, Zhou J, Huang YX, Guo Y, Yu JH, Wang YY, Chang C. An Ultrasound Radiomics Nomogram for Preoperative Prediction of Central Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma. Front Oncol 2020; 10:1591. [PMID: 33014810 PMCID: PMC7498535 DOI: 10.3389/fonc.2020.01591] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose: This study aimed to establish and validate an ultrasound radiomics nomogram for the preoperative prediction of central lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). Patients and Methods: The prediction model was developed in 609 patients with clinicopathologically confirmed unifocal PTC who received ultrasonography between Jan 2018 and June 2018. Radiomic features were extracted after the ultrasonography of PTC. Lasso regression model was used for data dimensionality reduction, feature selection, and radiomics signature building. The predicting model was established based on the multivariable logistic regression analysis in which the radiomics signature, ultrasonography-reported LN status, and independent clinicopathologic risk factors were incorporated, and finally a radiomics nomogram was established. The performance of the nomogram was assessed with respect to the discrimination and consistence. An independent validation was performed in 326 consecutive patients from July 2018 to Sep 2018. Results: The radiomics signature consisted of 23 selected features and was significantly associated with LN status in both primary and validation cohorts. The independent predictors in the radiomics nomogram included the radiomics signature, age, TG level, TPOAB level, and ultrasonography-reported LN status. The model showed good discrimination and consistence in both cohorts: C-index of 0.816 (95% CI, 0.808–0.824) in the primary cohort and 0.858 (95% CI, 0.849–0.867) in the validation cohort. The area under receiver operating curve was 0.858. In the validation cohort, the accuracy, sensitivity, specificity and AUC of this model were 0.812, 0.816, 0.810, and 0.858 (95% CI, 0.785–0.930), respectively. Decision curve analysis indicated the radiomics nomogram was clinically useful. Conclusion: This study presents a convenient, clinically useful ultrasound radiomics nomogram that can be used for the pre-operative individualized prediction of central LN metastasis in patients with PTC.
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Affiliation(s)
- Shi-Chong Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tong-Tong Liu
- Department of Electronic Engineering, Fudan University, Shanghai, China.,Key Laboratory of Medical Imaging, Computing and Computer-Assisted Intervention, Shanghai, China
| | - Jin Zhou
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yun-Xia Huang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi Guo
- Department of Electronic Engineering, Fudan University, Shanghai, China.,Key Laboratory of Medical Imaging, Computing and Computer-Assisted Intervention, Shanghai, China
| | - Jin-Hua Yu
- Department of Electronic Engineering, Fudan University, Shanghai, China.,Key Laboratory of Medical Imaging, Computing and Computer-Assisted Intervention, Shanghai, China
| | - Yuan-Yuan Wang
- Department of Electronic Engineering, Fudan University, Shanghai, China.,Key Laboratory of Medical Imaging, Computing and Computer-Assisted Intervention, Shanghai, China
| | - Cai Chang
- Department of Ultrasonography, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Wang L, Zhang L, Zhu M, Qi X, Yi Z. Automatic diagnosis for thyroid nodules in ultrasound images by deep neural networks. Med Image Anal 2020; 61:101665. [DOI: 10.1016/j.media.2020.101665] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 12/23/2022]
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22
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Wang L, Zhang L, Zhu M, Qi X, Yi Z. Automatic diagnosis for thyroid nodules in ultrasound images by deep neural networks. Med Image Anal 2020. [DOI: 10.1016/j.media.2020.101665 10.1016/j.media.2020.101665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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23
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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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24
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Zhang H, Zheng X, Liu J, Gao M, Qian B. Active surveillance as a management strategy for papillary thyroid microcarcinoma. Cancer Biol Med 2020; 17:543-554. [PMID: 32944389 PMCID: PMC7476094 DOI: 10.20892/j.issn.2095-3941.2019.0470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/20/2020] [Indexed: 12/28/2022] Open
Abstract
Active surveillance (AS) can be considered as a treatment strategy for low risk papillary thyroid microcarcinoma (PTMC), with the absence of clinically apparent lymph nodes, extrathyroidal extensions, and distant metastasis. After reviewing the reports on AS of low risk PTMCs worldwide, we introduced AS, and discussed the selection criteria for active surveillance candidates based on different guidelines and the follow-up schedules. Moreover, the requirement of cytological diagnosis, progression evaluation methods, necessity of thyrotropin suppression, and medical costs were issues that both clinicians and patients considered. The usefulness of AS for low risk PTMC patients depended on accurate and confidential evaluation of patient risk. Clinicians may adopt measures like dynamic monitoring, risk stratification, and making personal follow-up schedules to minimize these potential risks. By appropriately selecting PTMC patients, AS can be an effective alternative treatment to immediate surgery.
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Affiliation(s)
- Huan Zhang
- Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xiangqian Zheng
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Juntian Liu
- Cancer Prevention Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Ming Gao
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and Faculty of Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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25
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Resultados del seguimiento de pacientes con carcinoma diferenciado de tiroides en Castilla-La Mancha (2001-2015). Estudio CADIT-CAM. ENDOCRINOL DIAB NUTR 2019; 66:164-172. [DOI: 10.1016/j.endinu.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/01/2018] [Accepted: 10/04/2018] [Indexed: 01/02/2023]
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26
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López-Bru D, Palazón-Bru A, Folgado-de la Rosa DM, Gil-Guillén VF. A scoring system to predict recurrence in patients with differentiated thyroid cancer. Clin Otolaryngol 2018; 44:26-31. [PMID: 30220101 DOI: 10.1111/coa.13227] [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: 06/05/2017] [Revised: 07/24/2018] [Accepted: 09/09/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Though predictive models have been constructed to determine the risk of recurrence in differentiated thyroid carcinoma, various aspects of these models are inadequate. Therefore, we aimed to construct, internally validate and implement on a mobile application a scoring system to determine this risk within 10 years. DESIGN A retrospective cohort study in 1984-2016. SETTING A Spanish region. PARTICIPANTS We enrolled 200 patients with differentiated thyroid carcinoma without distant metastasis at diagnosis. MAIN OUTCOME MEASURES Time-to-recurrence. A risk table was constructed based on the sum of points to estimate the likelihood of recurrence. The model was internally validated and implemented as a mobile application for Android. RESULTS Predictive factors were follicular histology, T, N and multifocality. This risk table had a C-statistic of 0.723. The calibration was satisfactory. CONCLUSIONS This study provides an instrument able to predict rapidly and very simply which patients with differentiated thyroid carcinoma have a greater risk of recurrence.
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Affiliation(s)
- David López-Bru
- Department of Otolaryngology, General University Hospital of Elda, Elda, Alicante, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | | | - Vicente F Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Research Unit, General University Hospital of Elda, Elda, Alicante, Spain
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Ke Z, Liu Y, Zhang Y, Li J, Kuang M, Peng S, Liang J, Yu S, Su L, Chen L, Sun C, Li B, Cao J, Lv W, Xiao H. Diagnostic value and lymph node metastasis prediction of a custom‑made panel (thyroline) in thyroid cancer. Oncol Rep 2018; 40:659-668. [PMID: 29901149 PMCID: PMC6072293 DOI: 10.3892/or.2018.6493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/05/2018] [Indexed: 01/21/2023] Open
Abstract
Differentiation of benign and malignant thyroid nodules is crucial for clinical management. Here, we explored the efficacy of next-generation sequencing (NGS) in predicting the classification of benign and malignant thyroid nodules and lymph node metastasis status, and simultaneously compared the results with ultrasound (US). Thyroline was designed to detect 15 target gene mutations and 2 fusions in 98 formalin-fixed, paraffin-embedded (FFPE) tissues, including those from 82 thyroid cancer (TC) patients and 16 patients with benign nodules. BRAF mutations were found in 57.69% of the papillary thyroid cancer (PTC) cases, while RET mutations were detected among all the medullary thyroid cancer (MTC) cases. Multiple mutations were positive but none showed dominance in anaplastic thyroid cancer (ATC) and follicular thyroid cancer (FTC). The sensitivity and specificity of NGS prediction in differentiation of benign and malignant thyroid nodules were 79.27 and 93.75%, respectively, and the positive predictive value (PPV) and negative predictive value (NPV) were 98.48 and 46.88%, respectively. The sensitivity and specificity of US were 76.83 and 6.25%, respectively, and the PPV and NPV were 80.77 and 5.00%, respectively. The area under curve (AUC) of NGS and US were 0.865 and 0.415, respectively. A total of 27 patients had ≥1 metastases to lymph nodes, 19 of which carried mutations, including BRAF, RET, NRAS, PIK3CA, TP53, CTNNB1 and PTEN. However, there was no correlation between the variant allele frequency of specific gene mutations and the number of metastatic lymph nodes. In conclusion, the prediction value of NGS was higher than the US-based Thyroid Imaging Reporting and Data System (TI-RADS). NGS is valuable for the accurate differentiation of benign and malignant thyroid nodules, and pathological subtypes in FFPE samples. The findings of the present study may pave the way for the application of NGS in analyzing fine-needle aspiration (FNA) biopsy samples.
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Affiliation(s)
- Zunfu Ke
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yihao Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Yunjian Zhang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Jie Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Ming Kuang
- Cancer Center, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Sui Peng
- Clinical Trial Unit, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Jinyu Liang
- Department of Ultrasound, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Shuang Yu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Lei Su
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Cong Sun
- Department of Pathology, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Bin Li
- Clinical Trial Unit, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Jessica Cao
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Weiming Lv
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510080, P.R. China
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Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol 2018; 6:500-514. [PMID: 29102432 DOI: 10.1016/s2213-8587(17)30325-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022]
Abstract
Follicular thyroid cancer is the second most common differentiated thyroid cancer histological type and has been overshadowed by its more common counterpart-papillary thyroid cancer-despite its unique biological behaviour and less favourable outcomes. In this Review, we comprehensively review the literature on follicular thyroid cancer to provide an evidence-based guide to the management of these tumours, to highlight the lack of evidence behind guideline recommendations, and to identify changes and challenges over the past decades in diagnosis, prognosis, and treatment. We highlight that correct identification of cancer in indeterminate cytological samples is challenging and ultrasonographic features can be misleading. Despite certain unique aspects of follicular thyroid cancer presentation and prognosis, no specific recommendations exist for follicular thyroid cancer and Hürthle cell carcinoma in evidence-based guidelines. Efforts should be made to stimulate additional research in this field.
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Affiliation(s)
- Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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29
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Liu W, Cheng R, Ma Y, Wang D, Su Y, Diao C, Zhang J, Qian J, Liu J. Establishment and validation of the scoring system for preoperative prediction of central lymph node metastasis in papillary thyroid carcinoma. Sci Rep 2018; 8:6962. [PMID: 29725017 PMCID: PMC5934378 DOI: 10.1038/s41598-018-24668-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 04/03/2018] [Indexed: 01/27/2023] Open
Abstract
Early preoperative diagnosis of central lymph node metastasis (CNM) is crucial to improve survival rates among patients with papillary thyroid carcinoma (PTC). Here, we analyzed clinical data from 2862 PTC patients and developed a scoring system using multivariable logistic regression and testified by the validation group. The predictive diagnostic effectiveness of the scoring system was evaluated based on consistency, discrimination ability, and accuracy. The scoring system considered seven variables: gender, age, tumor size, microcalcification, resistance index >0.7, multiple nodular lesions, and extrathyroid extension. The area under the receiver operating characteristic curve (AUC) was 0.742, indicating a good discrimination. Using 5 points as a diagnostic threshold, the validation results for validation group had an AUC of 0.758, indicating good discrimination and consistency in the scoring system. The sensitivity of this predictive model for preoperative diagnosis of CNM was 4 times higher than a direct ultrasound diagnosis. These data indicate that the CNM prediction model would improve preoperative diagnostic sensitivity for CNM in patients with papillary thyroid carcinoma.
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Affiliation(s)
- Wen Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ruochuan Cheng
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Yunhai Ma
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dan Wang
- Department of health management center, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yanjun Su
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang Diao
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jianming Zhang
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jun Qian
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jin Liu
- Department of Thyroid Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
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Shulin JH, Aizhen J, Kuo SM, Tan WB, Ngiam KY, Parameswaran R. Rising incidence of thyroid cancer in Singapore not solely due to micropapillary subtype. Ann R Coll Surg Engl 2018. [PMID: 29543059 DOI: 10.1308/rcsann.2018.0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The annual incidence of thyroid cancer is known to vary with geographic area, age and gender. The increasing incidence of thyroid cancer has been attributed to increase in detection of micropapillary subtype, among other factors. The aim of the study was to investigate time trends in the incidence of thyroid cancer in Singapore, an iodine-sufficient area. Materials and methods Data retrieved from the Singapore National Cancer Registry on all thyroid cancers that were diagnosed from 1974 to 2013 were reviewed. We studied the time trends of thyroid cancer based on gender, race, pathology and treatment modalities where available. Results The age-standardised incidence rate of thyroid cancer increased to 5.6/100,000 in 2013 from 2.5/100,000 in 1974. Thyroid cancer appeared to be more common in women, with a higher incidence in Chinese and Malays compared with Indians. Papillary carcinoma is the most common subtype. The percentage of papillary microcarcinoma has remained relatively stable at around 38% of all papillary cancers between 2007 and 2013. Although the incidence of thyroid cancer has increased since 1974, the mortality rate has remained stable. Conclusion This trend of increase in incidence of thyroid cancer in Singapore compares with other published series; however, the rise seen was not solely due to micropapillary type. Thyroid cancer was also more common in Chinese and Malays compared with Indians for reasons that needs to be studied further.
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Affiliation(s)
- J H Shulin
- Division of Endocrine Surgery, National University Hospital , Singapore
| | - J Aizhen
- National Registry of Disease Office, Health Promotion Board , Singapore
| | - S M Kuo
- National Registry of Disease Office, Health Promotion Board , Singapore
| | - W B Tan
- Division of Endocrine Surgery, National University Hospital , Singapore
| | - K Y Ngiam
- Division of Endocrine Surgery, National University Hospital , Singapore
| | - R Parameswaran
- Division of Endocrine Surgery, National University Hospital , Singapore
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Abstract
The objective was to quantify thyroid cancer incidence and mortality trends in Portugal. The number of thyroid cancer cases and incidence rates were retrieved from the Regional Cancer Registries for the period 1989-2011. The number of deaths and mortality rates were obtained from the WHO cancer mortality database (1988-2003 and 2007-2012) and Statistics Portugal (2004-2006; 1988-2012 by region). Joinpoint regression of the standardized incidence and mortality rates was performed. A significant, rapid and continued increase in incidence was observed for both sexes in each of the Regional Cancer Registries, with annual per cent changes (APCs) ranging between 2 and 9. Incidence in Portuguese women is higher than estimates for the world and Europe. Mortality decreased for women (APC: -1.5), with the greatest decrease in the North, and increased marginally for men (APC: +0.2), with a greater increase in the South. The significant increases in incidence in Portugal are predominantly because of the increase in incidence among women from the North. These trends, combined with an overall low mortality and high 5-year relative survival, raise concerns on the extent to which overdiagnosis may be taking place. Further research is needed, quantifying the importance of the most likely determinants of these trends as well as the extent and potentially deleterious effects of overdiagnosis and overtreatment in the Portuguese setting.
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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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Vigneri R, Malandrino P, Gianì F, Russo M, Vigneri P. Heavy metals in the volcanic environment and thyroid cancer. Mol Cell Endocrinol 2017; 457:73-80. [PMID: 27794445 DOI: 10.1016/j.mce.2016.10.027] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 12/22/2022]
Abstract
In the last two decades thyroid cancer incidence has increased worldwide more than any other cancer. Overdiagnosis of subclinical microcarcinomas has certainly contributed to this increase but many evidences indicate that a true increase, possibly due to environmental factors, has also occurred. Thyroid cancer incidence is markedly increased in volcanic areas. Thus, the volcanic environment is a good model to investigate the possible factors favoring thyroid cancer. In the volcanic area of Mt. Etna in Sicily, as well as in other volcanic areas, a non-anthropogenic pollution with heavy metals has been documented, a consequence of gas, ash and lava emission. Soil, water and atmosphere contamination, via the food chain, biocontaminate the residents as documented by high levels in the urines and the scalp hair compared to individuals living in adjacent non-volcanic areas. Trace amounts of metals are essential nutrients but, at higher concentrations, can be toxic for living cells. Metals can behave both as endocrine disruptors, perturbing the hormonal system, and as carcinogens, promoting malignant transformation. Similarly to other carcinogens, the transforming effect of heavy metals is higher in developing organisms as the fetus (contaminated via the mother) and individuals in early childhood. In the last decades environment metal pollution has greatly increased in industrialized countries. Although still within the "normal" limits for each single metal the hormesis effect (heavy metal activity at very low concentration because of biphasic, non linear cell response) and the possible potentiation effect resulting from the mixture of different metals acting synergistically can explain cell damage at very low concentrations. The effect of metals on the human thyroid is poorly studied: for some heavy metals no data are available. The scarce studies that have been performed mainly focus on metal effect as thyroid endocrine disruptors. The metal concentration in tissues has been rarely measured in the thyroid. Heavy metal accumulation and metabolism in the thyroid or the carcinogenic activity of different doses and different speciation of metals has not been investigated. These studies are now warranted to better understand thyroid biology and heavy metal role in human thyroid carcinogenesis.
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Affiliation(s)
- R Vigneri
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy; Humanitas, Catania Oncology Center, Via V. E. Dabormida, 64, 95126 Catania, Italy; CNR, Institute of Bioimages and Biostructures, Via P Gaifami 18, 95126 Catania, Italy.
| | - P Malandrino
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy
| | - F Gianì
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122 Catania, Italy
| | - M Russo
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98100 Messina, Italy
| | - P Vigneri
- Medical Oncology, University of Catania Medical School, Policlinico Via S. Sofia 78, 95123 Catania, Italy
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Second generation of familial nonmedullary thyroid carcinoma: A meta-analysis on the clinicopathologic features and prognosis. Eur J Surg Oncol 2017; 43:2248-2256. [DOI: 10.1016/j.ejso.2017.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 08/08/2017] [Accepted: 09/05/2017] [Indexed: 01/10/2023] Open
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Rojo Álvaro J, Bermejo Fraile B, Menéndez Torre E, Ardanaz E, Guevara M, Anda Apiñániz E. Increased incidence of thyroid cancer in Navarra (Spain). Evolution and clinical characteristics, 1986-2010. ACTA ACUST UNITED AC 2017; 64:303-309. [PMID: 28604340 DOI: 10.1016/j.endinu.2017.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The latest published studies show an increased incidence of thyroid cancer worldwide. The aim of this study was to analyze the changes in the incidence of thyroid cancer in Navarra and its clinical presentation regarding sex, histological subtype and size over the last 25 years. METHODS Thyroid cancer incidence rates were calculated on the basis of data from the Cancer Registry of Navarra during 1986-2010. Clinical data were obtained from the historical cohort of the Hospital Registry of Cancer of Navarra, which includes all the new cases of differentiated thyroid carcinoma diagnosed and treated in the public health network of this Community in that period. RESULTS The overall incidence of thyroid cancer in Navarra increased over the last 25 years, with an increase in the adjusted rate in men from 2.24 (1986-1990) to 5.85 (2006-2010) per 100,000 population/year (P<.001) and in women from 9.05 to 14.04, respectively (P<.001). This increase occurs only in papillary carcinoma. The clinical characteristics of 739 patients with differentiated thyroid cancer were studied. The mean age at diagnosis increased over the years and the predominance of women (about 80%) remains stable. Mean tumor size decreased over the five-year periods from 30.9 to 22.5mm (P<.001), the proportion of microcarcinomas (T1a) increased from 8.8% to 30% (P<.001) and, despite this increase, there were no statistical differences in the TNM stage at diagnosis during the study period. The distribution of histological variants of papillary and follicular carcinoma did not change over 25 years. CONCLUSIONS During the period studied, the incidence of thyroid cancer increased in Navarra in both sexes. The increase occurred only in papillary carcinoma, without changes in the distribution of his histological variants. The increase in the proportion of T1a tumors is remarkable, but the TNM stage distribution was maintained. These results suggest an increase in the diagnosis of thyroid microcarcinomas due to changes in clinical practice, without ruling out a real increase in the incidence of papillary carcinoma in Navarra.
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Affiliation(s)
- Jorge Rojo Álvaro
- Servicio de Endocrinología, Complejo Hospitalario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, España
| | - Begoña Bermejo Fraile
- Servicio de Medicina Preventiva, Complejo Hospitalario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, España
| | | | - Eva Ardanaz
- Instituto de Salud Pública de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Marcela Guevara
- Instituto de Salud Pública de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), Pamplona, España
| | - Emma Anda Apiñániz
- Servicio de Endocrinología, Complejo Hospitalario de Navarra, IdiSNA, Navarra Institute for Health Research, Pamplona, España.
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Galofré JC. Thyroid cancer incidence: The discovery of the hidden iceberg. ACTA ACUST UNITED AC 2017; 64:285-287. [PMID: 28604337 DOI: 10.1016/j.endinu.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 04/07/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Juan C Galofré
- Departamento de Endocrinología y Nutrición, Clínica Universidad de Navarra, Universidad Navarra, Instituto de investigación en la Salud de Navarra (IdiSNA), Pamplona, España.
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Clinicopathological characteristics of thyroid cancer in the federal state of Salzburg. Wien Klin Wochenschr 2017; 129:540-544. [PMID: 28493027 PMCID: PMC5552837 DOI: 10.1007/s00508-017-1207-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/12/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of our investigation was to evaluate the clinicopathological characteristics and mutation patterns in newly diagnosed cases of thyroid cancer in the federal state of Salzburg, Austria, in the year 2013. METHODS The medical records of all patients newly diagnosed with thyroid cancer in 2013 in the federal state of Salzburg were retrospectively reviewed. The clinicopathological characteristics and mutations of thyroid cancers were analyzed. RESULTS 63 patients (mean age: 51.0 years, range: 21-81 years; female 75%, male 25%) were identified. 53 patients had papillary (12 follicular variant), 4 patients follicular (1 oxyphilic variant), 3 patients medullary, and 3 patients anaplastic thyroid cancer. T1 tumors were found in 34 patients (pT1a, 20 patients; pT1b, 14 patients), T2 tumors in 10 patients, T3 tumors in 16 patients, and T4 tumors in 3 patients. Lymph node involvement was seen in 15 patients and metastatic disease in 1 patient. Mutations of BRAF (B-type Raf kinase) were detected in 23 and mutation of NRAS (Neuroblastoma RAS Viral Oncogene Homolog) in 2 papillary thyroid cancers. No concomitant mutations of BRAF and NRAS were found. CONCLUSION Females accounted for 75% of the patients with newly diagnosed thyroid cancer and the incidence peaked at a younger age than in males. Papillary thyroid cancer was the most frequent tumor type, accounting for 84% of the cases. A high frequency of T1 tumors and cancers with no lymph node involvement was found. Males had a higher proportion of large tumors and more aggressive forms of thyroid cancer than females. Mutations (mostly of BRAF) were found in 47% of the cases. Neither mutations of KRAS (Kirsten rat sarcoma viral oncogene homologue) nor concomitant mutations of BRAF and NRAS were found.
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Díez JJ, Iglesias P, Alonso-Gordoa T, Grande E. [Improvement in the quality of patient management after the implementation of a multidisciplinary committee on endocrine tumors: An analysis of 5-year experience]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2017; 32:187-189. [PMID: 27639829 DOI: 10.1016/j.cali.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 06/06/2023]
Affiliation(s)
- J J Díez
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, España.
| | - P Iglesias
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - T Alonso-Gordoa
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - E Grande
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
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Nickel B, Brito JP, Barratt A, Jordan S, Moynihan R, McCaffery K. Clinicians' Views on Management and Terminology for Papillary Thyroid Microcarcinoma: A Qualitative Study. Thyroid 2017; 27:661-671. [PMID: 28322617 DOI: 10.1089/thy.2016.0483] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is growing acceptance that the increase in thyroid cancer incidence is in part a result of overdiagnosis of small low-risk papillary microcarcinomas (PMCs) with indolent clinical course. Although surgery is the cornerstone treatment for patients with PMCs, recent management guidelines are shifting toward inclusion of more conservative treatments such as active surveillance. There is little evidence on clinicians' experience in managing PMC patients and their attitudes toward treatment options, including their willingness to accept a nonsurgical option. The aim of this study was to understand how clinicians perceive a diagnosis of PMC, potential changes to terminology, and the treatment options available to patients. METHODS This was a qualitative study using semi-structured interviews conducted between November 2015 and May 2016 with 22 clinicians (seven endocrinologists and 15 thyroid surgeons). Transcribed audio-recordings were thematically coded, and a framework method was used to analyze the data. RESULTS Across a sample of clinicians who manage thyroid cancer patients, awareness of overdiagnosis and overtreatment of PMC was common. However, there was little acceptance of active surveillance to manage these patients. Clinicians did not feel comfortable recommending this management approach, as they were worried about the risk of metastases, did not feel that evidence to support this approach was strong enough, and also believed that patients currently have a high preference for surgery. The majority of clinicians did not believe that changing the terminology of this diagnosis was a viable strategy to reduce patients' anxiety and their perceived preference for more aggressive treatments. However, most clinicians felt that thyroid nodules <1 cm should not be biopsied, which could help minimize the risk of overdiagnosis of PMC. CONCLUSIONS This study, based on a non-representative sample of 22 clinicians, which remains an important limitation, provides revealing insight into clinicians' management preferences and decision making for small low-risk thyroid cancers at a time when management guidelines and practices are evolving. It suggests that clinicians may not be ready to accept nonsurgical options, or changes in terminology, until evidence to support these options and changes is stronger.
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Affiliation(s)
- Brooke Nickel
- 1 Wiser Healthcare, Sydney School of Public Health, The University of Sydney , Sydney, Australia
- 2 Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney , Sydney, Australia
| | - Juan P Brito
- 3 Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, Mayo Clinic , Minnesota
| | - Alexandra Barratt
- 1 Wiser Healthcare, Sydney School of Public Health, The University of Sydney , Sydney, Australia
| | - Susan Jordan
- 4 QIMR Berghofer Medical Research Institute , Brisbane, Australia
- 5 School of Public Health, The University of Queensland , St. Lucia, Australia
| | - Ray Moynihan
- 1 Wiser Healthcare, Sydney School of Public Health, The University of Sydney , Sydney, Australia
- 6 Centre for Research in Evidence-Based Practice, Bond University , Robina, Australia
| | - Kirsten McCaffery
- 1 Wiser Healthcare, Sydney School of Public Health, The University of Sydney , Sydney, Australia
- 2 Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney , Sydney, Australia
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Dellal FD, Özdemir D, Tam AA, Baser H, Tatli Dogan H, Parlak O, Ersoy R, Cakir B. Clinicopathological features of thyroid cancer in the elderly compared to younger counterparts: single-center experience. J Endocrinol Invest 2017; 40:471-479. [PMID: 27885512 DOI: 10.1007/s40618-016-0577-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/02/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The incidence of thyroid cancer is increased in elderly patients. It tends to be larger and have more aggressive characteristics in these patients. Our aim was to compare features of thyroid carcinoma in geriatric and non-geriatric patients. METHODS In total, 933 patients with thyroid cancer were retrospectively reviewed. Thyroid functions, ultrasonography features of malignant nodules, cytological and histopathological findings and the rates of recurrence and persistence were compared in patients ≥65 and <65 years old. RESULTS There were 153 malignant foci in 109 (11.7%) patients ≥65 and 1185 malignant foci in 824 (88.3%) patients <65 years old. Mean nodule diameter was significantly higher in geriatric patients (p = 0.008). Most of the ultrasonographical features of malignant nodules were similar in two groups. Hypoechoic halo was observed in 16.4 and 28.6% of malignant nodules in geriatric and non-geriatric group, respectively (p = 0.034). There was no significant difference in cytological diagnosis. Histopathologically, tumor diameter, rates of microcarcinomas and incidentality were similar. Of all cancer types, 88.8% in geriatric and 93.9% in non-geriatric group were papillary thyroid cancer (p = 0.028). Hurthle cell cancer constituted 3.9 and 1.1% of carcinomas in geriatric and non-geriatric patients, respectively (p = 0.015); 2.0 and 0.2% of tumors in geriatric and non-geriatric group were anaplastic, respectively (p = 0.012). Capsular and vascular invasion, extrathyroidal extension, persistence and recurrence rates were similar. CONCLUSIONS Rates of anaplastic cancer and Hurthle cell cancer which is known to have worser prognosis among other differentiated thyroid cancers are increased in geriatric ages. Cytological evaluation of thyroid nodules should strongly be considered due to increased tendency for aggressive tumor types in these patients.
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Affiliation(s)
- F D Dellal
- Department of Endocrinology and Metabolism, Ataturk Training and Research Hospital, Universiteler Mahallesi Bilkent Caddesi No:1, 06800, Cankaya, Ankara, Turkey.
| | - D Özdemir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - A A Tam
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - H Baser
- Department of Endocrinology and Metabolism, Ataturk Training and Research Hospital, Universiteler Mahallesi Bilkent Caddesi No:1, 06800, Cankaya, Ankara, Turkey
| | - H Tatli Dogan
- Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - O Parlak
- Department of Surgery, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - R Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - B Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Shen FC, Hsieh CJ, Huang IC, Chang YH, Wang PW. Dynamic Risk Estimates of Outcome in Chinese Patients with Well-Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation. Thyroid 2017; 27:531-536. [PMID: 28007013 DOI: 10.1089/thy.2016.0479] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study was conducted to compare the staging systems for the prediction of long-term disease status in patients with well-differentiated thyroid carcinoma (WDTC), and to find out the earliest postoperative period predictor of long-term persistence/recurrence of disease. METHODS Patients with WDTC (n = 356; Mage = 41.5 ± 12.7 years) followed for at least five years (12.3 ± 5.0 years) after thyroidectomy and 131I remnant ablation at a tertiary regional hospital in Taiwan were retrospectively studied. Each patient was risk stratified using the American Joint Cancer Committee (stage I-IV) and American Thyroid Association (low, intermediate, and high risk) staging systems after operation and first 131I remnant ablation and using response to initial therapy reclassification (RTR; excellent, indeterminate, biochemical incomplete, and structural incomplete response) system, which is determined 6-24 months after the first 131I ablation. The clinical outcome was defined as no evidence of disease (NED; suppressed thyroglobulin [Tg] <0.5 ng/mL, stimulated Tg <1 ng/mL, and no structural detectable disease), biochemical persistent disease (BPD; suppressed Tg ≥0.5 ng/mL or stimulated Tg ≥1 ng/mL in the absence of structural disease), structural persistent disease (SPD; locoregional or distant metastases with any Tg level), or recurrent disease (RD; biochemical or structural disease identified after a period of NED). RESULTS At the time of final follow-up, 78.4% (n = 279) of the patients had NED, 9.3% (n = 33) had BPD, 10.1% (n = 36) had SPD, and 2.2% (n = 8) developed RD. All three systems could predict the increasing trend of SPD and the decreasing trend of NED with advancing stage of disease. However, the ATA risk estimates could be significantly refined by the RTR system, especially for the ATA high-risk group, in which 29.2% developed SPD/RD during follow-up. The RTR system reduced the likelihood of finding SPD/RD to 3.7% in those demonstrating an excellent response to therapy, and increased the likelihood to 78.6% in those demonstrating a structural incomplete response. Among the earliest postoperative factors, only the Tg level at the first 131I ablation could predict long-term persistence/recurrence. CONCLUSIONS The results highly support incorporating the RTR system to modify the initial risk estimate during follow-up among Chinese patients with WDTC.
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Affiliation(s)
- Feng-Chih Shen
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Ching-Jung Hsieh
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - I-Chin Huang
- 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Paochien Hospital , PingTung, Taiwan
| | - Yen-Hsiang Chang
- 3 Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung, Taiwan
| | - Pei-Wen Wang
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
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Malaguarnera R, Vella V, Nicolosi ML, Belfiore A. Insulin Resistance: Any Role in the Changing Epidemiology of Thyroid Cancer? Front Endocrinol (Lausanne) 2017; 8:314. [PMID: 29184536 PMCID: PMC5694441 DOI: 10.3389/fendo.2017.00314] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022] Open
Abstract
In the past few decades, the incidence of thyroid cancer (TC), namely of its papillary hystotype (PTC), has shown a steady increase worldwide, which has been attributed at least in part to the increasing diagnosis of early stage tumors. However, some evidence suggests that environmental and lifestyle factors can also play a role. Among the potential risk factors involved in the changing epidemiology of TC, particular attention has been drawn to insulin-resistance and related metabolic disorders, such as obesity, type 2 diabetes, and metabolic syndrome, which have been also rapidly increasing worldwide due to widespread dietary and lifestyle changes. In accordance with this possibility, various epidemiological studies have indeed gathered substantial evidence that insulin resistance-related metabolic disorders might be associated with an increased TC risk either through hyperinsulinemia or by affecting other TC risk factors including iodine deficiency, elevated thyroid stimulating hormone, estrogen-dependent signaling, chronic autoimmune thyroiditis, and others. This review summarizes the current literature evaluating the relationship between metabolic disorders characterized by insulin resistance and the risk for TC as well as the possible underlying mechanisms. The potential implications of such association in TC prevention and therapy are discussed.
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Affiliation(s)
- Roberta Malaguarnera
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Veronica Vella
- School of Human and Social Sciences, “Kore” University of Enna, Enna, Italy
- *Correspondence: Veronica Vella, ; Antonino Belfiore,
| | - Maria Luisa Nicolosi
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonino Belfiore
- Endocrinology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- *Correspondence: Veronica Vella, ; Antonino Belfiore,
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Wiltshire JJ, Drake TM, Uttley L, Balasubramanian SP. Systematic Review of Trends in the Incidence Rates of Thyroid Cancer. Thyroid 2016; 26:1541-1552. [PMID: 27571228 DOI: 10.1089/thy.2016.0100] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND A large proportion of global increase in thyroid cancer (TC) incidence has been attributed to increased detection of papillary thyroid cancer (PTC). Nonetheless, some reports support a real increase in incidence. This study aimed to perform a systematic review to evaluate the changing trends in TC incidence and summarize potential risk factors predisposing to this trend. METHODS Literature published in the English language between 1980 and August 2014 was searched via PubMed (MEDLINE) and OvidSP (EMBASE). Original studies on changes in TC incidence in defined geographic areas that described clear methods of case selection and population estimates were included. Data on incidence rates and risk factors were collected. RESULTS Of 4719 manuscripts, 60 studies were included, of which 31 were from Europe, 13 from North America, and the rest from Asia (n = 9), Oceania (n = 4), and South America (n = 3). Fifty-three articles reported a significant increase in incidence (highest was a 10-fold increase in South Korea), six reported stable rates, and one noted a decrease. PTC was the commonest type reported to have increased in incidence (in 10 studies with relevant data). Follicular TC increased in incidence (in four studies), albeit at a lower rate compared with PTC. Data on risk factors were sparse; factors discussed included ionizing radiation, iodine deficiency, and supplementation. CONCLUSION This systematic review strongly supports a widespread and persistent increase in TC incidence. Evidence for over-detection of PTC as the predominant influence includes increased numbers of smaller size tumors and improved or unchanged survival.
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Affiliation(s)
| | - Thomas M Drake
- 1 Medical School, University of Sheffield , Sheffield, United Kingdom
| | - Lesley Uttley
- 2 School of Health and Related Research, University of Sheffield , Sheffield, United Kingdom
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Leboulleux S, Tuttle RM, Pacini F, Schlumberger M. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol 2016; 4:933-942. [PMID: 27550849 DOI: 10.1016/s2213-8587(16)30180-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 02/08/2023]
Abstract
The incidence of differentiated thyroid cancer is increasing greatly in high-income countries. Roughly 50% of this increase is attributable to the identification of intrathyroidal papillary thyroid microcarcinomas. Since mortality associated with these tumours remains low and stable, the increasing diagnosis has led to concerns about overdiagnosis and overtreatment. Management of papillary thyroid microcarcinomas should take into account the reported absence of mortality when diagnosed in the absence of lymph node metastases and distant metastases, as shown even in recent studies promoting active surveillance; a low recurrence rate of 1-5%; and the risk of permanent complications from surgery that cannot be decreased to less than 1-3%, even in high-volume tertiary care centres with experienced surgeons. On the basis of these data, active surveillance with curative intent, in which active treatment is delayed until the cancer shows signs of significant progression to avoid side-effects of treatment, should be considered in properly selected patients.
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Affiliation(s)
- Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Furio Pacini
- Section of Endocrinology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France
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Konturek A, Barczyński M, Stopa M, Nowak W. Trends in Prevalence of Thyroid Cancer Over Three Decades: A Retrospective Cohort Study of 17,526 Surgical Patients. World J Surg 2016; 40:538-44. [PMID: 26560150 PMCID: PMC4746222 DOI: 10.1007/s00268-015-3322-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Thyroid cancer (TC) incidence has been increasing in recent years. The aim of this study was to investigate our institution-based estimates of operative volumes for TC over the last three decades. Materials and methods This was a retrospective cohort study of patients undergoing thyroid surgery at our institution. Patient characteristics were reviewed in three subgroups: Group I (treated in 1981–1986), Group II (treated in 1987–2002), and Group III (treated in 2003–2012). Results TC was diagnosed in 1578/17,526 (9.0 %) thyroid operations. Incidence of TC increased from 3.7 % in Group I to 10.4 % in Group III (p < 0.001). Incidence of papillary TC increased form 40.6 % in Group I to 81.3 % in Group III (p < 0.001). In the latter group, 23.5 % of all papillary TCs were diagnosed in patients with Hashimoto’s disease. Meanwhile, incidence of anaplastic TC decreased from 16.2 % in Group I to 2.1 % in Group III patients (p < 0.001). pT1 tumors were diagnosed in 8.1 % Group I and 54.8 % Group III (p < 0.001), whereas pT4 tumors were identified in 40.5 % Group I, 2.4 % Group II, and 0.84 % Group III subjects (p < 0.001). pT3 tumors were found in 51.6 % Group I, whereas multifocal papillary TCs were found in 15.7 % Group III patients, the latter with a higher prevalence of pN1 stage (p < 0.001). Conclusions The following trends in surgical volume for TC were identified throughout the study period: a fivefold increase of thyroid operations for TC, a threefold increase in incidence of papillary TC, and an eightfold decrease in incidence of anaplastic TC. It is of interest that a significant increase in incidence of multifocal papillary TC in young female patients with Hashimoto’s disease was found over time.
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Affiliation(s)
- Aleksander Konturek
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Krakow, Poland.
| | - Marcin Barczyński
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Krakow, Poland
| | - Małgorzata Stopa
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Krakow, Poland
| | - Wojciech Nowak
- Department of Endocrine Surgery, 3rd Chair of General Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202, Krakow, Poland
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Baser H, Topaloglu O, Tam AA, Alkan A, Kilicarslan A, Ersoy R, Cakir B. Comparing Clinicopathologic and Radiographic Findings Between TT-UMP, Classical, and Non-Encapsulated Follicular Variants of Papillary Thyroid Carcinomas. Endocr Pathol 2016; 27:233-42. [PMID: 27256097 DOI: 10.1007/s12022-016-9437-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Thyroid tumors of uncertain malignant potential (TT-UMP) comprise an accepted subgroup of follicular-patterned thyroid tumors for which benignancy or malignancy cannot be precisely assessed. We aimed to evaluate the demographic characteristics, ultrasound (US) findings, and cytological results of patients with TT-UMP and compare these findings to a classical variant of papillary thyroid carcinoma (CV-PTC) and non-encapsulated follicular variant of PTC (NEFV-PTC) patients; we also evaluated the immunohistochemical characteristics of patients with TT-UMP. Twenty-four patients with TT-UMP, 672 with CV-PTC, and 132 with NEFV-PTC were included in the study. Mean longitudinal nodule size and median nodule volume were higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p < 0.001 and p < 0.001 for CV-PTC; p < 0.001 and p = 0.008 for NEFV-PTC). The presence of halo and peripheral vascularization was observed more frequently in the TT-UMP group than in the CV-PTC group (p = 0.002 and p = 0.024). Benign and follicular neoplasm/suspicious for follicular neoplasm cytological results were higher in the TT-UMP group than in the CV-PTC group (p = 0.030 and p = 0.001). US findings were similar between TT-UMP and NEFV-PTC groups (all, p > 0.05). However, none of the patients with TT-UMP were called malignant; 105 patients (31.2 %) of CV-PTC and 11 patients (9.5 %) of NEFV-PTC (infiltrative FV) were classified as malignant cytologically. Tumor size was higher in the TT-UMP group than in the CV-PTC and NEFV-PTC groups (p < 0.001 and p = 0.006). In the TT-UMP group, positive expression of HBME-1, CK-19, and Gal-3 was found in 50, 33.3, and 25 % of patients, respectively. This study demonstrated that none of the TT-UMP patients were evaluated as malignant in preoperative cytology. However, patients with TT-UMP had higher nodule and tumor sizes than CV-PTC and NEFV-PTC patients; US features were similar between NEFV-PTC and TT-UMP patients.
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Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey.
| | - Oya Topaloglu
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Abbas Ali Tam
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Afra Alkan
- Faculty of Medicine, Department of Biostatistics, Yildirim Beyazit University, Ankara, Turkey
| | - Aydan Kilicarslan
- Faculty of Medicine, Department of Pathology, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Faculty of Medicine, Department of Endocrinology and Metabolism, Yildirim Beyazit University, Ankara, Turkey
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Díez JJ, Galofré JC, Oleaga A, Grande E, Mitjavila M, Moreno P. [Consensus statement for accreditation of multidisciplinary thyroid cancer units]. ACTA ACUST UNITED AC 2015; 63:e1-15. [PMID: 26456892 DOI: 10.1016/j.endonu.2015.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 12/24/2022]
Abstract
Thyroid cancer is the leading endocrine system tumor. Great advances have recently been made in understanding of the origin of these tumors and the molecular biology that makes them grow and proliferate, which have been associated to improvements in diagnostic procedures and increased availability of effective local and systemic treatments. All of the above makes thyroid cancer a paradigm of how different specialties should work together to achieve the greatest benefit for the patients. Coordination of all the procedures and patient flows should continue throughout diagnosis, treatment, and follow-up, and is essential for further optimization of resources and time. This manuscript was prepared at the request of the Working Group on Thyroid Cancer of the Spanish Society of Endocrinology and Nutrition, and is aimed to provide a consensus document on the definition, composition, requirements, structure, and operation of a multidisciplinary team for the comprehensive care of patients with thyroid cancer. For this purpose, we have included contributions by several professionals from different specialties with experience in thyroid cancer treatment at centers where multidisciplinary teams have been working for years, with the aim of developing a practical consensus applicable in clinical practice.
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Affiliation(s)
- Juan José Díez
- Servicio de Endocrinología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, España.
| | - Juan Carlos Galofré
- Departamento de Endocrinología, Clínica Universidad de Navarra, Pamplona, España
| | - Amelia Oleaga
- Servicio de Endocrinología, Hospital Universitario Basurto, Bilbao, España
| | - Enrique Grande
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Mercedes Mitjavila
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Pablo Moreno
- Servicio de Cirugía General y Digestiva, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Darre T, Amana B, Pegbessou E, Bissa H, Amegbor K, Boko E, Kpemessi E, Napo-Koura G. Descriptive Epidemiology of Thyroid Cancers in Togo. Asian Pac J Cancer Prev 2015; 16:6715-7. [PMID: 26434900 DOI: 10.7314/apjcp.2015.16.15.6715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to provide epidemiological and histological data of thyroid cancers in Togo. MATERIALS AND METHODS This was a retrospective cross-sectional study of cases of thyroid cancers diagnosed from 2000 to 2014 (15 years) at the pathology laboratory of the Sylvanus Olympio Teaching Hospital of Lome. All cases of review of a thyroid sample (biopsies, surgical specimens) were collected from the data records of that laboratory. RESULTS Thyroid cancers represented 1.1% (7930 cases) of all cancers registered during the study period. Mean age was 45.4±0.3 years and the proportion of females was 78.3%. We identified 92.4% carcinomas and 7.6% lymphomas. Carcinomas were well differentiated in 80 cases and were dominated by the papillary type (47 cases). Metastasis was observed in 13% of patients. The pTNM classification evaluated in 18 cases showed a predominance of grade I (13 cases). Lymphomas were dominated by lymphoma diffuse large B-cell (5 cases). CONCLUSIONS This study is the first global standard for thyroid cancer pathology in Togo. The high frequency of follicular form suggests an unrecognized iodine deficiency. The improvement of the technical platform of the LAP (immunohistochemistry) will increase the diagnosis of rare forms of thyroid cancer.
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Affiliation(s)
- Tchin Darre
- Department of Pathology, University Teaching Hospital Lome, Togo E-mail :
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Díez JJ, Grande E, Alonso T, Iglesias P. Abordaje multidisciplinar en el diagnóstico y tratamiento de pacientes con tumores endocrinos. Med Clin (Barc) 2015; 145:36-41. [DOI: 10.1016/j.medcli.2014.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/27/2014] [Accepted: 12/11/2014] [Indexed: 12/30/2022]
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López-Bru D, Palazón-Bru A, Folgado-de la Rosa DM, Gil-Guillén VF. Scoring System for Mortality in Patients Diagnosed with and Treated Surgically for Differentiated Thyroid Carcinoma with a 20-Year Follow-Up. PLoS One 2015; 10:e0128620. [PMID: 26115328 PMCID: PMC4482660 DOI: 10.1371/journal.pone.0128620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/29/2015] [Indexed: 11/18/2022] Open
Abstract
Background Differentiated thyroid carcinoma (DTC) is associated with an increased mortality. Few studies have constructed predictive models of all-cause mortality with a high discriminating power for patients with this disease that would enable us to determine which patients are more likely to die. Objective To construct a predictive model of all-cause mortality at 5, 10, 15 and 20 years for patients diagnosed with and treated surgically for DTC for use as a mobile application. Design We undertook a retrospective cohort study using data from 1984 to 2013. Setting All patients diagnosed with and treated surgically for DTC at a general university hospital covering a population of around 200,000 inhabitants in Spain. Participants The study involved 201 patients diagnosed with and treated surgically for DTC (174, papillary; 27, follicular). Exposures Age, gender, town, family history, type of surgery, type of cancer, histological subtype, microcarcinoma, multicentricity, TNM staging system, diagnostic stage, permanent post-operative complications, local and regional tumor persistence, distant metastasis, and radioiodine therapy. Main outcome measure All-cause mortality. Methods A Cox multivariate regression model was constructed to determine which variables at diagnosis were associated with mortality. Using the model a risk table was constructed based on the sum of all points to estimate the likelihood of death. This was then incorporated into a mobile application. Results The mean follow-up was 8.8±6.7 years. All-cause mortality was 12.9% (95% confidence interval [CI]: 8.3–17.6%). Predictive variables: older age, local tumor persistence and distant metastasis. The area under the ROC curve was 0.81 (95% CI: 0.72–0.91, p<0.001). Conclusion This study provides a practical clinical tool giving a simple and rapid indication (via a mobile application) of which patients with DTC are at risk of dying in 5, 10, 15 or 20 years. Nonetheless, caution should be exercised until validation studies have corroborated our results.
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Affiliation(s)
- David López-Bru
- Department of Otorhinolaryngology, General University Hospital, Elda, Alicante, Spain
| | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
- Research Unit, General University Hospital, Elda, Alicante, Spain
- * E-mail:
| | | | - Vicente Francisco Gil-Guillén
- Department of Clinical Medicine, Miguel Hernández University, San Juan de Alicante, Alicante, Spain
- Research Unit, General University Hospital, Elda, Alicante, Spain
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