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Lai HF, Hang JF, Chen JY. ASO Author Reflections: Is BRAF V600E Mutation Associated with Poorer Clinical Prognosis in Papillary Thyroid Carcinoma? Ann Surg Oncol 2024; 31:3974-3975. [PMID: 38366182 DOI: 10.1245/s10434-024-15058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Hon-Fan Lai
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China.
| | - Jen-Fan Hang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
| | - Jui-Yu Chen
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
- Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan, Republic of China
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2
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Belleannée G. [Encapsulated follicular carcinoma]. Ann Pathol 2024; 44:108-113. [PMID: 38388329 DOI: 10.1016/j.annpat.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
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Ramamoorthy S, Boddapati A, Venkata Renuka I, Imandi S, Mounica B. Unveiling Variations: A Comprehensive Comparison of Five Globally Used Thyroid Cytology Reporting Systems With Histopathological Correlation. Cureus 2024; 16:e53359. [PMID: 38314381 PMCID: PMC10831778 DOI: 10.7759/cureus.53359] [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: 01/31/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Accurate cytological assessment is pivotal for managing thyroid lesions and various global reporting systems are in use, such as the globally acclaimed The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), alongside other reporting systems namely, the Japanese Reporting System for Thyroid Aspiration Cytology (JRSTAC), Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC), the UK Royal College of Pathologists System for Reporting Thyroid Cytopathology (UK RCPath), the Royal College of Pathologists of Australasia and Australian Society of Cytology Classification System (RCPA/ASC). Notably, variations exist among these systems which are influenced by country-specific statistics. Given the lack of large-scale data in India and the difference in prevalence of diagnostic entities compared to the western population, this study aimed to identify reporting systems suitable for the Indian population focusing on distinguishing neoplastic from non-neoplastic lesions. Materials and methods A cross-sectional analysis of 40 thyroid cytology cases with histopathological correlation was conducted. Pathologists independently assessed cytology slides using JRSTAC, ICCRTC, RCPA/ASC, UK RCPath and TBSRTC. Five performance indicators, sensitivity, specificity, positive predictive value (PPV) of neoplastic conditions, negative predictive value (NPV) of non-neoplastic conditions, diagnostic accuracy and two quality indicators, percentage of Atypia of undetermined significance (AUS) and AUS/Malignant ratio were analyzed and compared. Results Among 40 cases, 22 cases were neoplastic (16 papillary thyroid carcinoma, six follicular adenoma) and 18 non-neoplastic (14 multinodular goiter, four lymphocytic thyroiditis). Specific patterns emerged in cases labeled "Non-diagnostic", prompted questions about categorizing inadequately cellular cases as "benign" in light of the presence of specific findings. All reporting systems showed 100% specificity in detecting non-neoplastic and neoplastic conditions in Category 1 and Category 6 respectively. Performance and quality indicators varied among reporting systems with TBSRTC (PPV of neoplastic cases 85.71%, NPV of non-neoplastic cases 70.58%, specificity 85.7%, sensitivity 70.58%, diagnostic accuracy 60%, AUS percentage 22.5% and AUS/Malignant ratio 3%) and RCPA/ASC (PPV of neoplastic cases 76.47%, NPV of non-neoplastic cases 70.58%, specificity 75%, sensitivity 72.2%, diagnostic accuracy 62.5%, AUS percentage 15% and AUS/Malignant ratio 3%) showing better results. Conclusion Among the five thyroid cytology reporting systems studied, TBSRTC and RCPA/ASC showed better overall performance results and quality indicators were close to benchmark. Better performance by TBSRTC 2023 could be due to the detailed criterion mentioned per category with subcategorization of AUS and suspicious for malignancy by features of cytological and architectural atypia. Similarly, RCPA/ASC has subcategorized AUS with defined criteria and certain background features were included as an isolated criterion for the suspicious for malignancy category. These defined criteria outlined in TBSRTC and RCPA/ASC played a crucial role in minimizing and reclassifying cases from the indeterminate categories (AUS and suspicious for malignancy) into well-defined categories with established management protocols.
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Hirokawa M, Ito M, Motoi N, Chiba T, Imamura Y, Yasuoka H, Hino R, Higuchi M, Miyauchi A, Akamizu T. Prevalence and diagnostic significance of non-invasive follicular thyroid neoplasm with papillary-like nuclear features in Japan-A multi-institutional study. Pathol Int 2024; 74:26-32. [PMID: 38050802 DOI: 10.1111/pin.13393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/16/2023] [Indexed: 12/06/2023]
Abstract
This multi-institutional study investigated non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) frequency and its diagnostic significance in Japan. We reviewed 4008 thyroid nodules resected in six institutions before NIFTP was proposed. Overall, 26 cases diagnosed as non-invasive encapsulated follicular variant of papillary thyroid carcinoma (PTC) and 145 cases of follicular thyroid adenoma (FTA) were included. Of these nodules, 80.8% and 31.0%, respectively, were NIFTPs. In five institutions, NIFTPs were more commonly found in FTA than in PTC nodules. When NIFTP was included with PTC, the overall prevalence was 2.3%, with rates in five institutions below 5.0% (0.8%-4.4%). One NIFTP case with nuclear score 3 revealed nodal metastasis 2.5 years post-resection, and the carcinoma cells were immunohistochemically positive for BRAF. FTAs or NIFTPs with nuclear score 2 did not metastasize. NIFTP was more common among FTA than among PTC nodules, possibly due to underdiagnosis of PTC on nuclear findings. Considering the clinical findings, molecular pathogenesis, and therapeutic strategy in Japan, NIFTP with nuclear score 2 is not different from FTA, and use of this entity terminology is not meaningful. In contrast, NIFTP with nuclear score 3 has potential for metastasis and BRAFV600E mutation. Therefore, in NIFTP cases, nuclear scores 2 and 3 should be separately reported.
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Affiliation(s)
| | - Masahiro Ito
- Department of Pathology, National Hospital Organization (NHO), Nagasaki Medical Center, Nagasaki, Japan
| | - Noriko Motoi
- Department of Pathology, Saitama Cancer Center, Saitama, Japan
| | - Tomohiro Chiba
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiaki Imamura
- Division of Diagnostic Pathology and Surgical Pathology, University of Fukui Hospital, Fukui, Japan
| | - Hironao Yasuoka
- Department of Pathology, Osaka Police Hospital, Osaka, Japan
| | - Rumi Hino
- Department of Sports and Health Science, Daito Bunka University, Saitama, Japan
| | - Miyoko Higuchi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
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Stewardson P, Eszlinger M, Wu J, Khalil M, Box A, Perizzolo M, Punjwani Z, Ziehr B, Sanyal R, Demetrick DJ, Paschke R. Prospective Validation of ThyroSPEC Molecular Testing of Indeterminate Thyroid Nodule Cytology Following Diagnostic Pathway Optimization. Thyroid 2023; 33:1423-1433. [PMID: 37742115 DOI: 10.1089/thy.2023.0255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
Background: Molecular testing for cytologically indeterminate thyroid nodules (ITNs) is often reported with incomplete data on clinical assessment and ultrasound malignancy risk (USMR) stratification. This study aimed to clinically validate the diagnostic accuracy of a novel molecular test, assess the incremental preoperative malignancy risk of other clinical factors, and measure the impacts of introducing molecular testing at the population level. Methods: Comprehensive clinical data were collected prospectively for the first 615 consecutive patients with ITNs in a centralized health care system following implementation of a reflexive molecular test. Clinical data include patient history, method of nodule discovery, clinical assessment, USMR, cytology, molecular testing, and surgery or follow-up along with surgeon notes on surgical decision-making. Accuracy of molecular testing and the impact of the introduction of molecular testing were calculated. A multivariable regression model was developed to identify which clinical factors have the most diagnostic significance for ITNs. Results: A locally developed, low-cost molecular test achieved a negative predictive value (NPV) of 76-91% [confidence interval, CI 66-95%] and a positive predictive value (PPV) of 46-65% [CI 37-75%] in ITNs using only residual material from standard liquid cytology fine-needle aspiration (FNA). Sensitivity was highest (80%; [CI 63-92%]) in the American Thyroid Association (ATA) intermediate-suspicion ultrasound category, and lowest (46%; [CI 19-75%]) in the ATA high-suspicion ultrasound category. Following implementation of molecular testing, diagnostic yield increased by 14% (p = 0.2442) and repeat FNAs decreased by 24% (p = 0.05). Mutation was the primary reason for surgery in 76% of resected, mutation-positive patients. High-risk mutations were associated with a 58% (p = 0.0001) shorter wait for surgery. Twenty-six percent of patients with a negative molecular test result underwent surgery. Multivariable regression highlighted molecular testing and USMR as significantly associated with malignancy. Conclusions: Molecular testing improves preoperative risk stratification but requires further stratification for intermediate-risk mutations. Incorporation of clinical factors (especially USMR) with molecular testing may increase the sensitivity for detection of malignancy. Introduction of molecular testing offers some clinical benefits even in a low resection rate setting, and directly influences surgical decision-making. This study illustrates the importance of the local diagnostic pathway in ensuring appropriate integrated use of molecular testing for best outcomes.
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Affiliation(s)
- Paul Stewardson
- Arnie Charbonneau Cancer Institute, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Markus Eszlinger
- Arnie Charbonneau Cancer Institute, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jiahui Wu
- Arnie Charbonneau Cancer Institute, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Moosa Khalil
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Adrian Box
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Marco Perizzolo
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Zoya Punjwani
- Arnie Charbonneau Cancer Institute, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Bjoern Ziehr
- Arnie Charbonneau Cancer Institute, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ratna Sanyal
- Arnie Charbonneau Cancer Institute, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Douglas J Demetrick
- Alberta Precision Laboratories, Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ralf Paschke
- Arnie Charbonneau Cancer Institute, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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6
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Kakudo K, Jung CK, Liu Z, Hirokawa M, Bychkov A, Vuong HG, Keelawat S, Srinivasan R, Hang JF, Lai CR. The Asian Thyroid Working Group, from 2017 to 2023. J Pathol Transl Med 2023; 57:289-304. [PMID: 37981725 PMCID: PMC10660359 DOI: 10.4132/jptm.2023.10.04] [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: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 11/21/2023] Open
Abstract
The Asian Thyroid Working Group was founded in 2017 at the 12th Asia Oceania Thyroid Association (AOTA) Congress in Busan, Korea. This group activity aims to characterize Asian thyroid nodule practice and establish strict diagnostic criteria for thyroid carcinomas, a reporting system for thyroid fine needle aspiration cytology without the aid of gene panel tests, and new clinical guidelines appropriate to conservative Asian thyroid nodule practice based on scientific evidence obtained from Asian patient cohorts. Asian thyroid nodule practice is usually designed for patient-centered clinical practice, which is based on the Hippocratic Oath, "First do not harm patients," and an oriental filial piety "Do not harm one's own body because it is a precious gift from parents," which is remote from defensive medical practice in the West where physicians, including pathologists, suffer from severe malpractice climate. Furthermore, Asian practice emphasizes the importance of resource management in navigating the overdiagnosis of low-risk thyroid carcinomas. This article summarizes the Asian Thyroid Working Group activities in the past 7 years, from 2017 to 2023, highlighting the diversity of thyroid nodule practice between Asia and the West and the background reasons why Asian clinicians and pathologists modified Western systems significantly.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Cancer Genome Center and Thyroid Disease Center, Izumi City General Hospital, Izumi, Osaka, Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Zhiyan Liu
- Department of Pathology, Shanghai Sixth People’s Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Huy Gia Vuong
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Somboon Keelawat
- Special Task Force for Activating Research (STAR), Department of Pathology, Chulalongkorn University, Bangkok, Thailand
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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Phipps WS, Kilgore MR, Kennedy JJ, Whiteaker JR, Hoofnagle AN, Paulovich AG. Clinical Proteomics for Solid Organ Tissues. Mol Cell Proteomics 2023; 22:100648. [PMID: 37730181 PMCID: PMC10692389 DOI: 10.1016/j.mcpro.2023.100648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023] Open
Abstract
The evaluation of biopsied solid organ tissue has long relied on visual examination using a microscope. Immunohistochemistry is critical in this process, labeling and detecting cell lineage markers and therapeutic targets. However, while the practice of immunohistochemistry has reshaped diagnostic pathology and facilitated improvements in cancer treatment, it has also been subject to pervasive challenges with respect to standardization and reproducibility. Efforts are ongoing to improve immunohistochemistry, but for some applications, the benefit of such initiatives could be impeded by its reliance on monospecific antibody-protein reagents and limited multiplexing capacity. This perspective surveys the relevant challenges facing traditional immunohistochemistry and describes how mass spectrometry, particularly liquid chromatography-tandem mass spectrometry, could help alleviate problems. In particular, targeted mass spectrometry assays could facilitate measurements of individual proteins or analyte panels, using internal standards for more robust quantification and improved interlaboratory reproducibility. Meanwhile, untargeted mass spectrometry, showcased to date clinically in the form of amyloid typing, is inherently multiplexed, facilitating the detection and crude quantification of 100s to 1000s of proteins in a single analysis. Further, data-independent acquisition has yet to be applied in clinical practice, but offers particular strengths that could appeal to clinical users. Finally, we discuss the guidance that is needed to facilitate broader utilization in clinical environments and achieve standardization.
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Affiliation(s)
- William S Phipps
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark R Kilgore
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jacob J Kennedy
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jeffrey R Whiteaker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA; Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Amanda G Paulovich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
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8
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Dolezal JM, Wolk R, Hieromnimon HM, Howard FM, Srisuwananukorn A, Karpeyev D, Ramesh S, Kochanny S, Kwon JW, Agni M, Simon RC, Desai C, Kherallah R, Nguyen TD, Schulte JJ, Cole K, Khramtsova G, Garassino MC, Husain AN, Li H, Grossman R, Cipriani NA, Pearson AT. Deep learning generates synthetic cancer histology for explainability and education. NPJ Precis Oncol 2023; 7:49. [PMID: 37248379 PMCID: PMC10227067 DOI: 10.1038/s41698-023-00399-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 05/31/2023] Open
Abstract
Artificial intelligence methods including deep neural networks (DNN) can provide rapid molecular classification of tumors from routine histology with accuracy that matches or exceeds human pathologists. Discerning how neural networks make their predictions remains a significant challenge, but explainability tools help provide insights into what models have learned when corresponding histologic features are poorly defined. Here, we present a method for improving explainability of DNN models using synthetic histology generated by a conditional generative adversarial network (cGAN). We show that cGANs generate high-quality synthetic histology images that can be leveraged for explaining DNN models trained to classify molecularly-subtyped tumors, exposing histologic features associated with molecular state. Fine-tuning synthetic histology through class and layer blending illustrates nuanced morphologic differences between tumor subtypes. Finally, we demonstrate the use of synthetic histology for augmenting pathologist-in-training education, showing that these intuitive visualizations can reinforce and improve understanding of histologic manifestations of tumor biology.
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Affiliation(s)
- James M Dolezal
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Rachelle Wolk
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Hanna M Hieromnimon
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Frederick M Howard
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | | | | | - Siddhi Ramesh
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Sara Kochanny
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Jung Woo Kwon
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Meghana Agni
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Richard C Simon
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Chandni Desai
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Raghad Kherallah
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Tung D Nguyen
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Jefree J Schulte
- Department of Pathology and Laboratory Medicine, University of Wisconsin at Madison, Madison, WN, USA
| | - Kimberly Cole
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Galina Khramtsova
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Marina Chiara Garassino
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Aliya N Husain
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Huihua Li
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA
| | - Robert Grossman
- University of Chicago, Center for Translational Data Science, Chicago, IL, USA
| | - Nicole A Cipriani
- Department of Pathology, University of Chicago Medicine, Chicago, IL, USA.
| | - Alexander T Pearson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medicine, Chicago, IL, USA.
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Wong KS, Barletta JA. Challenges in Encapsulated Follicular-Patterned Tumors: How Much Is Enough? Evaluation of Nuclear Atypia, Architecture, and Invasion. Surg Pathol Clin 2023; 16:27-44. [PMID: 36739165 DOI: 10.1016/j.path.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thyroid pathology is notoriously fraught with high interobserver variability, and follicular-patterned tumors are among some of the most challenging to assess accurately and reproducibly. Given that encapsulated or well-circumscribed follicular-patterned tumors often have similar molecular profiles, that is, frequent RAS or RAS-like alterations, the diagnosis usually relies on histopathologic examination alone. Unfortunately, many of the features that are used for diagnosis and prognosis of these tumors have long been controversial and frequently debated topics, both due to their subjectivity and their evolving (or not yet resolved) definitions. In more recent years, the introduction of noninvasive follicular thyroid neoplasm with papillary-like nuclear features has added further complexity to this discussion. In particular, the criteria and significance of nuclear features of papillary thyroid carcinoma, architectural patterns, and invasive growth still pose significant diagnostic challenges and confusion. This review explores some of the challenges in evaluating encapsulated follicular-patterned tumors, focusing on those histologic elements.
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Affiliation(s)
- Kristine S Wong
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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10
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Valderrabano P, Eszlinger M, Stewardson P, Paschke R. Clinical value of molecular markers as diagnostic and prognostic tools to guide treatment of thyroid cancer. Clin Endocrinol (Oxf) 2023; 98:753-762. [PMID: 36715016 DOI: 10.1111/cen.14882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/21/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Advances in our understanding of the molecular biology of thyroid tumours is being rapidly translated into their clinical management. This review summarizes the current use of molecular testing in thyroid tumours, focusing on their usefulness as diagnostic and prognostic tools to guide treatment with consideration of present limitations. DESIGN Considerations about molecular testing applications for the diagnosis and treatment of thyroid tumours are divided into four sections/roles: (1) evaluating cytologically indeterminate thyroid nodules; (2) guiding extent of surgery in indeterminate thyroid nodules; (3) completing histological characterization of thyroid tumours and (4) identifying actionable mutations in advanced progressive thyroid cancers. RESULTS Genomic testing can improve the presurgical malignancy risk assessment in indeterminate thyroid nodules. However, a prior in-depth analysis of institutional quality and outcomes of sonographical, cytological and histological characterization of thyroid tumours is necessary. Presently, it remains uncertain whether knowing the molecular profile of a cytologically indeterminate thyroid nodule might be advantageous to modify the extent of initial surgery. Molecular characterization of thyroid tumours can be a valuable adjunct to morphological diagnosis in some challenging cases, such as in low-risk follicular cell-derived neoplasms, or rare tumours. Finally, as selective kinase inhibitors are available, molecular testing in locally advanced/metastatic progressive thyroid cancers should also be integrated into the institutional clinical management pathway to improve outcomes and limit toxicity. CONCLUSIONS Molecular testing needs to be implemented into the local evidence-based clinical management thyroid nodule/cancer pathways to improve its diagnostic and prognostic value and to optimize cost-effectiveness.
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Affiliation(s)
- Pablo Valderrabano
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Markus Eszlinger
- Department of Oncology and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Institute of Pathology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Paul Stewardson
- Department of Medical Science and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ralf Paschke
- Departments of Medicine, Oncology, Pathology and Laboratory Medicine, Biochemistry and Molecular Biology, and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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11
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Swan KZ, Madsen SH, Bonnema SJ, Nielsen VE, Jespersen ML. Preoperative BRAF V600E mutation detection in thyroid carcinoma by immunocytochemistry. APMIS 2022; 130:627-636. [PMID: 35951496 PMCID: PMC9804421 DOI: 10.1111/apm.13267] [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: 06/26/2022] [Accepted: 08/09/2022] [Indexed: 01/05/2023]
Abstract
The BRAFV600E (BRAF) mutation is present in 40-50% of papillary thyroid carcinomas (PTC) and has been associated with more aggressive clinicopathological characteristics of PTC. The aim of this study was to evaluate different methods for preoperative identification of the BRAF mutation in PTC using cytological and histological specimens. Prospectively collected preoperative cytological clots from patients with suspected PTC were tested with BRAF immunocytochemistry (ICC) and the Cobas Test (PCR). In addition, histological specimens were tested with BRAF immunohistochemistry (IHC) and the Cobas Test. All nodules were histologically examined. Fifty-three patients were included in the study. Complete mutation testing was available in 32 patients. The main reason for exclusion was insufficient cell content in the cytological specimen. Twenty-seven nodules were histologically diagnosed as PTC, and 41% (n = 11) of PTCs were BRAF ICC positive. All non-PTC nodules were negative by BRAF ICC. In 26 nodules, all four BRAF tests were concordant, while discordant test results were found in six nodules. ICC was in accordance with the consensus BRAF status in five of these nodules, while BRAF status was undetermined in one nodule. BRAF ICC showed high concordance with the Cobas Test and a low rate of false negative stain. These results indicate that BRAF ICC may be a feasible method for preoperative detection of the BRAFV600E mutation in patients with PTC.
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Affiliation(s)
- Kristine Zøylner Swan
- Department of Otorhinolaryngology Head & Neck SurgeryAarhus University HospitalAarhusDenmark
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12
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Chen DW, Rob FI, Mukherjee R, Giordano TJ, Haymart MR, Banerjee M. Variation in the Diagnosis of Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features. J Clin Endocrinol Metab 2022; 107:e4072-e4077. [PMID: 35918064 PMCID: PMC9516041 DOI: 10.1210/clinem/dgac466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Noninvasive encapsulated follicular variant of papillary thyroid cancer was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in January 2017. The impact of this nomenclature change at a population level remains unknown. OBJECTIVE Examine use of NIFTP across different US regions and populations. DESIGN Descriptive epidemiology study using SEER-22 data (2000-2019). PARTICIPANTS Individuals diagnosed with papillary or follicular thyroid cancer (2000-2019) or NIFTP (2017-2019). MAIN OUTCOME MEASURES Annual incidence rates of thyroid cancer by subtype and NIFTP. Using 2018-2019 data, (1) rates of NIFTP at the 17 SEER-22 sites and (2) comparison of demographics for patients diagnosed with NIFTP vs papillary and follicular thyroid cancer. RESULTS NIFTP comprised 2.2% and 2.6% of cases in 2018 and 2019, respectively. Between 2018 and 2019, large heterogeneity was observed in the regional use of NIFTP diagnosis, with site-specific incidence rates between 0.0% and 6.2% (median 2.8%, interquartile range 1.3-3.6%). A diagnosis of NIFTP (vs papillary and follicular thyroid cancer) in 2018 and 2019 was significantly associated with older age (P = 0.012 and P = 0.009, respectively), Black race (both Ps < 0.001), and non-Hispanic ethnicity (both Ps < 0.001). CONCLUSIONS Marked variation exists in the use of the NIFTP diagnosis. The recent 2021 coding change that resulted in NIFTP, a tumor with uncertain malignant potential and for which there is no long-term outcome data available, no longer being a reportable diagnosis to SEER will disproportionately affect vulnerable patient groups such as older patients and Black patients, in addition to patients who reside in regions with higher rates of NIFTP diagnoses.
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Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Farizah I Rob
- University of Michigan College of Literature, Science and the Arts, Ann Arbor, MI, USA
| | - Rik Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Thomas J Giordano
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
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CD56 Expression in Papillary Thyroid Carcinoma Is Highly Dependent on the Histologic Subtype: A Potential Diagnostic Pitfall. Appl Immunohistochem Mol Morphol 2022; 30:389-396. [PMID: 35510774 DOI: 10.1097/pai.0000000000001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
Abstract
Loss of CD56 expression has been regarded as a diagnostic marker of papillary thyroid carcinoma (PTC). However, certain variants of PTC can aberrantly express CD56. Using a digital image analysis tool, we evaluated H-scores of CD56 immunostaining in 216 thyroid tumors. The H-score of the CD56 of all PTCs was lower than that of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) (P<0.001). The H-scores of CD56 were lower in classic PTC, the infiltrative follicular variant, and the diffuse sclerosing variant than in other PTC variants (P<0.001), whereas the H-scores were higher in tall cell variant, Warthin-like variant, and cribriform-morular variant than in classic PTC (P<0.001). The optimal cutoff value of H-scores for the CD56 expression was 180 for differentiating the NIFTP from the follicular adenoma and 30 for the differential diagnosis of NIFTP and infiltrative follicular variant PTC. CD56 expression is predominantly lost in classic and infiltrative follicular variants of PTCs and more preserved in the other histologic subtypes of PTC and NIFTP. CD56 is particularly useful for differentiating PTC from follicular-pattern thyroid neoplasms, but the aberrant expression in uncommon variants of PTC could be a diagnostic pitfall.
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14
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Ma T, Semsarian CR, Barratt A, Parker L, Kumarasinghe MP, Bell KJL, Nickel B. Rethinking Low-Risk Papillary Thyroid Cancers < 1cm (Papillary Microcarcinomas): An Evidence Review for Recalibrating Diagnostic Thresholds and/or Alternative Labels. Thyroid 2021; 31:1626-1638. [PMID: 34470465 DOI: 10.1089/thy.2021.0274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Recalibrating diagnostic thresholds or using alternative labels may mitigate overdiagnosis and overtreatment of papillary microcarcinoma (mPTC). We aimed at identifying and collating relevant epidemiological evidence on mPTC, to assess the case for recalibration and/or new labels. Methods: We searched EMBASE and PubMed databases from inception to December 2020 for natural history, autopsy, diagnostic drift, and diagnostic reproducibility studies. Where a relevant systematic review was pre-identified, only new articles were additionally included. Non-English articles were excluded. One author screened titles and abstracts. Two authors screened full text articles, performed quality assessments, and extracted data. We undertook narrative synthesis of included evidence (pooled estimates from systematic reviews and single estimates from primary studies). Results: One systematic review of patients undergoing active surveillance found that after 5 years of follow-up, 5.3% (95% confidence interval [CI 4.4-6.4%]) of the mPTC lesions had increased in size by ≥3 mm, and 1.6% [CI 1.1-2.4%] of patients had lymph node metastases. Among 7 new primary studies (including 3 updates on 2 studies included in the systematic review), 1-5% of patients undergoing active surveillance had lymph node metastases after a median follow-up of 1-10 years. One systematic review found that subclinical thyroid cancer incidentally discovered at autopsy is relatively common, with a pooled prevalence of 11.2% [CI 6.7-16.1%] among studies that examined the whole thyroid. Four diagnostic drift studies evaluated the new classification of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Three studies of cases previously diagnosed as papillary thyroid cancer found 1.3-2.3% were reclassified as NIFTP (reclassifications were from follicular variation of papillary thyroid cancer [FVPTC]). One study of 48 cases previously diagnosed as mPTC found that 23.5% were reclassified as NIFTP. Thirteen reproducibility studies of papillary thyroid lesions found substantial variation in the histopathological diagnosis of thyroid lesions, including FVPTC and NIFTP classifications (no study evaluated mPTC). Conclusions: This review supports consideration of recalibrating diagnostic thresholds and/or alternative labels for low-risk mPTC.
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Affiliation(s)
- Tara Ma
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Caitlin R Semsarian
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Parker
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marian Priyanthi Kumarasinghe
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Discipline of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Katy J L Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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15
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Rana C, Vuong HG, Nguyen TQ, Nguyen HC, Jung CK, Kakudo K, Bychkov A. The Incidence of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: A Meta-Analysis Assessing Worldwide Impact of the Reclassification. Thyroid 2021; 31:1502-1513. [PMID: 34060946 DOI: 10.1089/thy.2021.0158] [Citation(s) in RCA: 6] [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] [Indexed: 12/17/2022]
Abstract
Background: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification has significantly influenced the field of thyroidology. However, the extent of this impact depends upon the incidence of NIFTP in a given population. In this meta-analysis, we aimed to obtain robust information about the actual incidence of NIFTP worldwide by reviewing the published data. Methods: Comprehensive literature search was performed using electronic databases of PubMed and Web of Science over a five-year period (January 1, 2016, to January 30, 2021). The incidence of NIFTP was calculated by dividing the number of NIFTPs by the number of papillary thyroid carcinomas (PTCs). Meta-analysis of proportion and their 95% confidence interval [CI] were pooled using the random-effect model. Heterogeneity across the included studies was assessed using I2 statistics. Egger's regression test and funnel plot of estimates were used to evaluate the publication bias. p-Value <0.05 was considered significant. Results: From 505 publications, we included 50 studies, all retrospective, with 100,780 PTCs and 3990 NIFTP from 92 institutions worldwide. The overall incidence of NIFTP was 6.0% [CI 4.4-8.2] among PTCs or thyroid malignancies with a high level of heterogeneity among the included studies (I2 = 98.6%). NIFTP incidence was largely similar in North America and Europe (9.3% vs. 9.6%), with a significantly lower overall rate in Asia (2.1%). There was a significant decline in the reported incidence of NIFTP in non-Asian studies published after 2017 (p = 0.002). On applying our data on global thyroid cancer statistics, this reclassification would affect ∼30,881 patients annually, with a lower impact in Asia compared with North America and Europe. Conclusions: This comprehensive meta-analysis confirms that the worldwide NIFTP incidence is much lower than estimated initially. The NIFTP rates are significantly lower in Asian compared with North American and European countries. Apart from geography, NIFTP rates are significantly influenced by the nature of study, type of database used for sample collection, and the diagnostic criteria used. Introduction of NIFTP may potentially spare over 30,000 patients worldwide annually from clinical and psychological consequences of a thyroid cancer diagnosis.
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Affiliation(s)
- Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Huy Gia Vuong
- Department of Neurosurgery, Oklahoma University of Health Sciences Center, Oklahoma City, Oklahoma, USA
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Thu Quynh Nguyen
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hoang Cong Nguyen
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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16
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LiVolsi VA, Baloch Z. Noninvasive Follicular Tumor With Papillary-like Nuclear Features: A Practice Changer in Thyroid Pathology. Arch Pathol Lab Med 2021; 145:659-663. [PMID: 32223558 DOI: 10.5858/arpa.2019-0689-ra] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— This article presents a review of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), including its separation from follicular variant of papillary carcinoma of the thyroid, its evolution, and current definition and pathologic characteristics. OBJECTIVES.— To emphasize the understanding of the concept of NIFTP as a neoplasm based on molecular analyses, its critical histopathologic features, the microscopic findings that exclude the diagnosis, and the importance of complete sectioning of the tumor to exclude neoplasms that should be diagnosed as carcinomas. Important distinctions are discussed including difficulties with literature that shows NIFTP with metastases, inadequacy of sectioning of the tumor, and lack of descriptive histology of the surrounding thyroid and possible other lesions. DATA SOURCES.— Review of articles in the English literature on NIFTP, as well as comparative papers showing differences and distinctions between this entity and papillary carcinomas. CONCLUSIONS.— This article concludes that with the current state of knowledge on NIFTP with studies from all over the world, this entity is a low-risk neoplasm that, when diagnosed using appropriate criteria, should not be associated with metastatic or recurrent disease, at least on intermediate length of follow-up. This review includes discussion of multifocal NIFTP, as well as the recently defined micro-NIFTP (1 cm or less), and describes features of the tumor that remain to be studied and correlated with outcome: oncocytic variants of NIFTP, percentage of allowable solid areas of growth in the lesions, and definitions of true neoplastic papillae and hyperplastic ones and how these should influence the diagnosis of NIFTP.
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Affiliation(s)
- Virginia A LiVolsi
- From the Department of Pathology & Laboratory Medicine, the Hospital of the University of Pennsylvania, Philadelphia
| | - Zubair Baloch
- From the Department of Pathology & Laboratory Medicine, the Hospital of the University of Pennsylvania, Philadelphia
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17
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Sadiq Q, Sekhri R, Dibaba DT, Zhao Q, Agarwal S. HBME1 and CK19 expression in non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) vs other follicular patterned thyroid lesions. World J Surg Oncol 2021; 19:143. [PMID: 33964951 PMCID: PMC8106857 DOI: 10.1186/s12957-021-02258-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/30/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Thyroid neoplasms with follicular architecture can have overlapping morphologic features and pose diagnostic confusion among pathologists. Various immunohistochemical stains have been investigated as potential diagnostic markers for PTC, among which HBME1 and CK19 have gained popularity. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) poses similar diagnostic challenges with interobserver variability and is often misdiagnosed as adenomatoid nodule or follicular adenoma. This study aims to evaluate expression of HBME1 and CK19 in NIFTPs in comparison to other well-differentiated thyroid neoplasms and benign mimickers. METHOD Seventy-three thyroid cases diagnosed over a period of 3 years at Methodist University Hospital, Memphis, TN, USA, were included in this study: 9 NIFTP; 18 papillary thyroid carcinoma (PTC); 11 follicular variant of papillary thyroid carcinoma, invasive (I-FVPTC); 24 follicular adenomas (FA); and 11 multinodular goiters/adenomatoid nodules (MNG). A tissue microarray (TMA) was constructed and HBME1 and CK19 immunohistochemistry was performed. RESULTS 77.8% of NIFTPs, 88.9% of PTCs, 81.8% of I-FVPTCs, 16.7% of FAs, and 18.2% of MNGs showed HBME-1 expression. 66.7% of NIFTPs, 83.3% of PTCs, 81.8% of I-FVPTCs, 33.3% of FAs, and 45.4% of MNGs expressed CK19. Difference in expression of HBME1 and CK19 was statistically significant for NIFTP vs FA (qualitative; p < 0.05) and NIFTP vs MNG (p < 0.05). No statistically significant difference was found for HBME1 in NIFTP vs PTC (conventional and FVPTC), p ≥ 0.2. Sensitivity of HBME1 and CK19 for NIFTP were 78% and 67%, ~ 88% each for PTC, and 89% and 100% for FVPTC, respectively, while specificity of HBME1 and CK19 for NIFTP were 53% each, ~ 62% each for PTC, and ~55% each for FVPTC. CONCLUSION Our study indicated that HBME1 and CK19 are valuable markers in differentiating NIFTPs from morphologic mimics like follicular adenoma and adenomatoid nodules/multinodular goiter. While HBME1 and CK19 are both sensitive in diagnosing lesions with PTC-like nuclear features, CK19 stains a higher number of benign lesions in comparison to HBME1. No increase in sensitivity or specificity in diagnosis of NIFTP, PTC, or FVPTC was noted on combining the two antibodies.
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Affiliation(s)
- Qandeel Sadiq
- Department of Pathology, Methodist University Hospital, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Radhika Sekhri
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, NY, USA
| | - Daniel T Dibaba
- Tennessee Clinical and Translational Science Institute, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Qi Zhao
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shweta Agarwal
- Department of Pathology, University of New Mexico School of Medicine, MSC08 4640, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
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18
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Dolezal JM, Trzcinska A, Liao CY, Kochanny S, Blair E, Agrawal N, Keutgen XM, Angelos P, Cipriani NA, Pearson AT. Deep learning prediction of BRAF-RAS gene expression signature identifies noninvasive follicular thyroid neoplasms with papillary-like nuclear features. Mod Pathol 2021; 34:862-874. [PMID: 33299111 PMCID: PMC8064913 DOI: 10.1038/s41379-020-00724-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) are follicular-patterned thyroid neoplasms defined by nuclear atypia and indolent behavior. They harbor RAS mutations, rather than BRAFV600E mutations as is observed in papillary thyroid carcinomas with extensive follicular growth. Reliably identifying NIFTPs aids in safe therapy de-escalation, but has proven to be challenging due to interobserver variability and morphologic heterogeneity. The genomic scoring system BRS (BRAF-RAS score) was developed to quantify the extent to which a tumor's expression profile resembles a BRAFV600E or RAS-mutant neoplasm. We proposed that deep learning prediction of BRS could differentiate NIFTP from other follicular-patterned neoplasms. A deep learning model was trained on slides from a dataset of 115 thyroid neoplasms to predict tumor subtype (NIFTP, PTC-EFG, or classic PTC), and was used to generate predictions for 497 thyroid neoplasms within The Cancer Genome Atlas (TCGA). Within follicular-patterned neoplasms, tumors with positive BRS (RAS-like) were 8.5 times as likely to carry an NIFTP prediction than tumors with negative BRS (89.7% vs 10.5%, P < 0.0001). To test the hypothesis that BRS may serve as a surrogate for biological processes that determine tumor subtype, a separate model was trained on TCGA slides to predict BRS as a linear outcome. This model performed well in cross-validation on the training set (R2 = 0.67, dichotomized AUC = 0.94). In our internal cohort, NIFTPs were near universally predicted to have RAS-like BRS; as a sole discriminator of NIFTP status, predicted BRS performed with an AUC of 0.99 globally and 0.97 when restricted to follicular-patterned neoplasms. BRAFV600E-mutant PTC-EFG had BRAFV600E-like predicted BRS (mean -0.49), nonmutant PTC-EFG had more intermediate predicted BRS (mean -0.17), and NIFTP had RAS-like BRS (mean 0.35; P < 0.0001). In summary, histologic features associated with the BRAF-RAS gene expression spectrum are detectable by deep learning and can aid in distinguishing indolent NIFTP from PTCs.
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Affiliation(s)
- James M Dolezal
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Anna Trzcinska
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, USA
| | - Chih-Yi Liao
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Sara Kochanny
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Elizabeth Blair
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Nishant Agrawal
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Xavier M Keutgen
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Nicole A Cipriani
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, USA.
| | - Alexander T Pearson
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA.
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19
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Jung CK, Bychkov A, Song DE, Kim JH, Zhu Y, Liu Z, Keelawat S, Lai CR, Hirokawa M, Kameyama K, Kakudo K. Molecular Correlates and Nuclear Features of Encapsulated Follicular-Patterned Thyroid Neoplasms. Endocrinol Metab (Seoul) 2021; 36:123-133. [PMID: 33677934 PMCID: PMC7937839 DOI: 10.3803/enm.2020.860] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/14/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Assessing nuclear features is diagnostically challenging in the aspect of thyroid pathology. The aim of this study was to determine whether pathologists could distinguish BRAF-like and RAS-like nuclear features morphologically and identify morphological features to differentiate thyroid tumors with RAS-like mutations from encapsulated papillary thyroid carcinoma (PTC) with predominant follicular growth and BRAFV600E mutation. METHODS Representative whole slide images of 16 encapsulated thyroid tumors with predominant follicular growth were reviewed by 12 thyroid pathologists using a web browser-based image viewer. Total nuclear score was calculated from semi-quantitatively scored eight nuclear features. The molecular profile of RAS and BRAF genes was determined by Sanger sequencing. RESULTS Total nuclear score ranging 0 to 24 could differentiate BRAF-like tumors from RAS-like tumors with a cut-off value of score 14. The interobserver agreement was the highest for the assessment of nuclear pseudoinclusions (NPIs) but the lowest for nuclear elongation and sickle-shaped nuclei. NPIs were found in tumors with BRAFV600E mutation, but not in tumors with RAS-like mutations. Total nuclear scores were significantly higher for tumors with BRAFV600E than for those with RAS-like mutations (P<0.001). CONCLUSION Our results suggest that NPIs and high nuclear scores have diagnostic utility as rule-in markers for differentiating PTC with BRAFV600E mutation from benign or borderline follicular tumors with RAS-like mutations. Relaxation of rigid criteria for nuclear features resulted in an overdiagnosis of PTC. Immunostaining or molecular testing for BRAFV600E mutation is a useful adjunct for cases with high nuclear scores to identify true PTC.
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Affiliation(s)
- Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang-Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Yun Zhu
- Department of Pathology, Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Zhiyan Liu
- Department of Pathology, Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chiung-Ru Lai
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Kaori Kameyama
- Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
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20
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Chung R, Guan H, Ponchiardi C, Cerda S, Marwaha N, Yilmaz OH, Pinjic E, McAneny D, Lee SL, Drake FT. Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: Epidemiology and Long-Term Outcomes in a Strictly Defined Cohort. Thyroid 2021; 31:68-75. [PMID: 32539676 PMCID: PMC8098764 DOI: 10.1089/thy.2019.0616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: A subset of encapsulated/circumscribed follicular variant of papillary thyroid carcinoma (FVPTC) was reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 2016 to reduce overtreatment of a low-risk tumor. Study objectives were to describe the epidemiology and long-term outcomes of NIFTP in a high-volume, urban, tertiary referral center. Methods: Among patients enrolled in the Boston Medical Center (BMC) Thyroid Cancer Registry, 110 cases of FVPTC underwent index thyroid surgery at BMC between 2000 and 2016. Historically, BMC pathologists assess all malignant nodules using sections ≤0.3 cm with evaluation of the entire nodule and capsule. After review of pathology reports to identify potential NIFTPs, slides were rereviewed using criteria established by the NIFTP Working Group in 2016 and 2018. We evaluated interobserver reliability using Cohen's Kappa coefficient. Results: Among 110 FVPTCs, 15 (13%) met NIFTP criteria; 11 women and 4 men, age range 31-64 (mean 47.5) years. Mean tumor diameter was 1.7 cm (compared with 2.2 cm for FVPTC). Among NIFTP cases, there were no lymph node metastases, distant metastases, or tumor recurrences. All NIFTP cases were American Thyroid Association (ATA) low risk compared with only 68% of FVPTC (p = 0.011). Among FVPTCs, 14% had positive lymph nodes at index operation. Four patients (4%) had distant metastases. Mean follow-up time was 46 and 69 months for FVPTC and NIFTP, respectively. Among FVPTCs with an excellent response to therapy (2015 ATA guidelines), there were no recurrences. Just over half (n = 8) of patients with NIFTP received postoperative radioactive iodine (RAI) therapy. Concordance between pathologists was high for ruling out NIFTP (75%), but only 36% for ruling in NIFTP. Overall, for NIFTP designation, Cohen's Kappa was 0.39, which is considered fair. Conclusions: Although this is a relatively small cohort, all NIFTP specimens underwent updated pathology review consistent with current guidelines; mean follow-up was nearly 6 years. NIFTP represents a small fraction of the total papillary neoplasia diagnosed at this tertiary referral center (2.3%). None of the NIFTP cohort experienced an adverse oncologic event, and there were no regional or distant metastases. Over 50% of patients with NIFTP received RAI. Thus, the NIFTP reclassification may substantially reduce the number of patients who require adjuvant therapies, such as completion surgery or RAI.
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Affiliation(s)
- Rainjade Chung
- Department of Surgery, Section of Endocrine Surgery, Boston University, Boston, Massachusetts, USA
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Haixia Guan
- Department of Endocrinology and Metabolism, The First Hospital of China Medical University, Shenyang, China
- Department of Medicine, Section of Endocrinology, Nutrition, Diabetes, and Weight Management, Boston University, Boston, Massachusetts, USA
| | | | - Sandra Cerda
- Department of Pathology, Boston University, Boston, Massachusetts, USA
| | - Nitin Marwaha
- Department of Pathology, Boston University, Boston, Massachusetts, USA
| | - Osman H. Yilmaz
- Department of Pathology, Boston University, Boston, Massachusetts, USA
| | - Emma Pinjic
- Department of Surgery, Section of Endocrine Surgery, Boston University, Boston, Massachusetts, USA
| | - David McAneny
- Department of Surgery, Section of Endocrine Surgery, Boston University, Boston, Massachusetts, USA
| | - Stephanie L. Lee
- Department of Medicine, Section of Endocrinology, Nutrition, Diabetes, and Weight Management, Boston University, Boston, Massachusetts, USA
| | - Frederick Thurston Drake
- Department of Surgery, Section of Endocrine Surgery, Boston University, Boston, Massachusetts, USA
- Address correspondence to: Frederick Thurston Drake, MD, MPH, Department of Surgery, Section of Endocrine Surgery, Boston University, Boston, MA 02118, USA
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21
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Bai Y, Kakudo K, Jung CK. Updates in the Pathologic Classification of Thyroid Neoplasms: A Review of the World Health Organization Classification. Endocrinol Metab (Seoul) 2020; 35:696-715. [PMID: 33261309 PMCID: PMC7803616 DOI: 10.3803/enm.2020.807] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Abstract
Advances in medical sciences and evidence-based medicine have led to momentous changes in classification and management of thyroid neoplasms. Much progress has been made toward avoiding overdiagnosis and overtreatment of thyroid cancers. The new 2017 World Health Organization (WHO) classification of thyroid neoplasms updated the diagnostic criteria and molecular and genetic characteristics reflecting the biology and behavior of the tumors, and newly introduced the category of borderline malignancy or uncertain malignant potential. Some neoplasms were subclassified, renamed, or redefined as a specific entity. This review introduces changes in the fourth edition WHO classification of thyroid tumors and updates the contemporary diagnosis and classification of thyroid tumors. We also discuss several challenges with the proposal of new diagnostic entities, since they have unique histopathologic and molecular features and clinical relevance.
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Affiliation(s)
- Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, Beijing,
China
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi,
Japan
- Department of Human Pathology, Wakayama Medical University, Graduate School of Medicine, Wakayama,
Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, The Catholic University of Korea, Seoul,
Korea
- Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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22
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Aloqaily A, Polonia A, Campelos S, Alrefae N, Vale J, Caramelo A, Eloy C. Digital Versus Optical Diagnosis of Follicular Patterned Thyroid Lesions. Head Neck Pathol 2020; 15:537-543. [PMID: 33128731 PMCID: PMC8134627 DOI: 10.1007/s12105-020-01243-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To study the concordance between pathologists in the diagnosis of follicular patterned thyroid lesions using both digital and conventional optical settings. MATERIAL AND METHODS Five pathologists reviewed 50 hematoxylin and eosin-stained slides of follicular patterned thyroid lesions using both digital (the D-Sight 2.0 scanner and navigator viewer) and conventional optical instruments with washout interval time. RESULTS The mean concordance rate with the ground truth (GT) was similar between conventional optical and digital observation (83.2 and 85.2%, respectively). The most frequent reason for diagnostic discordance with GT on both systems was the evaluation of nuclear features (69.1% for conventional optical observation and 59.4% for digital observation). The intraobserver diagnostic concordance mean was 86.8%. Time for digital observation (mean time per case = 2.9 ± 0.8 min) was higher than that for conventional optical observation (mean time per case = 2.0 ± 0.7 min). Interobserver correlation of measurements was higher in the digital observation than the conventional optical observation. CONCLUSION Conventional optical and digital observation settings showed a comparable accuracy for the diagnosis of follicular patterned thyroid nodules, as well as substantial intraobserver agreement and a significant improvement in the reproducibility of the measurements that support the use of digital diagnosis in thyroid pathology. The origins underlying the variability of the diagnosis were the same in both conventional optical microscopy and digital pathology systems.
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Affiliation(s)
- Ayat Aloqaily
- grid.5808.50000 0001 1503 7226Institute of Molecular Pathology and Immunology, Ipatimup Diagnostics, University of Porto (IPATIMUP)/i3S, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal ,grid.460946.90000 0004 0411 3985King Abdullah University Hospital (KAUH), Jordan, University of Science and Technology (JUST), Irbid, Jordan
| | - Antonio Polonia
- grid.5808.50000 0001 1503 7226Institute of Molecular Pathology and Immunology, Ipatimup Diagnostics, University of Porto (IPATIMUP)/i3S, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Investigação E Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
| | - Sofia Campelos
- grid.5808.50000 0001 1503 7226Institute of Molecular Pathology and Immunology, Ipatimup Diagnostics, University of Porto (IPATIMUP)/i3S, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
| | - Nusaiba Alrefae
- grid.5808.50000 0001 1503 7226Institute of Molecular Pathology and Immunology, Ipatimup Diagnostics, University of Porto (IPATIMUP)/i3S, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal ,Kuwait Institute for Medical Specializations, Kuwait, Kuwait
| | - Joao Vale
- grid.5808.50000 0001 1503 7226Institute of Molecular Pathology and Immunology, Ipatimup Diagnostics, University of Porto (IPATIMUP)/i3S, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
| | - Ana Caramelo
- grid.5808.50000 0001 1503 7226Institute of Molecular Pathology and Immunology, Ipatimup Diagnostics, University of Porto (IPATIMUP)/i3S, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
| | - Catarina Eloy
- grid.5808.50000 0001 1503 7226Institute of Molecular Pathology and Immunology, Ipatimup Diagnostics, University of Porto (IPATIMUP)/i3S, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal ,grid.5808.50000 0001 1503 7226Medical Faculty, Porto University, Porto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Investigação E Inovação Em Saúde (i3S), University of Porto, Porto, Portugal
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23
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Hirokawa M, Higuchi M, Suzuki A, Hayashi T, Kuma S, Miyauchi A. Prevalence and diagnostic significance of noninvasive follicular thyroid neoplasm with papillary-like nuclear features among tumors previously diagnosed as follicular adenoma: a single-institutional study in Japan. Endocr J 2020; 67:1071-1075. [PMID: 32595200 DOI: 10.1507/endocrj.ej20-0198] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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 noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in papillary thyroid carcinoma (PTC) is significantly lower in Asian countries than Western countries; however, the difference remains unexplained. This study aimed to evaluate the incidence of NIFTP in tumors diagnosed as follicular adenoma (FA) in a Japanese institution and discuss the significance of NIFTP. In this study, 44 tumors were investigated, which were histologically diagnosed as FA at the Kuma Hospital in 2008. Of the 44 tumors, 13 (29.5%) were revised as NIFTP. In the remaining 31 tumors, the FA diagnosis was reconfirmed. On aspiration cytology, most of the NIFTPs were categorized into follicular neoplasm or suspicious for a follicular neoplasm. On histological examination, 9 (29.0%) of 31 FA nodules showed a nuclear score of 1. Twelve (92.3%) of 13 NIFTP nodules showed a nuclear score of 2, and the remaining nodule had a nuclear score of 3. No metastasis of FA or NIFTP was detected. There were no evidences of distant metastasis during follow-up. This is the first study to describe that NIFTP is more frequently included in tumors diagnosed as FA rather than PTC in Japan. As clinical management of FA and NIFTP is the same, in Japan, there is no reason to distinguish between FA and NIFTP. Conclusively, the necessity of using the disease entity "NIFTP" is not found in Japan.
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Affiliation(s)
- Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Miyoko Higuchi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Seiji Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
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24
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Guleria P, Mani K, Agarwal S. Indian experience of AUS/FLUS diagnosis: is it different from rest of Asia and the West?-A systematic review and meta-analysis. Gland Surg 2020; 9:1797-1812. [PMID: 33224856 DOI: 10.21037/gs-20-392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is the most heterogeneous subcategory of the Bethesda system for thyroid cytopathology with laid down permissible limits of frequency and risk of malignancy (ROM). Due to differences in thyroid clinical practice worldwide, variations have been found in frequency, resection rates (RR) and ROM. Therefore, this systematic review and meta-analysis of AUS/FLUS across different regions was conducted and comparison of data from India was done with the rest of Asia and the West. Methods We searched PubMed and Google search engines from January 2009-Dec 2019 using terms "AUS Thyroid" and "FLUS Thyroid". Meta-analysis was performed using DerSimonian-Laird method and 95% confidence intervals were calculated using random effects model. Independent samples t-test was used to compare frequency, RR, and ROM of AUS/FLUS between India, rest of Asia and the West. Results Out of 15,000 studies on internet, 60 (18 Indian, 12 Asian and 30 Western) were included. Total aspirates were 201,657; 14,279 Indian, 62,448 Asian, 124,930 Western. Pooled estimates were: frequency 7.3% (6.3-8.3%), RR 41.9% (37.4-46.6%), ROM 33.3% (26.8-39.9%). Pooled prevalence of rate did not vary significantly across the three regions. Pooled prevalence of RR was highest in India (52.9%) and lowest in rest of Asia (26.5%); of ROM was highest in Asia (45.9%), lowest in the West (26.3%) (P<0.01). Statistical analysis demonstrated publication bias, limited to Indian and Western studies. Papillary thyroid carcinoma was the most common surgical diagnosis (87.9%; 1,082/1,231). Conclusions This meta-analysis showed differences in thyroid clinical practice followed in India, rest of Asia and the West. Although pooled prevalence of rate of AUS/FLUS was similar across the three, pooled RR and ROM varied. AUS/FLUS nodules were more frequently resected in Indian and Western studies than in rest of Asia. ROM was higher than recommended values in all three areas, being intermediate for India.
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Affiliation(s)
- Prerna Guleria
- Department of Laboratory Sciences and Molecular Medicine, Army Hospital Research and Referral, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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25
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Kakudo K. Asian and Western practice in thyroid pathology: similarities and differences. Gland Surg 2020; 9:1614-1627. [PMID: 33224839 DOI: 10.21037/gs-2019-catp-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan.,Cytopathology Laboratory, Okamoto Thyroid Clinic, Osaka, Japan.,Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma-city, Japan.,Department of Human Pathology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
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26
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Kumarasinghe MP. Standardisation of thyroid cytology terminology and practice: are modifications necessary?-a narrative review. Gland Surg 2020; 9:1639-1647. [PMID: 33224841 DOI: 10.21037/gs-2019-catp-25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Universally accepted guidelines for diagnosis and management of any disease are desirable. Standardization of thyroid cytology reporting is aimed at guiding and improving clinical decision-making and management. However, socio-economic, and local factors and differences in disease prevalence and patterns require modification to suit local settings. 'One size fit all' approach is not possible for any disease diagnosis or management. The same concept is applicable in diagnosis and management of thyroid nodules. An additional special issue is the well-known high inter and intra-observer variability in the histological and cytological diagnosis of thyroid neoplasms. Despite this, thyroid cytology has a very significant influence in the management of thyroid diseases. An approach based on common principals with appropriate modifications that suits countries or continents is desirable and sustainable. The principals of TBSRTC have served as a framework for similar tiered classifications for reporting thyroid cytopathology. This article discusses globally available professional guidelines based on a common framework with appropriate modifications, with the universal aim of risk stratification of thyroid nodules.
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Affiliation(s)
- M Priyanthi Kumarasinghe
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Discipaline of Pathology and Laboratory Medicine, University of Western Australia, QEII Medical Centre, Nedlands, Australia
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27
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Nguyen TPX, Truong VT, Kakudo K, Vuong HG. The diversities in thyroid cytopathology practices among Asian countries using the Bethesda system for reporting thyroid cytopathology. Gland Surg 2020; 9:1735-1746. [PMID: 33224851 DOI: 10.21037/gs-20-404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been adopted and widely used among Asian countries. This study aims to investigate the application of TBSRTC in thyroid cytology practice among Asian countries. Methods We searched electronic databases including PubMed and Web of Science from 2010 to 2019. Meta-analysis of proportion and their 95% confidence intervals (CIs) were calculated using the random-effect model. Meta-regression and subgroup analysis were used to search for heterogeneity origins. Results We included 42 Asian studies with 84.953 fine-needle aspirations. Among six categories, benign was the most commonly diagnosed category. The resection rate (RR) and risk of malignancy (ROM) were highest in malignant and SM categories, and lowest among benign nodules. Thyroid cytology practice in Asia was characterized by a low RR and high ROM in patients with indeterminate thyroid nodules. There was a significant amount of heterogeneities of TBSRTC outputs (frequency, resection rate, and malignancy risk) among Asian countries. Meta-regression showed that the sources of heterogeneity might stem from the differences in study origin and the application of molecular testing. We highlighted the usefulness of preoperative molecular testing to select patients for surgery. Conclusions Our study provided insight regarding thyroid cytology practice among Asian countries. Active surveillance is commonly used in Asian practice resulting in a low RR and high ROM for indeterminate nodules. There are still variations in general thyroid cytology practice in Asia. Future guidelines and consensus regarding the application of TBSRTC in thyroid cytology practice among Asian countries are required.
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Affiliation(s)
| | - Vien Thanh Truong
- Department of Cardiology, The Christ Hospital Health Network, Cincinnati, OH, USA
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi-city, Japan
| | - Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA.,Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
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28
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Hirokawa M, Suzuki A, Higuchi M, Hayashi T, Kuma S, Ito Y, Miyauchi A. The Japanese reporting system for thyroid aspiration cytology 2019 (JRSTAC2019). Gland Surg 2020; 9:1653-1662. [PMID: 33224843 DOI: 10.21037/gs-2019-catp-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We introduce the Japanese reporting system for thyroid aspiration cytology 2019 (JRSTAC2019) proposed by the Japan Association of Endocrine Surgery and the Japanese Society of Thyroid Pathology. Pathological classification and recommended clinical management for thyroid nodules in Japan are different from those described in the World Health Organization classification or the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Therefore, it was necessary to develop a reporting system adapted for Japan. JRSTAC2019 is a modified version of TBSRTC. Currently, JRSTAC2019 is widely used in Japan, although the details of the system have not been introduced in English. JRSTAC2019 comprises seven categories: (I) unsatisfactory, (II) cyst fluid, (III) benign, (IV) undetermined significance, (V) follicular neoplasm (FN), (VI) suspicious for malignancy (SFM), and (VII) malignant. "Cyst fluid" nodules are classified as an independent category, and "recommended management" is in the same category as "benign" nodules. Surgical resection for FN nodules is decided upon by considering several parameters, and the decision is made without performing gene analysis. Non-invasive follicular thyroid neoplasm with papillary-like nuclear features tends to be more often diagnosed as papillary carcinoma. The risk of malignancy of SFM in Japan is higher than that in Western countries, and resection rates of SFM and malignant tumors are lower owing to active surveillance for low-risk papillary microcarcinoma. We recommend that each country should develop its reporting system, suitable for its medical and social needs. However, it should be easily compatible with TBSRTC for the ease of academic data sharing.
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Affiliation(s)
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Miyoko Higuchi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Seiji Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
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29
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Tokarz D, Cisek R, Joseph A, Asa SL, Wilson BC, Barzda V. Characterization of pathological thyroid tissue using polarization-sensitive second harmonic generation microscopy. J Transl Med 2020; 100:1280-1287. [PMID: 32737408 DOI: 10.1038/s41374-020-0475-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/09/2022] Open
Abstract
Polarization-sensitive second harmonic generation (SHG) microscopy is an established imaging technique able to provide information related to specific molecular structures including collagen. In this investigation, polarization-sensitive SHG microscopy was used to investigate changes in the collagen ultrastructure between histopathology slides of normal and diseased human thyroid tissues including follicular nodular disease, Grave's disease, follicular variant of papillary thyroid carcinoma, classical papillary thyroid carcinoma, insular or poorly differentiated carcinoma, and anaplastic or undifferentiated carcinoma ex vivo. The second-order nonlinear optical susceptibility tensor component ratios, χ(2)zzz'/χ(2)zxx' and χ(2)xyz'/χ(2)zxx', were obtained, where χ(2)zzz'/χ(2)zxx' is a structural parameter and χ(2)xyz'/χ(2)zxx' is a measure of the chirality of the collagen fibers. Furthermore, the degree of linear polarization (DOLP) of the SHG signal was measured. A statistically significant increase in χ(2)zzz'/χ(2)zxx' values for all the diseased tissues except insular carcinoma and a statistically significant decrease in DOLP for all the diseased tissues were observed compared to normal thyroid. This finding indicates a higher ultrastructural disorder in diseased collagen and provides an innovative approach to discriminate between normal and diseased thyroid tissues that is complementary to standard histopathology.
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Affiliation(s)
- Danielle Tokarz
- Department of Chemistry, Saint Mary's University, Halifax, NS, Canada.
| | - Richard Cisek
- Department of Chemistry, Saint Mary's University, Halifax, NS, Canada
| | - Ariana Joseph
- Department of Chemistry, Saint Mary's University, Halifax, NS, Canada
| | - Sylvia L Asa
- University Health Network, University of Toronto, Toronto, ON, Canada.,University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Brian C Wilson
- Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada. .,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
| | - Virginijus Barzda
- Department of Physics, University of Toronto, Toronto, ON, Canada. .,Department of Chemical and Physical Sciences, University of Toronto Mississauga, Mississauga, ON, Canada.
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30
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Rashid FA, Munkhdelger J, Fukuoka J, Bychkov A. Prevalence of BRAFV600E mutation in Asian series of papillary thyroid carcinoma-a contemporary systematic review. Gland Surg 2020; 9:1878-1900. [PMID: 33224863 PMCID: PMC7667088 DOI: 10.21037/gs-20-430] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/04/2020] [Indexed: 12/30/2022]
Abstract
Papillary thyroid carcinoma (PTC), the most common malignancy of the endocrine system, is frequently driven by BRAFV600E mutation, which was reported in 35-60% cases in Western series. Numerous studies have recently emerged from Asian countries and regions; however sufficient summary is lacking to date. BRAF mutation serves as a diagnostic and prognostic tool in thyroid cancer, therefore establishing a rate of BRAF on the national scale could be of practical significance. We performed systematic reviews of available literature to investigate the prevalence of BRAF mutation in series of PTC from various Asian countries and regions. Out of the total 3,966 reports identified via initial screening, 138 studies encompassing over 40,000 PTCs were included for the final analysis. A vast majority (90.2%) of PTCs with known BRAF status were from East Asia, including China, South Korea, and Japan, with BRAF mutation rates of 71.2%, 75.5%, and 70.6%, respectively. Less abundant Indian and Saudi Arabian series found 45.6% and 46.3% prevalence of BRAFV600E in PTC, respectively. Much limited evidence was available from Thailand, Iran, Kazakhstan, Taiwan, Singapore, Indonesia, Hong Kong, Philippines, Vietnam, Iraq, and Myanmar. No relevant publications were found from other highly populated countries, such as Pakistan, Bangladesh, and Malaysia. After grouping by geographic region, we found that the highest rate of BRAFV600E was reported in the PTC series from East Asia (76.4%). Much lower rate (45-48%) was seen in PTC cohorts from South Asia, Central Asia, and the Middle East while the Southeast Asian series were in between (57%). Further subgroup analysis revealed that studies employing fresh frozen tissue and fine-needle aspirates showed higher rates of BRAF compared to those used formalin-fixed paraffin-embedded tissues. We found that the PTC series enrolled patients' cohorts after 2010 demonstrated a higher rate of BRAF compared to the earlier series. Finally, pediatric PTCs had lower BRAF prevalence compared to the baseline rate for the country. In conclusion, despite considerable among and within countries heterogeneity, the Asian PTC series showed a higher prevalence of BRAFV600E mutation than that in Western series. Causes of geographic heterogeneity, whether genuine (etiology, genetics) or methodology-related should be further investigated.
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Affiliation(s)
- Faiza Abdul Rashid
- Department of Biological Sciences, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad, Pakistan
| | | | - Junya Fukuoka
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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31
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Poller DN. Litigation in thyroid cytology and histopathology in England: a very brief overview. Gland Surg 2020; 9:1648-1652. [PMID: 33224842 DOI: 10.21037/gs.2020.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This brief review discusses legal issues in thyroid cytology and histopathology in England. The principal risks in thyroid cyto/histopathology are either underdiagnosis of a malignant condition as benign, overdiagnosis of a benign condition as malignant, or the failure to recognise or the overdiagnosis as malignant of a benign or inflammatory condition. There are multiple diagnostic pitfalls in both cytology and histopathology and these are reasonably well documented. The interobserver reproducibility as assessed by kappa statistics of some of the major criteria for malignancy, specifically papillary-type nuclei in the diagnosis of papillary thyroid carcinoma, capsular invasion or vascular invasion are comparatively poor hence diagnoses of well differentiated papillary or follicular carcinoma may often be to some extent subjective. This article reviews the current legal situation in England discussing recent legal case precedents with a suggestion for improving communication and the preoperative consent process for patients.
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Affiliation(s)
- David N Poller
- Department of Pathology, Queen Alexandra Hospital, Cosham, Portsmouth, UK
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32
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Odate T, Oishi N, Vuong HG, Mochizuki K, Kondo T. Genetic differences in follicular thyroid carcinoma between Asian and Western countries: a systematic review. Gland Surg 2020; 9:1813-1826. [PMID: 33224857 DOI: 10.21037/gs-20-356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Thyroid cancer is the most common endocrine malignancy, and follicular thyroid carcinoma (FTC) is the second most common thyroid cancer following papillary thyroid carcinoma (PTC). RAS mutation and PAX8/PPARγ rearrangement are the two representative genetic alterations in FTC, and there are studies from various countries on their regional frequencies. In this study, we systematically reviewed all available literature aiming to create a complete global map showing the frequencies of these common oncogenic drivers in FTC and to highlight the trends in Asian and Western countries. We performed a search in two electronic databases and identified 71 studies that fit our criteria from 1,329 studies found with our database search terms. There were 54 articles with 1,143 FTC patients and 39 articles with 764 FTC patients available for calculating the frequency of RAS mutation and PAX8/PPARγ rearrangement, respectively. NRAS mutation was the most frequent RAS mutation in all regions, followed by HRAS and KRAS mutation. The frequency of RAS mutation in Asian countries was higher than Western countries (34% vs. 27%, P=0.006) when the mutation detection method was not taken into account. In contrast, this difference in RAS mutation incidence between Asian and Western countries (28% vs. 25%, P=0.47) did not show up in our subgroup analysis incorporating only studies using direct sequencing method. The reported difference of RAS mutation frequency in the previous literature might not be due to the true prevalence of RAS mutation. They could be attributed to the difference in the detection method. As to PAX8/PPARγ rearrangement, Western countries overall had a much higher prevalence than Asian countries (23% vs. 4%, P<0.001), but some European countries had a low incidence, implying regional heterogeneity of PAX8/PPARγ rearrangement. A substantial lack of mutation data in FTC was found in several regions of the world such as Central Asia, Middle East, Africa, and Central and South America. Our results provide the most comprehensive global status of representative genetic alterations in FTC and highlight the similarities and differences between Asian and Western countries.
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Affiliation(s)
- Toru Odate
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City, OK, USA
| | - Kunio Mochizuki
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Yamanashi, Japan
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33
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Zhu Y, Li Y, Jung CK, Song DE, Hang JF, Liu Z, Jain D, Lai CR, Hirokawa M, Kakudo K, Bychkov A. Histopathologic Assessment of Capsular Invasion in Follicular Thyroid Neoplasms-an Observer Variation Study. Endocr Pathol 2020; 31:132-140. [PMID: 32236857 DOI: 10.1007/s12022-020-09620-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The assessment of capsular invasion is an essential but challenging step in the diagnosis of encapsulated follicular thyroid neoplasms. Therefore, interobserver agreement in the assessment of capsular invasion in these tumors was investigated among 11 thyroid pathologists by using virtual slides of 20 cases in which the original diagnosis considered the differential diagnosis of definite capsular invasion versus questionable capsular invasion. The assessment of capsular invasion was divided into three categories: (1) non-invasive, (2) questionable invasive, and (3) clear-cut invasive. The interobserver agreements for clear-cut invasive and non-invasive categories were fair (Kappa value = 0.578 and 0.404, respectively), whereas agreement for the questionable invasion was poor (Kappa value = 0.186). Disagreements in the assessment of invasion resulted in variable final pathological diagnoses. For example, the agreement for a diagnosis of malignancy was only fair (Kappa value = 0.545). Moreover, pathologists did not have a uniform approach for rendering a final diagnosis in cases with questionable capsular invasion, though nine of 11 pathologists did use the follicular tumor of uncertain malignant potential diagnosis as proposed by the World Health Organization classification of endocrine organs published in 2017. In conclusion, this study revealed considerable interobserver variation in the evaluation of capsular invasion, especially in follicular neoplasms with questionable invasion.
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Affiliation(s)
- Yun Zhu
- Department of Pathology, JiangYuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine, Wuxi, Jiangsu, China
| | - Yaqiong Li
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jen-Fan Hang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Zhiyan Liu
- Department of Pathology, Qilu Hospital of Shandong University, Shandong, China
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chiung-Ru Lai
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Wake-cho 4-5-1, Izumi, Osaka, 594-0073, Japan.
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kopczyński J, Suligowska A, Niemyska K, Pałyga I, Walczyk A, Gąsior-Perczak D, Kowalik A, Hińcza K, Mężyk R, Góźdź S, Kowalska A. Did Introducing a New Category of Thyroid Tumors (Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features) Decrease the Risk of Malignancy for the Diagnostic Categories in the Bethesda System for Reporting Thyroid Cytopathology? Endocr Pathol 2020; 31:143-149. [PMID: 32236858 DOI: 10.1007/s12022-020-09619-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In 2016, Nikiforov et al. (JAMA Oncol 2:1023-1029, 2016) proposed replacing the term "non-invasive encapsulated follicular variant of papillary thyroid carcinoma" (FVPTC) with the term "non-invasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP). In 2018, to avoid the misdiagnosis of papillary thyroid cancer as NIFTP, the authors proposed changes to the criteria for NIFTP classification. Some previous studies evaluated the impact of NIFTP on the risk of malignancy (ROM) in the fine-needle aspiration cytology (FNAC) diagnostic categories according to the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). However, little is known about the influence of an NIFTP diagnosis on ROM on the basis of the revised criteria. The aim of this study was to assess the influence of NIFTP on ROM using the revised diagnostic criteria. The present study included 998 thyroid nodules that were diagnosed and resected at the same medical center. All specimens with a diagnosis of cancer were reviewed to identify NIFTP according to the revised 2018 criteria. Additionally, molecular diagnostics were performed to detect the BRAF p.V600E mutation and TERT promoter mutations in all the NIFTP cases. The number of cases that met the revised criteria was determined, and the ROM was calculated in each of the FNAC diagnostic categories. Only five cases (2.3% of all papillary thyroid carcinoma diagnoses) were considered NIFTP, according to the 2018 criteria. With respect to the FNAC category, one case was a follicular neoplasm or suspicious for a follicular neoplasm (FN/SFN), three cases were suspicious for malignancy (SM), and one case was malignant (M). The ROM decreased in each of the Bethesda categories (0.7% in FN/SFN, 4.3% in SM, and 0.5% in M) when a diagnosis of NIFTP was taken into account. These reductions were not statistically significant. These data indicate that the NIFTP entity has very little impact on ROM for the diagnostic categories of the Bethesda system.
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Affiliation(s)
- Janusz Kopczyński
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | - Agnieszka Suligowska
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland.
| | - Kornelia Niemyska
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | - Iwona Pałyga
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
| | - Agnieszka Walczyk
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
| | - Danuta Gąsior-Perczak
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Center, Kielce, Poland
| | - Kinga Hińcza
- Department of Molecular Diagnostics, Holycross Center, Kielce, Poland
| | - Ryszard Mężyk
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
| | - Stanisław Góźdź
- Oncology Clinic, Holycross Cancer Center, Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3 Street, 25-734, Kielce, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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35
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Malignancy is in the eye of the beholder: Pathologic diagnosis of challenging follicular neoplasms in the era of noninvasive follicular thyroid neoplasms with papillary-like nuclear features and immunohistochemical and molecular adjuncts. Surgery 2020; 169:22-26. [PMID: 32471652 DOI: 10.1016/j.surg.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/24/2020] [Accepted: 04/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Classification of thyroid follicular neoplasms can be challenging for pathologists. Introduction of noninvasive follicular thyroid neoplasms with papillary-like nuclear features, the utilization of immunohistochemistry, and molecular analysis are all thought to be valuable diagnostic adjuncts. Our aim was to determine whether interobserver variability for follicular neoplasms has improved since the application of these adjuncts. METHODS One representative section from a cohort of follicular neoplasms previously proven difficult for pathologists were examined independently by 7 pathologists and assigned to 1 of 3 diagnostic categories (benign, neoplasms with papillary-like nuclear features, or malignant). This process was carried out separately 3 times: (1) after viewing hematoxylin and eosin stain slides, (2) hematoxylin and eosin stain in conjunction with immunohistochemistry, and (3) hematoxylin and eosin stain/immunohistochemistry in conjunction with molecular analysis. The interobserver variability and overall agreement were then calculated using the free-marginal kappa coefficient. RESULTS Agreement on hematoxylin and eosin stain was 57%, with a kappa coefficient of 0.36 (minimal agreement). The agreement improved slightly with the application of immunohistochemistry (kappa coefficient = 0.49 [weak agreement] and a percentage agreement 67%). The level of agreement decreased slightly after the addition of molecular analysis (kappa coefficient = 0.43 [weak agreement] and percentage agreement 62%). CONCLUSION Despite attempts to standardize the diagnostic criteria for neoplasms with papillary-like nuclear features and the utilization immunohistochemistry and molecular analysis, attaining pathologic consensus for difficult follicular neoplasms of the thyroid remains a challenge.
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36
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Jung CK, Park SY, Kim JH, Kakudo K. New insights into classification and risk stratification of encapsulated thyroid tumors with a predominantly papillary architecture. J Pathol Transl Med 2020; 54:197-203. [PMID: 32460473 PMCID: PMC7253957 DOI: 10.4132/jptm.2020.04.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jang-Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
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Armanious H, Adam B, Meunier D, Formenti K, Izevbaye I. Digital gene expression analysis might aid in the diagnosis of thyroid cancer. ACTA ACUST UNITED AC 2020; 27:e93-e99. [PMID: 32489258 DOI: 10.3747/co.27.5533] [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: 12/25/2022]
Abstract
Background Thyroid cancer represents approximately 90% of endocrine cancers. Difficulties in diagnosis and low inter-observer agreement are sometimes encountered, especially in the distinction between the follicular variant of papillary thyroid carcinoma (fvptc) and other follicular-patterned lesions, and can present significant challenges. In the present proof-of-concept study, we report a gene-expression assay using NanoString nCounter technology (NanoString Technologies, Seattle, WA, U.S.A.) that might aid in the differential diagnosis of thyroid neoplasms based on gene-expression signatures. Methods Our cohort included 29 patients with classical papillary thyroid carcinoma (ptc), 13 patients with fvptc, 14 patients with follicular thyroid carcinoma (ftc), 14 patients with follicular adenoma (fa), and 14 patients without any abnormality. We developed a 3-step classifier that shows good correlation with the pathologic diagnosis of various thyroid neoplasms. Step 1 differentiates normal from abnormal thyroid tissue; step 2 differentiates benign from malignant lesions; and step 3 differentiates the common malignant entities ptc, ftc, and fvptc. Results Using our 3-step classifier approach based on selected genes, we developed an algorithm that attempts to differentiate thyroid lesions with varying levels of sensitivity and specificity. Three genes-namely SDC4, PLCD3, and NECTIN4/PVRL4-were the most informative in distinguishing normal from abnormal tissue with a sensitivity and a specificity of 100%. One gene, SDC4, was important for differentiating benign from malignant lesions with a sensitivity of 89% and a specificity of 92%. Various combinations of genes were required to classify specific thyroid neoplasms. Conclusions This preliminary proof-of-concept study suggests a role for nCounter technology, a digital gene expression analysis technique, as an adjunct assay for the molecular diagnosis of thyroid neoplasms.
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Affiliation(s)
- H Armanious
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB.,Alberta Public Laboratories, University of Alberta, Edmonton, AB
| | - B Adam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB.,Alberta Public Laboratories, University of Alberta, Edmonton, AB
| | - D Meunier
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB.,Alberta Public Laboratories, University of Alberta, Edmonton, AB
| | - K Formenti
- Alberta Public Laboratories, University of Alberta, Edmonton, AB
| | - I Izevbaye
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB.,Alberta Public Laboratories, University of Alberta, Edmonton, AB
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Zajkowska K, Kopczyński J, Góźdź S, Kowalska A. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a problematic entity. Endocr Connect 2020; 9:EC-19-0566.R1. [PMID: 32061158 PMCID: PMC7077601 DOI: 10.1530/ec-19-0566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/12/2020] [Indexed: 01/14/2023]
Abstract
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a borderline thyroid tumour formerly known as noninvasive encapsulated follicular variant of papillary thyroid carcinoma. The prevalence of NIFTP is estimated at 4.4-9.1% of all papillary thyroid carcinomas worldwide; however, the rate of occurrence of NIFTP is eight times lower in Asian countries than in Western Europe and America. At the molecular level, NIFTP is characterised by the lack of BRAF V600E and BRAF V600E-like mutations or other high-risk mutations (TERT, TP53), and a high rate of RAS mutations, which is similar to other follicular-pattern thyroid tumours. The diagnosis of NIFTP can only be made after histological examination of the entire tumour removed during surgery, and is based on strictly defined inclusion and exclusion criteria. Although the diagnosis is postoperative, the combination of certain findings of preoperative tests including ultrasonography, cytology, and molecular testing may raise suspicion of NIFTP. These tumours can be effectively treated by lobectomy, although total thyroidectomy remains an option for some patients. Radioactive iodine and thyroid stimulating hormone suppression therapy are not required. NIFTP has an extremely good prognosis, even when treated conservatively with lobectomy alone. Nevertheless, it cannot be considered as a benign lesion. The risk of adverse outcomes, including lymph node and distant metastases, is low but not negligible.
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Affiliation(s)
| | | | - Stanisław Góźdź
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology, Holycross Cancer Centre, Kielce, Poland
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
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39
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Baloch Z, LiVolsi VA. The Bethesda System for Reporting Thyroid Cytology (TBSRTC): From look-backs to look-ahead. Diagn Cytopathol 2020; 48:862-866. [PMID: 31999070 DOI: 10.1002/dc.24385] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was formalized in October 2007 by experts in thyroidology at the National Institute of Health in Bethesda, Maryland. The first edition of the TBSRTC book was published in 2010 and the second edition in 2018. The TBSRTC is widely employed in cytology practices in the United States and has also served as a model for similar tiered classification schemes for reporting thyroid cytopathology specimens. The tremendous success of TBSRTC cannot be underscored, it has provided a diagnostic framework which is well aligned with the present and the future of thyroid nodule management.
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Affiliation(s)
- Zubair Baloch
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Virginia A LiVolsi
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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40
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Melo-Hanchuk TD, Martins MB, Cunha LL, Soares FA, Ward LS, Vassallo J, Kobarg J. Expression of the NEK family in normal and cancer tissue: an immunohistochemical study. BMC Cancer 2020; 20:23. [PMID: 31906878 PMCID: PMC6945616 DOI: 10.1186/s12885-019-6408-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/28/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The NEK serine/threonine protein kinases are involved in cell cycle checkpoints, DNA damage repair, and apoptosis. Alterations in these pathways are frequently associated with cell malignant cellular transformations. Thyroid cancer is the most common malignant tumour in the endocrine system. Despite good treatment methods, the number of cases has increased significantly in recent years. Here, we studied the expression of NEK1, NEK2, NEK3, and NEK5 in different types of normal and malignant tissues, using tissue microarray analysis, and identified NEKs as potential markers in thyroid malignancy. METHODS The studied cases comprised multiple cancer tissue microarrays, including breast, colon, esophagus, kidney, lung, pancreas, prostate, stomach, thyroid and uterine cervix, as well as 281 patients who underwent thyroid resection for thyroid cancer or thyroid nodules. The expression of NEK1, NEK2, NEK3, and NEK5 was analyzed by immunohistochemistry. The expression pattern was evaluated in terms of intensity by two methods, semiquantitative and quantitative, and was compared between normal and cancer tissue. RESULTS We analysed the expression of each member of the NEK family in a tissue-dependent manner. Compared to normal tissue, most of the evaluated proteins showed lower expression in lung tumour. However, in the thyroid, the expression was higher in malignant tissue, especially for NEK 1, NEK3 and NEK5. Concerning characteristics of the thyroid tumour, such as aggressiveness, NEK1 expression was higher in tumours with multifocality and in patients with lymph node metastasis. NEK3 expression was stronger in patients with stage II, that involved metastasis. NEK5, on the other hand, showed high expression in patients with invasion and metastasis and in patients with tumour size > 4 cm. Furthermore, this work, demonstrated for the first time a high specificity and sensitivity of over-expression of NEK1 in classical and follicular variants of papillary thyroid cancer and NEK3 in tall-cell papillary thyroid cancer. CONCLUSION Taken together, the NEK protein kinases emerge as important proteins in thyroid cancer development and may help to identify malignancy and aggressiveness features during diagnosis. TRIAL REGISTRATION This study was retrospectively registered. www.accamargo.org.br/cientistas-pesquisadores/comite-de-etica-em-pequisa-cep.
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Affiliation(s)
- Talita Diniz Melo-Hanchuk
- Departamento de Bioquímica e de Biologia Tecidual, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Mariana Bonjiorno Martins
- Departamento de Bioquímica e de Biologia Tecidual, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Lucas Leite Cunha
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | | | - Laura Sterian Ward
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - José Vassallo
- Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
| | - Jörg Kobarg
- Departamento de Bioquímica e de Biologia Tecidual, Instituto de Biologia, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. .,Faculdade de Ciências Farmacêuticas-UNICAMP, Universidade Estadual de Campinas, Campinas, Inst. de Biologia, Dep. Bioquímica e Biologia Tecidual, Rua Monteiro Lobato 255, CEP 13083-862, Campinas-SP, Brazil.
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41
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Vuong HG, Ngo HTT, Bychkov A, Jung CK, Vu TH, Lu KB, Kakudo K, Kondo T. Differences in surgical resection rate and risk of malignancy in thyroid cytopathology practice between Western and Asian countries: A systematic review and meta-analysis. Cancer Cytopathol 2019; 128:238-249. [PMID: 31883438 DOI: 10.1002/cncy.22228] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022]
Abstract
There is increasing evidence showing that clinicians employ different management strategies in their use of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). In this meta-analysis, we investigated the differences in diagnosis frequency, resection rate (RR), and risk of malignancy (ROM) between Western (ie, American and European) and Asian cytopathology practices. We searched PubMed and Web of Science from January 2010 to January 2019. Proportion and 95% CIs were calculated using a random-effect model. We used independent sample t tests to compare frequencies, RR, and ROM between Western and Asian practices. We analyzed a total of 38 studies with 145,066 fine-needle aspirations. Compared with Asian practice, Western series had a significantly lower ROM in most of TBSRTC categories, whereas the RR was not statistically different. Focusing on indeterminate nodules, the RR in Western series was significantly higher (51.3% vs 37.6%; P = .048), whereas the ROM was significantly lower (25.4% vs 41.9%; P = .002) compared with those in Asian series. The addition of Asian cohorts increased ROM for most of diagnostic categories compared with the original TBSRTC. In conclusion, this study demonstrates a difference in Western and Asian thyroid cytology practice, especially regarding the indeterminate categories. Lower RR and higher ROM suggest that Asian clinicians adopt a more conservative approach, whereas immediate diagnostic surgery is favored in Western practice for indeterminate nodules. The addition of Asian series into a meta-analysis of TBSRTC altered ROM for several categories, which should be considered in future revisions of TBSRTC.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Hanh Thi Tuyet Ngo
- Department of Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa City, Japan.,Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Trang Huyen Vu
- Department of Pathology, Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Kim Bach Lu
- Department of Pathology, Oncology Hospital, Ho Chi Minh City, Vietnam
| | - Kennichi Kakudo
- Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Japan
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42
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Cubero Rego D, Lee H, Boguniewicz A, Jennings TA. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is rare, benign lesion using modified stringent diagnostic criteria: Reclassification and outcome study. Ann Diagn Pathol 2019; 44:151439. [PMID: 31865250 DOI: 10.1016/j.anndiagpath.2019.151439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rigid diagnostic criteria for NIFTP have been recently proposed. The frequency of NIFTP using the new criteria is unknown, and whether abortive papillae are associated with BRAFV600E mutation has not been studied. The aim of this study is to identify NIFTP by a retrospective review of Follicular Variant of Papillary Thyroid Carcinoma (FVPTC), and to study its incidence as well as the association between immunohistochemical BRAFV600E expression and abortive papillae in NIFTP. DESIGN Thyroid tumors diagnosed as FVPTC or NIFTP over a period of 18 years (2000-2017) were identified using the laboratory information system. The final pathology reports were reviewed and potential NIFTP were retrieved. The archived slides for these cases were independently reviewed by 2 pathologists. BRAFV600E (clone: VE1) immunostain was performed on representative tumor blocks. Clinical information including follow-up data was obtained from the electronic medical records. RESULTS Among the 1918 cases with the diagnosis of papillary thyroid carcinoma (PTC), 589 (30.7%) of FVPTC and 136 cases of potential NIFTP were identified. After the review of the archived pathology slides, 29 lesions were morphologically reclassified as NIFTP. Four (13.7%) of these were positive for BRAFV600E; no association was found between the presence of abortive papillae and BRAFV600Eexpression (p=0.3). Exclusion of the 4 cases with BRAFV600Eexpression resulted in 25 lesions of final NIFTP, representing 4.2% of the FVPTC and 1.3% of the PTC. The mean age of the NIFTP patients was 50 years, 87.5% were females. The mean size of the lesions was 1.4 cm (0.1-4.0 cm). Intranuclear pseudoinclusions were not identified, and abortive papillae were identified in 60% of NIFTP. The average follow-up was 70 (28-166) months. There were no adverse events (recurrence or metastasis) in the NIFTP group. CONCLUSION When strictly defined, NIFTP comprises 1.3% of cases perviously classified as PTC. In morphological NIFTP, no correlation is found between the presence of abortive papillae and the BRAFV600E expression. Intranuclear pseudo-inclusions are not observed in NIFTP. Modification of current morphological criteria to include BRAFV600E immunohistochemistry test may stratify NIFTP with benign outcome.
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Affiliation(s)
| | - Hwajeong Lee
- Anatomic Pathology, Albany Medical College, Albany, NY 12208, USA
| | - Anne Boguniewicz
- Anatomic Pathology, Albany Medical College, Albany, NY 12208, USA
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43
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Shrestha RT, Kizilgul M, Shahi M, Amin K, Evasovich MR, Burmeister LA. Impact of molecular testing on thyroid nodule neoplastic diagnosis, stratified by 4-cm size, in a surgical series. Sci Rep 2019; 9:17861. [PMID: 31780751 PMCID: PMC6883052 DOI: 10.1038/s41598-019-52581-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/17/2019] [Indexed: 11/09/2022] Open
Abstract
Whether molecular testing adds diagnostic value to the evaluation of thyroid nodules 4-cm or larger is unknown. The impact of molecular testing on cytopathologic-histopathologic diagnosis of neoplasm (adenoma or malignant), stratified by nodule size
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Affiliation(s)
| | - Muhammed Kizilgul
- Department of Medicine, University of Minnesota, Minneapolis, USA
- Department of Endocrinology and Metabolism, UHS Diskapi Training and Research Hospital, Ankara, Turkey
| | - Maryam Shahi
- Department of Pathology, University of Minnesota, Minneapolis, USA
| | - Khalid Amin
- Department of Pathology, University of Minnesota, Minneapolis, USA
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Abstract
The past half century has seen a number of advances in pathology of thyroid diseases, especially neoplastic lesions. These include the description of new entities, the definition of prognostically important lesions, the incorporation of fine needle aspiration biopsy and its functional risk stratification of diagnoses into the clinical evaluation and therapeutic recommendations of the patient with thyroid nodules and the understanding of thyroid neoplastic development, diagnostic and prognostic parameters by use of molecular analysis so that such techniques are becoming standard of care for patients with thyroid tumors. The histopathologist and cytopathologist have been and continue to be at the forefront in the definition and understanding of these areas of thyroid disease. This review describes many of the most important advances in this area in an attempt bring the practicing pathologist up to date in these developments.
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45
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Seo JY, Park JH, Pyo JY, Cha YJ, Jung CK, Song DE, Kwak JJ, Park SY, Na HY, Kim JH, Seok JY, Kim HS, Hong SW. A Multi-institutional Study of Prevalence and Clinicopathologic Features of Non-invasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP) in Korea. J Pathol Transl Med 2019; 53:378-385. [PMID: 31634988 PMCID: PMC6877441 DOI: 10.4132/jptm.2019.09.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background In the present multi-institutional study, the prevalence and clinicopathologic characteristics of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were evaluated among Korean patients who underwent thyroidectomy for papillary thyroid carcinoma (PTC). Methods Data from 18,819 patients with PTC from eight university hospitals between January 2012 and February 2018 were retrospectively evaluated. Pathology reports of all PTCs and slides of potential NIFTP cases were reviewed. The strict criterion of no papillae was applied for the diagnosis of NIFTP. Due to assumptions regarding misclassification of NIFTP as non-PTC tumors, the lower boundary of NIFTP prevalence among PTCs was estimated. Mutational analysis for BRAF and three RAS isoforms was performed in 27 randomly selected NIFTP cases. Results The prevalence of NIFTP was 1.3% (238/18,819) of all PTCs when the same histologic criteria were applied for NIFTP regardless of the tumor size but decreased to 0.8% (152/18,819) when tumors ≥1 cm in size were included. The mean follow-up was 37.7 months and no patient with NIFTP had evidence of lymph node metastasis, distant metastasis, or disease recurrence during the follow-up period. A difference in prevalence of NIFTP before and after NIFTP introduction was not observed. BRAFV600E mutation was not found in NIFTP. The mutation rate for the three RAS genes was 55.6% (15/27). Conclusions The low prevalence and indolent clinical outcome of NIFTP in Korea was confirmed using the largest number of cases to date. The introduction of NIFTP may have a small overall impact in Korean practice.
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Affiliation(s)
- Ja Yeong Seo
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hyun Park
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Yeon Pyo
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jin Cha
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Ja Kwak
- Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jang-Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Yeon Seok
- Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hee Sung Kim
- Department of Pathology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soon Won Hong
- Department of Pathology, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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46
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Bongiovanni M, Faquin WC, Giovanella L, Durante C, Kopp P, Trimboli P. Impact of non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) on risk of malignancy in patients undergoing lobectomy/thyroidectomy for suspected malignancy or malignant fine-needle aspiration cytology findings: a systematic review and meta-analysis. Eur J Endocrinol 2019; 181:389-396. [PMID: 31340203 PMCID: PMC7494014 DOI: 10.1530/eje-19-0223] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The second version of The Bethesda System for Reporting Thyroid Cytopathology endorsed the introduction of non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) as a distinct entity with low malignant potential into clinical practice. Consequently, the risk of malignancy (ROM) of cytological diagnoses has changed, but the magnitude of the change remains uncertain. The present systematic review was undertaken to obtain more robust information about the true impact of NIFTP on the ROM among patients undergoing surgery following a fine-needle aspiration cytology (FNAC) diagnosis of suspicious for malignancy (Bethesda V) or malignant (Bethesda VI). As they are managed surgically, these two diagnostic categories are the primary entities that are clinically impacted by the advent of NIFTP. DESIGN Systematic review and meta-analysis. METHODS A comprehensive literature search of online databases was performed in November 2018. The search was conducted looking for data of histologically proven NIFTP with preoperative FNAC. RESULTS One-hundred fifty-seven articles were identified and nine were included in the study. Overall, there were 13,752 thyroidectomies with a cancer prevalence of 45.7%. When NIFTP was considered non-malignant, the pooled risk difference for ROM was 5.5%. Applying meta-analysis, the pooled prevalence of NIFTP among nodules with FNAC of Bethesda V or Bethesda VI was 14 and 3%, respectively. CONCLUSION This meta-analysis shows that the inclusion of NIFTP leads to a reduction in the ROM for the Bethesda V and Bethesda VI FNAC diagnostic categories by 14 and 3%, respectively. Clinicians should be aware of these data to avoid overtreatment.
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Affiliation(s)
- Massimo Bongiovanni
- Service of Clinical Pathology, Lausanne University Hospital, Institute of Pathology, Lausanne, Switzerland
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Cosimo Durante
- Dipartimento di Medicina Traslazionale e di Precisione, Azienda Ospedaliera Universitaria Policlinico Umberto I, Sapienza Università di Roma, Rome, Italy
| | - Peter Kopp
- Service of Endocrinology, Diabetology and Metabolism, CHUV, Lausanne University Hospital, Lausanne, Switzerland
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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47
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Kakudo K, Bychkov A, Abelardo A, Keelawat S, Kumarasinghe P. Malpractice Climate Is a Key Difference in Thyroid Pathology Practice Between North America and the Rest of the World. Arch Pathol Lab Med 2019; 143:1171. [DOI: 10.5858/arpa.2019-0228-le] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kennichi Kakudo
- Department of Pathology, Wakayama Medical University, Wakayama, Japan
- Department of Pathology and Laboratory Medicine, Nara Hospital, Kindai University Faculty of Medicine, Ikoma, Nara, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Agustina Abelardo
- Department of Pathology, College of Medicine, University of the Philippines, Manila, Philippines
| | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Priyanthi Kumarasinghe
- Department of Anatomical Pathology, PathWest Laboratories, Needlands, Western Australia, Australia
- University of Western Australia, Crawley, Western Australia, Australia
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48
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Valderrabano P, Khazai L, Thompson ZJ, Otto KJ, Hallanger-Johnson JE, Chung CH, Centeno BA, McIver B. Association of Tumor Size With Histologic and Clinical Outcomes Among Patients With Cytologically Indeterminate Thyroid Nodules. JAMA Otolaryngol Head Neck Surg 2019; 144:788-795. [PMID: 30027226 DOI: 10.1001/jamaoto.2018.1070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Tens of thousands of unnecessary operations are performed each year for diagnostic purposes among patients with cytologically indeterminate thyroid nodules. Whereas a diagnostic lobectomy is recommended for most patients with solitary indeterminate thyroid nodules, a total thyroidectomy is preferred for nodules larger than 4 cm. Objective To determine whether histologic or clinical outcomes of indeterminate thyroid nodules 4 cm or larger are worse than those for nodules smaller than 4 cm, thus justifying a more aggressive initial surgical approach. Design, Setting, and Participants In this retrospective cohort study, 652 indeterminate thyroid nodules (546 nodules <4 cm and 106 nodules ≥4 cm) with surgical follow-up were consecutively evaluated at an academic cancer center from October 1, 2008, through April 30, 2016. Exposure Tumor size. Main Outcomes and Measures Differences in cancer rates, rates of invasive features, cancer aggressiveness, and response to therapy between indeterminate thyroid nodules smaller than 4 cm and 4 cm or larger. Results A total of 652 indeterminate thyroid nodules (546 nodules <4 cm and 106 nodules ≥4 cm) from 589 patients (mean [SD] age, 53.1 [13.8] years; 453 [76.9%] female) were studied. No differences were found in the baseline characteristics of patients or nodules between the 2 size groups. Tumor size was not associated with the cancer rate as a categorical (140 of 546 [25.6%] for nodules <4 cm and 33 of 106 [31.1%] for nodules ≥4 cm; effect size, 0.05; 95% CI, 0.002-0.12) or continuous (odds ratio [OR], 1.03; 95% CI, 0.92-1.15) variable. No association was found between nodule size and prevalence of extrathyroidal extension, positive margins, lymphovascular invasion, lymph node metastasis, or distant metastasis. Most malignant tumors were low risk in both size groups (70% in the nodules <4 cm and 72% in the nodules ≥4 cm), and tumor size was not associated with tumor aggressiveness as a categorical (effect size, 0.10; 95% CI, 0.03-0.31) or continuous variable (OR for intermediate-risk cancer, 0.91; 95% CI, 0.72-1.14; OR for high-risk cancer, 1.43; 95% CI, 0.96-2.15). At the last follow-up visit, 88 of 105 patients (83.8%) with malignant tumors in the smaller than 4 cm group and 21 of 25 (84.0%) in the 4 cm or greater group had no evidence of disease, and tumor size was not associated with response to therapy (effect size, 0.13; 95% CI, 0.07-0.33). Conclusions and Relevance Most indeterminate thyroid nodules are benign or low-risk malignant tumors regardless of tumor size. In the absence of other indications for total thyroidectomy, this study suggests that a thyroid lobectomy is sufficient initial treatment for most solitary cytologically indeterminate thyroid nodules independent of the tumor size.
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Affiliation(s)
- Pablo Valderrabano
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Laila Khazai
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Zachary J Thompson
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristen J Otto
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julie E Hallanger-Johnson
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Barbara A Centeno
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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49
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Sauter JL, Lehrke H, Zhang X, Al Badri OT, Rodriguez-Gutierrez R, Delivanis DA, Singh Ospina N, Donegan D, Hamidi O, Iñiguez-Ariza N, Sharma A, Kittah NEN, Tamhane SU, Hurtado Andrade MD, Kotwal A, Jenkins SM, Spears G, Rivera M, Dean DS, Henry MR. Assessment of The Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol 2019; 152:502-511. [PMID: 31305880 DOI: 10.1093/ajcp/aqz076] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Long-term follow-up is important for determining performance characteristics of thyroid fine-needle aspiration (FNA). METHODS Histologic or 3 or more years of clinical follow-up was used to calculate performance characteristics of thyroid FNA before and after implementation of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). The impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) classification was also investigated. RESULTS Follow-up was obtained for 1,277/1,134 and 1,616/1,393 aspirates/patients (median clinical follow-up, 9.9 and 4.4 years, pre- and post-TBSRTC, respectively). Nondiagnostic, suspicious for follicular neoplasm, and suspicious for malignancy (SFM) diagnoses decreased and benign diagnoses increased post-TBSRTC, while atypical rate remained less than 1%. Negative predictive value for benign nodules and positive predictive value (PPV) for SFM increased significantly. Eleven nodules were reclassified as NIFTP, slightly decreasing PPV/risk of malignancy (ROM). CONCLUSIONS Appropriate ROM for thyroid FNA can be achieved through application of TBSRTC terminology with minimal use of atypical category.
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Affiliation(s)
- Jennifer L Sauter
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heidi Lehrke
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Xiaotun Zhang
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | | | - Rene Rodriguez-Gutierrez
- Division of Endocrinology, Mayo Clinic, Rochester, MN
- KER-Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico)
- Endocrinology Division, Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez,” Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | | | - Naykky Singh Ospina
- Division of Endocrinology, Mayo Clinic, Rochester, MN
- Division of Endocrinology, University of Florida, Gainesville
| | - Diane Donegan
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | - Oksana Hamidi
- Division of Endocrinology, Mayo Clinic, Rochester, MN
- Division of Endocrinology and Metabolism, UT Southwestern Medical Center, Dallas, TX
| | - Nicole Iñiguez-Ariza
- Division of Endocrinology, Mayo Clinic, Rochester, MN
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anu Sharma
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | | | | | | | - Anupam Kotwal
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | - Sarah M Jenkins
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Grant Spears
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Michael Rivera
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
| | - Diana S Dean
- Division of Endocrinology, Mayo Clinic, Rochester, MN
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50
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Ruanpeng D, Cheungpasitporn W, Thongprayoon C, Hennessey JV, Shrestha RT. Systematic Review and Meta-analysis of the Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Cytological Diagnosis and Thyroid Cancer Prevalence. Endocr Pathol 2019; 30:189-200. [PMID: 31338752 DOI: 10.1007/s12022-019-09583-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A re-named diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) likely impacts the prevalence of thyroid cancer and risk of malignancy in populations based on the established Bethesda System of Reporting Thyroid Cytopathology (TBSRTC). This study was done to investigate the prevalence and cytological distribution of NIFTP. PRISMA guided systematic review was done from a database search of Pubmed, EMBASE, and Medline using the search terms "non-invasive follicular thyroid neoplasm with papillary-like nuclear features", "non-invasive follicular variant of papillary carcinoma", "niftp", and "Bethesda" until November 2018. Original articles with surgically proven diagnoses of NIFTP using strict NIFTP criteria were included. Twenty-nine studies with 1563 cases of NIFTP were included. The pooled prevalence of NIFTP in cases which would be classified previously as the follicular variant of papillary thyroid cancer (FVPTC) and papillary thyroid cancer (PTC) were 43.5% (95% CI 33.5-54.0%) and 4.4% (95% CI 2.0-9.0%) respectively. The pooled TBSRTC distribution of cases diagnosed as NIFTP was: from the non-diagnostic category 3.6% (95% CI 2.4-5.3%), benign 10.0% (95% CI 7.2-13.6%), AUS/FLUS 34.2% (95% CI 28.2-40.8%), FN/SFN 22.7% (95% CI 17.2-29.4%), suspicious for malignancy 22.4% (95% CI 17.7-27.9%), and malignant 7.5% (95% CI 4.2-12.9%). While a significant reduction in FVPTC prevalence is anticipated, a modest reduction of PTC prevalence is also expected with adoption of the NIFTP terminology that would be distributed mainly among lesions classified as indeterminate thyroid nodules. Further studies are needed to identify unique clinical characteristics of these lesions preoperatively.
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MESH Headings
- Biopsy, Fine-Needle/standards
- Biopsy, Fine-Needle/statistics & numerical data
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/epidemiology
- Carcinoma, Papillary, Follicular/pathology
- Cell Nucleus/pathology
- Cytodiagnosis/methods
- Cytodiagnosis/standards
- Cytodiagnosis/statistics & numerical data
- Diagnosis, Differential
- Guideline Adherence/standards
- Guideline Adherence/statistics & numerical data
- Humans
- Predictive Value of Tests
- Prevalence
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/epidemiology
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
- Thyroid Nodule/diagnosis
- Thyroid Nodule/epidemiology
- Thyroid Nodule/pathology
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Affiliation(s)
- Darin Ruanpeng
- Department of Medicine, University Minnesota, 516 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Wisit Cheungpasitporn
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - James V Hennessey
- Department of Endocrinology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, GZ-6, 02215, MA, USA
| | - Rupendra T Shrestha
- Department of Medicine, University Minnesota, 516 Delaware St SE, Minneapolis, MN, 55455, USA.
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