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Shi W, Cai W, Wang S, Gao Y, Yang R, Liu Q, Liu Y, Peng Y, Ni X. Safety and efficacy of microwave ablation for symptomatic benign thyroid nodules in children. Eur Radiol 2024; 34:3851-3860. [PMID: 37938388 DOI: 10.1007/s00330-023-10282-2] [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: 12/01/2022] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of microwave ablation (MWA) for the treatment of symptomatic benign thyroid nodules in children. METHODS A retrospective study of MWA for the treatment of 34 symptomatic benign thyroid nodules in 25 children was conducted. Volume reduction ratio (VRR), technique efficacy, symptom score, cosmetic score, and thyroid function were used to evaluate the efficacy of the technique. The associated complications and side effects were recorded. RESULTS The participants were followed for at least 6 months (median 12 months, range 6-48 months). After MWA treatment, the volumes of the targeted nodules decreased gradually (median volume 5.86 mL before MWA and 0.34 mL at the final follow-up assessment), the VRR achieved was up to 85.03% at the final follow-up assessment, and the technical efficacy at this time was 91.2%. The subjective and objective nodule-related symptoms were also ameliorated. The circulating hormone concentrations reflecting thyroid function remained within their normal ranges in all the participants after one month of follow-up. The procedure had no major complications. CONCLUSIONS MWA seems to be an effective and safe technique for the treatment of symptomatic benign thyroid nodules in pediatric patients. CLINICAL RELEVANCE STATEMENT Microwave ablation is a safe and effective method to treat symptomatic benign thyroid nodules in pediatric patients. This treatment may be selected if the patient or parents are not suitable or refuse to undergo surgery. KEY POINTS • Microwave ablation is effective in reducing the volume of benign thyroid nodules and ameliorating nodule-related symptoms in pediatric patients. • Microwave ablation is a safe method in children, with low complications. • Microwave ablation does not affect the circulating thyroid hormone concentrations of children.
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Affiliation(s)
- Wenyuan Shi
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Wenjia Cai
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yuanjin Gao
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Rui Yang
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Qinglin Liu
- Department of Ultrasound, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yuanhu Liu
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yun Peng
- Department of Radiology, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, National Center for Children's Health (Beijing), Beijing Children's Hospital, Capital Medical University, No. 56, Nanlishi Road, Xicheng District, Beijing, 100045, China.
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Chiba T. Molecular Pathology of Thyroid Tumors: Essential Points to Comprehend Regarding the Latest WHO Classification. Biomedicines 2024; 12:712. [PMID: 38672067 PMCID: PMC11048493 DOI: 10.3390/biomedicines12040712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
In 2022, the new WHO Classification of Endocrine and Neuroendocrine Tumors, Fifth Edition (beta version) (WHO 5th), was published. Large-scale genomic analyses such as The Cancer Genome Atlas (TCGA) have revealed the importance of understanding the molecular genetics of thyroid tumors. Consequently, the WHO 5th was fundamentally revised, resulting in a systematic classification based on the cell of origin of tumors and their clinical risk. This paper outlines the following critical points of the WHO 5th. 1. Genetic mutations in follicular cell-derived neoplasms (FDNs) highlight the role of mutations in the MAP kinase pathway, including RET, RAS, and BRAF, as drivers of carcinogenesis. Differentiated thyroid cancers such as follicular thyroid carcinoma (FTC) and papillary thyroid carcinoma (PTC) have specific genetic alterations that correlate with morphological classifications: RAS-like tumors (RLTs) and BRAF p.V600E-like tumors (BLTs), respectively. 2. The framework for benign lesions has been revised. The WHO 5th introduces a new category: "developmental abnormalities". Benign FDNs comprise "thyroid follicular nodular disease", follicular thyroid adenoma (FTA), FTA with papillary architecture, and oncocytic adenoma (OA). "Hürthle cell adenoma/carcinoma" is renamed oncocytic adenoma/carcinoma of the thyroid (OA/OCA), which can be distinguished from FTA/FTC by its unique genetic background. 3. Low-risk tumors include NIFTP, TT-UMP, and HTT, and they have an extremely low malignant potential or an uncertain malignant potential. 4. PTC histological variants are reclassified as "subtypes" in the WHO 5th. 5. The concept of high-grade carcinomas is introduced, encompassing poorly differentiated thyroid carcinoma (PDTC), differentiated high-grade thyroid carcinoma (DHGTC), and high-grade medullary thyroid carcinoma (MTC). 6. Squamous cell carcinoma is included in anaplastic thyroid carcinoma (ATC) in the WHO 5th due to their shared genetic and prognostic features. 7. Other miscellaneous tumors are categorized as salivary-gland-type carcinomas of the thyroid, thyroid tumors of uncertain histogenesis, thymic tumors within the thyroid, and embryonal thyroid neoplasms. The WHO 5th thus emphasizes the importance of classifying tumors based on both genetic abnormalities and histomorphology. This approach aids in achieving accurate pathological diagnosis and facilitates the early selection of appropriate treatment options, including molecular targeted therapies.
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Affiliation(s)
- Tomohiro Chiba
- Department of Cytology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan; ; Tel.: +81-3-3520-0111; Fax: +81-3-3570-0558
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
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An J, Kwon H, Kim YJ. The Role of Blood Microbiome in the Development of Thyroid Cancer in Breast Cancer Survivors. Cancers (Basel) 2023; 15:4492. [PMID: 37760462 PMCID: PMC10526815 DOI: 10.3390/cancers15184492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Patients diagnosed with breast cancer are likely to be diagnosed with thyroid cancer as a second primary cancer. Similarly, patients with thyroid cancer are likely to develop breast cancer. In this study, we found an association between these two types of cancers in the microbiomes of patients with breast cancer. Blood samples were collected from 96 patients with breast cancer, their bacterial extracellular vesicles were isolated, and their microbiomes were analyzed. After microbiome analysis, researchers performed thyroid function tests, estrogen levels, and thyroid ultrasound results of these patients, and the relationships among these parameters were analyzed. Based on the thyroid ultrasonography results, differences in the microbiome were confirmed in the normal, cyst, nodule, and thyroid lobectomy groups. We investigated the microbiome differences between normal thyroid and thyroid cancer. In particular, the abundance of the genus Bacillus is related to estrogen levels, which could affect thyroid abnormalities and increase thyroid-stimulating hormone levels. This study explains the causes of thyroid cancer in patients with breast cancer using microbiomes and serological tests for thyroid hormones and estrogen. These can be used as basic data for preventing thyroid cancer in patients with breast cancer.
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Affiliation(s)
- Jeongshin An
- Institute of Convergence Medicine Research, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
- Department of Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Hyungju Kwon
- Department of Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Young Ju Kim
- Department of Obstetrics and Gynecology, Ewha Medical Institute, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
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Orlando G, Graceffa G, Mazzola S, Vassallo F, Proclamà MP, Richiusa P, Radellini S, Paladino NC, Melfa G, Scerrino G. The Role of "Critical" Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1484. [PMID: 37629774 PMCID: PMC10456377 DOI: 10.3390/medicina59081484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Bethesda III (BIII) thyroid nodules have an expected malignancy rate of 5-15%. Our purpose was to assess which US criteria are most associated with cancer risk, and the value of critical ultrasound (US) reassessment. Methods: From 2018 to 2022, 298 BIII nodules were enrolled for thyroidectomy (79 malignancies). We evaluated ultrasonographic data: hechogenicity, intralesional vascularization, spiculated margins, micro-calcifications, "taller than wide" shape, extra-thyroidal growth, size increase, as well as their association with histology. We also evaluated if the ultrasound reassessment modified the strategy. Results: Spiculated margins and microcalcification were significantly correlated with malignancy risk. Spiculated margins showed a specificity of 0.95 IC95% (0.93-0.98); sensitivity 0.70 IC95% (0.59-0.80). Microcalcifications showed a sensitivity of 0.87 CI95% (0.80-0.94); specificity 0.75 CI95% (0.72-0.83). The presence of these signs readdressed the strategy in 76/79 cases Then, the indication for surgery was appropriate in 75% of cases. Conclusions: Microcalcifications and spiculated margins should be routinely sought during a final ultrasound reassessment in BIII nodules. These signs allowed for a modification of the strategy in favor of surgery in 96% of the cases that were not otherwise referred to surgery. The importance of integrating ultrasound and cytology in the evaluation of BIII thyroid nodules is confirmed. Reassessment with ultrasound of BIII nodules allowed for a redirection of the surgical choice.
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Affiliation(s)
- Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Giuseppa Graceffa
- Unit of Oncological Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone”, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
| | - Fabrizio Vassallo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Maria Pia Proclamà
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Stefano Radellini
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005 Marseille, France
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
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Choi HR, Kim K. Mouse Models to Examine Differentiated Thyroid Cancer Pathogenesis: Recent Updates. Int J Mol Sci 2023; 24:11138. [PMID: 37446316 DOI: 10.3390/ijms241311138] [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: 05/19/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Although the overall prognosis of differentiated thyroid cancer (DTC), the most common endocrine malignancy, is favorable, a subset of patients exhibits aggressive features. Therefore, preclinical models that can be utilized to investigate DTC pathogenesis and novel treatments are necessary. Various mouse models have been developed based on advances in thyroid cancer genetics. This review focuses on recent progress in mouse models that have been developed to elucidate the molecular pathogenesis of DTC.
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Affiliation(s)
- Hye Ryeon Choi
- Department of Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, Catholic University of Korea, Seoul 06591, Republic of Korea
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Tang J, Ma J, Xi X, Wang L, Li H, Huo S, Zhang B. Real-life utility of five-gene panel test in preoperative thyroid fine-needle aspiration biopsy: a large cohort of 740 patients study. Endocrine 2022; 80:552-562. [PMID: 36542267 DOI: 10.1007/s12020-022-03286-3] [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: 09/29/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Fine-needle aspiration (FNA) biopsy is an effective method to discriminate malignant thyroid nodules but reaches indeterminate results in approximately 30% of cases. Molecular testing can improve the diagnostic accuracy of FNA. This study aimed to investigate the real-life utility of the five-gene panel testing in thyroid FNAs. METHODS 759 thyroid nodules from 740 patients under FNAs were retrospectively enrolled. Gene mutation information and clinical parameters, including age, gender, tumor size, and lymph node metastasis, were respectively recorded. Cytological results were classified based on The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). We analyzed mutational hotspots in BRAF, KRAS, NRAS, HRAS, and TERT genes from FNA specimens. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated to assess diagnostic performance. RESULTS We identified 549 five-gene mutations in 759 nodules (72.3%), and the mutation frequency increased from the lower TBSRTC category to the upper category. BRAF.p.V600E showed the highest mutation incidence (71.3%) in the five-gene panel, correlated with the small to medium diameter (p = 0.008, p = 0.012) and high cytological categories (p < 0.001). The sensitivity, specificity, PPV, NPV, and accuracy of the combination of FNA cytology and five-gene detection were 96.83%, 100%, 100%, 42.86%, and 96.90%, respectively. CONCLUSIONS The mutation frequency of the five-gene panel is 72.3% in thyroid FNAs. BRAF.p.V600E has the highest alteration rate, which is closely associated with tumor size and cytological results. The five-gene panel can improve the sensitivity and accuracy of FNA cytology, which may represent a valid adjunct technique in distinguishing thyroid nodules.
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Affiliation(s)
- Jiajia Tang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, 100029, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jiaojiao Ma
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xuehua Xi
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Liangkai Wang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, 100029, China
- Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Huilin Li
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, 100029, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Shirui Huo
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Bo Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- Department of Ultrasound, China-Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, 100029, China.
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Rodríguez-Rodero S, Morales-Sánchez P, Tejedor JR, Coca-Pelaz A, Mangas C, Peñarroya A, Fernández-Vega I, Fernández-Fernández L, Álvarez-López CM, Fernández AF, Arranz Álvarez M, Astudillo A, Pujante Alarcón P, Ragnarssön C, Colina Alonso A, Torres Rivas HE, Rodrigo Tapia JP, Nieto Torrero S, Pedroche-Just Y, Regojo Zapata RM, Rodríguez-García AM, Abó A, Balbín M, Menéndez E, Delgado E, Fraga MF. Classification of follicular-patterned thyroid lesions using a minimal set of epigenetic biomarkers. Eur J Endocrinol 2022; 187:335-347. [PMID: 35895726 DOI: 10.1530/eje-22-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The minimally invasive fine-needle aspiration cytology (FNAC) is the current gold standard for the diagnosis of thyroid nodule malignancy. However, the correct discrimination of follicular neoplasia often requires more invasive diagnostic techniques. The lack of suitable immunohistochemical markers to distinguish between follicular thyroid carcinoma and other types of follicular-derived lesions complicates diagnosis, and despite most of these tumours being surgically resected, only a small number will test positive for malignancy. As such, the development of new orthogonal diagnostic approaches may improve the accuracy of diagnosing thyroid nodules. DESIGN This study includes a retrospective, multi-centre training cohort including 54 fresh-frozen follicular-patterned thyroid samples and two independent, multi-centre validation cohorts of 103 snap-frozen biopsies and 33 FNAC samples, respectively. METHODS We performed a genome-wide genetic and epigenetic profiling of 54 fresh-frozen follicular-patterned thyroid samples using exome sequencing and the Illumina Human DNA Methylation EPIC platform. An extensive validation was performed using the bisulfite pyrosequencing technique. RESULTS Using a random forest approach, we developed a three-CpG marker-based diagnostic model that was subsequently validated using bisulfite pyrosequencing experiments. According to the validation cohort, this cost-effective method discriminates between benign and malignant nodules with a sensitivity and specificity of 97 and 88%, respectively (positive predictive value (PPV): 0.85, negative predictive value (NPV): 0.98). CONCLUSIONS Our classification system based on a minimal set of epigenetic biomarkers can complement the potential of the diagnostic techniques currently available and would prioritize a considerable number of surgical interventions that are often performed due to uncertain cytology. SIGNIFICANCE STATEMENT In recent years, there has been a significant increase in the number of people diagnosed with thyroid nodules. The current challenge is their etiological diagnosis to discount malignancy without resorting to thyroidectomy. The method proposed here, based on DNA pyrosequencing assays, has high sensitivity (0.97) and specificity (0.88) for the identification of malignant thyroid nodules. This simple and cost-effective approach can complement expert pathologist evaluation to prioritize the classification of difficult-to-diagnose follicular-patterned thyroid lesions and track tumor evolution, including real-time monitoring of treatment efficacy, thereby stimulating adherence to health promotion programs.
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Affiliation(s)
- Sandra Rodríguez-Rodero
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Paula Morales-Sánchez
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Juan Ramón Tejedor
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
| | - Andrés Coca-Pelaz
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Central University Hospital of Asturias, HUCA Otorhinolaryngology Service, Oviedo, Asturias, Spain
| | - Cristina Mangas
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
| | - Alfonso Peñarroya
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
| | - Iván Fernández-Vega
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Department of Pathology, University Hospital of Asturias (HUCA), Oviedo, Asturias, Spain
| | - Luís Fernández-Fernández
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Department of Pathology, University Hospital of Asturias (HUCA), Oviedo, Asturias, Spain
| | - Carmen M Álvarez-López
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
- University Hospital of Asturias (HUCA), Laboratory of Molecular Oncology, Oviedo, Asturias, Spain
| | - Agustín F Fernández
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
| | | | - Aurora Astudillo
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
- Department of Pathology, University Hospital of Asturias (HUCA), Oviedo, Asturias, Spain
| | - Pedro Pujante Alarcón
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Cecilia Ragnarssön
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Alberto Colina Alonso
- General Surgery, Innovation in Surgery, Transplants and Health Technologies Service, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Héctor Enrique Torres Rivas
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Department of Pathology, University Hospital of Asturias (HUCA), Oviedo, Asturias, Spain
| | - Juan Pablo Rodrigo Tapia
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias, HUCA Otorhinolaryngology Service, Oviedo, Asturias, Spain
| | | | | | | | | | - Anabel Abó
- Arnau de Vilanova University Hospital, IRBLleida, Lleida, Spain
| | - Milagros Balbín
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
- University Hospital of Asturias (HUCA), Laboratory of Molecular Oncology, Oviedo, Asturias, Spain
| | - Edelmiro Menéndez
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Elías Delgado
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Central University Hospital of Asturias (HUCA), Endocrinology and Nutrition Department, Endocrinology, Nutrition, Diabetes and Obesity Unit (ENDO-ISPA), ISPA, Oviedo, Asturias, Spain
| | - Mario F Fraga
- Nanomaterials and Nanotechnology Research Center (CINN), Spanish National Research Council (CSIC), El Entrego, Asturias, Spain
- Health Research Institute of the Principality of Asturias (ISPA), Oviedo, Asturias, Spain
- Spanish Biomedical Research Network in Rare Diseases (CIBERER), Madrid, Spain
- Institute of Oncology of Asturias (IUOPA), University of Oviedo, Oviedo, Asturias, Spain
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Xu D, Wang Y, Wu H, Lu W, Chang W, Yao J, Yan M, Peng C, Yang C, Wang L, Xu L. An artificial intelligence ultrasound system's ability to distinguish benign from malignant follicular-patterned lesions. Front Endocrinol (Lausanne) 2022; 13:981403. [PMID: 36387869 PMCID: PMC9660226 DOI: 10.3389/fendo.2022.981403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the application value of a generally trained artificial intelligence (AI) automatic diagnosis system in the malignancy diagnosis of follicular-patterned thyroid lesions (FPTL), including follicular thyroid carcinoma (FTC), adenomatoid hyperplasia nodule (AHN) and follicular thyroid adenoma (FTA) and compare the diagnostic performance with radiologists of different experience levels. METHODS We retrospectively reviewed 607 patients with 699 thyroid nodules that included 168 malignant nodules by using postoperative pathology as the gold standard, and compared the diagnostic performances of three radiologists (one junior, two senior) and that of AI automatic diagnosis system in malignancy diagnosis of FPTL in terms of sensitivity, specificity and accuracy, respectively. Pairwise t-test was used to evaluate the statistically significant difference. RESULTS The accuracy of the AI system in malignancy diagnosis was 0.71, which was higher than the best radiologist in this study by a margin of 0.09 with a p-value of 2.08×10-5. Two radiologists had higher sensitivity (0.84 and 0.78) than that of the AI system (0.69) at the cost of having much lower specificity (0.35, 0.57 versus 0.71). One senior radiologist showed balanced sensitivity and specificity (0.62 and 0.54) but both were lower than that of the AI system. CONCLUSIONS The generally trained AI automatic diagnosis system can potentially assist radiologists for distinguishing FTC from other FPTL cases that share poorly distinguishable ultrasonographical features.
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Affiliation(s)
- Dong Xu
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuan Wang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Hao Wu
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenliang Lu
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Wanru Chang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Jincao Yao
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Meiying Yan
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Chanjuan Peng
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Chen Yang
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Liping Wang
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- *Correspondence: Liping Wang, ; Lei Xu,
| | - Lei Xu
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- Group of Computational Imaging and Digital Medicine, Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou, China
- Group of Intelligent Medical Devices, South and North Lake Institute for Medical Artificial Intelligence, Haiyan, China
- *Correspondence: Liping Wang, ; Lei Xu,
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9
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Suster D, Mackinnon AC, Nosé V, Suster S. Solid Thyroid Follicular Nodules With Longitudinal Nuclear Grooves: Clinicopathologic, Immunohistochemical, and Molecular Genetic Study of 18 Cases. Arch Pathol Lab Med 2021; 146:984-993. [PMID: 34739542 DOI: 10.5858/arpa.2020-0816-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Follicular thyroid nodules can be a source of diagnostic difficulties, particularly when they display atypical features commonly associated with malignancy, such as nuclear grooves. OBJECTIVE.— To differentiate lesions with atypical features from similar-appearing benign and malignant lesions. DESIGN.— Eighteen cases of atypical follicular thyroid nodules characterized by a solid growth pattern and prominent longitudinal nuclear grooves were studied and examined for clinicopathologic characteristics. RESULTS.— The lesions occurred in 16 women and 2 men aged 36 to 88 years and measured from 0.2 to 1.5 cm. The tumors were well circumscribed and noninvasive, and histologically characterized by a predominantly solid growth pattern with rare scattered follicles or a combination of solid growth pattern with minor follicular areas. A striking feature seen in all cases was the occurrence of longitudinal nuclear grooves. Immunohistochemical stains showed negativity for cytokeratin 19 (CK19) and HBME-1 in 8 cases; in the other 10, there was focal positivity for HBME-1 in 4 cases and diffuse positivity in 6. All cases were negative for galectin-3 and for CK19, with the exception of 1 case, which was CK19+/HBME-1-. Next-generation sequencing of 16 cases with a 161-gene panel detected 14 single nucleotide variants in 12 cases, predominantly NRAS and HRAS mutations. Clinical follow-up ranging from 18 to 72 months (median, 43.7 months) did not disclose any evidence of recurrence or metastases. CONCLUSIONS.— We interpret these lesions as low-grade, indolent follicular proliferations that need to be distinguished from papillary thyroid carcinoma, follicular adenoma, and noninvasive follicular thyroid neoplasms with papillary-like nuclear features.
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Affiliation(s)
- David Suster
- From the Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (D. Suster, Nosé)
| | | | - Vania Nosé
- From the Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston (D. Suster, Nosé)
| | - Saul Suster
- The Medical College of Wisconsin, Milwaukee (S. Suster). D. Suster is currently at the Department of Pathology, Rutgers University School of Medicine, Newark, New Jersey
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10
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Marotta V, Bifulco M, Vitale M. Significance of RAS Mutations in Thyroid Benign Nodules and Non-Medullary Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13153785. [PMID: 34359686 PMCID: PMC8345070 DOI: 10.3390/cancers13153785] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Only about 4% of thyroid nodules are carcinomas and require surgery. Fine-needle aspiration cytology is the most accurate tool to distinguish benign from malignant thyroid nodules, however it yields an indeterminate result in about 30% of the cases, posing diagnostic and prognostic dilemmas. Testing for genetic mutations, including those of RAS, has been proposed for indeterminate cytology to solve these dilemmas and support the clinician decision making process. A passionate debate is ongoing on the biological and clinical significance of RAS mutations, calling into question the utility of RAS as tumor marker. Recently, the description of a new entity of non-invasive follicular thyroid neoplasm and the accurate review of more recent analyses demonstrate that RAS mutations have limited utility in both the diagnostic and prognostic setting of thyroid nodular disease. Abstract Thyroid nodules are detected in up to 60% of people by ultrasound examination. Most of them are benign nodules requiring only follow up, while about 4% are carcinomas and require surgery. Malignant nodules can be diagnosed by the fine-needle aspiration cytology (FNAC), which however yields an indeterminate result in about 30% of the cases. Testing for RAS mutations has been proposed to refine indeterminate cytology. However, the new entity of non-invasive follicular thyroid neoplasm, considered as having a benign evolution and frequently carrying RAS mutations, is expected to lower the specificity of this mutation. The aggressive behavior of thyroid cancer with RAS mutations, initially reported, has been overturned by the recent finding of the cooperative role of TERT mutations. Although some animal models support the carcinogenic role of RAS mutations in the thyroid, evidence that adenomas harboring these mutations evolve in carcinomas is lacking. Their poor specificity and sensitivity make the clinical impact of RAS mutations on the management of thyroid nodules with indeterminate cytology unsatisfactory. Evidence suggests that RAS mutation-positive benign nodules demand a conservative treatment. To have a clinical impact, RAS mutations in thyroid malignancies need not to be considered alone but rather together with other genetic abnormalities in a more general context.
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Affiliation(s)
- Vincenzo Marotta
- UOC Clinica Endocrinologica e Diabetologica, AOU S. Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy;
| | - Maurizio Bifulco
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80100 Naples, Italy;
| | - Mario Vitale
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
- Correspondence: ; Tel.: +39-089-672-753
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11
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Perdana AB, Putri RI, Rachmawati R, Andinata B, Brahma B. Clinical Utility of BRAF, NRAS, and TERT Promoter Mutation in Preoperative Thyroid Fine-Needle Aspiration Biopsy: A Diagnostic Study From Dharmais Cancer Hospital. Asian Pac J Cancer Prev 2020; 21:3267-3277. [PMID: 33247684 PMCID: PMC8033131 DOI: 10.31557/apjcp.2020.21.11.3267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Indexed: 01/08/2023] Open
Abstract
Objective: Molecular testing of thyroid nodules becomes important for improving the accuracy of fine-needle aspiration biopsy (FNAB). This study aimed to investigate the diagnostic utility of BRAF, NRAS, and TERT promoter mutation in thyroid nodules at Dharmais Cancer Hospital. Methods: We performed a prospective diagnostic study involving 50 patients with thyroid nodules who needed surgery between September 2013 and August 2014. Mutational hotspots in BRAF exon 15, NRAS exon 3, and TERT promoter region were analyzed by Sanger sequencing from FNAB specimens. Cytology and molecular data were compared to histopathology results. Results: Of the 50 cases included in the analysis, 39 cases (78%) were thyroid malignancies. Mutations of BRAF, NRAS, and TERT promoter were detected in 31% (12/39), 18% (7/39), and 13% (5/39) cases, respectively. BRAF and NRAS mutations were found mutually exclusive, while all of TERT promoter mutation was found coexistent either with BRAF (40%) or NRAS (60%). The combination of FNAB cytology and molecular testing resulted in 69% sensitivity, 100% specificity, 100% positive predictive value, 48% negative predictive value, and 76% accuracy. Conclusion: Molecular testing of BRAF, NRAS, and TERT mutations improve the sensitivity of thyroid FNAB and is beneficial for more definitive treatment in selective cases. However, the NPV is relatively low to avoid the need for diagnostic surgery. Therefore, further studies to identify more sensitive methods and more comprehensive molecular markers in the diagnosis of thyroid nodules are needed.
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Affiliation(s)
- Adhitya Bayu Perdana
- Department of Research and Development, Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia
| | - Rizky Ifandriani Putri
- Department of Anatomical Pathology, Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia
| | - Rachmawati Rachmawati
- Surgical Oncology Study Program, Department of Surgery, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bob Andinata
- Department of Surgical Oncology, Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia
| | - Bayu Brahma
- Department of Surgical Oncology, Dharmais Cancer Hospital - National Cancer Center, Jakarta, Indonesia
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12
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Endo M, Porter K, Long C, Azaryan I, Phay JE, Ringel MD, Sipos JA, Nabhan F. Features of Cytologically Indeterminate Molecularly Benign Nodules Treated With Surgery. J Clin Endocrinol Metab 2020; 105:5890166. [PMID: 32772084 PMCID: PMC7497819 DOI: 10.1210/clinem/dgaa506] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Most cytologically indeterminate thyroid nodules (ITNs) with benign molecular testing are not surgically removed. The data on clinical outcomes of these nodules are limited. METHODS We retrospectively analyzed all ITNs where molecular testing was performed either with the Afirma gene expression classifier or Afirma gene sequencing classifier between 2011 and 2018 at a single institution. RESULTS Thirty-eight out of 289 molecularly benign ITNs were ultimately resected. The most common reason for surgery was compressive symptoms (39%). In multivariable modeling, patients aged <40 years, nodules ≥3 cm, presence of an Afirma suspicious nodule other than the index nodule, and compressive symptoms were associated with higher surgery rates with hazard ratios for surgery of 3.5 (P < 0.001), 3.2 (P < 0.001), 16.8 (P < 0.001), and 7.31 (P < 0.001), respectively. Of resected nodules, 5 were malignant. False-negative rate (FNR) was 1.7%, presuming all unresected nodules were truly benign and 13.2% restricting analysis to resected cases. The FNR was significantly higher in nodules with a high-risk sonographic appearance for cancer (American Thyroid Association high-risk classification and American College of Radiology Thyroid Imaging Reporting and Data Systems score of 5) compared with nodules with all other sonographic categories (11.8% vs 1.1%; P = 0.03 and 11.1% vs 1.1%; P = 0.02, respectively). CONCLUSIONS Younger age, larger nodule size, presence of an Afirma suspicious nodule other than the index nodule, and compressive symptoms were associated with a higher rate of surgery. The FNR of benign Afirma was significantly higher in nodules with high-risk sonographic features.
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Affiliation(s)
- Mayumi Endo
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
- Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Clarine Long
- The Ohio State University, College of Medicine, Columbus, Ohio
| | - Irina Azaryan
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - John E Phay
- Department of Surgery, The Ohio State University Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Matthew D Ringel
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Jennifer A Sipos
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
| | - Fadi Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University and Arthur G. James Cancer Center, Columbus, Ohio
- Correspondence and Reprint Requests: Fadi Nabhan, MD, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, 1581 Dodd Drive, Columbus, OH 43210, USA. E-mail:
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13
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Bellevicine C, Migliatico I, Sgariglia R, Nacchio M, Vigliar E, Pisapia P, Iaccarino A, Bruzzese D, Fonderico F, Salvatore D, Biondi B, Masone S, Novizio V, Scavuzzo F, Serino D, De Palma M, Chiofalo MG, Botti G, Pezzullo L, Nuzzo V, Spiezia S, De Chiara G, Iorio S, Conzo G, Docimo G, Faggiano A, Bongiovanni M, Malapelle U, Colao A, Triassi M, Troncone G. Evaluation of
BRAF
,
RAS
,
RET/PTC
, and
PAX8/PPARg
alterations in different Bethesda diagnostic categories: A multicentric prospective study on the validity of the 7‐gene panel test in 1172 thyroid FNAs deriving from different hospitals in South Italy. Cancer Cytopathol 2019; 128:107-118. [DOI: 10.1002/cncy.22217] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022]
Affiliation(s)
| | - Ilaria Migliatico
- Department of Public Health University of Naples Federico II Naples Italy
| | - Roberta Sgariglia
- Department of Public Health University of Naples Federico II Naples Italy
| | | | - Elena Vigliar
- Department of Public Health University of Naples Federico II Naples Italy
| | - Pasquale Pisapia
- Department of Public Health University of Naples Federico II Naples Italy
| | - Antonino Iaccarino
- Department of Public Health University of Naples Federico II Naples Italy
| | - Dario Bruzzese
- Department of Public Health University of Naples Federico II Naples Italy
| | - Francesco Fonderico
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Domenico Salvatore
- Department of Public Health University of Naples Federico II Naples Italy
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Stefania Masone
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Vincenzo Novizio
- Department of Endocrinology Aziena Ospedaliera di Rilievo Nazionale A. Cardarelli Naples Italy
| | - Francesco Scavuzzo
- Department of Endocrinology Aziena Ospedaliera di Rilievo Nazionale A. Cardarelli Naples Italy
| | - Domenico Serino
- Department of Endocrinology Aziena Ospedaliera di Rilievo Nazionale A. Cardarelli Naples Italy
| | - Maurizio De Palma
- Department of Surgery Aziena Ospedaliera di Rilievo Nazionale A. Cardarelli Naples Italy
| | | | | | - Luciano Pezzullo
- Thyroid and Parathyroid Surgery Unit IRCCS G. Pascale Naples Italy
| | - Vincenzo Nuzzo
- Department of Endocrinology Hospital of the Sea‐Azienda Sanitaria Locale Naples 1 Center Naples Italy
| | - Stefano Spiezia
- Department of Endocrine Surgery Hospital of the Sea‐Azienda Sanitaria Locale Naples 1 Center Naples Italy
| | - Giovanni De Chiara
- Department of Pathology Aziena Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino Italy
| | - Sergio Iorio
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences University of Campania Luigi Vanvitelli Caserta Italy
| | - Giovanni Conzo
- Department of Cardiothoracic and Respiratory Sciences University of Campania Luigi Vanvitelli Caserta Italy
| | - Giovanni Docimo
- Department of Medical, Surgical, Neurological, Metabolic, and Aging Sciences University of Campania Luigi Vanvitelli Caserta Italy
| | | | | | - Umberto Malapelle
- Department of Public Health University of Naples Federico II Naples Italy
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - Maria Triassi
- Department of Public Health University of Naples Federico II Naples Italy
| | - Giancarlo Troncone
- Department of Public Health University of Naples Federico II Naples Italy
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14
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Angell TE. GROWTH HAPPENS: HOW CAN INCREASING THYROID NODULE SIZE BE USED TO PREDICT MALIGNANCY? Endocr Pract 2019; 25:1074-1076. [PMID: 31613160 DOI: 10.4158/ep-2019-0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Borowczyk M, Szczepanek-Parulska E, Dębicki S, Budny B, Verburg FA, Filipowicz D, Więckowska B, Janicka-Jedyńska M, Gil L, Ziemnicka K, Ruchała M. Differences in Mutational Profile between Follicular Thyroid Carcinoma and Follicular Thyroid Adenoma Identified Using Next Generation Sequencing. Int J Mol Sci 2019; 20:ijms20133126. [PMID: 31248021 PMCID: PMC6651591 DOI: 10.3390/ijms20133126] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 02/06/2023] Open
Abstract
We aimed to identify differences in mutational status between follicular thyroid adenoma (FTA) and follicular thyroid cancer (FTC). The study included 35 patients with FTA and 35 with FTC. DNA was extracted from formalin-fixed paraffin-embedded (FFPE) samples from thyroidectomy. Next-generation sequencing (NGS) was performed with the 50-gene Ion AmpliSeq Cancer Hotspot Panel v2. Potentially pathogenic mutations were found in 14 (40%) FTA and 24 (69%) FTC patients (OR (95%CI) = 3.27 (1.22−8.75)). The number of mutations was higher in patients with FTC than FTA (p-value = 0.03). SMAD4 and STK11 mutations were present only in patients with FTA, while defects in FBXW7, JAK3, KIT, NRAS, PIK3CA, SMARCB1, and TP53 were detected exclusively in FTC patients. TP53 mutations increased the risk of FTC; OR (95%CI) = 29.24 (1.64–522.00); p-value = 0.001. FLT3-positivity was higher in FTC than in the FTA group (51.4% vs. 28.6%; p-value = 0.051). The presence of FLT3 and TP53 with no RET mutations increased FTC detectability by 17.1%, whereas the absence of FLT3 and TP53 with a presence of RET mutations increased FTA detectability by 5.7%. TP53 and FLT3 are candidate markers for detecting malignancy in follicular lesions. The best model to predict FTA and FTC may consist of FLT3, TP53, and RET mutations considered together.
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Affiliation(s)
- Martyna Borowczyk
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland.
| | - Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland
| | - Szymon Dębicki
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland
| | - Bartłomiej Budny
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland
| | - Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Marburg, 35043 Marburg, Germany
| | - Dorota Filipowicz
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland
| | - Barbara Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznań, Poland
| | | | - Lidia Gil
- Department of Hematology and Bone Marrow Transplantation, Poznan University of Medical Sciences, 60-569 Poznań, Poland
| | - Katarzyna Ziemnicka
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, 60-355 Poznań, Poland
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16
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Kim M, Jeon MJ, Han M, Lee JH, Song DE, Baek JH, Kim TY, Kim WB, Shong YK, Kim WG. Tumor Growth Rate Does Not Predict Malignancy in Surgically Resected Thyroid Nodules Classified as Bethesda Category III with Architectural Atypia. Thyroid 2019; 29:216-221. [PMID: 30421654 DOI: 10.1089/thy.2018.0366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is unknown whether the growth of thyroid nodules with a Bethesda category III cytology (atypia of undetermined significance [AUS]) is predictive of malignancy, especially in cases with architectural atypia (AUS-A). This study evaluated whether tumor growth rates can help distinguish malignant from benign nodules in the AUS-A subcategory. METHODS This retrospective, single-center cohort study included 172 patients who underwent diagnostic thyroid surgery because of a nodule with a cytological diagnosis of AUS-A. The growth kinetics of nodules was assessed by serial preoperative neck ultrasonography over a median follow-up of 52.6 months (range 12.7-198.3 months). RESULTS Pathologic examinations showed that 112 (65%) and 60 (35%) patients had benign and malignant nodules, respectively. The largest diameter and volume of both benign and malignant nodules increased gradually (p < 0.001). However, there was no significant difference in the growth rates of benign and malignant nodules based on the largest diameter (p = 0.132) and volume (p = 0.200). The time to tumor growth curves and estimated median time to significant tumor growth from baseline were not significantly different in malignant nodules compared to benign nodules (p = 0.458 and p = 0.568, respectively). The relative risk (RR) of malignancy of growing and stable nodules did not differ significantly based on the largest diameter (RR = 0.5; p = 0.064) and volume (RR = 0.9; p = 0.748). CONCLUSIONS The size of thyroid nodules classified as AUS-A increased linearly, regardless whether these nodules were benign or malignant. These results suggest that growth kinetics on serial preoperative neck ultrasonography cannot predict malignancy in the AUS-A subcategory.
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Affiliation(s)
- Mijin Kim
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- 2 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- 2 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minkyu Han
- 3 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- 4 Department of Radiology, and Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- 5 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- 4 Department of Radiology, and Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- 2 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- 2 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- 2 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- 2 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Jeong SH, Hong HS, Lee EH, Kwak JJ, Lee JY. Analysis of RAS mutation in thyroid nodular hyperplasia and follicular neoplasm in a Korean population. Endocrinol Diabetes Metab 2018; 1:e00040. [PMID: 30815568 PMCID: PMC6354824 DOI: 10.1002/edm2.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/26/2018] [Accepted: 06/30/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To investigate the difference in frequency of RAS mutations between nodular hyperplasia (NH), follicular thyroid adenomas (FTAs) and follicular thyroid carcinomas (FTCs) in a Korean population. METHODS RAS mutations in 50 NH, 57 FTAs and 39 FTCs between January 2002 and May 2015 were analysed by pyrosequencing. RESULTS Nine nodules of 50 NHs (18%), 18 nodules of 39 FTCs (46.2%) and 19 nodules of 57 FTAs (33.3%) harboured RAS mutations. Three FTCs and three FTAs showed two point mutations simultaneously. N-RAS codon 61 (n = 6 of 9, 66.7%) and H-RAS codon 61 (n = 3 of 9, 33.3%) were found in NHs. K-RAS codons 12-13, K-RAS codon 61, N-RAS codons 12-13 and H-RAS codons 12-13 were not found in NHs. N-RAS codon 61 (n = 7 of 21, 33.3%), K-RAS codons 12-13 (n = 6 of 21, 28.6%), H-RAS codon 61 (n = 4 of 21, 19.0%), K-RAS codon 61 (n = 3 of 21, 14.3%) and N-RAS codons 12-13 (n = 1 of 21, 4.7%) were found in FTCs, and N-RAS codon 61 (n = 10 of 22, 45.5%), K-RAS codons 12-13 (n = 5 of 22, 22.7%), H-RAS codon 61 (n = 5 of 22, 22.7%), K-RAS codon 61 (n = 1 of 22, 4.5%) and N-RAS codons 12-13 (n = 1 of 22, 4.5%) were observed in FTAs. CONCLUSIONS The frequencies of RAS mutations among our Korean population were 18% in NHs, 46.2% in FTC and 33.3% in FTAs. N-RAS codon 61 was the most frequent mutation in NHs, FTCs and FTAs, and the frequency was not significantly different among the three groups. K-RAS codons 12-13 were the second most commonly involved site in FTCs and FTAs, whereas no mutation was detected at this site in NHs.
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Affiliation(s)
- Sun Hye Jeong
- Department of RadiologySoonchunhyang University Bucheon HospitalBucheonKorea
| | - Hyun Sook Hong
- Department of RadiologySoonchunhyang University Bucheon HospitalBucheonKorea
| | - Eun Hye Lee
- Department of RadiologySoonchunhyang University Bucheon HospitalBucheonKorea
| | - Jeong Ja Kwak
- Department of PathologySoonchunhyang University Bucheon HospitalBucheonKorea
| | - Ji Ye Lee
- Department of RadiologySoonchunhyang University Bucheon HospitalBucheonKorea
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18
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Yim JH, Choi AH, Li AX, Qin H, Chang S, Tong SWT, Chu P, Kim BW, Schmolze D, Lew R, Ibrahim Y, Poroyko VA, Salvatierra S, Baker A, Wang J, Wu X, Pfeifer GP, Fong Y, Hahn MA. Identification of Tissue-Specific DNA Methylation Signatures for Thyroid Nodule Diagnostics. Clin Cancer Res 2018; 25:544-551. [PMID: 30093451 DOI: 10.1158/1078-0432.ccr-18-0841] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/01/2018] [Accepted: 08/06/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Thyroid cancer is frequently difficult to diagnose due to an overlap of cytologic features between malignant and benign nodules. This overlap leads to unnecessary removal of the thyroid in patients without cancer. While providing some improvement over cytopathologic diagnostics, molecular methods frequently fail to provide a correct diagnosis for thyroid nodules. These approaches are based on the difference between cancer and adjacent thyroid tissue and assume that adjacent tissues are the same as benign nodules. However, in contrast to adjacent tissues, benign thyroid nodules can contain genetic alterations that can be found in cancer.Experimental Design: For the development of a new molecular diagnostic test for thyroid cancer, we evaluated DNA methylation in 109 thyroid tissues by using genome-wide single-base resolution DNA methylation analysis. The test was validated in a retrospective cohort containing 65 thyroid nodules. RESULTS By conducting reduced representation bisulfite sequencing in 109 thyroid specimens, we found significant differences between adjacent tissue, benign nodules, and cancer. These tissue-specific signatures are strongly linked to active enhancers and cancer-associated genes. Based on these signatures, we developed a new epigenetic approach for thyroid diagnostics. According to the validation cohort, our test has an estimated specificity of 97% [95% confidence interval (CI), 81-100], sensitivity of 100% (95% CI, 87-100), positive predictive value of 97% (95% CI, 83-100), and negative predictive value of 100% (95% CI, 86-100). CONCLUSIONS These data show that epigenetic testing can provide outstanding diagnostic accuracy for thyroid nodules.See related commentary by Mitmaker et al., p. 457.
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Affiliation(s)
- John H Yim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California.
| | - Audrey H Choi
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Arthur X Li
- Department of Information Sciences, Beckman Research Institute of City of Hope, Duarte, California
| | - Hanjun Qin
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, California
| | - Sue Chang
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sun-Wing T Tong
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Peiguo Chu
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Byung-Wook Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Daniel Schmolze
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ryan Lew
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Yasmine Ibrahim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Valeriy A Poroyko
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Sylvana Salvatierra
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Alysha Baker
- Department of Pathology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jinhui Wang
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, California
| | - Xiwei Wu
- Department of Molecular and Cellular Biology, Beckman Research Institute of City of Hope, Duarte, California
| | - Gerd P Pfeifer
- Center for Epigenetics, Van Andel Research Institute, Grand Rapids, Michigan
| | - Yuman Fong
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Maria A Hahn
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California.
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19
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Kim M, Han M, Lee JH, Song DE, Kim K, Baek JH, Shong YK, Kim WG. Tumour growth rate of follicular thyroid carcinoma is not different from that of follicular adenoma. Clin Endocrinol (Oxf) 2018; 88:936-942. [PMID: 29509975 DOI: 10.1111/cen.13591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Distinguishing malignancy from benign thyroid nodule has always been challenging, especially in follicular lesions. Thyroid nodules with small size and indeterminate cytology do not lead to immediate surgery. We tried to evaluate whether tumour size and tumour growth rate can distinguish follicular thyroid carcinoma (FTC) from follicular adenoma (FA). DESIGN AND PATIENTS This retrospective study included patients with pathologically proven FTCs (n = 50) and FAs (n = 110) who underwent preoperative serial neck ultrasonography (US) at least 3 times: it comprises 30% of all follicular tumours (32% FAs and 25% FTCs). The growth rates of follicular tumours on serial US were measured using at least 3 consecutive examinations during a median follow-up of 4.1 years (range, 0.7-13.3 years) by experienced radiologists. RESULTS The FA and FTC groups showed no significant difference in clinicopathological characteristics, including age, proportion of large nodules (>4 cm) and preoperative cytology. The maximum diameter of thyroid nodule was gradually increased in both groups with statistical significance (P < .001 and P < .001, respectively). No significant differences in change of maximum diameter of thyroid nodule (P = .132) and tumour volume (P = .208) were found between the FA and FTC groups during the follow-up. The median time to a significant tumour growth from baseline was not different between the FA and FTC groups (1.4 years and 1.7 years, respectively, P = .556). When we divided the patients into four groups (rapid, moderate, slow and no growth) according to the growth velocity of the thyroid tumours, no significant difference in growth velocity was found among the groups. CONCLUSIONS The tumour size and growth rate of the thyroid nodule itself could not predict malignancy. Diagnostic approaches that use molecular markers would be more important than clinical features for the decision of diagnostic surgery for patients with follicular tumours.
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Affiliation(s)
- Mijin Kim
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Minkyu Han
- Departments of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hyun Lee
- Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyunggon Kim
- Departments of Convergence medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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20
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Acquaviva G, Visani M, Repaci A, Rhoden KJ, de Biase D, Pession A, Giovanni T. Molecular pathology of thyroid tumours of follicular cells: a review of genetic alterations and their clinicopathological relevance. Histopathology 2018; 72:6-31. [PMID: 29239040 DOI: 10.1111/his.13380] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/28/2017] [Accepted: 08/29/2017] [Indexed: 02/05/2023]
Abstract
Thyroid cancer is the most common endocrine malignancy. Knowledge of the molecular pathology of thyroid tumours originating from follicular cells has greatly advanced in the past several years. Common molecular alterations, such as BRAF p.V600E, RAS point mutations, and fusion oncogenes (RET-PTC being the prototypical example), have been, respectively, associated with conventional papillary carcinoma, follicular-patterned tumours (follicular adenoma, follicular carcinoma, and the follicular variant of papillary carcinoma/non-invasive follicular thyroid neoplasm with papillary-like nuclear features), and with papillary carcinomas from young patients and arising after exposure to ionising radiation, respectively. The remarkable correlation between genotype and phenotype shows how specific, mutually exclusive molecular changes can promote tumour development and initiate a multistep tumorigenic process that is characterised by aberrant activation of mitogen-activated protein kinase and phosphoinositide 3-kinase-PTEN-AKT signalling. Molecular alterations are becoming useful biomarkers for diagnosis and risk stratification, and as potential treatment targets for aggressive forms of thyroid carcinoma. What follows is a review of the principal genetic alterations of thyroid tumours originating from follicular cells and of their clinicopathological relevance.
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Affiliation(s)
- Giorgia Acquaviva
- Anatomical Pathology, Molecular Diagnostic Unit, University of Bologna School of Medicine, Azienda USL di Bologna, Bologna, Italy
| | - Michela Visani
- Anatomical Pathology, Molecular Diagnostic Unit, University of Bologna School of Medicine, Azienda USL di Bologna, Bologna, Italy
| | - Andrea Repaci
- Endocrinology Unit, University of Bologna School of Medicine, Bologna, Italy
| | - Kerry J Rhoden
- Medical Genetics Unit, University of Bologna School of Medicine, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, Bologna, Italy
| | - Annalisa Pession
- Department of Pharmacy and Biotechnology, Molecular Diagnostic Unit, University of Bologna, Azienda USL di Bologna, Bologna, Italy
| | - Tallini Giovanni
- Anatomical Pathology, Molecular Diagnostic Unit, University of Bologna School of Medicine, Azienda USL di Bologna, Bologna, Italy
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21
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Abstract
PURPOSE OF REVIEW The current review focuses on the uncertainty regarding the management of rat sarcoma viral oncogene homolog RAS-positive thyroid nodules. The application of oncogene testing has been heralded for improving risk assessment for indeterminate cytology thyroid nodules and has grown in clinical use. RAS mutations are historically considered oncogenic. However, RAS mutation detection in thyroid nodules has proven problematic, as these mutations are found in benign and malignant lesions. RECENT FINDINGS RAS-positive thyroid nodules frequently have indeterminate cytology and a finding of a positive RAS mutation identifies a significant number of benign lesions as well as thyroid cancers. Long-term follow-up of RAS-positive nodules with benign cytology shows an indolent course not consistent with eventual malignant transformation. Many RAS-positive nodules previously diagnosed as follicular variant of papillary thyroid carcinoma now will be reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features, indicating a more indolent nature of these RAS-positive lesions. SUMMARY Recent findings have underscored that diagnosis of a RAS-positive thyroid nodule is not synonymous with thyroid malignancy. The ideal clinical and surgical management of these nodules remains challenging.
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Affiliation(s)
- Trevor E Angell
- Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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22
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Abstract
PURPOSE OF REVIEW The review is focused on new information about the presentation and management of thyroid nodules in children and adolescents. RECENT FINDINGS Palpable thyroid nodules are uncommon in children but many children have nodules detected by radiologic imaging. How to evaluate them, when to suspect thyroid cancer, and how best to follow apparently benign nodules has become an area of great interest. The American Thyroid Association recently published treatment guidelines for children with thyroid nodules and cancers but much has been learned since that publication. SUMMARY Personal and family history, ultrasound features, and fine needle aspiration cytology are used to determine the risk of cancer in thyroid nodules, which are then managed according to cancer risk.
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23
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Halászlaki C, Tóbiás B, Balla B, Kósa JP, Horányi J, Bölöny E, Nagy Z, Speer G, Járay B, Székely E, Istók R, Székely T, Putz Z, Dank M, Lakatos P, Takács I. PREDICTIVE VALUE OF SOMATIC MUTATIONS FOR THE DEVELOPMENT OF MALIGNANCY IN THYROID NODULES BY CYTOPATHOLOGY. Endocr Pract 2016; 22:1081-7. [PMID: 27214302 DOI: 10.4158/ep151057.or] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The purpose of our prospective longitudinal study was to evaluate the predictive efficacy of genetic testing for malignancies in fine-needle aspiration biopsy samples that are cytologically benign at the time of biopsy. METHODS A total of 779 aspirated cytological samples collected from thyroid nodules of 626 patients were included in a 3-year follow-up study. Consecutive patients with cytologically benign thyroid nodules by the Bethesda System for Reporting Thyroid Cytopathology were enrolled in the study. At enrollment, somatic 1-point nucleotide polymorphisms of BRAF and RAS family genes were tested by melting-point analysis, while RET/PTC and PAX8/PPAR-gamma rearrangements were examined by real-time polymerase chain reaction. The genetic test was considered to be positive if a somatic mutation was found. Malignant cytopathologic diagnoses were confirmed by histopathology. RESULTS In samples collected from 779 thyroid nodules, there were 39 BRAF, 33 RAS mutations, and 1 RET/PTC rearrangements found at the beginning of the study. No PAX8/PPAR-gamma rearrangement was identified. There were 52 malignant thyroid tumors removed during follow-up, out of which 24 contained a somatic mutation. The specificity of the presence of somatic mutations for malignancies was as high as 93.3%, and sensitivity was 46.2%. The negative predictive value of genetic testing reached 96.0%. CONCLUSION Our results show that our set of genetic tests can predict the appearance of malignancy in benign thyroid nodules (at the beginning of follow-up) with high specificity and strong negative predictive value. ABBREVIATIONS BRAF = v-raf murine sarcoma viral oncogene homolog B1 FLUS = follicular lesion of undetermined significance FNAB = fine-needle aspiration biopsy FTC = follicular thyroid carcinoma HRAS = homologous to the oncogene from the Harvey rat sarcoma virus KRAS = homologous to the oncogene from the Kirsten rat sarcoma virus NRAS = first isolated from a human neuroblastoma/neuroblastoma RAS = viral oncogene homolog PAX8 = paired box 8 PCR = polymerase chain reaction PPAR-gamma = peroxisome proliferator-activated receptor gamma PTC = papillary thyroid carcinoma RAS = rat sarcoma RET = rearranged during transfection tyrosine-kinase proto-oncogene SM = somatic mutation SNP = single-nucleotide polymorphism.
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