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Al-Ibraheem A, Abdlkadir AS, Al-Adhami DA, Lopci E, Al-Omari A, Al-Masri M, Yousef Y, Al-Hajaj N, Mohamad I, Singer S, Sykiotis GP. Comparative analysis through propensity score matching in thyroid cancer: unveiling the impact of multiple malignancies. Front Endocrinol (Lausanne) 2024; 15:1366935. [PMID: 38894738 PMCID: PMC11184125 DOI: 10.3389/fendo.2024.1366935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Background The incidence of thyroid cancer is on the rise worldwide, with childhood exposure to radiation being the sole acknowledged catalyst for its emergence. Nonetheless, numerous other factors that may pose risks are awaiting thorough examination and validation. This retrospective study aims to explore the malignancies linked to thyroid cancer and contrast the survival rates of those afflicted with a solitary tumor versus those with multiple primary neoplasms (MPN). Methods This retrospective study examined data from King Hussein Cancer Center (KHCC), Jordan. Among 563 patients diagnosed with thyroid cancer, 30 patients had thyroid malignancy as part of MPN. For a 1:3 propensity score-matched analysis, 90 patients with only a primary thyroid malignancy were also enrolled. Results Hematologic and breast malignancies were among the most frequent observed cancers alongside thyroid neoplasm. Patients who had MPN were diagnosed at older age, had higher body mass index and presented with higher thyroglobulin antibody levels (p < 0.05 for each). Additionally, MPN patient displayed a stronger family history for cancers (p= 0.002). A median follow-up duration of 135 months unveiled that MPN patients faced a worse 5-year survival compared to their counterparts with a singular neoplasm (87% vs 100% respectively; p < 0.01). However, no distinction emerged in the 5-year event-free survival between these two groups. Conclusion MPN correlates with a significantly altered survival outcome of thyroid cancer patients. The diagnosis of thyroid carcinoma at an older age, accompanied by elevated initial thyroglobulin antibody levels and a notable familial predisposition, may raise concerns about the potential occurrence of synchronous or metachronous tumors.
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Affiliation(s)
- Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, the University of Jordan, Amman, Jordan
| | - Ahmed Saad Abdlkadir
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Dhuha Ali Al-Adhami
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS– Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Amal Al-Omari
- Office of Scientific Affairs and Research (OSAR), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Mahmoud Al-Masri
- Department of Surgery, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Yacoub Yousef
- Department of Surgery, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Nabeela Al-Hajaj
- Department of Nuclear Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre Mainz, Mainz, Germany
| | - Gerasimos P. Sykiotis
- Department of Endocrinology, Diabetology and Metabolism, Vaud University Hospital Center (CHUV), Lausanne, Switzerland
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Еrmakova O, Raskosha О. Changes in the structural and functional state of the thyroid gland of small mammals when exposed to low-intensity chronic radiation. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:34170-34183. [PMID: 38696014 DOI: 10.1007/s11356-024-33504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/25/2024] [Indexed: 05/31/2024]
Abstract
The study gives a morphofunctional assessment of the state of the thyroid gland of tundra voles (Microtus oeconomus Pall.) in conditions of an increased radiation background (the Ukhta district of the Komi Republic (Russia) and the 30-km zone of the Chernobyl NPP), as well as in an experiment with chronic external gamma irradiation in the low dose range. The work summarizes the experience of more than 35 years of field and laboratory research. The authors have noted the high sensitivity of the thyroid gland to chronic radiation against the general irradiation of the organism both in natural conditions and in the experiment. The repeatability of the observed effects in voles from natural populations and the comparability of some effects with the morphological changes occurring in animals after exposure to ionizing radiation in the experiment indicates the radiation nature of these effects. The tundra voles living in conditions of increased radiation background have been identified for a greater variety of morphological rearrangements in the thyroid parenchyma than the experimental animals. The complex and ambiguous nature of the thyroid gland responses to radiation exposure indicates the possibility of a significant increase in the risk of negative effects of ionizing radiation in contrast with the expected results of biological effects' extrapolation from high to low doses.
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Affiliation(s)
- Olga Еrmakova
- Institute of Biology Federal Research Centre Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, Kommunisticheskaya 28, Syktyvkar, Russian Federation, 167982
| | - Оksana Raskosha
- Institute of Biology Federal Research Centre Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, Kommunisticheskaya 28, Syktyvkar, Russian Federation, 167982.
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Bellastella G, Scappaticcio L, Caiazzo F, Tomasuolo M, Carotenuto R, Caputo M, Arena S, Caruso P, Maiorino MI, Esposito K. Mediterranean Diet and Thyroid: An Interesting Alliance. Nutrients 2022; 14:nu14194130. [PMID: 36235782 PMCID: PMC9571437 DOI: 10.3390/nu14194130] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022] Open
Abstract
The Mediterranean diet, recognized as being cultural heritage by UNESCO, is mostly plant-based and includes a high consumption of whole-grain, fruit, and vegetables with a moderate consumption of alcohol during meals. Thus, it provides a small amount of saturated fatty acids and a high quantity of antioxidants and fiber. For this reason, it has been considered to have an important role in preventing cardiovascular diseases, chronic kidney diseases, type 2 diabetes mellitus, and cancer, but its relationship with thyroid function and diseases is still under debate. The aim of this review was to search for the possible correlation between the Mediterranean diet and thyroid function, and to critically evaluate the pathophysiological link between selected food intake and thyroid disorders.
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Affiliation(s)
- Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Unit of Endocrinology and Metabolic Diseases, University Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Correspondence: ; Tel.: +39-0815665289
| | - Lorenzo Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Francesco Caiazzo
- Unit of Endocrinology and Metabolic Diseases, University Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Maria Tomasuolo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Raffaela Carotenuto
- Unit of Endocrinology and Metabolic Diseases, University Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Mariangela Caputo
- Unit of Endocrinology and Metabolic Diseases, University Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Stefania Arena
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Paola Caruso
- Unit of Endocrinology and Metabolic Diseases, University Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Unit of Endocrinology and Metabolic Diseases, University Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Unit of Endocrinology and Metabolic Diseases, University Hospital, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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Feletti F, Mellini L, Pironi F, Carnevale A, Parenti GC. Role of the cytopathologist during the procedure of fine-needle aspiration biopsy of thyroid nodules. Insights Imaging 2021; 12:111. [PMID: 34370089 PMCID: PMC8350303 DOI: 10.1186/s13244-021-01053-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/05/2021] [Indexed: 01/30/2023] Open
Abstract
Purpose This study aimed to conduct a diagnostic and cost-effective analysis of the cytopathology assistance in the ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for characterising thyroid nodules. Materials and methods We reviewed the reports relative to 9061 US-guided FNABs for the histologic definition of the nature of thyroid nodules: 45.4% completed with the cytopathologist assistance and 54.6% by the radiologist alone. We also performed the cost-effectiveness analysis (CEA) of the procedure with and without the cytopathologist assistance. Results We found a significant positive correlation between the adoption/non-adoption of cytopathologist assistance and the number of indeterminate (TIR1) (Chi-square; z-score, Z = 10.22; critical value 5%, C = 1.96; p < 0.001). The cytopathologist's absence was correlated with the number of TIR 1 (Pearson correlation, product–moment correlation r = 0.059; critical value 5%, C = 0.008; p < 0.001). The total cost of the model's cytopathologist-assistance branch is 109.87€, while the total cost of the non-cytopathologist-assistance branch is 95.08€. Conclusion The cytopathologist assistance resulted in fewer nondiagnostic results, thus excluding the procedure's repetition but involved a higher expense, mainly due to the professional cost of the pathologist's participation. These data may provide decision-makers in healthcare with a practical evidence based on the opportunity to include the cytopathologist assistance in the thyroid nodule's FNAB depending on the available resources and the population's expectance. Supplementary information The online version contains supplementary material available at 10.1186/s13244-021-01053-y.
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Affiliation(s)
- F Feletti
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy.
| | - L Mellini
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy
| | - F Pironi
- DAMeTLab, Unit of Anatomical Pathology, S. M. Delle Croci Hospital, Ravenna, Italy
| | - A Carnevale
- Department of Radiology, University Radiology Unit, Sant'Anna University Hospital, Ferrara, Italy
| | - G C Parenti
- Department of Diagnostic Imaging Ausl Romagna, Unit of Radiology, S. Maria Delle Croci Hospital, Viale Randi 5, Ravenna, Italy
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Kase S, Baburin A, Kuddu M, Innos K. Incidence and Survival for Head and Neck Cancers in Estonia, 1996-2016: A Population-Based Study. Clin Epidemiol 2021; 13:149-159. [PMID: 33658861 PMCID: PMC7917307 DOI: 10.2147/clep.s293929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Changing patterns of alcohol and tobacco consumption and human papillomavirus (HPV) infection have affected the epidemiology of head and neck cancers. The aim of this study was to examine 20-year trends in the incidence and survival of head and neck cancers in Estonia by site, sex, morphology, and stage. Methods Data on all adult cases of invasive head and neck cancers diagnosed in Estonia in 1996–2016 were obtained from a population-based cancer registry. TNM stage was available for 2010–2016. Incidence trends were modeled with join-point regression, and five-year relative survival ratios (RSRs) were calculated. Results A total of 6,769 cases were included, 64% men. We observed declining incidence of lip and laryngeal cancer and substantial increases in the incidence of hypopharyngeal and oropharyngeal cancers. Over 60% of mouth and pharyngeal cancers were diagnosed at stage IV. Age-standardized 5-year RSR for mouth and pharyngeal cancer increased substantially over the study period, from 21% (95% CI 16%–25%) in 1996–2002 to 33% (29%–38%) in 2010–2016. The largest survival increases were seen for cancers of the oral cavity (reaching 44% in 2010–2016), tongue (41%), and larynx (63%), while modest changes were seen for the oropharynx (24%) and hypopharynx (17%). The latest 5-year RSR was 90% for thyroid cancers (99% for papillary carcinoma). Large female survival advantage was seen for most sites. Conclusion The observed trends suggest an emerging role of HPV infection in combination with traditional risk factors in the development of head and neck cancers in Estonia. Efforts targeting health behavior, HPV vaccination, and earlier diagnosis are crucial for reducing mortality from these cancers.
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Affiliation(s)
- Sandra Kase
- Medical Faculty of Tartu University, Tartu, Estonia
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Maire Kuddu
- Department of Radiotherapy, Clinic of Haematology and Oncology, North Estonia Medical Centre, Tallinn, Estonia
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
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Rangel-Pozzo A, Sisdelli L, Cordioli MIV, Vaisman F, Caria P, Mai S, Cerutti JM. Genetic Landscape of Papillary Thyroid Carcinoma and Nuclear Architecture: An Overview Comparing Pediatric and Adult Populations. Cancers (Basel) 2020; 12:E3146. [PMID: 33120984 PMCID: PMC7693829 DOI: 10.3390/cancers12113146] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
Thyroid cancer is a rare malignancy in the pediatric population that is highly associated with disease aggressiveness and advanced disease stages when compared to adult population. The biological and molecular features underlying pediatric and adult thyroid cancer pathogenesis could be responsible for differences in the clinical presentation and prognosis. Despite this, the clinical assessment and treatments used in pediatric thyroid cancer are the same as those implemented for adults and specific personalized target treatments are not used in clinical practice. In this review, we focus on papillary thyroid carcinoma (PTC), which represents 80-90% of all differentiated thyroid carcinomas. PTC has a high rate of gene fusions and mutations, which can influence the histologic subtypes in both children and adults. This review also highlights telomere-related genomic instability and changes in nuclear organization as novel biomarkers for thyroid cancers.
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Affiliation(s)
- Aline Rangel-Pozzo
- Cell Biology, Research Institute of Oncology and Hematology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Luiza Sisdelli
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
| | - Maria Isabel V. Cordioli
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
| | - Fernanda Vaisman
- Instituto Nacional do Câncer, Rio de Janeiro, RJ 22451-000, Brazil;
| | - Paola Caria
- Department of Biomedical Sciences, University of Cagliari, 09042 Cagliari, Italy
| | - Sabine Mai
- Cell Biology, Research Institute of Oncology and Hematology, University of Manitoba, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Janete M. Cerutti
- Genetic Bases of Thyroid Tumors Laboratory, Division of Genetics, Department of Morphology and Genetics, Universidade Federal de São Paulo/EPM, São Paulo, SP 04039-032, Brazil; (L.S.); (M.I.V.C.); (J.M.C.)
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Gardner D, Nixon IJ. An analysis of waiting times in patients with thyroid cancer. Surgeon 2020; 18:e51-e54. [PMID: 32646674 DOI: 10.1016/j.surge.2020.06.006] [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] [Received: 05/05/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Scottish guidelines suggest that following a referral with a suspicion of cancer, patients should have a diagnosis within 31 days and commence treatment within 62 days. Thyroid cancer is not included in these targets. This study investigates the timelines of management of thyroid cancer, looking at factors that affect time to treatment and diagnosis in our network. METHODS The study was a review of a prospectively held database of patients discussed at MDT meetings between January 2016 and September 2018. Of the 153 potentially suitable thyroid cancer patients in NHS Lothian, 62 were eligible for inclusion in the study, having been referred to secondary care by their general practitioner (GP) and diagnosed with differentiated thyroid cancer (DTC). RESULTS At present only 10% and 16% of patients would meet the 62-day treatment and 31-day diagnosis targets respectively. The time to both diagnosis (p=<0.0005) and treatment (p = 0.022) is significantly improved in patients that have a diagnostic biopsy or FNA (Thy5) or a highly suggestive FNA (Thy4), compared with those that do not. There is no significant effect of GP referral type on time to diagnosis or management of thyroid cancer. With a median follow-up of 33 weeks, only one patient had died. CONCLUSIONS Thyroid cancer does not fit the classical cancer targets well. It is a relatively indolent form of cancer, with many cases diagnosed either incidentally or after undergoing treatment. It is important to balance the resource implications of providing rapid treatment with the psychological effects of the diagnosis.
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Affiliation(s)
| | - Iain J Nixon
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, University of Edinburgh, United Kingdom
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8
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Deng Y, Li H, Wang M, Li N, Tian T, Wu Y, Xu P, Yang S, Zhai Z, Zhou L, Hao Q, Song D, Jin T, Lyu J, Dai Z. Global Burden of Thyroid Cancer From 1990 to 2017. JAMA Netw Open 2020; 3:e208759. [PMID: 32589231 PMCID: PMC7320301 DOI: 10.1001/jamanetworkopen.2020.8759] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Thyroid cancer is the most pervasive endocrine cancer worldwide. Studies examining the association between thyroid cancer and country, sex, age, sociodemographic index (SDI), and other factors are lacking. OBJECTIVE To examine the thyroid cancer burden and variation trends at the global, regional, and national levels using data on sex, age, and SDI. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, epidemiologic data were gathered using the Global Health Data Exchange query tool, covering persons of all ages with thyroid cancer in 195 countries and 21 regions from January 1, 1990, to December 31, 2017; data analysis was completed on October 1, 2019. All participants met the Global Burden of Disease Study inclusion criteria. MAIN OUTCOMES AND MEASURES Outcomes included incidence, deaths, and disability-adjusted life-years (DALYs) of thyroid cancer. Measures were stratified by sex, region, country, age, and SDI. The estimated annual percentage changes (EAPCs) and age-standardized rates were calculated to evaluate the temporal trends. RESULTS Increases of thyroid cancer were noted in incident cases (169%), deaths (87%), and DALYs (75%). Age-standardized incidence rate (ASIR) showed an upward trend over time, with an EAPC of 1.59 (95% CI, 1.51-1.67); decreases were noted in EAPCs of age-standardized death rate (-0.15; 95% CI, -0.19 to -0.12) and age-standardized DALY rate (-0.11; 95% CI, -0.15 to -0.08). Almost half (41.73% for incidence, 50.92% for deaths, and 54.39% for DALYs) of the thyroid cancer burden was noted in Southern and Eastern Asia. In addition, females accounted for most of the thyroid cancer burden (70.22% for incidence, 58.39% for deaths, and 58.68% for DALYs) and increased by years in this population, although the ASIR of males with thyroid cancer (EAPC, 2.18; 95% CI, 2.07-2.28) increased faster than that of females (EAPC, 1.38; 95% CI, 1.30-1.46). A third (34%) of patients with thyroid cancer resided in countries with a high SDI, and most patients were aged 50 to 69 years, which was older than the age in other quintiles (high SDI quintile compared with all other quintiles, P<.05). The most common age at onset of thyroid cancer worldwide was 15 to 49 years in female individuals compared with 50 to 69 years in male individuals (P<.05). Death from thyroid cancer was concentrated in participants aged 70 years or older and increased by years (average annual percentage change, 0.10; 95% CI, 0.01-0.21; P<.05). Furthermore, people in lower SDI quintiles developed thyroid cancer and died from it earlier than those in other quintiles (high and high-middle SDI vs low and low-middle SDI, P<.05). CONCLUSIONS AND RELEVANCE Data from this study suggest considerable heterogeneity in the epidemiologic patterns of thyroid cancer across sex, age, SDI, region, and country, providing information for governments that may help improve national and local cancer control policies.
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Affiliation(s)
- YuJiao Deng
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - HongTao Li
- Department of Breast, Head and Neck Surgery, The Third Affiliated Teaching Hospital of Xinjiang Medical University (Affiliated Tumor Hospital), Urumqi, China
| | - Meng Wang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Na Li
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Tian Tian
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ying Wu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Peng Xu
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Si Yang
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhen Zhai
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - LingHui Zhou
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Qian Hao
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - DingLi Song
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - TianBo Jin
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Life Sciences, Northwest University, Xi’an, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - ZhiJun Dai
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Marina M, Serra MF, Aldigeri R, Ceresini G. Incidental versus clinically diagnosed differentiated thyroid cancer in both adult and elderly subjects: histological characteristics and follow-up in a retrospective analysis from a single institution. Endocrine 2020; 68:584-591. [PMID: 31970586 DOI: 10.1007/s12020-020-02200-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/13/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Most thyroid cancer are incidentally diagnosed. However, little is known on the different modalities of incidental diagnosis in adult versus older patients. METHODS We retrospectively analyzed data from 440 patients consecutively diagnosed with differentiated thyroid cancer (DTC) in a single institution. Modalities of diagnosis were categorized as follows: (A) clinically diagnosed, nonincidental cases; (B) incidental during carotid power-duplex (CPD); (C) incidental during neck imaging other than carotid power-duplex; (D) incidental during imaging workup of thyroid dysfunction or at histological examination after thyroidectomy for benign lesions. Demographics, histology and follow-up were compared between adult (<65 years) and older (≥65 years) patients according to the different modalities of diagnosis. RESULTS A total of 363 and 67 cases were recorded in adult and older patients, respectively with incidental proportions of 79% and 85%, respectively. A P < 0.001 significant difference in the modality of diagnosis was found between adult and older subjects, the latter presenting with a higher prevalence of Group B. In the nonincidental group, papillary histotype, larger size, and extrathyroidal invasion were more frequently observed in older subjects. Disease-free survival was comparable between adult and older subjects in the incidental cases, whereas it was reduced, though not significantly, in older subjects. CONCLUSION Incidental cases of DTC are more frequently diagnosed in the old subjects and are mainly due to CPD. Disease-free survival is comparable between adult and older subjects in both incidental and nonincidental cases, although it may be slightly reduced in nonincidentally diagnosed older patients.
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Affiliation(s)
- Michela Marina
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Maria Francesca Serra
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Raffaella Aldigeri
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Graziano Ceresini
- Unit of Internal Medicine and Oncological Endocrinology, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy.
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Al-Hakami HA, Alqahtani R, Alahmadi A, Almutairi D, Algarni M, Alandejani T. Thyroid Nodule Size and Prediction of Cancer: A Study at Tertiary Care Hospital in Saudi Arabia. Cureus 2020; 12:e7478. [PMID: 32351856 PMCID: PMC7188016 DOI: 10.7759/cureus.7478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Thyroid noduleshave become relatively common in clinical practice,and their prevalence increases with age. The majority of thyroid nodules are benign, with 5-15% being malignant. There are a number of well-established predictors of malignancy in thyroid nodules, but thyroid nodule size has been a cause for concern for many researchers and results of the studies are still controversial about their probability of malignancy. Up to the current knowledge, there is no published study that evaluates if thyroid nodule size is associated with the risk of malignancy in Saudi Arabia, so in this study, we aim to find that. Methods This is a retrospective study of 987 patients who underwent thyroid nodule fine-needle aspiration (FNA) and subsequent thyroidectomy for thyroid nodules measuring ≥ 1 cm. Results Thyroid cancer was more prevalent in males than females, and in patients who were older than or equal to 45 years. Nodular size of 1 - 1.9 cm was more prevalent among cancer patients than in benign cases (p<0.001). Conclusions The highest malignancy risk was observed in nodules <2 cm and no increase in malignancy risk for nodules >2 cm. Nevertheless, when examined by type of thyroid malignancy, the rate of follicular carcinoma and other rare malignancy increased with increasing nodule size.
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Affiliation(s)
- Hadi Afandi Al-Hakami
- Otolaryngology, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Raneem Alqahtani
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Dakheelallah Almutairi
- Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Mohammed Algarni
- Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, SAU
| | - Talal Alandejani
- Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU.,Otolaryngology, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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11
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Al-Lawati NA, Shenoy SM, Al-Bahrani BJ, Al-Lawati JA. Increasing Thyroid Cancer Incidence in Oman: A Joinpoint Trend Analysis. Oman Med J 2020; 35:e98. [PMID: 32095279 PMCID: PMC7029156 DOI: 10.5001/omj.2020.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives We sought to investigate the epidemiology of thyroid cancer and its trends in Oman over a 20-year period. Methods We analyzed all cases of primary thyroid cancer reported to the Oman National Cancer Registry between 1996 and 2015. Age-standardized incidence rates (ASR) were calculated using the World Standard Population. Joinpoint regression was used to assess trends and obtain annual percentage changes (APC) in incidence rates with 95% confidence intervals (95% CI) and p-values at the alpha = 0.050 level. Gender-specific APC was used to project thyroid cancer incidence rates in Oman over the next 20 years. Population attributable fraction was calculated for obesity and current non-smoking. Results A total of 1285 cases of primary thyroid cancer cases were registered in Oman between 1996 and 2015, with a female to male ratio of 4:1. In men, the ASR was 2.0 per 100 000 while in females it was 7.6 per 100 000 (p < 0.010). Over 80.0% of thyroid tumors were of a papillary type and 19.0% follicular type. Statistically significant trends for thyroid cancer were detected in women from 2008–2015 (APC = 14.3%, 95% CI: 8.0–20.9, p < 0.010) and among both genders (APC = 16.7%, 95% CI: 4.9–29.9, p < 0.010). If current trends continue, thyroid cancer incidence will increase to 3.1, 16.6, and 11.8 per 100 000 by 2040 in men, women, and both genders, respectively. Nearly 10.0% of thyroid cancer can be prevented by controlling obesity in the Omani population. Conclusions Oman has had moderate incidence rates of thyroid cancer with an increasing trend among women. Since projections estimate that the rates of this disease will double in women over the next 20 years, health authorities should consider providing sufficient resources to manage this condition and establish prevention programs that address obesity as part of the strategy for the prevention and control of noncommunicable diseases.
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Affiliation(s)
- Najla A Al-Lawati
- Department of Non-communicable Diseases Control, Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Sarooj M Shenoy
- Department of Non-communicable Diseases Control, Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Bassim J Al-Bahrani
- Department of Medical Oncology, National Oncology Centre, Royal Hospital, Muscat, Oman
| | - Jawad A Al-Lawati
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
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12
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Seifert P, Winkens T, Kühnel C, Gühne F, Freesmeyer M. I-124-PET/US Fusion Imaging in Comparison to Conventional Diagnostics and Tc-99m Pertechnetate SPECT/US Fusion Imaging for the Function Assessment of Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2298-2308. [PMID: 31196748 DOI: 10.1016/j.ultrasmedbio.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
The purpose of this study is to investigate I-124 positron emission tomography (PET)/ultrasound (US) fusion imaging for function assessment of thyroid nodules. In 70 patients, 201 lesions were examined with conventional diagnostics (CD) (thyroid US, laboratory findings and Tc-99m pertechnetate scintigraphy), Tc-99m pertechnetate single photon emission computed tomography (SPECT) and I-124 PET/computed tomography (CT). Subsequently, US fusion imaging (SPECT/US and PET/US) was performed by three experienced investigators. Patients referred for thyroid diagnostics in a clinical routine setting were included in this study if CD produced equivocal results. PET/US was superior to CD and SPECT/US in 96% and 86%, respectively, and ambiguous findings in CD were clarified by PET/US in 96% of the 70 patients. Regarding nodule-based function assessment, 10% (66%), 39% (14%) and 71% (4%) of the 201 lesions were rated with absolute certainty (equivocal or uncertain) using CD, SPECT/US and PET/US, respectively (p < 0.001). PET/US has the potential to improve the function assessment of thyroid nodules in comparison to CD.
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Affiliation(s)
- Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Thomas Winkens
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Christian Kühnel
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany.
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13
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Weller A, Sharif B, Qarib MH, St Leger D, De Silva HS, Lingam RK. British Thyroid Association 2014 classification ultrasound scoring of thyroid nodules in predicting malignancy: Diagnostic performance and inter-observer agreement. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2019; 28:4-13. [PMID: 32063989 DOI: 10.1177/1742271x19865001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/20/2019] [Indexed: 01/21/2023]
Abstract
Objectives To assess the inter-observer agreement amongst five observers of differing levels of expertise in applying the British Thyroid Association (2014) guidelines for ultrasound scoring of thyroid nodules (BTA-U score) in the management of thyroid cancer, and to assess the U-score diagnostic performance in predicting malignancy. Method A total of 73 consecutive patients were included over a two-year period (July 2012 to July 2014), after referral to a tertiary head and neck oncology centre for ultrasound plus fine needle aspiration and cytology. Our five observers retrospectively and independently reviewed static ultrasound images on PACS and scored the thyroid nodules according to BTA-U classification. The observers were blinded to each other's scoring, cytology and histology results. Either the Kappa-statistic or intra-class correlation was used to assess the level of inter-observer agreement, plus agreement between the radiological and cytological diagnoses. The diagnostic performance of U-scoring for predicting final histological diagnosis was assessed with sensitivity, specificity, positive and negative predictive values. Results A Kappa-value of 0.73 (95% CI: 0.68-0.77) confirmed substantial inter-observer agreement amongst the five observers. All 17 histology confirmed malignant nodules were correctly classified as potentially malignant by all observers. The sensitivity and negative predictive value of BTA-U score in detecting and predicting malignancy were 100%, whereas the specificity and positive predictive values were 34% and 32%, respectively. Conclusions There is good inter-observer agreement in using the BTA-U score amongst different observers at differing levels of expertise. Adhering to BTA-U scoring can potentially achieve 100% sensitivity in selecting malignant nodules for sampling.
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Affiliation(s)
- Alexander Weller
- Department of Radiology, Northwick Park & Central Middlesex Hospitals, London Northwest University Healthcare NHS Trust, London, UK
| | - Ban Sharif
- Department of Radiology, Northwick Park & Central Middlesex Hospitals, London Northwest University Healthcare NHS Trust, London, UK
| | - Mohammad H Qarib
- Department of Radiology, Central Middlesex Hospital, London Northwest University Healthcare NHS Trust, London, UK
| | - Dominic St Leger
- Department of Radiology, Northwick Park & Central Middlesex Hospitals, London Northwest University Healthcare NHS Trust, London, UK
| | - Hakkini Sl De Silva
- Department of Radiology, Northwick Park & Central Middlesex Hospitals, London Northwest University Healthcare NHS Trust, London, UK
| | - Ravi K Lingam
- Department of Radiology, Northwick Park & Central Middlesex Hospitals, London Northwest University Healthcare NHS Trust, London, UK
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Imran SA, Chu K, Rajaraman M, Rajaraman D, Ghosh S, De Brabandere S, Kaiser SM, Van Uum S. Primary versus Tertiary Care Follow-Up of Low-Risk Differentiated Thyroid Cancer: Real-World Comparison of Outcomes and Costs for Patients and Health Care Systems. Eur Thyroid J 2019; 8:208-214. [PMID: 31602364 PMCID: PMC6738170 DOI: 10.1159/000494835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/15/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND An unprecedented rise in the prevalence of low-risk well-differentiated thyroid cancer (TC) has been reported in several countries, which is partly due to an increased utility of sensitive imaging techniques. The outcome of these cancers has generally remained excellent and the overall 5-year survival is almost 100%. However, the extended follow-up strategy for these patients remains unclear and while the initial management is done in specialist centres some experts opt to follow them on a long-term basis while others discharge them to primary care after the initial management. The effectiveness of one strategy versus the other has not been studied. METHODS We conducted a real-world comparison to assess the outcome of low-risk TC (AJCC stage I) with undetectable thyroglobulin (TG) 2 years after radio-iodine (I-131) therapy. The outcome from Halifax (NS, Canada) and London (ON, Canada), where all TC patients are routinely followed by the tertiary care team, was compared with that from Edmonton (AB, Canada), where patients are routinely discharged to primary care. RESULTS All patients were diagnosed between January 1, 2006, and December 31, 2011. The mean follow-up in primary care after discharge was 62.2 months and in tertiary care it was 64.6 months (p = 0.43). Rates of recurrence were similar in both groups, i.e., 1.1% in primary care and 1.3% in tertiary care (p = 0.69). Ultrasound surveillance was conducted in 56.5% of the patients in primary care and 52.6% of the tertiary care group (p = 0.26). The rate of annual unstimulated TG testing per patient was 0.58 (range 0-14) in primary care and 0.96 (range 0-6) in tertiary care (p = 0.06). More patients in primary care (86%) than in tertiary care (29.9%) consistently had thyroid-stimulating hormone levels within the target range (p < 0.001). The mean healthcare cost, based on a single follow-up visit with a blood test and ultrasound in the primary care group was CAD 118.01 and in the tertiary care group it was CAD 164.12. CONCLUSION Our study shows that extended follow-up of low-risk TC patients is perfectly feasible in primary care and provides significant economic benefit for the healthcare system.
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Affiliation(s)
- Syed Ali Imran
- Division of Endocrinology, Dalhousie University, Halifax, Nova Scotia, Canada
- *Dr. S.A. Imran, MBBS, FRCP, FRCPC, Room 047, North Victoria Building, 7th Floor, VG Site, 1276 South Park Street, Halifax, NS B3H 2Y9 (Canada), E-Mail
| | - Karen Chu
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Murali Rajaraman
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Drew Rajaraman
- Division of Endocrinology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah De Brabandere
- Department of Diagnostic Imaging, Western University, London, Ontario, Canada
| | - Stephanie M. Kaiser
- Division of Endocrinology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stan Van Uum
- Department of Medicine, Western University, London, Ontario, Canada
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Salamanca-Fernández E, Rodriguez-Barranco M, Chang-Chan YL, Redondo-Sánchez D, Domínguez-López S, Bayo E, Narankiewicz D, Expósito J, Sánchez MJ. Thyroid Cancer Epidemiology in South Spain: a population-based time trend study. Endocrine 2018; 62:423-431. [PMID: 30043094 DOI: 10.1007/s12020-018-1681-6] [Citation(s) in RCA: 10] [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] [Received: 03/08/2018] [Accepted: 07/09/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Thyroid cancer (TC) is the most common malignant disease of the endocrine system. The aim of this study was to analyze incidence and mortality trends of TC (C73 according to ICD-O-3) in Granada (Southern Spain) during the period 1985-2013, by sex, age, and histological type. METHODS This is a population-based cross-sectional study. Incidence data were obtained from the population-based Cancer Registry of Granada. All newly diagnosed cases of thyroid cancer over the period 1985-2013 were included. Joinpoint regression analysis with age-standardized rates were used to estimate annual percentage change (APC), CI 95% and turning points in trends. Results are presented by sex, age group, and histological type. RESULTS During the study period there were 1265 diagnosed cases of TC in Granada (72.6% in women). Incidence trends significantly increased in both men (APC: + 5.4%) and women (APC: + 4.7%). The most common histological types in both sexes were papillary (74.8%) and follicular (16.8%). The incidence has increased during the study period mainly due to papillary carcinoma, which has increased annually around 6% in both sexes. TC mortality trend during this period decreased in men (APC: -0.3%) and women (APC: -2.3%). CONCLUSION Our data showed an increasing trend in incidence of thyroid cancer in Granada, especially in women between 55-64 years. Mortality showed a slight decrease trend during the study period in both sexes. Papillary carcinoma was the most common histological type, with an increase of the relative weight of papillary microcarcinomas. Our study is in accordance with the European and worldwide trends in thyroid cancer incidence and mortality and sex differences.
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Affiliation(s)
- Elena Salamanca-Fernández
- Andalusian School of Public Health (EASP), Granada, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain
- Biosanitary Investigation Institute ibs, Granada, Spain
| | - Miguel Rodriguez-Barranco
- Andalusian School of Public Health (EASP), Granada, Spain.
- CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain.
- Biosanitary Investigation Institute ibs, Granada, Spain.
| | - Yoe-Ling Chang-Chan
- Andalusian School of Public Health (EASP), Granada, Spain
- Biosanitary Investigation Institute ibs, Granada, Spain
| | - Daniel Redondo-Sánchez
- Andalusian School of Public Health (EASP), Granada, Spain
- Biosanitary Investigation Institute ibs, Granada, Spain
| | | | - Eloísa Bayo
- Radiation Oncology Department, University Hospital Virgen Macarena, Sevilla, Spain
| | - Dariusz Narankiewicz
- Preventive Medicine and Public Health Department, Hospital Virgen de la Victoria of Málaga, Málaga, Spain
| | - José Expósito
- Biosanitary Investigation Institute ibs, Granada, Spain
- Radiotherapy and Oncology Department, University Hospital Virgen de las Nieves Granada, Granada, Spain
| | - María José Sánchez
- Andalusian School of Public Health (EASP), Granada, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain
- Biosanitary Investigation Institute ibs, Granada, Spain
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Jakobsen KK, Grønhøj C, Jensen DH, Karnov KKS, Agander TK, Specht L, von Buchwald C. Increasing incidence and survival of head and neck cancers in Denmark: a nation-wide study from 1980 to 2014. Acta Oncol 2018; 57:1143-1151. [PMID: 29447088 DOI: 10.1080/0284186x.2018.1438657] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The purpose of the study was to determine trends in age-adjusted incidence rates (AAIR) and survival probability in head and neck cancers (HNCs) in the Danish population from 1980 to 2014. MATERIAL AND METHODS All patients registered with HNC in the nationwide Danish Cancer Registry from 1980 to 2014 were included. We evaluated the AAIR per 100,000 and the average annual percent change (AAPC). The relative survival probability at 5 years was calculated in relation to gender, anatomical location and histology, and we constructed age-period-cohort models of incidence. RESULTS About 34,606 patients were included (64.7% men). The AAIR increased from 9.1 per 100,000 in 1980 to 17.4 per 100,000 in 2014 with an AAPC of 2.1%. The greatest incidence increase was observed in oropharyngeal cancer (AAPC: 5.4%) followed by hypopharyngeal cancer (AAPC: 4.2%). Adenocarcinomas had the highest AAPC (5.0%) followed by squamous cell carcinomas (AAPC: 2.0%). The AAPC was significantly higher in women (2.4%) compared with men (1.6%). For all HNC patients, the relative survival at 5 years rose significantly from 49.0% in 1980-1984 to 62.4% in 2010-2014. Women had a significantly higher survival than men with a relative survival of 61.7% compared to 50.0% in men. Laryngeal cancer had the best survival probability of cancers in the upper aerodigestive tract with hypopharyngeal cancer having the poorest survival. CONCLUSION This nation-wide study showed a significant rise in incidence of HNC for men and women along with a significant increase in relative survival. Oropharyngeal cancer had the highest increase in incidence followed by hypopharyngeal cancer which showed the poorest survival of HNCs.
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Affiliation(s)
- Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - David Hebbelstrup Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Kim Schmidt Karnov
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Chakravarthy NS, Chandramohan A, Prabhu AJ, Gowri M, Mannam P, Shyamkumar NK, Naik D, Cherian AJ, Thomas N, Paul MJ, Abraham D. Ultrasound-guided Fine-needle Aspiration Cytology along with Clinical and Radiological Features in Predicting Thyroid Malignancy in Nodules ≥1 cm. Indian J Endocrinol Metab 2018; 22:597-604. [PMID: 30294566 PMCID: PMC6166559 DOI: 10.4103/ijem.ijem_1_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIMS AND OBJECTIVES The aim of the study is to examine the adequacy and accuracy of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in thyroid nodules ≥1 cm and to analyze the clinical, sonological, and cytological features in predicting thyroid malignancy. MATERIALS AND METHODS US-FNAC was done on 290 patients from December 2013 to December 2014 by the radiologist. The Thyroid Imaging Reporting and Data System (TIRADS) was used to record the sonological features. FNAC samples were reported by a dedicated cytopathologist. Accuracy was calculated by comparing US-FNAC, clinical features and ultrasound (US) features for those who had final histopathology till April 2017. RESULTS The adequacy of US-FNAC in this study was 80.2%. Thyroidectomy was performed in 128/290 (44.1%). The sensitivity and specificity of US-FNAC in this study is 83.9 and 76.3%, respectively, with a positive predictive value of 85.2%, negative predictive value of 74.4%, and an accuracy of 81% in predicting malignancy in thyroid nodules ≥1 cm. The malignancy rate in benign FNAC sample was 25% (10/40), and was 69% (8/13) in those with a follicular lesion of undetermined significance (FLUS). Around 80% of benign and 89% of FLUS had follicular variant of papillary carcinoma of thyroid (FVPTC). US-FNAC, a high TIRADS score, and US features such as marked hypoechogenicity, taller than wide, irregular margins, microcalcification, and clinical features, such as hard in consistency and significant cervical lymph nodes, were important in predicting malignancy (P < 0.001). CONCLUSIONS The accuracy of US-FNAC in this study is 81%. The US-FNAC, a high TIRADS score, a hard thyroid nodule, and significant cervical lymph nodes are important in predicting malignancy. The accuracy rate in benign and atypia undetermined significance categories needs to improve in this study. Further research to help in decreasing false negative rates of FVPTC will help in increasing the accuracy of US-FNAC in the present study.
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Affiliation(s)
| | - Anuradha Chandramohan
- Department of Radiology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Anne Jennifer Prabhu
- Department of Pathology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - M. Gowri
- Department of Biostatistics, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Pavithra Mannam
- Department of Radiology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - N. K. Shyamkumar
- Department of Radiology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - A. J. Cherian
- Department of Endocrine Surgery, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - M. J. Paul
- Department of Endocrine Surgery, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Deepak Abraham
- Department of Endocrine Surgery, Christian Medical College (CMC), Vellore, Tamil Nadu, India
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Grani G, Lamartina L, Durante C, Filetti S, Cooper DS. Follicular thyroid cancer and Hürthle cell carcinoma: challenges in diagnosis, treatment, and clinical management. Lancet Diabetes Endocrinol 2018; 6:500-514. [PMID: 29102432 DOI: 10.1016/s2213-8587(17)30325-x] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 12/16/2022]
Abstract
Follicular thyroid cancer is the second most common differentiated thyroid cancer histological type and has been overshadowed by its more common counterpart-papillary thyroid cancer-despite its unique biological behaviour and less favourable outcomes. In this Review, we comprehensively review the literature on follicular thyroid cancer to provide an evidence-based guide to the management of these tumours, to highlight the lack of evidence behind guideline recommendations, and to identify changes and challenges over the past decades in diagnosis, prognosis, and treatment. We highlight that correct identification of cancer in indeterminate cytological samples is challenging and ultrasonographic features can be misleading. Despite certain unique aspects of follicular thyroid cancer presentation and prognosis, no specific recommendations exist for follicular thyroid cancer and Hürthle cell carcinoma in evidence-based guidelines. Efforts should be made to stimulate additional research in this field.
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Affiliation(s)
- Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, University of Rome, Sapienza, Rome, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Du L, Wang Y, Sun X, Li H, Geng X, Ge M, Zhu Y. Thyroid cancer: trends in incidence, mortality and clinical-pathological patterns in Zhejiang Province, Southeast China. BMC Cancer 2018; 18:291. [PMID: 29544469 PMCID: PMC5856225 DOI: 10.1186/s12885-018-4081-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/31/2018] [Indexed: 01/17/2023] Open
Abstract
Background Thyroid cancer is the most common malignant disease of the endocrine system. Previous studies indicate a rapid increase in the incidence of thyroid cancer in recent decades, and this increase has aroused the great public concern. The aim of this study was to analyze the trends in incidence, mortality and clinical-pathological patterns of thyroid cancer in Zhejiang province. Methods Population-based incidence and mortality rates of thyroid cancer were collected from eight cancer registries in Zhejiang from 2000 to 2012. The incidence and mortality rates were age-standardized to Segi’s world population. A Joinpoint model was used to examine secular trends in age-adjusted thyroid cancer rates with the Joinpoint Regression Program Version 4.0.0. Thyroid cancer patients were recruited from Zhejiang Cancer Hospital from 1972 to 2014. Patient demographics, tumor histology and tumor size were compared among the different periods of 1972–1985, 1986–1999 and 2000–2014. Results The age-standardized incidence rate of thyroid cancer in Zhejiang cancer registries was 2.75/105 in 2000, and increased to 19.42/105 in 2012. Additionally, we observed significantly increasing incidence rates with the Annual Percent Change (APC) of 22.86% (95%CI, 19.2%–26.7%). The age-standardized mortality of thyroid cancer in Zhejiang cancer registries was 0.23/105 in 2000 and 0.25/105 in 2012. No significant change in mortality rate was found. We observed a rapid increase in the proportions of papillary thyroid carcinoma (PTC) in 12,508 patients with thyroid carcinoma identified in the Zhejiang Cancer Hospital from 1972 to 2014 while the proportions of poorly differentiated thyroid cancer (PDTC), medullary thyroid carcinoma (MTC) and follicular thyroid carcinoma (FTC) decreased over the decades. In the PTC cases, the proportion of patients with maximum tumor diameter (MTD) < 1 cm dramatically and significantly increased from 0 in 1972–1985 to 32.1% in 2000–2014. Conclusions A rapid increase in incidence and a stable trend in mortality of thyroid cancer were found in the distribution of thyroid cancer. Most of the increased incidence was PTC, especially the papillary thyroid microcarcinoma (PTMC) with MTD < 1 cm. This increase in incidence might be due to increased diagnosis with advanced technology.
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Affiliation(s)
- Lingbin Du
- Zhejiang Cancer Center, Zhejiang Cancer Hospital, No.30 Jichang Road, Hangzhou, Zhejiang, 310004, China
| | - Youqing Wang
- Zhejiang Cancer Center, Zhejiang Cancer Hospital, No.30 Jichang Road, Hangzhou, Zhejiang, 310004, China
| | - Xiaohui Sun
- Department of Epidemiology & Biostatistics, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Zhejiang, Hangzhou, 310058, China
| | - Huizhang Li
- Zhejiang Cancer Center, Zhejiang Cancer Hospital, No.30 Jichang Road, Hangzhou, Zhejiang, 310004, China
| | - Xinwei Geng
- Department of Pharmacology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | - Minghua Ge
- Zhejiang Cancer Center, Zhejiang Cancer Hospital, No.30 Jichang Road, Hangzhou, Zhejiang, 310004, China. .,Head and Neck Surgery, Zhejiang Cancer Hospital, No.1 East Banshan Road, Hangzhou, Zhejiang, 310022, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, Zhejiang University School of Public Health, 388 Yu-Hang-Tang Road, Zhejiang, Hangzhou, 310058, China.
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20
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Sanabria A, Kowalski LP, Shah JP, Nixon IJ, Angelos P, Williams MD, Rinaldo A, Ferlito A. Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis. Head Neck 2017; 40:855-866. [PMID: 29206325 DOI: 10.1002/hed.25029] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/24/2017] [Accepted: 10/25/2017] [Indexed: 01/03/2023] Open
Abstract
There is an increasing incidence of well-differentiated thyroid cancer worldwide. Much of the increase is secondary to increased detection of small, low-risk tumors, with questionable clinical significance. This review addresses the factors that contribute to the increasing incidence and considers environmental, and patient-based and clinician-led influences. Articles addressing the causes of the increased incidence were critically reviewed. A complex interplay of environmental, medical, and social pressures has resulted in increased awareness of the thyroid disease risk, increased screening of thyroid cancers, and increased diagnosis of thyroid cancers. Although there is evidence to suggest that the true disease incidence may be changing slightly, most of the increase is related to factors that promote early diagnosis of low-risk lesions, which is resulting in a significant phenomenon of overdiagnosis. An improved understanding of these pressures at a global level will enable healthcare policymakers to react appropriately to this challenge in the future.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Clinica Vida/Instituto de Cancerología Las Americas, Medellin, Colombia, South America
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Jatin P Shah
- Department of Head and Neck Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Michelle D Williams
- Department of Pathology, Division of Pathology/Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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Marina M, Ceda GP, Aldigeri R, Ceresini G. Causes of referral to the first endocrine visit of patients with thyroid carcinoma in a mildly iodine-deficient area. Endocrine 2017; 57:247-255. [PMID: 27738889 DOI: 10.1007/s12020-016-1140-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
To evaluate the causes of the first referral to an endocrine visit of patients with thyroid cancer in a mildly iodine-deficient area and to correlate them with prognostic features. We studied 298 consecutive patients (64 M and 234 F) with thyroid cancer. Of these, 281 had differentiated thyroid cancer. The causes of referral were categorized as follows: (Group A) clinical evidence of a neck lump; (Group B) incidental imaging in subjects without known thyroid diseases; (Group C) incidental imaging during a workup of thyroid disorders. Also, in differentiated thyroid cancer cases, clinical, histomorphologic, and prognostic parameters were compared among the three different groups of referral causes. In both total thyroid cancer and differentiated thyroid cancer cohorts, Group A, B, and C accounted for about 25, 35, and 40 % of causes, respectively. Considering the differentiated thyroid cancer, in Group B, ultrasound accounted for 94 % of cases, with 73 % resulting from screening or serendipitous study. Within a median follow-up of 5.6 [IQR: 2.7-9.5] years, disease-free survival was significantly lower in patients of Group A (Log-Rank test p = 0.030 vs. the other groups of causes). However, at the Cox multivariate analysis only male sex (p = 0.002) and stage (p = 0.005), but not referral cause, resulted independent predictors of events. In patients without known thyroid disease, unjustified thyroid ultrasound represents the main cause of referral of thyroid cancer patients to the first endocrine visit. The fact that this is not related to the disease-free survival strengthens the concept of the uselessness of thyroid cancer screening.
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Affiliation(s)
- Michela Marina
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Gian Paolo Ceda
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Raffaella Aldigeri
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
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22
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Boucai L, Bernet V, Shaha A, Shindo ML, Stack BC, Tuttle RM. Surgical considerations for papillary thyroid microcarcinomas. J Surg Oncol 2017; 116:269-274. [PMID: 28513849 DOI: 10.1002/jso.24673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/19/2017] [Indexed: 01/13/2023]
Abstract
We reevaluate current treatment recommendations of papillary thyroid microcarcinomas taking into account the indolent behavior of these tumors, and the potential morbidity that may result from an unnecessary surgery. The goals of this communication are to: 1) provide surgeons and endocrinologists with the most up-to-date evidence on management of microcarcinomas, 2) outline appropriate instances for active surveillance, and 3) describe the role of surgical interventions for microcarcinomas including lobectomy, total thyroidectomy, and central neck dissection.
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Affiliation(s)
- Laura Boucai
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victor Bernet
- Division of Endocrinology, Department of Medicine, Mayo Clinic Jacksonville, Florida
| | - Ashok Shaha
- Head Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Maisie L Shindo
- Head Neck Surgery, Oregon Head Science University, New York, New York
| | - Brendan C Stack
- Head Neck Surgery, University of Arkansas for Medical Sciences, New York, New York
| | - Robert M Tuttle
- Division of Endocrinology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
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23
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Resende de Paiva C, Grønhøj C, Feldt-Rasmussen U, von Buchwald C. Association between Hashimoto's Thyroiditis and Thyroid Cancer in 64,628 Patients. Front Oncol 2017; 7:53. [PMID: 28443243 PMCID: PMC5385456 DOI: 10.3389/fonc.2017.00053] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/13/2017] [Indexed: 11/22/2022] Open
Abstract
Background The incidence of thyroid cancer (TC) is increasing although explanatory causes are lacking. A link between cancer and inflammation is well documented but unclear for autoimmune thyroid diseases and TC. We aimed to systematically review the association between Hashimoto’s thyroiditis (HT) and papillary, follicular, medullary, anaplastic thyroid carcinoma, and thyroid lymphoma (TL). Methods PubMed, OVID Medline, Google Scholar, and the Cochrane Library were searched from 1955 to 2016. The inclusion criteria were age >18 years, ≥20 cases of HT or TC. We collectively examined the incidence of HT in TC and of TC in HT. Results We identified 36 studies (64,628 subjects) published between 1955 and 2016 from 13 countries. We found a relative risk (RR) of HT among papillary thyroid cancer (PTC) of 2.36 [95% confidence intervals (CIs) 1.55–3.29, p < 0.001], an RR of PTC among HT of 1.40 (95% CI 1.07–1.85, p = 0.016), and an RR of TL among HT of 9.74 (95% CI 3.93–24.13, p < 0.001). Conclusion We report an association between HT and PTC and between HT and TL. No association was found between HT and follicular, medullary, or anaplastic thyroid cancer.
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Affiliation(s)
- Christina Resende de Paiva
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Feldt-Rasmussen
- Department of Medical Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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24
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Shen FC, Hsieh CJ, Huang IC, Chang YH, Wang PW. Dynamic Risk Estimates of Outcome in Chinese Patients with Well-Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation. Thyroid 2017; 27:531-536. [PMID: 28007013 DOI: 10.1089/thy.2016.0479] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study was conducted to compare the staging systems for the prediction of long-term disease status in patients with well-differentiated thyroid carcinoma (WDTC), and to find out the earliest postoperative period predictor of long-term persistence/recurrence of disease. METHODS Patients with WDTC (n = 356; Mage = 41.5 ± 12.7 years) followed for at least five years (12.3 ± 5.0 years) after thyroidectomy and 131I remnant ablation at a tertiary regional hospital in Taiwan were retrospectively studied. Each patient was risk stratified using the American Joint Cancer Committee (stage I-IV) and American Thyroid Association (low, intermediate, and high risk) staging systems after operation and first 131I remnant ablation and using response to initial therapy reclassification (RTR; excellent, indeterminate, biochemical incomplete, and structural incomplete response) system, which is determined 6-24 months after the first 131I ablation. The clinical outcome was defined as no evidence of disease (NED; suppressed thyroglobulin [Tg] <0.5 ng/mL, stimulated Tg <1 ng/mL, and no structural detectable disease), biochemical persistent disease (BPD; suppressed Tg ≥0.5 ng/mL or stimulated Tg ≥1 ng/mL in the absence of structural disease), structural persistent disease (SPD; locoregional or distant metastases with any Tg level), or recurrent disease (RD; biochemical or structural disease identified after a period of NED). RESULTS At the time of final follow-up, 78.4% (n = 279) of the patients had NED, 9.3% (n = 33) had BPD, 10.1% (n = 36) had SPD, and 2.2% (n = 8) developed RD. All three systems could predict the increasing trend of SPD and the decreasing trend of NED with advancing stage of disease. However, the ATA risk estimates could be significantly refined by the RTR system, especially for the ATA high-risk group, in which 29.2% developed SPD/RD during follow-up. The RTR system reduced the likelihood of finding SPD/RD to 3.7% in those demonstrating an excellent response to therapy, and increased the likelihood to 78.6% in those demonstrating a structural incomplete response. Among the earliest postoperative factors, only the Tg level at the first 131I ablation could predict long-term persistence/recurrence. CONCLUSIONS The results highly support incorporating the RTR system to modify the initial risk estimate during follow-up among Chinese patients with WDTC.
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Affiliation(s)
- Feng-Chih Shen
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - Ching-Jung Hsieh
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
| | - I-Chin Huang
- 2 Division of Endocrinology and Metabolism, Department of Internal Medicine, Paochien Hospital , PingTung, Taiwan
| | - Yen-Hsiang Chang
- 3 Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung, Taiwan
| | - Pei-Wen Wang
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine , Kaohsiung, Taiwan
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Pagano L, Mele C, Arpaia D, Samà MT, Caputo M, Ippolito S, Peirce C, Prodam F, Valente G, Ciancia G, Aimaretti G, Biondi B. How do etiological factors can explain the different clinical features of patients with differentiated thyroid cancer and their histopathological findings? Endocrine 2017; 56:129-137. [PMID: 27230768 DOI: 10.1007/s12020-016-0992-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
The aim was to retrospectively analyse the clinical-histopathological characteristics of patients with newly diagnosis of differentiated thyroid cancer (DTC) referred to two Italian centres, one in Northern and the other in Southern Italy, between 2000 and 2013. 1081 patients were included and subdivided into two groups: group A (474 patients from Novara) and group B (607 patients from Naples). The group A came from the industrial area of Novara, while the Group B came from the areas around Vesuvius and Campi Flegrei. The two groups were comparable for iodine levels, body mass index, diagnostic timing and clinical procedures. For all patients, demographic and clinical data were collected. No difference was found in gender, whereas the age at diagnosis was later in the group A (group A 53.1 ± 15.16 years, group B 41.9 ± 14.25 years, p < 0.001). In both groups, the most frequent histotype was papillary thyroid cancer (PTC) with prevalence of follicular variant in group A (p < 0.0001) and classical variant in group B (p < 0.0001). Aggressive histological features were mainly seen in group A (bilaterality p < 0.0001, multifocality p < 0.0001 and thyroid capsular invasion p < 0.0001). Microcarcinomas were more frequent in group A (p < 0.0001) but mostly characterized by bilaterality (p < 0.001) and multifocality (p < 0.04). In both groups, tumour-associated thyroiditis showed a significant increase over the years (group A p < 0.05, group B p < 0.04). Environmental factors could justify the differences found in our study. These preliminary data should stimulate the need for an Italian Cancer Registry of DTC in order to allow an epidemiological characterization, allowing the identification of specific etiological factors and an improvement in the management of the disease.
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Affiliation(s)
- Loredana Pagano
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
| | - Chiara Mele
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Debora Arpaia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Teresa Samà
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Marina Caputo
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Serena Ippolito
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Carmela Peirce
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Flavia Prodam
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Guido Valente
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Giuseppe Ciancia
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Gianluca Aimaretti
- Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy
| | - Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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26
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Khatami F, Larijani B, Tavangar SM. Circulating Tumor BRAF Mutation and Personalized Thyroid
Cancer Treatment. Asian Pac J Cancer Prev 2017; 18:293-294. [PMID: 28345323 PMCID: PMC5454719 DOI: 10.22034/apjcp.2017.18.2.293] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and
Metabolism Population Sciences Institute,Tehran University of Medical Sciences,
Tehran, Iran. and
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27
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Evaluation of Prognostic Factors Associated With Differentiated Thyroid Carcinoma With Pulmonary Metastasis. Clin Nucl Med 2016; 41:917-921. [DOI: 10.1097/rlu.0000000000001426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
During the past few decades, the incidence of thyroid cancer has increased substantially in many countries, including the USA. The rise in incidence seems to be attributable both to the growing use of diagnostic imaging and fine-needle aspiration biopsy, which has led to enhanced detection and diagnosis of subclinical thyroid cancers, and environmental factors. The latest American Thyroid Association (ATA) practice guidelines for the management of adult patients with thyroid nodules and differentiated thyroid cancer differ substantially from the previous ATA guidelines published in 2009. Specifically, the problems of overdiagnosis and overtreatment of a disease that is typically indolent, where treatment-related morbidity might not be justified by a survival benefit, now seem to be acknowledged. As few modifiable risk factors for thyroid cancer have been established, the specific environmental factors that have contributed to the rising incidence of thyroid cancer remain speculative. However, the findings of several large, well-designed epidemiological studies have provided new information about exposures (such as obesity) that might influence the development of thyroid cancer. In this Review, we describe the changing incidence of thyroid cancer, suggest potential explanations for these trends, emphasize the implications for patients and highlight ongoing and potential strategies to combat this growing clinical and public health issue.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/pathology
- Age Distribution
- Biopsy, Fine-Needle
- Carcinoma/diagnostic imaging
- Carcinoma/epidemiology
- Carcinoma/pathology
- Carcinoma, Neuroendocrine/diagnostic imaging
- Carcinoma, Neuroendocrine/epidemiology
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Papillary
- Humans
- Incidence
- Medical Overuse
- Obesity/epidemiology
- Radiation Exposure/statistics & numerical data
- Risk Factors
- Sex Distribution
- Smoking/epidemiology
- Thyroid Cancer, Papillary
- Thyroid Carcinoma, Anaplastic/diagnostic imaging
- Thyroid Carcinoma, Anaplastic/epidemiology
- Thyroid Carcinoma, Anaplastic/pathology
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
- Thyroid Nodule/diagnostic imaging
- Thyroid Nodule/epidemiology
- Thyroid Nodule/pathology
- United States/epidemiology
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Affiliation(s)
- Cari M Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 7E-536, Bethesda, Maryland 20892-9778, USA
| | - Julie A Sosa
- Section of Endocrine Surgery, Department of Surgery, Duke University, Seeley Mudd Building #484, 10 Searle Center Drive, DUMC #2945, Durham, North Carolina 27710, USA
- Duke Clinical Research Institute, North Pavilion, 2400 Pratt Street, Durham, North Carolina 27705, USA
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Witczak J, Taylor P, Chai J, Amphlett B, Soukias JM, Das G, Tennant BP, Geen J, Okosieme OE. Predicting malignancy in thyroid nodules: feasibility of a predictive model integrating clinical, biochemical, and ultrasound characteristics. Thyroid Res 2016; 9:4. [PMID: 27313663 PMCID: PMC4910190 DOI: 10.1186/s13044-016-0033-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Although the majority of thyroid nodules are benign the process of excluding malignancy is challenging and sometimes involves unnecessary surgical procedures. We explored the development of a predictive model for malignancy in thyroid nodules by integrating a combination of simple demographic, biochemical, and ultrasound characteristics. Methods Retrospective case-record review. We reviewed records of patients with thyroid nodules referred to our institution from 2004 to 2011 (n = 536; female 84 %, mean age 51 years). All malignancy was proven histologically while benign disease was either confirmed histologically, or on cytology with minimum 36-month observation period. We focused on the following predictors: age, sex, smoking status, thyroid hormones (FT4 and TSH) and nodule characteristics on ultrasound. Variables were included in a multivariate logistic regression and bootstrap analyses were used to confirm results. Results Independent predictors of malignancy in the fully adjusted model were TSH (OR 1.53, 95 % CI 1.10, 2.12, p = 0.01), male gender (OR 3.45, 95 % CI 1.33, 8.92, p = 0.01), microcalcifications (OR 6.32, 95 % CI 2.82, 14.1, p < 0.001), and irregular nodule margins (OR 5.45, 95 % CI 1.61, 18.6, p = 0.006) Bootstrap analyses strengthened these associations and a parsimonious analysis consisting of these variables and age-group demonstrated an area under the curve of 0.77. A predictive score was sensitive (86.9 %) at low scores and highly specific (94.87 %) at higher scores for distinguishing benign from malignant disease. Conclusions A predictive model for malignancy using a combination of clinical, biochemical, and radiological characteristics may support clinicians in reducing unnecessary invasive procedures in patients with thyroid nodules. Electronic supplementary material The online version of this article (doi:10.1186/s13044-016-0033-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Justyna Witczak
- Centre for Endocrine and Diabetes Science, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, University Hospital Wales, Cardiff, CF14 4XN UK.,Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK
| | - Peter Taylor
- Centre for Endocrine and Diabetes Science, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, University Hospital Wales, Cardiff, CF14 4XN UK.,Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK
| | - Jason Chai
- Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK
| | - Bethan Amphlett
- Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK
| | - Jean-Marc Soukias
- Radiology Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK
| | - Gautam Das
- Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK
| | - Brian P Tennant
- Clinical Biochemistry Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK
| | - John Geen
- Clinical Biochemistry Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK.,Faculty of Life Sciences and Education, University of South Wales, Glyntaff Campus, Pontypridd, CF37 1DL UK
| | - Onyebuchi E Okosieme
- Centre for Endocrine and Diabetes Science, Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, University Hospital Wales, Cardiff, CF14 4XN UK.,Endocrinology and Diabetes Department, Prince Charles Hospital, Cwm Taf Health Board, Gurnos Estate Merthyr Tydfil, CF47 9DT UK
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Haser GC, Tuttle RM, Su HK, Alon EE, Bergman D, Bernet V, Brett E, Cobin R, Dewey EH, Doherty G, Dos Reis LL, Harris J, Klopper J, Lee SL, Levine RA, Lepore SJ, Likhterov I, Lupo MA, Machac J, Mechanick JI, Mehra S, Milas M, Orloff LA, Randolph G, Revenson TA, Roberts KJ, Ross DS, Rowe ME, Smallridge RC, Terris D, Tufano RP, Urken ML. ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM. Endocr Pract 2016; 22:602-11. [PMID: 26799628 DOI: 10.4158/ep151065.ra] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy. METHODS We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed. RESULTS Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance. CONCLUSION With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.
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López Daza D, Castro Jímenez M. Estabilidad de la mortalidad por cáncer de tiroides en un país emergente. Rev Salud Publica (Bogota) 2015. [DOI: 10.15446/rsap.v17n1.42209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p><strong>Objetivo</strong> Establecer características y tendencia de la mortalidad por cáncer de tiroides en Colombia.</p><p><strong>Materiales y Métodos</strong> Estudio de la mortalidad por cáncer de tiroides empleando las bases oficiales nacionales de muertes en Colombia (1998-2010). Se analizaron año de defunción, sexo, edad y departamento de residencia. Se utilizaron proporciones, media aritmética y mediana. El valor de <em>p</em> límite para significación estadística fue 0,05. Se calcularon tasas crudas, específicas y ajustadas por edad.</p><p><strong>Resultados</strong> En total, 2 570 personas, 1 827 (71,1 %) muertes ocurrieron en mujeres. Las edades medianas a la muerte fueron de 68 años en hombres y de 70 años en mujeres. La tasa anual media de mortalidad por cáncer de tiroides ajustada (2006-2010) fue de 0,52 muertes por 100 000 personas (ambos sexos), 0,32 muertes por 100 000 hombres y 0,70 por 100 000 mujeres.</p><p><strong>Conclusiones</strong> Deben realizarse estudios que muestren posibles factores asociados a muerte a más temprana edad en mujeres colombianas.</p><p> </p>
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32
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Corsten MJ, Hearn M, McDonald JT, Johnson-Obaseki S. Incidence of differentiated thyroid cancer in Canada by City of residence. J Otolaryngol Head Neck Surg 2015; 44:36. [PMID: 26374205 PMCID: PMC4570639 DOI: 10.1186/s40463-015-0088-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 08/31/2015] [Indexed: 12/02/2022] Open
Abstract
Background Thyroid cancer incidence in Canada is increased in high socioeconomic groups, and in urban compared with rural areas. The objective of this study was to analyze patterns in thyroid cancer incidence across Canada, particularly with respect to the major urban areas across the country, to identify whether there are any discrepancies in thyroid cancer incidence between Canadian cities. Methods Cases were drawn from the Canadian Cancer Registry. Demographic and socioeconomic information were extracted from the Canadian Census of Population data. We linked cases to income quintiles (InQs) by patients’ postal codes, and categorized residence by census metropolitan area ((CMA), population >100,000). Within the Toronto CMA we further classified by census subdivision (CSD). Results There were a total of 33 CMAs across the country. After controlling for demographic and socio-economic factors, we found that the Toronto CMA had an IRR of thyroid cancer that was significantly higher than all other CMAs across the country. For 70 % of CMAs and CAs across Canada, the IRR for thyroid cancer was less than half of the IRR for thyroid cancer in the Toronto CMA. As Toronto is one of the largest CMAs, we then subdivided the Toronto area into CSDs to examine how incidence of thyroid cancer varies within this large area. The Toronto City core was used as the reference category and all other areas were compared directly to it. In doing so, we found that a contiguous area of three CSDs North of Toronto had higher IRRs compared with the Toronto city core: Markham, Vaughan and Richmond Hill. Conclusions After controlling for demographic and socioeconomic factors, we found that the Toronto CMA has the highest incidence of thyroid cancer nationwide. Several explanations could account for this discrepancy including increased detection due to increased access to imaging, differences in ethnicity or environmental exposures.
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Affiliation(s)
- Martin J Corsten
- Department of Otolaryngology - Head and Neck Surgery, Aurora St. Luke's Hospital, Suite 630, 2801W Kinnickkinnik River Parkway, Milwaukee, WI, 53215, USA.
| | - Matthew Hearn
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, S3 - 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
| | - James Ted McDonald
- Department of Economics, University of New Brunswick, PO box 4400, Fredericton, NB, E3B6C4, Canada.
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, S3 - 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
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Sen A, Tsilidis KK, Allen NE, Rinaldi S, Appleby PN, Almquist M, Schmidt JA, Dahm CC, Overvad K, Tjønneland A, Rostgaard-Hansen AL, Clavel-Chapelon F, Baglietto L, Boutron-Ruault MC, Kühn T, Katze VA, Boeing H, Trichopoulou A, Tsironis C, Lagiou P, Palli D, Pala V, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Lund E, Weiderpass E, Quirós JR, Agudo A, Sánchez MJ, Arriola L, Gavrila D, Gurrea AB, Tosovic A, Hennings J, Sandström M, Romieu I, Ferrari P, Zamora-Ros R, Khaw KT, Wareham NJ, Riboli E, Gunter M, Franceschi S. Baseline and lifetime alcohol consumption and risk of differentiated thyroid carcinoma in the EPIC study. Br J Cancer 2015; 113:840-7. [PMID: 26313664 PMCID: PMC4559837 DOI: 10.1038/bjc.2015.280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/21/2015] [Accepted: 07/02/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Results from several cohort and case-control studies suggest a protective association between current alcohol intake and risk of thyroid carcinoma, but the epidemiological evidence is not completely consistent and several questions remain unanswered. METHODS The association between alcohol consumption at recruitment and over the lifetime and risk of differentiated thyroid carcinoma was examined in the European Prospective Investigation into Cancer and Nutrition. Among 477 263 eligible participants (70% women), 556 (90% women) were diagnosed with differentiated thyroid carcinoma over a mean follow-up of 11 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards models. RESULTS Compared with participants consuming 0.1-4.9 g of alcohol per day at recruitment, participants consuming 15 or more grams (approximately 1-1.5 drinks) had a 23% lower risk of differentiated thyroid carcinoma (HR=0.77; 95% CI=0.60-0.98). These findings did not differ greatly when analyses were conducted for lifetime alcohol consumption, although the risk estimates were attenuated and not statistically significant anymore. Similar results were observed by type of alcoholic beverage, by differentiated thyroid carcinoma histology or according to age, sex, smoking status, body mass index and diabetes. CONCLUSIONS Our study provides some support to the hypothesis that moderate alcohol consumption may be associated with a lower risk of papillary and follicular thyroid carcinomas.
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Affiliation(s)
- Abhijit Sen
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim N-7491, Norway
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Sabina Rinaldi
- International Agency for Research on Cancer, Lyon, France
| | - Paul N Appleby
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - Martin Almquist
- Department of Surgery, University Hospital Lund, Lund, Sweden
- Malmö Diet and Cancer Study, University Hospital Malmö, Malmö, Sweden
| | | | - Christina C Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | | | - Françoise Clavel-Chapelon
- Inserm, Centre for research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health team, Villejuif, France
- Université Paris Sud, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Laura Baglietto
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marie-Christine Boutron-Ruault
- Inserm, Centre for research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health team, Villejuif, France
- Université Paris Sud, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena A Katze
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrueke, Nuthetal, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | | | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy
| | - Valeria Pala
- Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia, Federico Ii University, Naples, Italy
| | - Rosario Tumino
- Ragusa Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Human Genetics Foundation (HuGeF), Torino, Italy
| | - HB(as) Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Petra H Peeters
- Julius Center for Health Sciences and Primary Care, Epidemiology, University Medical Center, Utrecht, The Netherlands
| | - Anette Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, IDIBELL, Catalan Institute of Oncology-ICO, L'Hospitalet de LIobregat, Barcelona, Spain
| | - María- José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Larraitz Arriola
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, San Sebastian, Spain
| | - Diana Gavrila
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Aurelio Barricarte Gurrea
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - Ada Tosovic
- Department of Surgery, University Hospital Malmö, Malmö, Sweden
| | - Joakim Hennings
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Maria Sandström
- Department for Radiation Sciences, Umeå University, Umeå, Sweden
| | | | - Pietro Ferrari
- International Agency for Research on Cancer, Lyon, France
| | | | - Kay-Tee Khaw
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Scheffel RS, Zanella AB, Antunes D, Dora JM, Maia AL. Low Recurrence Rates in a Cohort of Differentiated Thyroid Carcinoma Patients: A Referral Center Experience. Thyroid 2015; 25:883-9. [PMID: 26061907 DOI: 10.1089/thy.2015.0077] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Trends in the epidemiological profiles of differentiated thyroid cancer (DTC) have shifted the disease spectrum. This study aimed to evaluate the recurrence rates and identify factors related to persistent disease in a contemporary cohort of patients with DTC. METHODS A cohort of DTC patients submitted to total thyroidectomy followed in a referral center were included in the study. "Disease free" was defined as no clinical, imaging, or biochemical evidence of tumors. "Recurrence" was defined as evidence of disease in a patient who had been previously classified as disease free. RESULTS A total of 786 patients were included. The mean age at diagnosis was 45.8±15.1 years, 81.6% were female, and papillary thyroid cancer accounted for 86.6% of cases. The median tumor size was 2.0 cm, 28.5% had lymph node involvement, and 6.1% had distant metastases. Disease status after the initial therapy was available for 548 patients: 357 (65.1%) were disease free, and 191 (34.9%) had persistent disease (90 biochemical and 101 structural disease). In multivariate model analyses, the variables male sex, lateral lymph nodal involvement, distant metastasis, and 2009 ATA high-risk classification were independent prognostic factors for persist disease. After a four-year follow-up (two to eight years), 97.2% of the patients who had been classified as disease free remained in disease remission status. Of the 10 (2.8%) patients with recurrent disease, eight presented biochemical and two cervical structural disease. CONCLUSIONS The majority of the DTC patients who were considered to be disease free after the initial treatment remained with this status at long-term follow-up. These data suggest that less intensive follow-up may apply for these patients.
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Affiliation(s)
- Rafael Selbach Scheffel
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André B Zanella
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Denise Antunes
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José Miguel Dora
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Section, Endocrine Division, Hospital de Clínicas de Porto Alegre and Faculdade de Medicina , Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Somboonporn C, Ngamjarus C, Chathum K, Roysri K. Low- versus high-dose of radioiodine for thyroid remnant ablation in differentiated thyroid carcinoma after thyroidectomy. Hippokratia 2015. [DOI: 10.1002/14651858.cd008317.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Charoonsak Somboonporn
- Faculty of Medicine, Khon Kaen University; Department of Radiology (Division of Nuclear Medicine); Mitraparp Highway Muang District Khon Kaen Province Thailand 40002
| | - Chetta Ngamjarus
- Khon Kaen University; Department of Biostatistics and Demography, Faculty of Public Health; 123 Miltraparp Road Khon Kaen Thailand 40002
| | - Kannika Chathum
- Faculty of Medicine, Khon Kaen University; Department of Radiology (Division of Nuclear Medicine); Mitraparp Highway Muang District Khon Kaen Province Thailand 40002
| | - Krisana Roysri
- Faculty of Medicine, Khon Kaen University; Department of Radiology (Division of Nuclear Medicine); Mitraparp Highway Muang District Khon Kaen Province Thailand 40002
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Zimmermann MB, Galetti V. Iodine intake as a risk factor for thyroid cancer: a comprehensive review of animal and human studies. Thyroid Res 2015; 8:8. [PMID: 26146517 PMCID: PMC4490680 DOI: 10.1186/s13044-015-0020-8] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/08/2015] [Indexed: 11/29/2022] Open
Abstract
Thyroid cancer (TC) is the most common endocrine malignancy and in most countries, incidence rates are increasing. Although differences in population iodine intake are a determinant of benign thyroid disorders, the role of iodine intake in TC remains uncertain. We review the evidence linking iodine intake and TC from animal studies, ecological studies of iodine intake and differentiated and undifferentiated TC, iodine intake and mortality from TC and occult TC at autopsy, as well as the case–control and cohort studies of TC and intake of seafood and milk products. We perform a new meta-analysis of pooled measures of effect from case–control studies of total iodine intake and TC. Finally, we examine the post-Chernobyl studies linking iodine status and risk of TC after radiation exposure. The available evidence suggests iodine deficiency is a risk factor for TC, particularly for follicular TC and possibly, for anaplastic TC. This conclusion is based on: a) consistent data showing an increase in TC (mainly follicular) in iodine deficient animals; b) a plausible mechanism (chronic TSH stimulation induced by iodine deficiency); c) consistent data from before and after studies of iodine prophylaxis showing a decrease in follicular TC and anaplastic TC; d) the indirect association between changes in iodine intake and TC mortality in the decade from 2000 to 2010; e) the autopsy studies of occult TC showing higher microcarcinoma rates with lower iodine intakes; and f) the case control studies suggesting lower risk of TC with higher total iodine intakes.
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Affiliation(s)
- Michael B Zimmermann
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zürich, Schmelzbergstrasse 7, LFV D21, CH-8092 Zürich, Switzerland
| | - Valeria Galetti
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zürich, Schmelzbergstrasse 7, LFV E14, CH-8092 Zürich, Switzerland
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Colonna M, Uhry Z, Guizard AV, Delafosse P, Schvartz C, Belot A, Grosclaude P. Recent trends in incidence, geographical distribution, and survival of papillary thyroid cancer in France. Cancer Epidemiol 2015; 39:511-8. [PMID: 26003877 DOI: 10.1016/j.canep.2015.04.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/23/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Over the past few decades, the incidence of thyroid cancer has dramatically increased in many countries. This increase was mainly seen in papillary cancer. The role of diagnostic practices and the effects of other risk factors were suggested to explain this increase. We provide a descriptive analysis in terms of changes in incidence, geographical distribution, and survival to check the relevance of assumptions about the increase. METHODS A detailed analysis of changes in incidence recorded in French cancer registries between 1982 and 2010 was performed taking into account age, period, and birth cohort. The geographical distribution of the incidence in the 2006-2010 period was estimated from the standardized incidence ratios. The net survival was estimated to evaluate the effects of sex, age, and period of diagnosis in patients diagnosed between 1989 and 2004 and followed-up until 2013. RESULTS The incidence of papillary cancer has increased sharply over the 1982-2010 period; the average annual rate of increase was 7.8% in men and 7.2% in women. The increase has slowed in the recent period in people aged less than 50 at the time of diagnosis. It has also slowed in the cohorts born 1945 and after. There was a strong geographic disparity in incidence between areas covered by cancer registries. Finally, the net survival was very high; the 10-year net survival was 96% and improved progressively from 82% in patients diagnosed between 1989 and 1993 to 95% in those diagnosed between 1999 and 2004. CONCLUSION The increased incidence results most probably from the effect of medical practice, although other risk factors seem also involved, but to a lesser extent. The increase seems to have slowed down in the recent years, especially in the youngest age groups. This observation suggests a recent trend towards saturation of the effects of medical practices in post-1945 cohorts associated with an effect of the gradual dissemination of the recommendations relative to the management of thyroid nodules.
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Affiliation(s)
- M Colonna
- Registre du cancer de l'Isère, CHU Grenoble, F-38043, Grenoble, France; FRANCIM, F-31073, Toulouse, France.
| | - Z Uhry
- Institut de Veille Sanitaire, Département des Maladies Chroniques et Traumatismes, F-94410, Saint-Maurice, France; Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, CNRS UMR5558, F-69100, Villeurbanne France
| | - A V Guizard
- Registre des tumeurs du Calvados, Centre François Baclesse, F-14076, Caen, France; FRANCIM, F-31073, Toulouse, France
| | - P Delafosse
- Registre du cancer de l'Isère, CHU Grenoble, F-38043, Grenoble, France; FRANCIM, F-31073, Toulouse, France
| | - C Schvartz
- Registre des cancers de la thyroïde de Marne-Ardennes, CLCC Jean Godinot, F-51100, Reims, France; FRANCIM, F-31073, Toulouse, France
| | - A Belot
- Institut de Veille Sanitaire, Département des Maladies Chroniques et Traumatismes, F-94410, Saint-Maurice, France; Hospices Civils de Lyon, Service de Biostatistique, F-69495, Pierre-Bénite, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, F-69100, Villeurbanne, France; Laboratoire de Biométrie et Biologie Evolutive, Equipe Biotatistique-Santé, CNRS UMR5558, F-69100, Villeurbanne France; Cancer Research UK Cancer Survival Group, Faculty of Epidemiology and Population Health, London, UK
| | - P Grosclaude
- Registre des Cancer du Tarn, Centre Hospitalier spécialisé, F-81000, Albi, France; FRANCIM, F-31073, Toulouse, France
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Choi H, Kasaian K, Melck A, Ong K, Jones SJM, White A, Wiseman SM. Papillary thyroid carcinoma: prognostic significance of cancer presentation. Am J Surg 2015; 210:298-301. [PMID: 25997714 DOI: 10.1016/j.amjsurg.2014.12.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/15/2014] [Accepted: 12/22/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of this study was to evaluate whether the clinical presentation of papillary thyroid carcinoma (PTC) has prognostic significance. METHODS Retrospective evaluation was carried out of sequential, primary presentation, >1 cm diameter, PTC cases treated at a single center. PTC cases were grouped into 3 groups: (1) incidental detection by imaging, (2) incidental detection by physical examination, and (3) detection because of complaints related to a thyroid mass. The MACIS (metastasis, age, completeness of resection, invasion, and size) system was used to determine cancer prognosis for each group. RESULTS Of the 168 PTC cases, 28 patients (17%) were in group 1, 60 patients (36%) were in group 2, and 80 patients (47%) were in group 3. Overall, 53% of differentiated thyroid cancers were detected incidentally. The difference in the proportion of patients in each MACIS score groups among the 3 clinical presentation categories, and for each component of the MACIS score, was not statistically significant (P = .36). CONCLUSION The manner in which PTC initially clinically presents has no relationship with cancer prognosis.
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Affiliation(s)
- Heywood Choi
- Division of Endocrinology, Department of Medicine, St Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Katayoon Kasaian
- Michael Smith Genome Sciences Center, British Columbia Cancer Research Center, 100-570 West 7th Avenue, Vancouver, British Columbia, Canada
| | - Adrienne Melck
- Department of Surgery, St Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6
| | - Kaye Ong
- Department of Surgery, St Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6
| | - Steven J M Jones
- Department of Medical Genetics, University of British Columbia and Michael Smith Genome Sciences Center, British Columbia Cancer Research Center, 100-570 West 7th Avenue, Vancouver, British Columbia, Canada
| | - Adam White
- Division of Endocrinology, Department of Medicine, St Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, St Paul's Hospital & University of British Columbia, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6.
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Papillary thyroid carcinomas in patients under 21 years of age: clinical and histologic characteristics of tumors ≤10 mm. J Pediatr 2015; 166:451-6.e2. [PMID: 25453245 DOI: 10.1016/j.jpeds.2014.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/02/2014] [Accepted: 10/08/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare clinical and histologic characteristics of papillary thyroid carcinomas (PTCs) ≤10 mm in patients ≤21 years old with larger ones and with microcarcinomas in adults. STUDY DESIGN Retrospective study of patients with PTC diagnosed between 1983 and 2012. Medical records were reviewed and information about age, sex, tumor size, intra/extrathyroid extension, lymph node, and distant metastases were collected. RESULTS Patients ≤21 years old (n = 93) and adults (n = 1235) with PTC were identified. Among the former, 34 had PTC ≤10 mm (37.4%) and among the latter, 584 had papillary thyroid microcarcinoma (PTM) (47.3%), P = .082. Patients with tumors ≤10 mm less frequently had extrathyroidal extension and lymph node metastases compared with larger tumors (8.8% vs 33.3%, P = .017, and 60.0% vs 95.2%, P = .001, respectively). The percentage of PTC ≤10 mm increased with age (7.1%, 32.0%, and 48.1% in age groups ≤15, 15-18, and >18 to ≤21 years old, respectively; P = .016). Mean tumor size was larger (6.8 ± 2.7 vs 5.8 ± 2.8 mm, P = .030), and lymph nodes metastases were more frequent (41.2% vs 18.6%, P = .003) in patients ≤21 years of age compared with adults with PTM. The frequency of multifocal cancers decreased between 1983-1992, 1993-2002, and 2003-2012 (66.7%, 53.6%, and 27.1%, respectively, P = .019). CONCLUSIONS The frequency of PTC ≤10 mm is low in children, increases in adolescents, and reaches that of adults at 18-21 years of age. Mean tumor size is larger and metastases to regional lymph nodes more frequent in comparison with PTM in adults. Whether their treatment and follow-up could be based on guidelines used for PTM in adults is questionable.
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Krejbjerg A, Brilli L, Pikelis A, Pedersen HB, Laurberg P. Thyroid malignancy markers on sonography are common in patients with benign thyroid disease and previous iodine deficiency. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:309-316. [PMID: 25614404 DOI: 10.7863/ultra.34.2.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the characteristics of benign thyroid nodules on sonography and ultrasound elastography in a population exposed to iodine deficiency. METHODS We conducted a prospective systematic evaluation of preoperative thyroid sonography and elastography in patients assigned for surgical excision of benign thyroid nodules. Two experienced sonographers performed all sonographic and elastographic examinations. Thyroid nodules were evaluated by 7 generally accepted sonographic malignancy risk markers and assigned an elasticity score on elastography. The final diagnosis of a benign thyroid nodule was based on histopathologic analysis of resected thyroid gland tissue. RESULTS We evaluated 232 thyroid nodules in 105 patients (86 women and 19 men). In total, 57% of the examined nodules had 1 or 2 malignancy risk markers present, and 24% did not have any markers present. A solid nodule larger than 15 mm was the most common malignancy risk marker observed (63%), followed by low elasticity (33%), microcalcifications (26%), and hypoechogenicity (15%). In an analysis stratified according to the number of nodules (solitary versus multiple), low elasticity was described more frequently in solitary nodules (61.9% versus 30.4%; P= .004). A large nodular volume was a predictor (P < .05) of microcalcifications and intranodular vascularization, whereas an absent halo sign and a solid nodule were found less frequently in nodules with larger volumes. CONCLUSIONS Our results show that routine preoperative malignancy risk evaluation of presumably benign thyroid nodules is of little value when performed on patients exposed to iodine deficiency.
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Affiliation(s)
- Anne Krejbjerg
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.).
| | - Lucia Brilli
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.)
| | - Arunas Pikelis
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.)
| | - Henrik Baymler Pedersen
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.)
| | - Peter Laurberg
- Departments of Endocrinology (A.K., P.L.) and Ear, Nose, and Throat Head and Neck Surgery (A.P., H.B.P.), Aalborg University Hospital, Aalborg, Denmark; and Department of Endocrinology, University of Siena, Siena, Italy (L.B.)
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Ahn HY, Kim MS, Kim MJ, Cho SY, Kim YA, Lee GH, Lee BC, Park YJ, Yi KH. Loss of ERβ expression in papillary thyroid carcinoma is associated with recurrence in young female. Clin Endocrinol (Oxf) 2015; 82:300-6. [PMID: 24801822 DOI: 10.1111/cen.12486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 02/19/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We investigated the expression of oestrogen receptors (ERs) in papillary thyroid cancers (PTCs) and evaluated their prognostic role. METHODS We enrolled 81 female patients who underwent thyroid surgery and had a confirmed diagnosis of PTC between 01 January 1995 and 31 December 1996. Data on clinicopathologic parameters were obtained from patients' medical records. Tissue paraffin blocks of these 81 patients were collected for immunohistochemistry for ERα and ERβ. RESULTS ERα expression was observed in only eight patients (9·9%). In contrast, ERβ expression was positive in 36 (44·4%) patients. Total thyroidectomy (84·4% vs 61·1%, P = 0·017) and cervical lymph node metastasis (62·2% vs 22·2%, P = 0·000) were more frequent in the ERβ-negative group than in the ERβ-positive group. Among younger female patients (<45 years), the ERβ-negative group showed a tendency towards more frequent recurrent or persistent disease than the ERβ-positive group (42·3% vs 13·6%, P = 0·029). In contrast, the ERα-positive group showed more recurrent or persistent disease than the ERα-negative group in older female patients (100% vs 24·1%, P = 0·024). In multivariate analysis, ERβ negativity, extrathyroidal invasion and radioactive iodine treatment were risk factors for recurrence in young female patients. CONCLUSION Loss of ERβ expression was associated with recurrence in young female PTC patients. This finding suggests that oestrogen might play a protective role in the progression of PTC via ERβ, especially in young female patients.
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Affiliation(s)
- Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Dongjak-gu, Seoul, Korea
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Hong AR, Lim JA, Kim TH, Choi HS, Yoo WS, Min HS, Won JK, Lee KE, Jung KC, Park DJ, Park YJ. The Frequency and Clinical Implications of the BRAF(V600E) Mutation in Papillary Thyroid Cancer Patients in Korea Over the Past Two Decades. Endocrinol Metab (Seoul) 2014; 29:505-13. [PMID: 25325273 PMCID: PMC4285045 DOI: 10.3803/enm.2014.29.4.505] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Over the past several decades, there has been a rapid worldwide increase in the prevalence of papillary thyroid cancer (PTC) as well as a number of changes in the clinicopathological characteristics of this disease. BRAF(V600E), which is a mutation of the proto-oncogene BRAF, has become the most frequent genetic mutation associated with PTC, particularly in Korea. Thus, the present study investigated whether the prevalence of the BRAF(V600E) mutation has increased over the past two decades in the Korean population and whether various PTC-related clinicopathological characteristics have changed. METHODS The present study included 2,624 patients who underwent a thyroidectomy for PTC during two preselected periods; 1995 to 2003 and 2009 to 2012. The BRAF(V600E) mutation status of each patient was confirmed using the polymerase chain reaction-restriction fragment length polymorphism method or by the direct sequencing of DNA. RESULTS The prevalence of the BRAF(V600E) mutation in Korean PTC patients increased from 62.2% to 73.7% (P=0.001) over the last two decades. Additionally, there was a greater degree of extrathyroidal extension (ETE) and lymph node metastasis in 2009 to 2012 patients with the BRAF(V600E) mutation and a higher frequency of thyroiditis and follicular variant-PTC in 2009 to 2012 patients with wild-type BRAF. However, only the frequency of ETE was significantly higher in 1995 to 2003 patients with the BRAF(V600E) mutation (P=0.047). Long-term recurrence rates during a 10-year median follow-up did not differ based on BRAF(V600E) mutation status. CONCLUSION The BRAF(V600E) mutation rate in Korean PTC patients has been persistently high (approximately 70%) over the past two decades and continues to increase. The present findings demonstrate that BRAF(V600E)-positive PTC was associated with more aggressive clinicopathological features, especially in patients who were recently diagnosed, suggesting that BRAF(V600E) mutation status may be a useful prognostic factor for PTC in patients recently diagnosed with this disease.
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Affiliation(s)
- A Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Ah Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Won Sang Yoo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.; Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyung Won
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of General Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyeong Cheon Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Age of diagnosing physician impacts the incidence of thyroid cancer in a population. Cancer Causes Control 2014; 25:1627-34. [PMID: 25240802 DOI: 10.1007/s10552-014-0467-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Thyroid ultrasound and fine-needle aspiration (FNA) have been implicated in the overdiagnosis of thyroid cancer. To study how the use of diagnostic tools impacts thyroid cancer incidence, we propose using physician age as a surrogate. We aimed to determine whether thyroid cancer incidence is higher in areas with a high density of young physicians compared with areas with a high density of older physicians. METHODS SEER 13 database was used to determine thyroid cancer incidence. These data were linked to the Area Resource File data (2000), containing information on physician age at a county-specific level. Cohorts were divided by age based on the concentration of physicians within a population of 1,000,000 persons. The study period was divided into two time periods (1992-1995, 2006-2009). RESULTS The incidence of thyroid cancer was stable in areas with high concentrations of young and older physicians during the 1992-1995 time period [<35: 5.97; 55-64: 6.82; ≥65: 6.70 (per 100,000py)]. Areas with high concentrations of young physicians had an increased incidence of thyroid cancer compared with areas of high concentrations of older physicians during the 2006-2009 period [<35: 13.3; 55-64: 9.86; ≥65: 7.47 (per 100,000py)]. CONCLUSIONS Thyroid cancer incidence was lower in areas with high concentrations of older physicians. This may be the result of increased adoption of thyroid ultrasound and FNA among younger physicians who have trained after diagnostic tools became common. Age of the diagnosing physician is a surrogate for diagnostic utility contributing to thyroid cancer trends.
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Pazaitou-Panayiotou K, Toulis KA, Mandanas S, Tarlatzis BC. Thyroid cancer after in vitro fertilization: a retrospective, non-consecutive case-series analysis. Gynecol Endocrinol 2014; 30:569-72. [PMID: 24702193 DOI: 10.3109/09513590.2014.907258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although a firm association between fertility treatment and thyroid cancer has not been established, the widespread use of IVF, as a substantial reservoir of subclinical thyroid cancer disease and evidence suggesting an estrogen-dependent behavior may render thyroid cancer patients after IVF a distinct subpopulation of particular interest. Thus, a retrospective, non-consecutive case-series analysis of patients with history of thyroid cancer after in vitro fertilization was conducted. Twelve female patients with thyroid cancer who had previously undergone IVF treatment were identified within the cohort of thyroid cancer patients followed in our institution. All cases of thyroid cancer were papillary thyroid carcinoma (PTC) on histology and median tumor size (25th and 75th percentile) was 12 mm (7 and 17 mm). Thyroid cancer was diagnosed after a median of 4 years (2 and 6 years) from the last IVF cycle and at the time of diagnosis lymph node metastases were present in five patients (42%) and distant metastases where seen in four of them. Collectively, these data suggest that an aggressive pattern of PTC might be present in this distinct subpopulation. This preliminary observation may be explained, at least in part, by the delay in the diagnosis.
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Siu S, McDonald JT, Rajaraman M, Franklin J, Paul T, Rachinsky I, Morrison D, Imran SA, Burrell S, Hart R, Driedger A, Badreddine M, Yoo J, Corsten M, Van Uum S. Is lower socioeconomic status associated with more advanced thyroid cancer stage at presentation? A study in two Canadian centers. Thyroid 2014; 24:545-51. [PMID: 24020873 DOI: 10.1089/thy.2013.0090] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Some studies have shown a higher incidence of thyroid cancer in patients with insurance coverage and higher socioeconomic status (SES), and a higher thyroid cancer stage in patients with lower SES, suggesting SES-related health disparity in thyroid cancer. However, it is not known if the same is evident under a universal healthcare system such as that in Canada. METHODS We used data from the Canadian Thyroid Cancer Consortium, a large thyroid cancer registry that collects data from two major thyroid cancer referral centers (London, Ontario, and Halifax, Nova Scotia). We included patients who presented with thyroid cancer between 1998 and 2011. We determined age at presentation, sex, and thyroid cancer status using the American Joint Committee on Cancer (AJCC) staging criteria. Individuals' postal codes were used to retrieve data from the Canadian census for the years 1996, 2001, and 2006 to approximate household income. Ordered logistic regression was used to determine odds ratios of presenting with more advanced stage thyroid cancer as they relate to income, age, and sex. RESULTS We included 1701 patients: 1334 cases from London and 367 from Halifax. Thyroid cancer was diagnosed more frequently in the higher SES groups (p<0.001). Compared to patients in the top income quintile, patients in the lowest and second-lowest income quintiles had significantly higher odds of having more advanced stage thyroid cancer at presentation (OR 1.58, p=0.002; 1.37, p=0.024 respectively). CONCLUSIONS Our study suggests that, similar to countries that lack a universal healthcare system, health disparity in thyroid cancer also exists in Canada. It appears that while thyroid cancers were diagnosed more frequently in Canadian patients of higher SES, Canadian patients in the lower SES groups had more advanced stage thyroid cancer at presentation.
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Affiliation(s)
- Stephanie Siu
- 1 Department of Medicine, Schulich School of Medicine and Dentistry, Western University , London, Canada
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Cho SW, Choi HS, Yeom GJ, Lim JA, Moon JH, Park DJ, Chung JK, Cho BY, Yi KH, Park YJ. Long-term prognosis of differentiated thyroid cancer with lung metastasis in Korea and its prognostic factors. Thyroid 2014; 24:277-86. [PMID: 23758653 PMCID: PMC3926138 DOI: 10.1089/thy.2012.0654] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Distant metastasis, generally to lung and bone, is rare in differentiated thyroid carcinoma (DTC) and the prognosis is still elusive. We investigated long-term outcomes of lung metastasis in DTC patients and its prognostic factors. METHODS A retrospective review was performed of 4572 patients who underwent surgery for DTC from 1962 to 2009 at Seoul National University Hospital. Among them, 164 patients were identified with lung metastasis and 152 patients were enrolled in the final analysis. Poor prognosis was defined as progressive disease or death. RESULTS Of these 152 patients, 10- and 20-year survival rates were 85.0% and 71.0%, respectively. No evidence of disease, stable disease, progressive disease, and death was identified in 22.4%, 28.3%, 35.5%, and 13.8%, respectively, after 11 years of median follow-up (range 2-41 years). Older age at diagnosis (≥45 years), primary tumor size ≥2 cm, follicular thyroid cancer, metastasis diagnosed after initial evaluation or (131)I remnant ablation (late metastasis), multiple metastases other than lung, (131)I nonavidity, and the presence of macronodules (≥1 cm) were more frequent in poor prognoses. Cox proportional hazard ratio for progression-free survival showed that (131)I nonavidity was the only independent predictive factor for poor prognosis. CONCLUSIONS The prognosis of lung metastasis from DTC in Korea within this study was favorable. (131)I nonavidity, observed more frequently in late metastasis, was the only independent factor predicting poor prognosis.
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Affiliation(s)
- Sun Wook Cho
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Gye Jeong Yeom
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Jung Ah Lim
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Bundang Hospital, Seoul National University, Seoul, Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University, Seoul, Korea
| | - June-Key Chung
- Department of Nuclear Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Bo Youn Cho
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Boramae Medical Center; Seoul National University, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University, Seoul, Korea
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Abstract
The most common thyroid neoplasms are either follicular derived (papillary, follicular and Hürthle cell lesions) or C-cell derived (medullary carcinoma). The diagnosis of these tumors can usually be made at the histologic level, with immunohistochemical stains necessary in some circumstances. Specific molecular mutations have been described that can be diagnostically useful or explain, in part, their pathogenesis, including the well-known Ret/PTC and PPARgamma-PAX8 translocations, point mutations in the Ret, Ras and BRAF genes, and loss of heterozygosity of multiple different tumor suppressor genes. Some unusual tumors of the thyroid gland are more difficult to diagnose. In examining these lesions, the pathologist may use the hematoxylin and eosin-stained morphology, coupled with an analysis of the immunohistochemical staining profiles and possibly analysis of the underlying molecular mutational patterns. These less common thyroid tumors include tall cell and cribriform-morular variants of papillary carcinoma, hyalinizing trabecular tumor, mucoepidermoid and sclerosing mucoepidermoid carcinoma with eosinophilia, poorly differentiated (insular) carcinoma, and undifferentiated (anaplastic) carcinoma. The diagnostic features of these rare tumors, including the histology, immunohistochemical expression profiles and the known molecular mutational profiles of each, are reviewed.
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Affiliation(s)
- Jennifer L Hunt
- University of Pittsburgh Medical Center, Department of Pathology, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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Jung HS, Jeon MJ, Song DE, Hong SJ, Kim WG, Kim TY, Shong YK, Kim WB. Time Trends Analysis of Characteristics of Patients with Thyroid Cancer in a Single Medical Center. ACTA ACUST UNITED AC 2014. [DOI: 10.11106/cet.2014.7.2.159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Hyung Seo Jung
- University of Ulsan College of Medicine, Division of Endocrinology & Metabolism, Asan Medical Center, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, Seoul, Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
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Minelli G, Conti S, Manno V, Olivieri A, Ascoli V. The geographical pattern of thyroid cancer mortality between 1980 and 2009 in Italy. Thyroid 2013; 23:1609-18. [PMID: 23668719 PMCID: PMC3868258 DOI: 10.1089/thy.2013.0088] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mortality for thyroid cancer (TC) is low and has been decreasing worldwide; yet few population studies based on mortality have been conducted. Several nonradiation risk factors have been associated with TC, including residence in goiter-endemic areas (as an indicator of iodine deficiency). We used mortality data to perform a spatial-temporal analysis regarding TC in Italy and investigated the association between mortality and socioeconomic status and geographical features (residing in a mountainous area is a proxy for iodine deficiency). METHODS We analyzed data from Italy's National Mortality Database (1980-2009). To evaluate temporal trends in mortality the age-standardized death rate (ASR) was used; to identify geographic areas with excess deaths due to TC standardized mortality rates (SMR) were calculated. We also calculated the rate ratios (RR) of the ASR and the 95% CI by sex. We performed a cluster analysis to identify municipalities with major departures from expected mortality, both in the entire study period and in two separate periods to evaluate the spatial-temporal variability. Finally, we evaluated the association between mortality and index of deprivation and altitude. RESULTS There were 16,473 deaths due to TC (10,690 females, 5783 males). The mean ASR was unsurprisingly low (0.58/100.000). There was a trend of decrease in mortality throughout Italy (-42% for 2007-2009 vs. 1980-1984), more pronounced among women. The decrease was greater in the north. Four geographic clusters were identified when considering the entire study period, two in the north and two in the south; however, the clusters in northern Italy refer to the earlier period (1980-1994) and those in southern Italy to the later period (1995-2009). Mortality was associated with residing in a mountainous area. A slight association with high socioeconomic status was found. CONCLUSIONS This study reveals space-time differences in TC mortality in Italy. It shows an association between mortality and residing in mountainous areas, which is a proxy of iodine deficiency. The observed temporal north-south shift cannot be explained by socioeconomic differences, whereas the efficient prophylaxis program implemented in the 1980s in some areas of northern Italy can help to explain the disappearance of the clusters in those areas in the period 1995-2009.
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Affiliation(s)
- Giada Minelli
- Statistics Unit, Italian National Institute of Public Health, Rome, Italy
| | - Susanna Conti
- Statistics Unit, Italian National Institute of Public Health, Rome, Italy
| | - Valerio Manno
- Statistics Unit, Italian National Institute of Public Health, Rome, Italy
| | - Antonella Olivieri
- Italian National Observatory for Monitoring of Iodine Prophylaxis in Italy (OSNAMI), Italian National Institute of Public Health, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
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Choi SW, Ryu SY, Han MA, Park J. The association between the socioeconomic status and thyroid cancer prevalence; based on the Korean National Health and Nutrition Examination Survey 2010-2011. J Korean Med Sci 2013; 28:1734-40. [PMID: 24339702 PMCID: PMC3857368 DOI: 10.3346/jkms.2013.28.12.1734] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/23/2013] [Indexed: 11/20/2022] Open
Abstract
The incidence of thyroid cancer has recently increased in most industrialized countries, including Korea. To date, few studies have examined the association between thyroid cancer and socioeconomic status (SES). The current study was based on data collected from a total of 12,276 subjects (5,277 men and 6,999 women) by the Korean National Health and Nutrition Examination Survey (KNHANES) between 2010 and 2011. Univariate and multivariate logistic regression analysis revealed that older age (odds ration [OR], 1.03; 95% confidence interval [CI], 1.00-1.05), being female (OR, 8.16; 95%CI, 2.99-22.24), being overweight (OR, 1.04; 95%CI, 1.01-1.06), monthly household income (OR, 3.27; 95%CI, 1.16-9.20 for medium-highest household income vs lowest household income; OR, 3.30; 95%CI, 1.16-9.34 for highest household income vs lowest household income), educational level (OR, 2.74; 95%CI, 1.16-6.46 for 10-12 yr vs < 7 yr) and alcohol consumption (OR, 1.89; 95%CI 1.08-3.32) were significant risk factors for thyroid cancer. Our results indicate that the recent increase in thyroid cancer is attributable to better early detection rather than to any increase in actual prevalence.
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Affiliation(s)
- Seong-Woo Choi
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - So-Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Mi-ah Han
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
| | - Jong Park
- Department of Preventive Medicine, Chosun University Medical School, Gwangju, Korea
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