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Poma AM, Macerola E, Ghossein RA, Tallini G, Basolo F. Prevalence of Differentiated High-Grade Thyroid Carcinoma Among Well-Differentiated Tumors: A Systematic Review and Meta-Analysis. Thyroid 2024; 34:314-323. [PMID: 38115626 PMCID: PMC10951568 DOI: 10.1089/thy.2023.0350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Background: The current edition of the World Health Organization (WHO) classification of endocrine tumors introduced grading for follicular cell-derived thyroid cancer. Tumors with necrosis and/or high mitotic count but not fulfilling the Turin criteria for poorly differentiated carcinoma will be reclassified as differentiated high-grade thyroid carcinoma (DHGTC). However, the impact of this reclassification has not been evaluated. In this study, we performed a systematic review and meta-analysis to estimate the prevalence of this new entry across thyroid tumor subtypes. Methods: In this systematic review and meta-analysis, studies reporting data on necrosis and/or mitoses in well-differentiated thyroid carcinoma (WDTC) were used to estimate the prevalence of DHGTC. Heterogeneity and potential publication bias were also evaluated. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and quality assessment was performed using a modification of the Newcastle-Ottawa scale. The study has been registered in the International Prospective Register of Systematic Reviews (PROSPERO, ID: CRD42022378716). Results: In clinically unselected patients, the prevalence of DHGTC in WDTC was 0.072 [95% confidence interval, CI, = 0.045-0.113]. The proportion of high-grade tumors greatly varied across growth patterns and subtypes. Overall, the prevalence of DHGTC was higher in follicular thyroid carcinoma (FTC; 0.146 [CI = 0.101-0.205]) than in papillary thyroid carcinoma (PTC; 0.059 [CI = 0.036-0.097]). Diffuse sclerosing, follicular, and classic subtype PTC had the lowest rates of high-grade features (i.e., 0.018 [CI = 0.004-0.084]; 0.036 [CI = 0.010-0.124]; and 0.042 [CI = 0.027-0.066], respectively), while a greater proportion of solid trabecular and histologically aggressive PTC could be reclassified as DHGTC (i.e., 0.154 [CI = 0.067-0.314] and 0.168 [CI = 0.108-0.252], respectively). Similar proportions were obtained for minimally and widely invasive FTC (i.e., 0.136 [CI = 0.058-0.287] and 0.152 [CI = 0.086-0.254], respectively). Finally, in a cohort of patients with poor prognosis (i.e., fatal cases, metastatic and radioiodine resistant tumors, cases with biochemical recurrence), the proportion of DHGTC was 0.287 [CI = 0.155-0.469]. Conclusions: Following the current WHO indications, some tumors will be reclassified as DHGTC. The proportion of tumors with high-grade features is relevant in FTC, solid trabecular, and histologically aggressive PTC subtypes. A remarkable enrichment in DHGTC among patients with poor prognosis confirms the negative impact of high-grade features on outcome.
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Affiliation(s)
- Anello M. Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Elisabetta Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Ronald A. Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Giovanni Tallini
- Anatomic Pathology, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Solid Tumor Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
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Li HJ, Yang YP, Liang X, Zhang Z, Xu XH. Comparison of the diagnostic performance of three ultrasound thyroid nodule risk stratification systems for follicular thyroid neoplasm: K-TIRADS, ACR -TIRADS and C-TIRADS. Clin Hemorheol Microcirc 2023; 85:395-406. [PMID: 37694360 DOI: 10.3233/ch-231898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To explore the diagnostic performance of the currently used ultrasound-based thyroid nodule risk stratification systems (K-TIRADS, ACR -TIRADS, and C-TIRADS) in differentiating follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC). METHODS Clinical data and preoperative ultrasonographic images of 269 follicular thyroid neoplasms were retrospectively analyzed. All of them were detected by Color Doppler ultrasound instruments equipped with high-frequency liner array probes (e.g. Toshiba Apoli500 with L5-14MHZ; Philips IU22 with L5-12MHZ; GE LOGIQ E9 with L9-12MHZ and MyLab Class C with L9-14MHZ). The diagnostic performance of three TIRADS classifications for differentiating FTA from FTC was evaluated by drawing the receiver operating characteristic (ROC) curves and calculating the cut-off values. RESULTS Of the 269 follicular neoplasms (mean size, 3.67±1.53 cm), 209 were FTAs (mean size, 3.56±1.38 cm) and 60 were FTCs (mean size, 4.07±1.93 cm). There were significant differences in ultrasound features such as margins, calcifications, and vascularity of thyroid nodules between the FTA and FTC groups (P < 0.05). According to the ROC curve comparison analysis, the diagnostic cut-off values of K-TIRADS, ACR-TIRADS, and C-TIRADS for identifying FTA and FTC were K-TR4, ACR-TR4, and C-TR4B, respectively, and the areas under the curves were 0.676, 0.728, and 0.719, respectively. The difference between ACR-TIRADS and K-TIRADS classification was statistically significant (P = 0.0241), whereas the differences between ACR-TIRADS and C-TIRADS classification and between K-TIRADS and C-TIRADS classification were not statistically significant (P > 0.05). CONCLUSION The three TIRADS classifications were not conducive to distinguishing FTA from FTC. It is necessary to develop a novel malignant risk stratification system specifically for the identification of follicular thyroid neoplasms.
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Affiliation(s)
- Hua-Juan Li
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yu-Ping Yang
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xin Liang
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhi Zhang
- Department of Thyroid and Mammary Vascular Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiao-Hong Xu
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Mu N, Juhlin CC, Tani E, Sofiadis A, Reihnér E, Zedenius J, Larsson C, Nilsson IL. High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma. Endocrine 2018; 61:293-302. [PMID: 29796987 PMCID: PMC6061212 DOI: 10.1007/s12020-018-1627-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Preoperative distinction of follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) is a diagnostic challenge. Our aim was to investigate whether the Ki-67 proliferation index in fine needle aspiration material can contribute to the diagnosis of FTC. METHODS We analyzed retrospectively cytological Ki-67 index determined in routine clinical setting and clinical data for 61 patients with FTC, 158 patients with FTA and 15 patients with follicular tumor of uncertain malignant potential (FT-UMP) surgically treated and diagnosed by histopathology at Karolinska University Hospital 2006-2017 (Cohort A). A previously published cohort of 109 patients with follicular tumors was re-analyzed as well (Cohort B). RESULTS In Cohort A, patients with FTC had a higher Ki-67 index (p < 0.001), larger tumor size (p < 0.001) and higher age at diagnosis (p = 0.036) compared to patients with FTA or FT-UMP. Hürthle cell differentiation, present in 50 FTA, 20 FTC and 8 FT-UMP, was associated with higher Ki-67 index (p = 0.009). Multivariate analysis of Cohort A identified a high Ki-67 index (odds ratio [OR]: 1.215, p < 0.001) and large tumor size (OR: 1.038, p < 0.001) as independent predictors of FTC. Results remained consistent after exclusion of Hürthle cell tumors and in pooled analysis of Cohort A + B. The area under curve of the Ki-67 index for predicting FTC was 0.722 and a cut-off for Ki-67 index at above 5% resulted in a specificity at 93% and sensitivity at 31%. Subgroup analysis of FTCs in Cohort A showed an association of higher Ki-67 index to extrathyroidal extension (p = 0.001) as well as widely invasive subtype (p = 0.019) based on the WHO 2017 classification. CONCLUSIONS Pre-operative Ki-67 index may add diagnostic information for a subset of patients with follicular thyroid tumors.
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Affiliation(s)
- Ninni Mu
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden.
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden.
| | - C Christofer Juhlin
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Edneia Tani
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Anastasios Sofiadis
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Reihnér
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Zedenius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Catharina Larsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Cancer Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Pathology and Cytology, Karolinska University Hospital, Stockholm, Sweden
| | - Inga-Lena Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
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Paulsson JO, Mu N, Shabo I, Wang N, Zedenius J, Larsson C, Juhlin CC. TERT aberrancies: a screening tool for malignancy in follicular thyroid tumours. Endocr Relat Cancer 2018; 25:723-733. [PMID: 29692346 DOI: 10.1530/erc-18-0050] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/24/2018] [Indexed: 01/09/2023]
Abstract
Telomerase reverse transcriptase (TERT) promoter mutations have been linked to adverse clinical parameters in thyroid cancer, but TERT-expressing tumours are not always mutated. Little is known regarding other TERT-related genetic aberrations. To delineate the role of TERT gene aberrancies in follicular thyroid tumours, 95 follicular carcinomas (FTCs), 43 follicular adenomas (FTAs) and 33 follicular tumours of uncertain malignant potential (FT-UMPs) were collected. The tumours were assayed for TERT expression, TERT promoter mutations, TERT promoter hypermethylation and TERT gene copy number (CN) alterations and the results were compared to clinical parameters. Cases with mutation, detectable mRNA expression, CN gain or hypermethylation were classified as TERT aberrant, and these aberrancies were regularly found in FTC and FT-UMP but uncommonly found in FTA. In total, 59% FTCs and 63% FT-UMPs exhibited one or more of these TERT gene aberrancies. Moreover, 24 out of 28 FTCs (86%) with TERT expression displayed an evident TERT gene aberration, and statistics showed an increased risk for relapse in FTCs with TERT expression, CN gain or hypermethylation. We conclude that TERT expression in follicular thyroid tumours is coupled to promoter mutations, CN gain and increased promoter methylation. The molecular similarities regarding TERT aberrations between the FTC and FT-UMP groups indicate that a significant subset of FT-UMP cases may display future recurrences. TERT aberrancies are thus promising as future additional markers for determining malignant potential of follicular thyroid tumours.
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Affiliation(s)
- Johan O Paulsson
- Department of Oncology-PathologyKarolinska Institutet, Karolinska University Hospital CCK, Stockholm, Sweden
| | - Ninni Mu
- Department of Oncology-PathologyKarolinska Institutet, Karolinska University Hospital CCK, Stockholm, Sweden
| | - Ivan Shabo
- Department of Molecular Medicine and SurgeryKarolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of BreastEndocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Na Wang
- Department of Oncology-PathologyKarolinska Institutet, Karolinska University Hospital CCK, Stockholm, Sweden
| | - Jan Zedenius
- Department of Molecular Medicine and SurgeryKarolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of BreastEndocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Catharina Larsson
- Department of Oncology-PathologyKarolinska Institutet, Karolinska University Hospital CCK, Stockholm, Sweden
| | - C Christofer Juhlin
- Department of Oncology-PathologyKarolinska Institutet, Karolinska University Hospital CCK, Stockholm, Sweden
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Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland. Int Surg 2018. [DOI: 10.9738/intsurg-d-15-00187.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of the current study was to determine the risk of malignancy in patients with thyroid nodules with cytology of indeterminate follicular and indeterminate Hürthle cell neoplasm (HN). The cytologic diagnosis of follicular neoplasm (FN) or HN remains a diagnostic challenge. Often, surgery is recommended for such lesions. A retrospective analysis was performed on 80 patients who underwent thyroid surgery following a diagnosis of indeterminate FN and indeterminate HN in thyroid fine-needle aspiration biopsy. Sex; age; family history of thyroid cancer and radiation exposure; coexisting thyroid conditions, such as solitary nodule; multinodularity; cytologic diagnosis; sonographic features; type of surgical treatment; and histopathologic results were recorded. Of the 80 patients, 52 (65%) had FN on fine-needle aspiration biopsy cytology and 28 (35%) had HN. A total of 23 patients (28.7%) had primary thyroid cancers on surgical pathology, and 57 (71.3%) had benign diagnoses. Univariate analysis showed no differences between the benign and malignant groups by sex, nodule size, family history of thyroid cancer, history of radiation exposure, presence of solitary nodule or multinodularity in the nodular features. In multivariate binary logistic regression analysis, the factors that were statistically significant predictors of malignancy were microcalcification [odds ratio (OR), 10.9; 95% confidence interval (CI), 2.18–54.7; P = 0.004], being older than 45 years (OR, 4.2; 95% CI, 1.25–14.63; P = 0.02]. The independent predictors of malignancy in FN and HN are micorcalcification and being older than 45 years, the use of which may predict the risk of thyroid cancer.
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Pan DH, Wen DY, Luo YH, Chen G, Yang H, Chen JQ, He Y. The diagnostic and prognostic values of Ki-67/MIB-1 expression in thyroid cancer: a meta-analysis with 6,051 cases. Onco Targets Ther 2017; 10:3261-3276. [PMID: 28740401 PMCID: PMC5505609 DOI: 10.2147/ott.s135593] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Growing evidence has demonstrated that Ki-67/MIB-1 has an effect on the clinical progression and prognosis in cancers. However, the diagnostic and prognostic values of Ki-67/MIB-1 in thyroid cancer remain unclear. Materials and methods The meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from PubMed, EBSCO, EMBASE, ISI Web of Science, China National Knowledge Infrastructure, WanFang and Chinese VIP databases. MetaDiSc and STATA12.0 were used to analyze the meta-analysis. Fixed-effect analysis and random-effect analysis were applied to pool the relative ratio based on heterogeneity in this meta-analysis. Results In the meta-analysis, 51 eligible studies were included. The pooled sensitivity of Ki-67/MIB-1 was 0.61 (95% confidence interval [CI]: 0.59–0.63) and specificity was 0.75 (95% CI: 0.74–0.77) in thyroid cancer. The pooled positive likelihood ratio was 3.19 (95% CI: 2.30–4.42) and negative likelihood ratio was 0.43 (95% CI: 0.35–0.54). In the diagnosis of thyroid cancer, the pooled diagnostic odds ratio of Ki-67/MIB-1 was 8.54 (95% CI: 5.03–14.49). The area under the symmetric receiver operating characteristic curve was 0.804 (standard error =0.031). Our results showed that there were statistical associations between Ki-67/MIB-1 and age (odds ratio [OR] =1.71, 95% CI: 1.14–2.57, P=0.010), tumor size (OR =1.86, 95% CI: 1.17–2.96, P=0.008), lymph node metastasis (OR =2.49, 95% CI: 1.42–4.39, P=0.002), metastasis status (OR =6.96, 95% CI: 2.46–19.69, P<0.001), tumor node metastasis stage (OR =6.56, 95% CI: 3.80–11.34, P<0.001) and extrathyroid extension (OR =1.91, 95% CI: 1.27–2.87, P=0.002). Furthermore, thyroid cancer patients with a high level of Ki-67/MIB-1 had a worse disease-free survival as compared to patients with a low level of Ki-67/MIB-1 (hazard ratio =5.19, 95% CI: 3.18–8.46, P<0.001). Also, Ki-67/MIB-1 was found to be associated with increased risk of mortality (hazard ratio =3.56, 95% CI: 1.17–10.83, P=0.025). Conclusion Our results demonstrated that Ki-67/MIB-1 might act as a potential factor in diagnosing thyroid cancer in Chinese. Also, the meta-analysis indicated that Ki-67/MIB-1 might have an effect on prognosis in non-Chinese thyroid cancer patients.
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Affiliation(s)
| | | | | | - Gang Chen
- Department of Pathology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, People's Republic of China
| | | | | | - Yun He
- Department of Ultrasonography
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Heikkilä A, Fermér C, Hagström J, Louhimo J, Mäenpää H, Siironen P, Heiskanen I, Nilsson O, Arola J, Haglund C. A novel stem cell associated marker identified by monoclonal antibody HESC5:3 differentiates between neoplastic lesions in follicular thyroid neoplasms. APMIS 2015; 123:604-12. [DOI: 10.1111/apm.12393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 03/05/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Annukka Heikkilä
- Department of Pathology; Haartman Institute and HUSLAB; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | | | - Jaana Hagström
- Department of Pathology; Haartman Institute and HUSLAB; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Johanna Louhimo
- Department of Surgery; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Hanna Mäenpää
- Department of Oncology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Päivi Siironen
- Department of Surgery; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Ilkka Heiskanen
- Department of Surgery; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | | | - Johanna Arola
- Department of Pathology; Haartman Institute and HUSLAB; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Caj Haglund
- Department of Pathology; Haartman Institute and HUSLAB; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Department of Surgery; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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8
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Petric R, Besic H, Besic N. Preoperative serum thyroglobulin concentration as a predictive factor of malignancy in small follicular and Hürthle cell neoplasms of the thyroid gland. World J Surg Oncol 2014; 12:282. [PMID: 25213012 PMCID: PMC4168052 DOI: 10.1186/1477-7819-12-282] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 09/02/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cytologic examination of a fine-needle aspiration biopsy specimen cannot distinguish between benign and malignant follicular or Hürthle cell neoplasms. Serum thyroglobulin (Tg) concentrations are higher in follicular and Hürthle cell carcinomas than in benign follicular or Hürthle cell tumors, but preoperative measurement of Tg is not recommended for initial evaluation of thyroid nodules. The aim of this study was to find out whether preoperative serum Tg concentration is a predictive factor of malignant disease in patients with a follicular or Hürthle cell neoplasm with a diameter of 2 cm or less. METHODS From 1988 to 2013, a total of 244 patients (214 female, 30 male, age range 9 to 82 years, median age 52 years) had a surgical procedure at our institute because of follicular or Hürthle cell neoplasms with a tumor diameter of 2 cm or less. In these patients a preoperative concentration of Tg was determined and Tg-autoantibodies were negative. The risk factors for malignancy were identified by a chi-square test and multivariate logistic regression. RESULTS The histopathologic diagnoses were carcinoma, adenoma, and benign goiter in 62 (25.5%), 115 (47%), and 67 (27.5%) patients, respectively. The median preoperative Tg concentration in benign tumors, papillary carcinomas, follicular carcinomas, and Hürthle cell carcinomas was 41, 87, 72, and 106 ng/ml (P = 0.05), respectively. The predictive factors for carcinoma shown by the chi-square test were: sex, thyroid volume, and preoperative Tg concentration. The independent predictors of malignancy as shown by multivariate logistic regression were: male sex (odds ratio, 2.57; P = 0.02), and a Tg concentration of more than 80 ng/ml (odds ratio, 2.35; P = 0.005). CONCLUSION The independent predictors of malignancy in follicular or Hürthle cell neoplasms are sex and preoperative Tg concentration.
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MESH Headings
- Adenocarcinoma/blood
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenocarcinoma, Follicular/blood
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adenoma/blood
- Adenoma/pathology
- Adenoma/surgery
- Adenoma, Oxyphilic
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Biopsy, Fine-Needle
- Carcinoma, Papillary/blood
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Child
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Neoplasm Staging
- Preoperative Care
- Prognosis
- Radioimmunoassay
- Retrospective Studies
- Thyroglobulin/blood
- Thyroid Neoplasms/blood
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Nodule/blood
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Thyroidectomy
- Young Adult
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Affiliation(s)
- Rok Petric
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Hana Besic
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
| | - Nikola Besic
- Department of Surgical Oncology, Institute of Oncology, Zaloska 2, SI-1000 Ljubljana, Slovenia
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9
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Maruta J, Hashimoto H, Yamashita H, Noguchi H, Noguchi S, Kobayashi TK, Tsuneoka H, Takahashi M. Value of thyroid specific peroxidase and Ki-67 stains in preoperative cytology for thyroid follicular tumors. Diagn Cytopathol 2014; 43:202-9. [DOI: 10.1002/dc.23204] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 07/17/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Junko Maruta
- Department of Pathology; The Noguchi Thyroid Hospital and Foundation; Oita Japan
- Department of Laboratory Science; Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine; Yamaguchi Japan
| | - Hironobu Hashimoto
- Department of Pathology; The Noguchi Thyroid Hospital and Foundation; Oita Japan
| | - Hiroto Yamashita
- Department of Pathology; The Noguchi Thyroid Hospital and Foundation; Oita Japan
| | - Hitoshi Noguchi
- Department of Internal Medicine; The Noguchi Thyroid Hospital and Foundation; Oita Japan
| | - Shiro Noguchi
- Department of Surgery; The Noguchi Thyroid Hospital and Foundation; Oita Japan
| | - Tadao K. Kobayashi
- Cancer Education and Research Center; Osaka University Graduate School of Medicine and Health Science; Osaka Japan
| | - Hidehiro Tsuneoka
- Department of Laboratory Science; Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine; Yamaguchi Japan
| | - Mutsuo Takahashi
- Department of Administration; Mine City Hospital; Yamaguchi Japan
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10
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Heikkilä A, Hagström J, Mäenpää H, Louhimo J, Siironen P, Heiskanen I, Haglund C, Arola J. Loss of estrogen receptor Beta expression in follicular thyroid carcinoma predicts poor outcome. Thyroid 2013; 23:456-65. [PMID: 23106428 DOI: 10.1089/thy.2012.0363] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Well-differentiated follicular thyroid carcinomas (FTCs) usually act indolently, while aggressively acting tumors are difficult to detect early enough. Estrogen receptors (ERs) have prognostic significance in many cancers. Thyroid diseases, including neoplasms, are associated with the female sex. The prognostic significance of ERs in FTCs has not been reported previously. METHODS We studied the role of ERα and ERβ in 83 cases of follicular thyroid adenoma (FTA) and 43 FTC cases, including seven cases of poorly differentiated FTC, obtained from the Department of Surgery, Helsinki University Central Hospital between 1990 and 2009. Patient follow-up was conducted until March 2011. Expression of ERα, ERβ, and MIB-1/Ki-67 was investigated by immunohistochemistry and correlated with clinicopathological characteristics, including survival. RESULTS Two major observations were apparent. First, ERβ expression was significantly higher in FTA than in FTC, and it was a stronger differential diagnostic marker than MIB-1/Ki-67. Second, low ERβ expression correlated with poor survival in FTC. All cancer-specific deaths due to FTC were among low ERβ-score patients. CONCLUSION ERβ is a differential marker for malignancy and could thus be used as a preoperative tool. FTC patients with a low ERβ score need more thorough follow-up and may benefit from more aggressive treatment.
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Affiliation(s)
- Annukka Heikkilä
- Department of Pathology, Haartman Institute, University of Helsinki and HUSLAB, Helsinki, Finland
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Significance of AgNORs and Ki-67 Proliferative Markers in Differential Diagnosis of Thyroid Lesions. Pathol Oncol Res 2012; 19:167-75. [DOI: 10.1007/s12253-012-9565-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 08/02/2012] [Indexed: 10/27/2022]
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Petric R, Perhavec A, Gazic B, Besic N. Preoperative serum thyroglobulin concentration is an independent predictive factor of malignancy in follicular neoplasms of the thyroid gland. J Surg Oncol 2011; 105:351-6. [PMID: 21751218 DOI: 10.1002/jso.22030] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 06/22/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND A distinction between a benign follicular neoplasm (FN) and a malignant FN based entirely on cytologic examination of fine-needle aspiration biopsy is not possible. The aim of this retrospective study was to find predictive factors of carcinoma in patients with FN. METHODS A chart review of 388 patients (314 females, 74 males; mean age 50 years, range 9-81 years) with FN, who were surgically treated between 1988 and 2009, was performed. Predictive factors for malignancy were identified by the chi-squared test and multivariate logistic regression. RESULTS The histopathological diagnoses were carcinoma, adenoma, and benign goiter in 127 (33%), 126 (32%), and 135 (35%) patients, respectively. The independent predictors of malignancy as shown by multivariate logistic regression were age of patients (OR 1.88, P = 0.008), solitary tumor (OR 1.72, P = 0.037), and Tg concentration (OR 2.36, P = 0.001). Carcinoma was more common in patients younger than 45 years, with solitary tumor and with preoperative serum Tg concentration more than 400 ng/ml. CONCLUSIONS The independent predictors of malignancy in FN were age of patients, solitary tumor, and preoperative Tg concentration. The determination of Tg concentration may be useful in the patients with FN in order to decrease the number of completion thyroidectomies.
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Affiliation(s)
- Rok Petric
- Department of Surgical Oncology, Institute of Oncology, Zaloska, Ljubljana, Slovenia
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