Preoperative Factors Associated with Extrathyroidal Extension in Papillary Thyroid Cancer

Factors influencing extrathyroidal extension of papillary thyroid cancer and evaluation of ultrasonography for its diagnosis: a retrospective analysis

Pathologists usually explore extrathyroidal extensions (ETEs) in thyroid cancer; however, sonographers are often not concerned with ETEs. We investigated factors influencing ETEs and the efficacy of ultrasound evaluation of thyroid capsule invasion. We retrospectively analysed 1933 papillary thyroid carcinoma patients who underwent thyroidectomy during 2018-2021. Patients were divided into three groups: no ETE, minor ETE (mETE), and gross ETE. Clinical characteristic differences were assessed using binary logistic regression analysis to identify ETE predictors, and the kappa test was performed to analyse consistency between ultrasonographic and pathological diagnoses of ETE. The mETE group was more likely to have larger tumour diameters and more extensive lymph node metastasis (LNM) than the no ETE group and more likely to be diagnosed in the isthmus. In the multivariate logistic regression analysis, longest tumour diameter, lesion site, LNM extent, and thyroglobulin concentration were significant mETE predictors. Minimal consistency existed between pathological and ultrasonographic examinations for neighbouring tissue invasion. Many clinical differences were observed between the no ETE and mETE groups, suggesting the importance of considering mETE. Therefore, sonographers should pay more attention to relationships between nodules and capsule and indicate these on ultrasound reports to provide more accurate preoperative ETE information for surgeons.

Upregulation of dendrocyte-expressed seven transmembrane protein is associated with unfavorable outcomes in differentiated thyroid cancer

PURPOSE

Dendritic cell infiltrates are increased in thyroid cancer but may have a defective ability to provoke effective immune responses. In this study, we aimed to identify potential thyroid cancer biomarkers linked to dendritic cell development and evaluate their prognostic relevance.

METHODS

Through a bioinformatics search, we identified the dendrocyte-expressed seven transmembrane protein (DCSTAMP) as a prognostic gene involved in dendritic cell differentiation for thyroid cancer. Immunohistochemical analyses of DCSTAMP expression were performed and correlated with clinical outcomes.

RESULTS

DCSTAMP was overexpressed in a variety of types of thyroid cancers, while normal thyroid tissue or benign thyroid lesions exhibited low or undetectable DCSTAMP immunoreactivity. The results of automated quantification were consistent with subjective semiquantitative scoring. Among 144 patients with differentiated thyroid cancer, high DCSTAMP expression was associated with papillary tumor type (p < 0.001), extrathyroidal extension (p = 0.007), lymph node metastasis (p < 0.001), and BRAF V600E mutation (p = 0.029). Patients with tumors showing high DCSTAMP expression had shorter overall (p = 0.027) and recurrence-free (p = 0.042) survival.

CONCLUSION

This study provides the first evidence of DCSTAMP overexpression in thyroid cancer. Apart from the prognostic implications, studies are needed to explore its potential immunomodulatory role in thyroid cancer.

Can pre-operative ultrasound elastography predict aggressive features of solitary papillary thyroid carcinoma?

OBJECTIVE

To investigate whether pre-operative ultrasound elastography (USE) can be used to predict aggressive features of solitary papillary thyroid carcinomas (PTCs).

METHODS

Clinical and USE indices were retrospectively analyzed in 487 patients with surgically confirmed solitary PTCs. The patients were grouped per aggressive features on pathologic testing. Univariate and binary logistic regression analyses were performed to explore independent risk factors of aggressive features.

RESULTS

Univariate analysis revealed standard deviation (SD) values of the tumor shear-wave velocity (SWV) were associated with capsular invasion (p < 0.05). Further, shear-wave elasticity and SWV ratios correlated with extrathyroidal extension (all p < 0.05). The tumor shear-wave elasticity and SWV SD values were associated with cervical lymph node metastasis (CLNM) (all p < 0.05). Binary logistic regression analysis identified location and capsule contact as independent predictive risk factors for capsular invasion (all p < 0.05); size for extrathyroidal extension (all p < 0.05); and sex, age, margin, and suspected CLNM for CLNM (all p < 0.05). However, pre-operational USE indexes were not independent predictors of aggressive features (all p > 0.05).

CONCLUSION

Pre-operative USE indices were not independent risk factors of aggressive features of solitary PTCs. Thus, USE may have a limited value for predicting the aggressive features of PTC.

ADVANCES IN KNOWLEDGE

Pre-operative USE indices may have a limited value for predicting the aggressive features of PTC.

Aberrant Expression of Thymosin Beta-4 Correlates With Advanced Disease and BRAF V600E Mutation in Thyroid Cancer

Thymosin beta-4 (TMSB4X) was recently identified as a differentially expressed gene between malignant and non-malignant thyroid cells via single-cell RNA sequencing. In the present study, we aimed to study the immunostaining pattern of TMSB4X in benign and malignant thyroid neoplasms. Immunohistochemical analysis revealed that normal thyroid tissue or benign thyroid disorders exhibited undetectable immunoreactivity against TMSB4X except for positive staining of inflammatory infiltrates and stromal cells associated with autoimmune thyroid disease. By contrast, overexpression of TMSB4X was observed in a variety of thyroid malignancies, including papillary, follicular, poorly differentiated, and undifferentiated thyroid cancer. Among 141 patients with differentiated thyroid cancer, higher TMSB4X expression was associated with papillary tumor type, extrathyroidal extension, lymph node metastasis, and BRAF V600E mutation. The results were consistent with those from the public transcriptomic datasets. In summary, TMSB4X expression was aberrantly increased in various types of thyroid cancer, and higher TMSB4X expression was correlated with advanced disease characteristics. Thymosin beta-4 may be a novel downstream effector of the BRAF V600E mutation.

Clinical Significance of Tumor Size in Gross Extrathyroidal Extension to Strap Muscles (T3b) in Papillary Thyroid Carcinoma: Comparison with T2

The purpose of the present study was to compare the risk of recurrence between T2 and T3b papillary thyroid carcinoma (PTC) and the effect of tumor size on survival in T3b disease. A total of 634 patients with PTC who underwent thyroid surgery at a single center were retrospectively analyzed. Clinicopathological characteristics were compared according to the T category in the TNM staging system, with T3b divided into T3b-1 (tumor size, ≤2 cm) and T3b-2 (tumor size, 2–4 cm). Disease-free survival (DFS) and recurrence risk were compared between T2, T3b, T3b-1, and T3b-2. Tumor size was significantly larger in T2 than in T3b. A significant difference in recurrence was observed between T2 and T3b-2 but not between T2 and T3b-1. T3b-2 was identified as a significant risk factor for PTC recurrence. A significant difference in the DFS curve was observed between T2 and T3b-2. However, no significant differences in survival were observed between T2 and T3b or T3b-1. These results indicate that the prognostic impact of T3b may vary depending on tumor size. Further studies are required to determine the need for T classifications that account for tumor size and gETE invasion of the strap muscles.

The association of obesity with thyroid carcinoma risk

Background

The prevalence of obesity and an increased incidence of thyroid carcinoma (TC) threaten public health in parallel on a global scale. Sufficient evidence supports excess body fatness in thyroid carcinogenesis, and the role and anthropometric markers of obesity have been causally associated with the rising risk of TC.

Methods

A literature search was conducted in PubMed. Studies focused on the effect of obesity in TC.

Results

This review mainly discusses the global incidence and prevalence of obesity‐related TC. We also review the role of obesity in TC and potential clinical strategies for obesity‐related TC.

Conclusions

Excess body fatness in early life and TC survival initiate adverse effects later in life.

The incidence of thyroid cancer has been increasing in the last decades all over the world. Such a steady growth cannot be entirely attributable to more sensitive diagnostic procedures. Obesity has increased with sufficient rapidity in the same time frame and may as possible promoters and modifiable risk factors for thyroid cancer in recent years. The aim of this review was to focus on the relationship between obesity and the risk of thyroid cancer. Obesity seems to play a relevant role in thyroid cancer carcinogenesis as well as in its severity and aggressiveness. The possible underlying mechanism is involved chronic inflammation mediated by cytokines, leptin, and adiponectins.

Loss of Integrase Interactor 1 (INI1) Expression in a Subset of Differentiated Thyroid Cancer

Alterations in the switching defective/sucrose non-fermenting (SWI/SNF) chromatin-remodeling complex are enriched in advanced thyroid cancer. Integrase interactor 1 (INI1), encoded by the SMARCB1 gene on the long arm of chromosome 22, is one of the core subunits of the SWI/SNF complex. INI1 immunohistochemistry is frequently used for the diagnosis of malignant rhabdoid neoplasms. In the present study, we found normal and benign thyroid tissues generally had diffusely intense nuclear immunostaining. Loss of INI1 immunohistochemical expression was observed in 8% of papillary thyroid cancer and 30% of follicular thyroid cancer. Furthermore, loss of INI1 expression was associated with extrathyroidal extension (p < 0.001) and lymph node metastasis (p = 0.038). Analysis of The Cancer Genome Atlas database revealed that SMARCB1 underexpression was associated with the follicular variant subtype and aneuploidy in papillary thyroid cancer. We speculate that SMARCB1 is an important effector in addition to NF2 and CHEK2 inactivation among thyroid cancers with chromosome 22q loss.