1
|
Le Y, Geng C, Gao X, Zhang P. The risk of thyroid cancer and sex differences in Hashimoto's thyroiditis, a meta-analysis. BMC Endocr Disord 2024; 24:151. [PMID: 39135006 PMCID: PMC11321178 DOI: 10.1186/s12902-024-01670-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The prevalence of thyroid cancer (TC) has exhibited an upward trajectory in recent years. An accelerating amount of evidence shows a significant association between Hashimoto's thyroiditis (HT) and TC. The present study encompasses a meticulously designed systematic review and meta-analysis with the aim of scrutinizing the risk of TC and clarifying sex disparities in HT. METHODS A comprehensive search was conducted across reputable online databases, including PubMed, Cochrane Library, EMBASE, and Web of Science. English-language publications on the correlation between HT and TC were examined without temporal restrictions. Two authors independently screened the articles and extracted pertinent data. The collected data underwent statistical analysis using the STATA software, enabling the calculation of the pooled Odds Ratio (OR) and 95% confidence intervals (CI). Additionally, a supplementary analysis was conducted on studies incorporating sex-specific data to determine the OR (female vs. male) and the sex-based prevalence of TC in HT. RESULTS A total of 2,845 records were obtained, and 26 retrospective studies were included in this meta-analysis. The results indicated a significant role for HT in TC (OR: 2.22, 95% CI: 1.85-2.67). Supplementary analysis indicated that the prevalence of TC in HT patients was lower in women (0.31, 95% CI: 0.17-0.45) than in men (0.37, 95% CI: 0.21-0.53). However, the result was not statistically significant. CONCLUSION This systematic review and meta-analysis provide evidence that HT is associated with increasing odds of TC. Regular review of HT patients holds positive clinical significance.
Collapse
Affiliation(s)
- Yali Le
- Health Management Center, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, Shandong, PR China
| | - Chenchen Geng
- Department of Ultrasound, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, Shandong, PR China
| | - Xiaoqian Gao
- Department of Ultrasound, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, Shandong, PR China
| | - Ping Zhang
- Health Management Center, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, Shandong, PR China.
- Department of Ultrasound, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, Shandong, PR China.
| |
Collapse
|
2
|
Karaarslan S, Kasap E, İpek FN, Akyıldız M. Demonstration of Epstein-Barr Virus by In Situ Hybridization in Papillary Thyroid Carcinomas Developing on Background of Hashimoto's Thyroiditis. Exp Clin Endocrinol Diabetes 2024; 132:469-475. [PMID: 38718832 DOI: 10.1055/a-2322-7355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
AIM This study aimed to demonstrate the role of Epstein-Barr Virus (EBV) in papillary thyroid carcinomas (PTC) developing on the background of Hashimoto's thyroiditis (HT). METHODS The presence of EBV in tumoral tissue, lymphocytes, and peritumoral normal thyroid tissue was investigated using the in situ hybridization method in paraffin blocks. The subtypes of PTC, tumor diameter, TNM stage, multifocality, invasion of thyroid capsule, perineural invasion, and muscular tissue invasion were identified and compared according to EBV involvement. RESULTS Eighty-one patients with HT diagnosis, with 93.8% (n=76) female and 6.2% (n=5) male, were included in the study. Papillary microcarcinoma was the pathological diagnosis in 24.2% (n=15) of the cases. EBV was identified in 58.06% (n=36) of the tumor cells nuclei, 58.06% (n=36) in the tumor cell cytoplasm, 16.12% (n=10) in tumor infiltrative lymphocytes, and 53.2% (n=33) in normal parenchymal follicle epithelial cells (NPFEC). In the T2 stage, the rate of EBV nuclear positivity in patients was significantly higher (p=0.034). The classic variant of papillary carcinoma was accompanied by a significantly higher rate of EBV-negative NPFEC (67.6%, p=0.049). In multifocal tumors, EBV positivity was found to be significantly higher in lymphocytes in the surrounding tissues (58.3%, p=0.034). CONCLUSION A significant increase in EBV positivity in the surrounding tissue lymphocytes was observed in multifocal PTC developing on a background of HT. This suggests a possible association between HT and EBV.
Collapse
Affiliation(s)
- Serap Karaarslan
- Department of Pathology, İzmir Tınaztepe University, İzmir, Turkey
| | - Esin Kasap
- Department of Obstetrics and Gynecology, University of Health Sciences Tepecik Education and Research Hospital, İzmir, Turkey
| | | | - Mahir Akyıldız
- Department of General Surgery, Ege University, İzmir Turkey
| |
Collapse
|
3
|
Issa PP, Omar M, Buti Y, Aboueisha M, Munshi R, Hussein M, Haidari M, Blair G, Issa CP, Shama M, Toraih E, Kandil E. Hashimoto's Thyroiditis: A Protective Factor against Recurrence in BRAF-Wild Type Differentiated Thyroid Carcinoma. Cancers (Basel) 2023; 15:cancers15082371. [PMID: 37190300 DOI: 10.3390/cancers15082371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
A recent work analyzing the concomitant factors BRAF mutation (risk factor) and Hashimoto's thyroiditis (HT) (protective factor) found that the presence of HT reduced lymph node metastasis in BRAF-mutated papillary thyroid carcinoma. Whether this notion is upheld with respect to disease recurrence and differentiated thyroid carcinoma (DTC), however, is unknown. We aimed to investigate the effect of underlying HT in DTC patients and its influence on recurrence with a specific emphasis in BRAF-mutated tumors. A total of 469 patients were included. Patients were stratified according to BRAF and HT status. Multivariate regression analysis was conducted to determine protective and risk factors of disease recurrence in patients with DTC. HT was associated with less-aggressive carcinomas including more frequent microcarcinomas (HT: 45.0% vs. no-HT: 34.0%, p = 0.02), less lymph node involvement (HT: 16.4% vs. no-HT: 26.1%, p = 0.02), and less disease recurrence (HT: 2.9% vs. no-HT: 11.9%, p = 0.002). BRAF mutation was also significantly associated with higher rates of lymph node involvement (BRAF-mutant: 41.9% vs. BRAF-wild type: 14.6%, p < 0.001) and almost two times the rate of recurrence (BRAF-mutant: 14.9% vs. BRAF-wild type: 6.5%, p = 0.004). Underlying HT was the only protective factor determined, reducing the odds of developing recurrence by 70% (HR: 0.30, 95%CI: 0.11-0.88). In the BRAF-wild type cohort, regression analysis continued to determine HT as a protective factor (p = 0.03). However, in the BRAF-mutant cohort, HT was no longer an independent protective factor (p = 0.20) against recurrence. Sub-group regression analysis, including PTC patients, similarly found HT as a protective factor only in BRAF-wild type patients (p = 0.039) and not BRAF-mutant (p = 0.627). The presence of underlying HT is associated with less aggressive tumors and is an independent protective factor against DTC recurrence, reducing the risk by 70%. HT remains a protective factor in BRAF-wild type carcinoma, but not in patients with BRAF-mutant carcinoma. HT may potentially be considered as a parameter which enhances American Thyroid Association patient risk stratification.
Collapse
Affiliation(s)
- Peter P Issa
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Yusef Buti
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Aboueisha
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Ruhul Munshi
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohammad Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Muhib Haidari
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Graham Blair
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Chad P Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Mohamed Shama
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| |
Collapse
|
4
|
Januś D, Kujdowicz M, Wójcik M, Taczanowska-Niemczuk A, Kiszka-Wiłkojć A, Górecki W, Starzyk JB. Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma - a follow-up study. Front Endocrinol (Lausanne) 2023; 14:1172823. [PMID: 37124746 PMCID: PMC10130420 DOI: 10.3389/fendo.2023.1172823] [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: 02/23/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Background Follicular cell-derived thyroid carcinoma represents the vast majority of paediatric thyroid cancers (TCs). Papillary thyroid carcinoma (PTC) accounts for over 90% of all childhood TC cases, and its incidence in paediatric patients is increasing. The objective of this follow-up study was to present the outcome of ultrasound (US) and laboratory monitoring of paediatric patients with autoimmune thyroiditis (AIT) prior to the development of PTC. Patients and methods This prospective study included 180 children and adolescents (132 females; 73.3%) with a suspicion of thyroid disorder referred to the Outpatient Endocrine Department. The patients were divided into four groups: 1) 28 patients with a mean age of 10.7 [standard deviation (SD), 3.1] y, in whom PTC was detected during the active surveillance of AIT [AIT(+), PTC(+) follow up (F)]; 2) 18 patients with a mean age of 12.8 (SD, 3.4) y, in whom PTC and AIT were detected upon admission (A) [AIT(+), PTC(+) A]; 3) 45 patients with a mean age of 13.0 (SD, 3.4) y, in whom PTC was detected upon admission and AIT was excluded [AIT(-), PTC(+) A]; and 4) an age- and sex-matched control group of 89 patients with AIT and with a mean age of 9.4 (SD, 3.0) y. The analysis included clinical, US, and laboratory assessment results of children on admission (groups 1-4) and during follow-up (groups 1 and 4) in the Paediatric Endocrine Outpatient Department. Results Upon admission of those in group 1, the US evaluation revealed a hypoechogenic thyroid gland in 12 and an irregular normoechogenic gland in 16 patients. US monitoring revealed an increase in thyroid echogenicity and an increased irregularity of the thyroid structure during the follow-up period of all of the patients from group 1. Such changes were not noticed in group 4. PTC was diagnosed at the mean time of 3.6 y (3 mo-9 y) since AIT confirmation in group 1. The mean maximum PTC diameter as per the US was significantly smaller in group 1 than in groups 2 and 3 [13.2 (10.8) mm vs. 22.2 (12.8) and 22.05 (15.4) mm]. Fewer patients in group 1 were referred to 131I than in groups 2 and 3 (71.4% vs. 94.4 and 93.3%). Interestingly, significant differences were observed in the thyroglobulin antibody (TgAb)/thyroid peroxidase antibody (TPOAb) ratio between groups 2 and 3, as opposed to group 4, at the beginning of observation [15.3 (27.6) and 3.5 (8.8] vs. 0.77 (1.9)]. In group 1, after the follow-up, an increase in the TgAb/TPOAb ratio was observed [1.2 (9.8) to 5.2 (13.5)]. There were no significant differences between groups 1-3 in labeling index Ki67, lymph nodes metastasis, extrathyroidal extension, and angioinvasion. There were no associations between thyroid-stimulating hormone, TgAb, and the extent of the disease. Conclusion The use of thyroid US focused on the search for developing tumours in the routine follow-up of patients with AIT may not only help in the early detection of thyroid malignancies that are not clinically apparent but may also influence the invasiveness of oncological therapy and reduce the future side effects of 131I therapy. We propose that the repeat evaluation of TPOAb and TgAb warrants further exploration as a strategy to determine TC susceptibility in paediatric patients with AIT in larger multicentre studies.
Collapse
Affiliation(s)
- Dominika Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
| | - Monika Kujdowicz
- Department of Pathomorphology, Jagiellonian University Medical College, Krakow, Poland
- Department of Pathology, University Children Hospital in Krakow, Krakow, Poland
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
| | - Anna Taczanowska-Niemczuk
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Aleksandra Kiszka-Wiłkojć
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Wojciech Górecki
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Surgery, University Children Hospital in Krakow, Krakow, Poland
| | - Jerzy B. Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital in Krakow, Krakow, Poland
| |
Collapse
|
5
|
Osorio-Covo C, Ballestas-Barrera J, Correa-Palacio J, Zambrano-Pacheco V, Rosales-Becerra A, Camargo-Martínez W, Barrios-Castellar D, Ortega-Caballero D, Herrera-Sáenz F. Association between chronic lymphocityc thyroiditis and papillary thyroid carcinoma: Systematic review and meta-analysis of studies on surgical specimens. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.2228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction. Inconsistent results exist in the literature regarding the hypothesis statement suggesting an increased likelihood of documenting papillary thyroid carcinoma (PTC) in surgical specimens with changes compatible with chronic lymphocytic thyroiditis. Existing meta-analyses have included studies that are not methodologically comparable and do not propose clear sources of bias, thus, this is justification for the present meta-analysis.
Methods. A literature search in PubMed and Embase was performed from January 1, 1950 to December 31, 2020. Retrospective studies comparing the prevalence of papillary thyroid carcinoma in specimens with and without chronic lymphocytic thyroiditis changes were obtained. The collected evidence was statistically analyzed.
Results. A total of 22 articles were included. The study population consisted of 63,548 surgical specimens. The pooled OR, based on the studies, was 1.81 (95% CI: 1.51-2.21). There was heterogeneity between the distribution of prevalence ratios and opportunity ratios across studies (I²= 91%; p>0.00001). The funnel plot shape of the studies included in the analysis appears to be symmetrical, indicating the absence of bias attributable to small studies.
Conclusions. The current literature suggests that there is an increased risk of documenting papillary thyroid carcinoma in surgical specimens in which chronic lymphocytic thyroiditis-compatible changes are observed; however, there are sources of bias that will not be possible to control for in retrospective studies, so we recommend studying the hypothesis suggesting an increased likelihood of diagnosing PTC in specimens with chronic lymphocytic thyroiditis-compatible changes using prospective methodologies.
Collapse
|
6
|
Issa PP, Omar M, Buti Y, Issa CP, Chabot B, Carnabatu CJ, Munshi R, Hussein M, Aboueisha M, Shama M, Corsetti RL, Toraih E, Kandil E. Hashimoto’s Thyroiditis Minimizes Lymph Node Metastasis in BRAF Mutant Papillary Thyroid Carcinomas. Biomedicines 2022; 10:biomedicines10082051. [PMID: 36009596 PMCID: PMC9405831 DOI: 10.3390/biomedicines10082051] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Hashimoto’s thyroiditis (HT) (autoimmune thyroiditis) is a clinicopathological entity associated with chronic lymphocytic infiltration resulting in hypothyroidism. HT is a double-edged sword that increases the risk of papillary thyroid cancer (PTC), yet it serves as a protective factor for PTC progression. BRAF mutation in PTCs is associated with rapid cell growth, aggressive tumor characteristics, and higher mortality rates. Here, we aimed to analyze the influence of HT in patients with PTCs and its effect on lymph node metastasis (LNM) in BRAF mutant tumors. Adults diagnosed with PTC between 2008 and January 2021 were retrospectively included. A total of 427 patients, 128 of whom had underlying HT, were included. The HT group had significantly higher rates of microcarcinoma (49.2% vs. 37.5%, p = 0.025) and less lateral LNM (8.6% vs. 17.1%, p = 0.024). Interestingly, BRAF-mutated PTCs were found to have significantly less overall LNM (20.9% vs. 51%, p = 0.001), central LNM (25.6% vs. 45.1%, p = 0.040) and lateral LNM (9.3% vs. 29.4%, p = 0.010) in patients with HT when compared to those without underlying HT. HT was found to be an independent protective predictor of overall and lateral LNM. Altogether, HT was able to neutralize the effect of BRAF mutation and was determined to be an independent protective factor against LNM. Specifically, our work may influence treatment-aggressiveness decision making for endocrinologists, oncologists and surgeons alike.
Collapse
Affiliation(s)
- Peter P. Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Yusef Buti
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Chad P. Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Bert Chabot
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Ruhul Munshi
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohammad Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Aboueisha
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Shama
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Ralph L. Corsetti
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Correspondence: ; Tel.: + 504-988-7407; Fax: + 504-988-4762
| |
Collapse
|
7
|
Tang Q, Pan W, Peng L. Association between Hashimoto thyroiditis and clinical outcomes of papillary thyroid carcinoma: A meta-analysis. PLoS One 2022; 17:e0269995. [PMID: 35709179 PMCID: PMC9202927 DOI: 10.1371/journal.pone.0269995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To assess association between Hashimoto thyroiditis (HT) and clinical outcomes of papillary thyroid carcinoma (PTC). Methods Databases including Pubmed, Embase, Cochrane Library, and Web of Science were searched. Weighed mean differences (WMDs) and odds ratios (ORs) were used to evaluate association between HT and clinical outcomes of PTC, and the effect size was represented by 95% confidence intervals (CIs). Heterogeneity test was performed for each indicator. If the heterogeneity statistic I2≥50%, random-effects model analysis was carried out, otherwise, fixed-effect model analysis was performed. Sensitivity analysis was performed for all outcomes, and publication bias was tested by Begg’s test. Results Totally 47,237 patients in 65 articles were enrolled in this study, of which 12909 patients with HT and 34328 patients without HT. Our result indicated that PTC patients with HT tended to have lower risks of lymph node metastasis (OR: 0.787, 95%CI: 0.686–0.903, P = 0.001), distant metastasis (OR: 0.435, 95%CI: 0.279–0.676, P<0.001), extrathyroidal extension (OR: 0.745, 95%CI: 0.657–0.845, P<0.001), recurrence (OR: 0.627, 95%CI: 0.483–0.813, P<0.001), vascular invasion (OR: 0.718, 95%CI: 0.572–0.901, P = 0.004), and a better 20-year survival rate (OR: 1.396, 95%CI: 1.109–1.758, P = 0.005) while had higher risks of multifocality (OR: 1.245, 95%CI: 1.132–1.368, P<0.001), perineural infiltration (OR: 1.922, 95%CI: 1.195–3.093, P = 0.007), and bilaterality (OR: 1.394, 95%CI: 1.118–1.739, P = 0.003). Conclusions PTC patients with HT may have favorable clinicopathologic characteristics, compared to PTCs without HT. More prospective studies are needed to further elucidate this relationship.
Collapse
Affiliation(s)
- Qizhi Tang
- Department of Endocrinology, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, P.R. China
- * E-mail:
| | - Weiyu Pan
- Department of Endocrinology, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, P.R. China
| | - Liangyue Peng
- Department of Endocrinology, Guangdong Hospital of Integrated Traditional Chinese and Western Medicine, Foshan, P.R. China
| |
Collapse
|
8
|
Gejoe G, Yadev I, Kumaran A, Swasthik K, Chisthi MM. Coexistence of Histologically Proven Chronic Lymphocytic Thyroiditis with Other Thyroid Disorders: A Retrospective Study. Surg J (N Y) 2022; 8:e131-e135. [PMID: 35783029 PMCID: PMC9246528 DOI: 10.1055/s-0041-1740626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/09/2021] [Indexed: 11/09/2022] Open
Abstract
Background
Hashimoto's thyroiditis (HT) is the commonest autoimmune thyroid pathology. It has been reported in increased numbers recently, probably due to the increase in autoimmune diseases across many parts of the world. It is sometimes found associated with other diseases as well as other diseases of the thyroid. There is an unproven association of this condition with thyroid cancer, particularly papillary thyroid carcinoma (PTC).
Methods
This was a retrospective study performed over a period of 5 years. The objectives of this study were to find out the prevalence of histopathologically proven HT in surgically resected thyroid glands for various indications and its association with other thyroid disorders, especially thyroid malignancies. Total 4,630 patients who underwent thyroidectomy during the study period and met the criteria for inclusion were considered for analysis.
Results
Histopathologically proven features of HT were present in 1,295 (28%) of the cases. Among these, 445 (34.36%) had only HT while 850 (65.66%) had HT along with other thyroid diseases. The most common disease associated with HT was multinodular goiter (44.2%), followed by PTC (15.2%). Patients with HT exhibited a higher rate of papillary cancer (16.7%) compared with patients without this pathology (13.8%). Statistically significant association between papillary cancer and HT was found among the female patients.
Conclusion
The prevalence of HT in patients undergoing thyroidectomy is high in the studied population. A statistically significant association exists between papillary thyroid cancer and thyroiditis among female patients. This could form the basis for further research along these lines.
Collapse
Affiliation(s)
- G. Gejoe
- General Surgery, Government Medical College, Trivandrum, Kerala, India
| | - I.P. Yadev
- General Surgery, Government Medical College, Trivandrum, Kerala, India
| | - Amrutha Kumaran
- General Surgery, Government Medical College, Trivandrum, Kerala, India
| | - K.S. Swasthik
- General Surgery, Government Medical College, Trivandrum, Kerala, India
| | - Meer M. Chisthi
- General Surgery, Government Medical College, Trivandrum, Kerala, India
| |
Collapse
|
9
|
Battistella E, Pomba L, Costantini A, Scapinello A, Toniato A. Hashimoto's Thyroiditis and Papillary Cancer Thyroid Coexistence Exerts a Protective Effect: a Single Centre Experience. Indian J Surg Oncol 2022; 13:164-168. [PMID: 35462652 PMCID: PMC8986954 DOI: 10.1007/s13193-022-01515-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common malignant tumour of the thyroid and it is often found in association with Hashimoto's thyroiditis (HT). This concomitance is still under debate. The aim of this study is to investigate the influence of Hashimoto's thyroiditis in patients with papillary thyroid carcinoma. Two thousand two hundred eighteen patients underwent thyroidectomy in our department between January 2015 and January 2020. Of these, 435 patients had surgery for papillary thyroid carcinoma and form the basis of our studies. The association between PTC and HT was found in 180 patients (41.4%), mostly represented in the female group (78.9%), with a lower median age than patients with PTC without HT. In comparison to patients with PTC alone, the PTC-HT group had less invasive and smaller tumours, as well as less lymph node involvement. Moreover, tumours of patients with PTC-HT were diagnosed earlier. Our data showed that Hashimoto's thyroiditis may be considered a protective factor when PTC develops. Furthermore, we concluded that patients with PTC and HT had a better prognosis and a lower risk of recurrence than those that did not have HT.
Collapse
Affiliation(s)
- Enrico Battistella
- Department of Surgery, Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Luca Pomba
- Department of Surgery, Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Andrea Costantini
- Department of Surgery, Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | | | - Antonio Toniato
- Department of Surgery, Endocrine Surgery Unit, Veneto Institute of Oncology, IOV-IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| |
Collapse
|
10
|
Diagnostic Value of Galectin-3 in Distinguishing Invasive Encapsulated Carcinoma from Noninvasive Follicular Thyroid Neoplasms with Papillary-Like Nuclear Features (NIFTP). Cancers (Basel) 2021; 13:cancers13122988. [PMID: 34203725 PMCID: PMC8232163 DOI: 10.3390/cancers13122988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 01/21/2023] Open
Abstract
Simple Summary The reclassification of NIFTP raised the need for rebuilding the clinical, histologic, cytological and molecular parameters, including re-evaluation of the previously examined biomarkers, for assisting in the diagnosis of this subset of indolent noninvasive tumors from invasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). In this retrospective study, Galectin-3 (Gal-3) IHC staining on patient’s thyroid tissues showed a statistically significant higher cytoplasmic Gal-3 expression in invasive EFVPTC than in NIFTP and other benign subgroups. Our findings refined the diagnostic value of Gal-3 expression as an ancillary marker in identifying NIFTP among encapsulated follicular variant nodules. Abstract Background: non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), which is considered as low-risk cancer, should be distinguished from the malignant invasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). Improved discrimination of NIFTPs from invasive EFVPTCs using a molecular biomarker test could provide useful insights into pre- and post-surgical management of the indeterminate thyroid nodule. Galectin-3 (Gal-3), a β-galactosyl-binding molecule in the lectin group, is involved in different biological functions in well differentiated thyroid carcinomas. The aim of this study was to determine whether Gal-3 expression as a diagnostic marker could distinguish indolent NIFTP from invasive EFVPTC on tissue specimens from surgical thyroid nodules. Methods: immunohistochemical (IHC) analysis of cytoplasmic and nuclear Gal-3 expression was performed in formalin-fixed paraffin-embedded (FFPE) surgical tissues in four specific diagnostic subgroups- benign nodules, NIFTPs, EFVPTCs and lymphocytic/Hashimoto’s thyroiditis (LTs). Results: cytoplasmic Gal-3 expression (mean ± SD) was significantly increased in invasive EFVPTCs (4.80 ± 1.60) compared to NIFTPs (2.75 ± 1.58, p < 0.001) and benign neoplasms (2.09 ± 1.19, p < 0.001) with no significant difference between NIFTPs and benign lesions (p = 0.064). The presence of LT enhanced cytoplasmic Gal-3 expression (3.80 ± 1.32) compared to NIFTPs (p = 0.016) and benign nodules (p < 0.001). Nuclear Gal-3 expression in invasive EFVPTCs (1.84 ± 1.30) was significantly higher than in NIFTPs (1.00 ± 0.72, p = 0.001), but similar to benign nodules (1.44 ± 1.77, p = 0.215), thereby obviating its potential clinical application. Conclusions: our observations have indicated that increased cytoplasmic Gal-3 expression shows diagnostic potential in distinguishing NIFTP among encapsulated follicular variant nodules thereby serving as a possible ancillary test to H&E histopathological diagnostic criteria when LT interference is absent, to assist in the detection of the invasive EFVPTC among such nodules.
Collapse
|
11
|
Aydoğan Bİ, Mutlu ABB, Yüksel S, Güllü S, Emral R, Demir Ö, Şahin M, Gedik VT, Çorapçıoğlu D, Sak SD, Erdoğan MF. The Association of Histologically Proven Chronic Lymphocytic Thyroiditis with Clinicopathological Features, Lymph Node Metastasis, and Recurrence Rates of Differentiated Thyroid Cancer. Endocr Pathol 2021; 32:280-287. [PMID: 33188468 DOI: 10.1007/s12022-020-09653-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 10/23/2022]
Abstract
The influence of chronic lymphocytic thyroiditis (CLT) on clinicopathological features and behavior of differentiated thyroid carcinoma (DTC) is still debated. In the present study, we aimed to evaluate the prognosis of DTC on the presence of CLT. A total of 649 total thyroidectomized patients (379 female, 270 male) with DTC, who had follow-up data for at least 36 months were included. Clinical, histopathological data, preoperative thyroid peroxidase antibody (TPO-ab), thyroglobulin antibody (Tg-ab), thyroid-stimulating hormone (TSH) levels, and presence of recurrent/persistent disease (R/PD) were evaluated retrospectively. Presence of CLT was defined by histopathology. Frequency of CLT was 32% (n = 208) among DTC patients. Mean tumor size (maximal diameter) was smaller in CLT group when compared to non-CLTs (p = 0.006). Capsular invasion, vascular invasion, tumor stage, risk groups, and R/PD were negatively associated with CLT (p < 0.01, p = 0.04, p = 0.03, p = 0.02, p < 0.01, respectively). Extrathyroidal extension was more frequent in non-CLT group when compared CLT (p = 0.052). Preoperative TSH level was positively associated with lymph node metastasis (LNM) and higher in patients with lateral LNM when compared to central LNM (p < 0.01). Central LNM, lateral LNM, stage 4 tumor, and intermediate- and high-risk tumor groups increased the risk of R/PH, 2.5-, 2.9-, 12.7-, 2.3-, and 4.2-fold, respectively. Presence of CLT was independently related with favorable outcomes, as the risk of R/PD was decreased by 0.49-fold. In conclusion, coexistence of CLT was negatively associated with tumor size, capsular invasion, vascular invasion, and tumor stage in DTC. Risk of R/PD was decreased by approximately half in patients with CLT.
Collapse
Affiliation(s)
- Berna İmge Aydoğan
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey.
| | | | - Seher Yüksel
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sevim Güllü
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Rıfat Emral
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özgür Demir
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Vedia Tonyukuk Gedik
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serpil Dizbay Sak
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Murat Faik Erdoğan
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
12
|
Zhou L, Chen G, Sheng L, Liu N, Zhang B, Zeng Q, Chen B. Influence Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: Hashimoto's Thyroiditis Has a Weak Effect on Central or Lateral Lymph Node Metastasis. Cancer Manag Res 2021; 13:3953-3961. [PMID: 34017198 PMCID: PMC8131014 DOI: 10.2147/cmar.s310773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/24/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose To analyze the effect of Hashimoto’s thyroiditis (HT) concurrent with papillary thyroid cancer (PTC) on cervical lymph node metastasis (LNM). Methods Two thousand nine hundred twenty-six patients who underwent thyroidectomy and lymph node dissection between January 2015 and December 2018 were enrolled in this study. Patient demographics and clinicopathologic features were analyzed. Results Of the total enrolled patients, 598 (20.4%) had concurrent HT. There were 1482 PTC cases with N0, 1033 cases with N1a, and 411 cases with N1b. Patients with HT had lower frequency of extrathyroidal extension (ETE), lymphatic vascular (LV) invasion, high pathological T stage (III+IV) and central LNM rate. Stratifying central LNM by non-ETE or without intrathyroidal spreading, it was further found that central LNM rate in patients with HT was lower than that of patients without HT. However, there was no significant difference in the central LNM rate in patients with PTC stratified by ETE or intrathyroidal spreading. HT with PTC played a weak protective role in N1a, reducing the risk of N1a by 16.4%. Conversely, HT is a risk factor for N1b, increasing the risk by 1.336 times compared to patients without HT. TgAb is an independent risk factor for N1b, which appears related to the promotion of N1b by HT. Conclusion In PTC, HT has a protective effect on central LNM and a risk effect on lateral LNM, although the difference was not significant. This weak protective effect on N1a is more obvious in PTC with less aggressive clinicopathologic characteristics. The risk effect of HT on N1b may be associated with TgAb.
Collapse
Affiliation(s)
- Liguang Zhou
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Gang Chen
- Department of General Surgery, Shandong Guoxin Healthcare Group Xinwen Center Hospital, Taian, People's Republic of China
| | - Lei Sheng
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Nan Liu
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Bin Zhang
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Qingdong Zeng
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Bo Chen
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| |
Collapse
|
13
|
Liu Y, Lv H, Zhang S, Shi B, Sun Y. The Impact of Coexistent Hashimoto's Thyroiditis on Central Compartment Lymph Node Metastasis in Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:772071. [PMID: 34867817 PMCID: PMC8635140 DOI: 10.3389/fendo.2021.772071] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) is the most prevalent inflammatory disorder of the thyroid gland. Current studies have reported the coexistence rate between HT and papillary thyroid carcinoma (PTC) is quite high. The objective of this study was to evaluate the impact of HT on the predictive factors of central compartment lymph node metastasis (CLNM) in PTC. METHODS A retrospective investigation was performed on PTC patients. They were subclassified into HT and non-HT groups. The results of preoperative neck ultrasound (US) examinations were reviewed. The clinical characteristics and the predictive value for CLNM were explored and compared between the two groups. RESULTS A total of 756 patients were included in this study. There were more female patients (86.1%) in the PTC coexistent with the HT group than non-HT group. The patients with HT group had higher preoperative serum level of TSH. There was statistically significant difference between the HT patients and non-HT patients in nodular vascularization. Univariate and multivariate analyses showed that male, age ≤45 years old, tumor diameter >1 cm, and presence of suspicious central compartment lymph node on US, irregular nodular shape, multifocal carcinoma were independent predictive factors of CLNM in PTC patients. It was showed that male, age ≤45 years old, tumor diameter >1 cm, multifocality, and presence of suspicious central lymph node on US were risk factors for CLNM in non-HT patients. Only tumor diameter >1 cm and presence of suspicious central lymph node on US were independently correlated with CLNM in HT patients. The sensitivity of the multivariate model was 63.5%, and specificity was 88.9% for prediction CLNM in HT patients. For non-HT patients, the AUC was 80.6%, the sensitivity of the multivariate model was 64.5%, and specificity was 85.2. CONCLUSION PTC combined with HT is more common in women, and TSH level in HT group is higher than that in patients with PTC alone. Regardless of that HT is not a related risk factor of CLNM in PTC, our result suggested that different predictive systems should be used for HT and non-HT patients respectively to have a more accurate evaluation of CLNM in clinic.
Collapse
Affiliation(s)
- Yang Liu
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Hongjun Lv
- Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shaoqiang Zhang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yushi Sun
- Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yushi Sun,
| |
Collapse
|
14
|
Cho YY, Chung YJ, Kim HS. Malignancy Rate of Bethesda Class III Thyroid Nodules Based on the Presence of Chronic Lymphocytic Thyroiditis in Surgical Patients. Front Endocrinol (Lausanne) 2021; 12:745395. [PMID: 34659127 PMCID: PMC8515134 DOI: 10.3389/fendo.2021.745395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Hashimoto's thyroiditis (HT), also known as chronic lymphocytic thyroiditis (CLT), may interfere with the accurate cytological diagnosis of thyroid nodules. Recently, HT has been considered a premalignant condition for thyroid cancer development. The diagnosis of atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) thyroid nodules is challenging and evidence for the malignancy risk of AUS/FLUS thyroid nodules coexisting with CLT is scarce. Therefore, we assessed the malignancy risk of AUS/FLUS thyroid nodules according to the presence of background CLT. METHODS This study included 357 surgically resected thyroid nodules with AUS/FLUS cytology. Cases with concomitant malignant nodules were excluded. CLT was defined based on the pathologic report after thyroid surgery. RESULTS Among 357 tumors, 130 tumors (36%) were confirmed to have coexisting CLT, and 170 tumors (48%) were determined to be malignant after thyroidectomy. Malignancy rates were similar in both groups (48% in each) regardless of background CLT (62/130 with CLT vs. 108/227 without CLT). In the group with CLT, thyroiditis was more frequent in the final pathology (12% with CLT vs. 1% without CLT, P = 0.003). In multivariate analysis, positive BRAFV600E mutation, highly suspicious sonographic features (K-TIRADS 5), and smaller thyroid nodules were significant factors for thyroid malignancies. CONCLUSION The malignancy rate of thyroid nodules with AUS/FLUS cytology was comparable irrespective of the presence of underlying CLT.
Collapse
Affiliation(s)
- Yoon Young Cho
- Division of Endocrinology and Metabolism, Department of Medicine, Soonchunhyang University Bucheon Hospital, College of Medicine, Soonchunhyang University, Bucheon, South Korea
| | - Yun Jae Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, South Korea
- *Correspondence: Yun Jae Chung,
| | - Hee Sung Kim
- Department of Pathology, College of Medicine, Chung-Ang University, Seoul, South Korea
| |
Collapse
|
15
|
Sur ML, Gaga R, Lazăr C, Lazea C, Aldea C, Sur D. Papillary thyroid carcinoma in children with Hashimoto's thyroiditis - a review of the literature between 2000 and 2020. J Pediatr Endocrinol Metab 2020; 33:1511-1517. [PMID: 33180046 DOI: 10.1515/jpem-2020-0383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Thyroid cancer is the most common pediatric endocrine neoplasm representing 3% of all malignancies in children. Hashimoto's thyroiditis (HT) is also a common disorder in the pediatric age range. Patients with HT frequently develop enlarged thyroid with nodules. We aimed to provide a literature review on the frequency of papillary thyroid carcinoma (PTC) in patients with HT. CONTENT A literature search of the PubMed database between 2000 and 2020 was performed, using the relevant keywords "papillary thyroid carcinoma," "Hashimoto's thyroiditis" and "children". We followed the PRISMA statement guidelines during the preparation of this review. Six studies (n=2,065 patients with HT) were retained for the final analysis. The follow-up of the patients with HT was from 2 to 10 years. PTC was diagnosed in 0.67-7.87% of the HT patients included in these studies. In patients with HT and nodules, the percentage of PTC varied between 5.13 and 35%. The overall occurrence of PTC in patients with HT was 3.07%. SUMMARY AND OUTLOOK The number of patients developing thyroid nodules in relation to HT was increased. The development of PTC in children with HT appeared to be higher than in the normal population.
Collapse
Affiliation(s)
- Maria Lucia Sur
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Remus Gaga
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Călin Lazăr
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Cecilia Lazea
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Cornel Aldea
- Department of Pediatrics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Daniel Sur
- Department of Medical Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,The Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, Romania
| |
Collapse
|
16
|
Li T, Li H, Xue J, Miao J, Kang C. Shear wave elastography combined with gray-scale ultrasound for predicting central lymph node metastasis of papillary thyroid carcinoma. Surg Oncol 2020; 36:1-6. [PMID: 33271464 DOI: 10.1016/j.suronc.2020.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the relationship between shear wave elastography (SWE) elasticity indices of papillary thyroid carcinoma (PTC) and central lymph node metastasis (CLNM) and to evaluate the value of SWE combined with gray-scale ultrasound (US) for predicting preoperative CLNM. METHOD This study included 172 patients with a pathology diagnosis of PTC who underwent preoperative gray-scale US and SWE evaluation. Patients were divided into CLNM-positive and CLNM-negative groups. We analyzed the association between SWE elasticity indices (Emax, Emean and Emin) and CLNM, compared the diagnostic efficacy of gray-scale US alone versus SWE combined with gray-scale US for predicting CLNM, and analyzed the influence of Hashimoto's thyroiditis (HT) on the diagnostic efficacy of CLNM. RESULTS SWE elasticity values Emax, Emean and Emin were significantly higher in CLNM-positive patients (P=0.000, 0.000 and 0.003, respectively). The AUC of Emax was higher than that of other SWE indices for predicting CLNM (AUC = 0.749; 95% CI = 0.676-0.822). In multivariate analysis, microcalcification (OR = 5.254; 95% CI = 2.496-11.061), extrathyroidal extension (OR = 4.210; 95% CI = 1.423-12.456), multifocality (OR = 3.084; 95% CI = 1.190-7.991) and Emax >59.0 kpa (OR = 4.934; 95% CI = 2.318-10.500) were independent risk factors for predicting CLNM. The AUC of SWE combined with gray-scale US for predicting CLNM (AUC = 0.825; 95% CI = 0.760-0.879) was significantly higher (P = 0.011) than that for gray-scale US alone (AUC = 0.774; 95% CI = 0.704-0.834). There was no significant difference in AUC between the HT and non-HT subgroups in predicting CLNM (0.798 vs. 0.833, P = 0.640). CONCLUSIONS SWE can be used to predict CLNM in PTC patients. SWE combined with gray-scale US can improve the prediction of CLNM.
Collapse
Affiliation(s)
- Tingting Li
- Department of Ultrasound, Bethune Hospital Affiliated to Shanxi Medical University, China
| | - Huizhan Li
- Department of Ultrasound, Bethune Hospital Affiliated to Shanxi Medical University, China
| | - Jiping Xue
- Department of Ultrasound, Bethune Hospital Affiliated to Shanxi Medical University, China
| | - Junwang Miao
- Department of Ultrasound, Bethune Hospital Affiliated to Shanxi Medical University, China
| | - Chunsong Kang
- Department of Ultrasound, Bethune Hospital Affiliated to Shanxi Medical University, China.
| |
Collapse
|
17
|
Delayed Diagnosis of Langerhans Cell Histiocytosis Presenting With Thyroid Involvement and Respiratory Failure: A Pediatric Case Report. J Pediatr Hematol Oncol 2020; 42:e810-e812. [PMID: 31688661 PMCID: PMC7682793 DOI: 10.1097/mph.0000000000001625] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Langerhans cell histiocytosis (LCH) is a rare disease with localized to disseminated clinical features. Thyroid involvement in LCH is rare and presenting as either a single-organ or multisystem disease, it is usually misinterpreted as another thyroid disorder. Therefore, the LCH diagnosis is often delayed. We report a pediatric case of LCH with thyroid involvement as the initial clinical manifestation progressing to respiratory failure. Clinicians should note insidious extrathyroidal laboratory abnormalities and consider infiltrative thyroid diseases, such as LCH. Systematic clinical and laboratory investigations are needed to prevent delayed diagnosis because the classic features of LCH may become evident only over time.
Collapse
|
18
|
Dinčić M, Todorović J, Nešović Ostojić J, Kovačević S, Dunđerović D, Lopičić S, Spasić S, Radojević-Škodrić S, Stanisavljević D, Ilić AŽ. The Fractal and GLCM Textural Parameters of Chromatin May Be Potential Biomarkers of Papillary Thyroid Carcinoma in Hashimoto's Thyroiditis Specimens. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2020; 26:717-730. [PMID: 32588793 DOI: 10.1017/s1431927620001683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Occasionally, Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) share similar nuclear features. The current study aims to quantify the differences between the investigated specimens of HT-associated PTC versus the HT alone, to reduce the subjective experience of an observer, by the use of fractal parameters as well as gray-level co-occurrence matrix (GLCM) textural parameters. We have analyzed 250 segmented nuclei per group (nn = 25 per patient and np = 10 patients per group) using the ImageJ software (NIH, Bethesda, MD, USA) as well as an in-house written code for the GLCM analysis. The mean values of parameters were calculated for each patient. The results demonstrated that the malignant cells from the HT-associated PTC specimens showed lower chromatin fractal dimension (p = 0.0321) and higher lacunarity (p = 0.0038) compared with the corresponding cells from the HT specimens. Also, there was a statistically significant difference between the investigated specimens, in the contrast, correlation, angular second moment, and homogeneity, of the GLCM corresponding to the visual texture of follicular cell chromatin. The differences in chromatin fractal and GLCM parameters could be integrated with other diagnostic methods for the improved evaluation of distinctive features of the HT-associated PTC versus the HT in cytology and surgical pathology specimens.
Collapse
Affiliation(s)
- Marko Dinčić
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Jasna Todorović
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Jelena Nešović Ostojić
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Sanjin Kovačević
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Duško Dunđerović
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Srđan Lopičić
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | - Svetolik Spasić
- Institute of Pathological Physiology, Faculty of Medicine, University of Belgrade, Dr Subotica 9, Belgrade11000, Serbia
| | | | - Dejana Stanisavljević
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andjelija Ž Ilić
- Institute of Physics Belgrade, University of Belgrade, Pregrevica 118, 11080Zemun-Belgrade, Serbia
| |
Collapse
|
19
|
Papoian V, Rosen JE, Lee W, Wartofsky L, Felger EA. Differentiated thyroid cancer and Hashimoto thyroiditis: Utility of the Afirma gene expression classifier. J Surg Oncol 2020; 121:1053-1057. [PMID: 32115718 DOI: 10.1002/jso.25875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/08/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES The Afirma gene expression classifier (AGEC) has not been tested or validated in a high-risk group, such as patients with Hashimoto's thyroiditis (HT). We hypothesized that AGEC would perform worse in patients with HT. METHODS A retrospective review of patient charts in a single academic institution who underwent thyroidectomy between 2012 and 2017 was conducted. Patients with HT who underwent AGEC were identified to calculate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS We identified 69 patients with HT and atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) on cytology who underwent AGEC analysis. The mean age of AGEC cohort was 50 years (range, 26-77 years) with 90% female. The median nodule size was 1.9 cm (interquartile range [IQR], 1.2-2.7 cm). Of the 69 patients, 62 showed suspicious AGEC of which 26 showed TC on surgical pathology. Of the seven benign AGEC, two showed TC on surgical pathology. The sensitivity, specificity, PPV, and NPV were 93%, 12%, 42%, and 71%, respectively. Of the entire AGEC cohort, 17 (43%) showed multicentric disease. CONCLUSIONS We observed a lower NPV for AGEC to rule out thyroid cancer in patients with HT, which reduces the utility of the test for this population.
Collapse
Affiliation(s)
- Vardan Papoian
- Department of Surgery, Washington Hospital Center, MedStar Georgetown University, Washington, District of Columbia
| | - Jennifer E Rosen
- Department of Surgery, Washington Hospital Center, MedStar Georgetown University, Washington, District of Columbia
| | - Wen Lee
- Department of Pathology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Leonard Wartofsky
- Department of Endocrinology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Erin A Felger
- Department of Surgery, Washington Hospital Center, MedStar Georgetown University, Washington, District of Columbia
| |
Collapse
|
20
|
Del Rio P, Montana Montana C, Cozzani F, Rossini M, Loderer T, Dall'Aglio E, Cataldo S, Marina M, Graziano C. Is there a correlation between thyroiditis and thyroid cancer? Endocrine 2019; 66:538-541. [PMID: 31004335 DOI: 10.1007/s12020-019-01935-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In the past few decades, the incidence of thyroid cancer has increased significantly all over the world. In the same period, there also seems to have been an increase in the incidence of Hashimoto's Thyroiditis-the most common inflammatory autoimmune thyroid disease. Several studies have linked thyroiditis to thyroid cancer. METHODS In our study, we examined 2304 cases of thyroid surgery collected over a 12-year period starting from 2004. In 2090 cases (90.7%) out of our sample, it has been possible to compare the presence, or lack thereof, of thyroiditis by means of a histological diagnosis post-surgery; 214 (9.3%) cases were excluded from our study due to insufficient data. We then divided the different histological classifications into two groups. Group A included all the benign histological classifications and Group B included all the malignant histological classifications. In each group, we then assessed the presence, or lack thereof, of thyroiditis in order to evaluate if thyroiditis can be linked to a higher incidence of thyroid cancer. RESULTS Data analysis showed a higher incidence of thyroiditis in Group B, 36.4% (malignant pathology report), than in Group A, 32.4% (benign pathology report), but no statistically significant difference emerged between those two groups (P > 0.05). CONCLUSIONS Our conclusion was that a correlation between thyroiditis and a higher incidence of thyroid cancer is still undefined.
Collapse
Affiliation(s)
- Paolo Del Rio
- General Surgery Unit, University Hospital of Parma, Parma, Italy.
| | | | - Federico Cozzani
- General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Matteo Rossini
- General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Tommaso Loderer
- General Surgery Unit, University Hospital of Parma, Parma, Italy
| | | | - Simona Cataldo
- Endocrinology Unit, University Hospital of Parma, Parma, Italy
| | - Michela Marina
- Department of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| | - Ceresini Graziano
- Department of Clinical and Experimental Medicine, University Hospital of Parma, Parma, Italy
| |
Collapse
|
21
|
Januś D, Wójcik M, Taczanowska A, Sołtysiak P, Wędrychowicz A, Roztoczyńska D, Drabik G, Wyrobek Ł, Starzyk JB. Follow-up of parenchymal changes in the thyroid gland with diffuse autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma. J Endocrinol Invest 2019; 42:261-270. [PMID: 29872995 PMCID: PMC6394764 DOI: 10.1007/s40618-018-0909-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 05/30/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To present the outcomes of ultrasound (US) follow-ups in children with autoimmune thyroid disease who did not have a thyroid nodule on admission but developed papillary thyroid carcinoma (PTC) and to characterize the parenchymal changes in the thyroid gland prior to the development of PTC. METHODS A retrospective thyroid US scan review of 327 patients diagnosed with AIT was performed. Forty patients (40/327, 12.2%) presented nodular AIT variant with a normoechogenic background. Eleven patients (11/327, 3.4%, 11/40, 27.5%) presenting this variant were diagnosed with PTC (nine females-mean age 15.3 years; two males aged 11 and 13 years). In five of 11 patients, the suspicious nodule that was later confirmed to be PTC was detected on the initial US at presentation. For the remaining six females (6/11) who developed PTC during the follow-up, we retrospectively analysed their US thyroid scans and these patients were selected for analysis in this study. RESULTS On admission, the US evaluation revealed an enlarged normoechogenic thyroid gland in three patients and a hypoechogenic thyroid gland with fibrosis as indicated by irregular, chaotic hyperechogenic layers in three patients. No thyroid nodules were identified. Ultrasound monitoring revealed increasing echogenicity of the thyroid parenchyma during the follow-up. PTC developed in a mean time of 4.6 years (1 9/12-7 4/12 years) since referral to the outpatient thyroid clinic and 2.9 years (6/12-6 9/12) since the last nodule-free US thyroid scan. CONCLUSIONS Sonographic follow-up assessments warrant further exploration as a strategy to determine PTC susceptibility in the paediatric population.
Collapse
Affiliation(s)
- D Januś
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland.
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland.
| | - M Wójcik
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - A Taczanowska
- Department of Pediatric Surgery, University Children Hospital, Krakow, Poland
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - P Sołtysiak
- Department of Pediatric Surgery, University Children Hospital, Krakow, Poland
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - A Wędrychowicz
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - D Roztoczyńska
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| | - G Drabik
- Department of Clinical Immunology and Transplantation, Institute of Paediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Ł Wyrobek
- Department of Radiology, University Children Hospital, Krakow, Poland
| | - J B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Chair of Pediatrics, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265, 30-663, Krakow, Poland
- Department of Pediatric and Adolescent Endocrinology, University Children Hospital, Krakow, Poland
| |
Collapse
|
22
|
Molnár C, Molnár S, Bedekovics J, Mokánszki A, Győry F, Nagy E, Méhes G. Thyroid Carcinoma Coexisting with Hashimoto's Thyreoiditis: Clinicopathological and Molecular Characteristics Clue up Pathogenesis. Pathol Oncol Res 2019; 25:1191-1197. [PMID: 30666518 PMCID: PMC6614143 DOI: 10.1007/s12253-019-00580-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 01/10/2019] [Indexed: 01/14/2023]
Abstract
Thyroid cancer (TC) coexisting with Hashimoto’s thyroiditis (HT) presents with several characteristic features including multifocality and lower clinical stages compared to de novo carcinomas but its exact biology is still not understood. We reexamined clinico-pathological and molecular correlations between Hashimoto’s thyroditis and papillary thyroid cancer. A total of 262 patients with TC was evaluated who underwent thyroidectomy at the Surgical Department of the University of Debrecen. Clinical data, histology and molecular data were evaluated. Our cohort included 43 patients (16.4%) with (5 male, 38 female) and 219 (83.6%) patients without coexisting HT (48 male, 171 female). Hashimoto’s thyroiditis related thyroid cancer presented predominantly (93.0% of the cases) with the papillary histological type. Multifocality was observed more frequently with coexisting HT (16/40; 40.0%) compared to cases uninvolved (45/190; 23.7%)(p = 0.034). In contrast, lymphatic metastasis (pN1) with a significantly reduced frequency in patients with HT (4/11; 36.4%) then without HT (34/41 pN1; 82.9%)(p = 0.002). BRAF V600E mutation could be demonstrated at significantly lower rates in cases of PTC + HT (32.1 vs 60.7%, p < 0.005). High incidence, multifocality and papillary morphology strongly support a causal relation between TC and preexisting Hashimoto’s thyroiditis, the latter to be considered as a preneoplastic condition promoting thyroid carcinogenesis.
Collapse
Affiliation(s)
- Csaba Molnár
- Department of Pathology, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4042, Hungary.
| | - Sarolta Molnár
- Department of Pathology, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4042, Hungary
| | - Judit Bedekovics
- Department of Pathology, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4042, Hungary
| | - Attila Mokánszki
- Department of Pathology, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4042, Hungary
| | - Ferenc Győry
- Department of Surgery, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Endre Nagy
- Department of Internal Medicine, Clinical Center, University of Debrecen, Debrecen, Hungary
| | - Gábor Méhes
- Department of Pathology, University of Debrecen, Nagyerdei krt. 98, Debrecen, H-4042, Hungary
| |
Collapse
|
23
|
Vita R, Ieni A, Tuccari G, Benvenga S. The increasing prevalence of chronic lymphocytic thyroiditis in papillary microcarcinoma. Rev Endocr Metab Disord 2018; 19:301-309. [PMID: 30456477 DOI: 10.1007/s11154-018-9474-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although the incidence of some malignancy has decreased over the recent years, this is not the case of papillary thyroid microcarcinoma (PTMC), whose incidence has increased worldwide. Most PTMC are found incidentally after histological examination of specimens from surgery for benign thyroid disease. Hashimoto's thyroiditis, whose incidence has also increased, coexists in about one in three PTMC patients. Three different mechanisms have been proposed to clarify the association between chronic lymphocytic thyroiditis and PTMC, namely tumor development/growth by: (i) TSH stimulation, (ii) expression of certain proto-oncogenes, (iii) chemokines and other molecules produced by the lymphocytic infiltrate. Whether Hashimoto's thyroiditis protects against lymph node metastasis is debated. Overall, autommune thyroiditis seems to contribute to the favorable prognosis of PTMC. Major limitations of the studies so far performed include: (i) retrospective design, (ii) limited statistical power, (iii) high risk of selection bias, (iv) and predominant Asian ethnicity of patients. Full genetic profiling of both diseases and identification of environmental factors capable to trigger them, as well as well-powered prospective studies on different ethnical groups, may help understand their causal association and why their frequencies are continuing raising.
Collapse
Affiliation(s)
- Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Antonio Ieni
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi"-Section of Pathological Anatomy, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology of Adult and Evolutive Age "Gaetano Barresi"-Section of Pathological Anatomy, University of Messina, Viale Gazzi, 98125, Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Viale Gazzi, 98125, Messina, Italy.
- Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Viale Gazzi, 98125, Messina, Italy.
- Interdepartmental Program of Molecular & Clinical Endocrinology and Women's Endocrine Health, University Hospital, A.O.U. Policlinico G. Martino, Viale Gazzi, 98125, Messina, Italy.
| |
Collapse
|
24
|
Jia Q, Li X, Liu Y, Li L, Kwong JS, Ren K, Jiang Y, Sun X, Tian H, Li S. Incidental thyroid carcinoma in surgery-treated hyperthyroid patients with Graves' disease: a systematic review and meta-analysis of cohort studies. Cancer Manag Res 2018; 10:1201-1207. [PMID: 29872340 PMCID: PMC5973324 DOI: 10.2147/cmar.s164210] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background The association between Graves’ disease (GD) and thyroid carcinoma remains controversial. This study aimed to investigate incidental thyroid carcinoma (ITC) in surgery-treated hyperthyroid patients with and without GD. Materials and methods We searched PubMed and EMBASE for cohort studies investigating ITC in surgery-treated hyperthyroid patients without prediagnosed thyroid carcinoma in accordance with the Meta-Analysis of Observational Studies in Epidemiology guidelines. The last search was updated to January 23, 2018. All statistical tests were performed using Review Manager 5.3 and STATA version 12.0. Results Eleven cohort studies involving 10,743 GD and 3,336 non-GD patients were included. The pooled prevalence of ITC was 7.0% (95% confidence interval [CI] 4.5–9.6), and was comparable in surgery-treated GD and non-GD hyperthyroid patients (GD vs non-GD: pooled odds ratio [OR], 1.0; 95% CI: 0.68–1.46; P=0.98). In the subgroup analysis, toxic adenoma and toxic nodular goiter showed no difference when comparing with GD (pooled OR, 0.53; 95% CI: 0.21–1.36; P=0.18 and pooled OR, 1.01; 95% CI: 0.65–1.57; P=0.95, respectively). Conclusion Our study demonstrated that GD was not associated with increased risk of ITC in surgery-treated hyperthyroid patients.
Collapse
Affiliation(s)
- Qingyi Jia
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Xiaodan Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Ying Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Ling Li
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Joey Sw Kwong
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China.,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.,Department of Clinical Epidemiology and Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Kaiyun Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Yong Jiang
- Department of Pathology, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan, People's Republic of China
| |
Collapse
|
25
|
CUNR scoring system for the prediction of lateral lymph node metastasis in papillary thyroid carcinoma. Oncotarget 2017; 9:167-177. [PMID: 29416604 PMCID: PMC5787454 DOI: 10.18632/oncotarget.22772] [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] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/14/2017] [Indexed: 02/05/2023] Open
Abstract
Objective Our present study aimed to evaluate and compare the number and rate of central lymph node metastases (LNMs) for the prediction of lateral LNM (LLNM) in papillary thyroid carcinoma (PTC) and to develop a scoring system. Results Capsule invasion, tumor location in the upper portion of the thyroid, an ipsilateral central compartment LNM number ≥3, and an ipsilateral central compartment LNM rate of ≥56% were identified as significant independent predictors of ipsilateral lateral LNM in PTC. The predictive ability of an ipsilateral central compartment LNM rate ≥56% (area under the curve (AUC) = 0.802) was better than that of an ipsilateral central compartment LNM number ≥3 (AUC = 0.755). The ROC curves identified the best index point (CUNR) to distinguish the presence or absence of ipsilateral LLNM as 11, which has a high sensitivity (0.860) and a low false-negative rate (0.100, 1-Specificity). These findings were supported by the validation cohort. Conclusions Patients with a CUNR index point equal to or greater than 11 and ipsilateral lateral lymph node dissection should be considered for a diagnosis of LLNM. Patients and Methods A total of 1,281 PTC patients were included and divided into two groups: those with a presence of LLNM (n = 222) and those with an absence of LLNM (n = 1059). Univariate and multivariate analyses were performed to detect the risk factors for LLNM, and receiver operating characteristic (ROC) curves were used to detect the best cutoff values of these predictors. Additionally, a scoring system for the odds ratio (OR) of independent factors was developed and validated in an independent cohort of PTC patients (n = 560).
Collapse
|
26
|
Bai Y, Niu D, Huang X, Jia L, Kang Q, Dou F, Ji X, Xue W, Liu Y, Li Z, Feng Q, Lin D, Kakudo K. PD-L1 and PD-1 expression are correlated with distinctive clinicopathological features in papillary thyroid carcinoma. Diagn Pathol 2017; 12:72. [PMID: 28974264 PMCID: PMC5627454 DOI: 10.1186/s13000-017-0662-z] [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] [Received: 03/28/2017] [Accepted: 09/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immune checkpoint blockade targeting PD-1/PD-L1 has shown efficacy in several types of cancers. However, the correlation between PD-L1/PD-1 expression and the specific clinicopathological features in papillary thyroid carcinoma (PTC) has not been investigated. METHODS We examined the immunohistochemical expression of PD-L1, PD-1, and BRAF V600E on whole-tissue sections from 126 cases of primary PTC more than 1 cm in size. The correlation between the PD-L1/PD-1 expression and the clinicopathological features was evaluated. RESULTS PD-L1 was positively expressed in 53.2% PTCs, and its expression was positively correlated with rich tumor-infiltrating lymphocytes (TILs), background chronic lymphocytic thyroiditis (CLT), female gender, absence of psammoma bodies, and PD-1 expression. Among these parameters, rich TILs, female gender, and absence of psammoma bodies were independent factors affecting PD-L1 expression on the multivariate logistic regression analysis. PD-1 expression was detected in the TILs and was positively correlated with rich TILs, background CLT, and absence of stromal calcification. Lack of stromal calcification was an independent factor affecting PD-1 expression. Neither PD-L1 nor PD-1 expression showed significant correlation with BRAF V600E expression. CONCLUSIONS Our results show that the distinctive pathological features of PTCs, including TILs, background CLT, female gender, psammoma bodies, and stromal calcification, are useful parameters for predicting PD-L1 or PD-1 expression.
Collapse
Affiliation(s)
- Yanhua Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| | - Dongfeng Niu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xiaozheng Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Ling Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Qiang Kang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Fangyuan Dou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xinqiang Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Medical Statistics, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Weicheng Xue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yiqiang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Zhongwu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Qin Feng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Dongmei Lin
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Kennichi Kakudo
- Department of Pathology, Nara Hospital, Kindai University Faculty of Medicine, Ikoma-city, Nara, 630-0293, Japan
| |
Collapse
|
27
|
Lai X, Xia Y, Zhang B, Li J, Jiang Y. A meta-analysis of Hashimoto's thyroiditis and papillary thyroid carcinoma risk. Oncotarget 2017; 8:62414-62424. [PMID: 28977955 PMCID: PMC5617515 DOI: 10.18632/oncotarget.18620] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/29/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE It remains inconclusive whether Hashimoto's thyroiditis (HT) predisposes patients to the development of papillary thyroid carcinoma (PTC). We conducted a meta-analysis of the available data to address this question. RESULTS Twenty-seven eligible studies were selected, including 18 archival thyroidectomy studies, 6 fine-needle aspiration (FNA) studies, and 3 selective FNA or thyroidectomy studies. A total of 76,281 patients, including 12,476 cases of thyroid cancer, were included in these studies. The mean rate of PTC among patients with HT ranged from 1.12% (selective FNA or thyroidectomy studies) to 40.11% (thyroidectomy studies). All three types of studies supported the correlation between HT and PTC. The overall pooled odds ratio (OR) of the PTC risk for HT (HT versus non-HT) was 2.12 (95% confidence interval [CI]: 1.78-2.52). METHODS We searched all relevant published studies using the citation databases PubMed and Embase. The ORs and corresponding 95% CIs were calculated by the random-effects model for the association between HT and PTC. CONCLUSIONS Our meta-analysis confirmed that HT predisposed patients to the development of PTC.
Collapse
Affiliation(s)
- Xingjian Lai
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Yu Xia
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Bo Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| |
Collapse
|
28
|
Abstract
CONTEXT - The identification of precursor or dysplastic lesions in the thyroid is difficult. Pathology of the C cell has been extensively studied, and the preneoplastic nature of C-cell hyperplasia in the setting of familial medullary thyroid carcinomas is well established. However, the distinction between neoplastic and physiologic/reactive C-cell hyperplasia remains a challenge. Unlike C cells, the existence of a precursor lesion of follicular cell-derived tumors is less well established, and a dysplastic or preneoplastic follicular lesion has not been well defined. OBJECTIVE - To discuss putative precursor lesions in the thyroid arising from C cells and follicular epithelial cells. DATA SOURCES - Data were obtained from a review of the pertinent peer-reviewed literature. CONCLUSIONS - Although the preneoplastic nature of C-cell hyperplasia in the setting of familial medullary thyroid carcinoma is well recognized, the preneoplastic nature/malignant potential of reactive/physiologic C-cell hyperplasia and its role in the development of sporadic, medullary thyroid carcinoma is still unclear. Current data suggest that benign follicular lesions may have malignant potential, and there may be a multifocal progression from benign to malignant. Atypical follicular lesions in the background of chronic lymphocytic thyroiditis may represent dysplastic or premalignant lesions.
Collapse
|
29
|
The reliability of fine-needle aspiration biopsy in terms of malignancy in patients with Hashimoto thyroiditis. Int Surg 2016; 100:249-53. [PMID: 25692426 DOI: 10.9738/intsurg-d-13-00209.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to analyze the presence of malignancy in patients with Hashimoto's thyroiditis and to investigate the reliability of preoperative fine-needle aspiration biopsy (FNAB). The retrospective study included 44 patients who were operated on for nodular goiter between December 2010 and October 2011. The patients underwent thyroidectomy following a cytologic analysis plus FNAB. Hashimoto's thyroiditis was confirmed on histopathology in all patients. FNAB results were defined as benign in 14 (31.8%), suspicion for malignancy in 17 (38.6%), malignant in 9 (20.5%), and inadequate in 4 (9.1%). Following the thyroidectomy, presence of papillary thyroid carcinoma and follicular variant of papillary thyroid carcinoma were detected in 10 patients (22.7%) and 1 (2.3%) patient, respectively. The FNAB results were interpreted in terms of malignancy, which revealed the sensitivity as 80%; specificity, 40%; false positives, 69.2%; false negatives, 14.3%; positive predictive value, 31.8%; negative predictive value, 85.7%; and diagnostic accuracy, 50%. The coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma is quite common. The FNAB results for such cases are hard to evaluate, and they are likely to increase the number of false positives.
Collapse
|
30
|
Davies L, Morris LGT, Haymart M, Chen AY, Goldenberg D, Morris J, Ogilvie JB, Terris DJ, Netterville J, Wong RJ, Randolph G. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY DISEASE STATE CLINICAL REVIEW: THE INCREASING INCIDENCE OF THYROID CANCER. Endocr Pract 2016; 21:686-96. [PMID: 26135963 DOI: 10.4158/ep14466.dscr] [Citation(s) in RCA: 221] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE (1) Describe current epidemiology of thyroid cancer in the United States; (2) evaluate hypothesized causes of the increased incidence of thyroid cancer; and (3) suggest next steps in research and clinical action. METHODS Analysis of data from Surveillance, Epidemiology and End Results System and the National Center for Vital Statistics. Literature review of published English-language articles through December 31, 2013. RESULTS The incidence of thyroid cancer has tripled over the past 30 years, whereas mortality is stable. The increase is mainly comprised of smaller tumors. These facts together suggest the major reason for the increased incidence is detection of subclinical, nonlethal disease. This has likely occurred through: health care system access, incidental detection on imaging, more frequent biopsy, greater volumes of and extent of surgery, and changes in pathology practices. Because larger-size tumors have increased in incidence also, it is possible that there is a concomitant true rise in thyroid cancer incidence. The only clearly identifiable contributor is radiation exposure, which has likely resulted in a few additional cases annually. The contribution of the following causes to the increasing incidence is unclear: iodine excess or insufficiency, diabetes and obesity, and molecular disruptions. The following mechanisms do not currently have strong evidence to support a link with the development of thyroid cancer: estrogen, dietary nitrate, and autoimmune thyroid disease. CONCLUSION Research should focus on illuminating which thyroid cancers need treatment. Patients should be advised of the benefits as well as harms that can occur with treatment of incidentally identified, small, asymptomatic thyroid cancers.
Collapse
|
31
|
Kocer D, Karakukcu C, Karaman H, Gokay F, Bayram F. May the neutrophil/lymphocyte ratio be a predictor in the differentiation of different thyroid disorders? Asian Pac J Cancer Prev 2016; 16:3875-9. [PMID: 25987053 DOI: 10.7314/apjcp.2015.16.9.3875] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The neutrophil/lymphocyte ratio (NLR) is a simple index of systemic inflammatory response, and has been shown to be a prognostic indicator in some types of cancer. Inflammation has been implicated in the initiation and progression of thyroid cancer. The aim of this study was to examine the relationship of NLR with papillary thyroid cancer (PTC) and different benign thyroid pathologies like multinodular goiter (MNG) and lymphocytic thyroiditis (LT). MATERIALS AND METHODS We retrospectively evaluated the neutrophil, lymphocyte counts and NLR calculated from these parameters of 232 patients with histologically confirmed as multinodular goiter (group MNG) (n=70), lymphocytic thyroiditis (group LT) (n=97), LT with PTC (group LT- PTC) (n=25) and PTC (group PTC) (n=40). The optimal cut-off value for NLR was determined. RESULTS NLR level was significantly higher in groups LT-PTC and PTC as compared to groups MNG and LT (p<0.05). NLR of LT subgroups according to TSH levels were not different (p>0.05). When we grouped the patients as benign and malignant according to PTC presence, the optimum NLR cut-off point obtained from ROC analysis was 1.91 (sensitivity 89.0% and specificity 54.5%). CONCLUSIONS Since NLR was significantly elevated in group LT-PTC and group PTC, NLR value may give an opinion as a potential marker in differentiation of benign and malign thyroid disorders. For this purpose a cut-off value of 1.91 for NLR may be accepted.
Collapse
Affiliation(s)
- Derya Kocer
- Clinical Biochemistry, Training and Research Hospital, Kayseri, Turkey E-mail :
| | | | | | | | | |
Collapse
|
32
|
Diagnostic performance of thyroid ultrasonography screening in pediatric patients with a hypothyroid, hyperthyroid or euthyroid goiter. Pediatr Radiol 2016; 46:104-11. [PMID: 26298554 DOI: 10.1007/s00247-015-3435-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 05/19/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Goiter is frequently the first indicator of thyroid disease in children. OBJECTIVE To evaluate the usefulness of ultrasonography (US) in the identification of potential malignant nodules and autoimmune thyroiditis in children with diffuse goiter. MATERIALS AND METHODS This study consisted of 113 patients <20 years with a diffuse goiter who underwent thyroid US. Parenchymal echogenicity and the presence of nodules and abnormal lymph nodes were evaluated on US; if a thyroid nodule was detected, its characteristics were analyzed. The diagnostic accuracy of the US findings in the diagnosis of autoimmune thyroid disease was assessed. RESULTS Thyroid nodules were detected on US in 72 of the 113 (63.7%) patients. Of these, 65 (90.3%) had probably benign nodules and 4 (5.6%) patients had nodules suspicious of malignancy. The remaining had indeterminate nodules only. In one child with suspected malignant nodules, papillary thyroid cancer with coexisting autoimmune thyroiditis was confirmed. Hypoechogenicity was visualized in 23 (88.5%) patients with autoimmune thyroiditis and 12 (85.7%) with Graves disease. The sensitivity and specificity of micronodulation for autoimmune thyroiditis were 53.9% and 98.3%, respectively. CONCLUSION Although the potential for malignant nodules is relatively low in children with diffuse goiter, US can detect focal thyroid disease and characterize the nodules. US thus plays a useful role in excluding autoimmune thyroiditis in this population.
Collapse
|
33
|
The clinicopathologic differences of central lymph node metastasis in predicting lateral lymph node metastasis and prognosis in papillary thyroid cancer associated with or without Hashimoto’s thyroiditis. Tumour Biol 2015; 37:8037-45. [DOI: 10.1007/s13277-015-4706-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/20/2015] [Indexed: 12/28/2022] Open
|
34
|
Qu N, Zhang L, Lin DZ, Ji QH, Zhu YX, Wang Y. The impact of coexistent Hashimoto's thyroiditis on lymph node metastasis and prognosis in papillary thyroid microcarcinoma. Tumour Biol 2015; 37:7685-92. [PMID: 26692097 DOI: 10.1007/s13277-015-4534-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/21/2014] [Indexed: 11/25/2022] Open
Abstract
The impact of coexistent Hashimoto's thyroiditis (HT) on lymph node metastasis (LNM) and prognosis in papillary thyroid microcarcinoma (PTMC) remains controversial. We evaluated the association of coexistent HT with clinicopathologic parameters, LNM, and prognosis by retrospectively reviewing a series of consecutive patients treated for PTMC at Fudan University Cancer Center from January 2005 to December 2010. Of all 1,250 patients with complete data for analysis, 364 (29.1 %) had coexistent HT (HT group) and 886 patients (70.9 %) had no evidence of HT (control group). The HT group had higher proportion of female (87.9 vs 70.1 %) patients, higher mean level of thyroid-stimulating hormone (TSH) (2.39 vs 2.00 mIU/L), and lower incidence of extrathyroidal extension (7.4 vs 11.7 %) than those in the control group. However, the incidence of LNM and recurrence was similar between the two groups, and HT was not associated with LNM and recurrence. A series of clinicopathologic factors identified for predicting LNM and recurrence in the control group did not show any prediction in the HT group. In summary, this study suggested that coexistent HT had insignificant protective effect on LNM and prognosis in PTMC, which was inconsistent with prior studies. Further studies aiming to determine novel predictors are recommended in PTMC patients with coexistent HT.
Collapse
Affiliation(s)
- Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ling Zhang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Dao-Zhe Lin
- Department of Oncology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
| | - Yong-Xue Zhu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| |
Collapse
|
35
|
Baser H, Ozdemir D, Cuhaci N, Aydin C, Ersoy R, Kilicarslan A, Cakir B. Hashimoto's Thyroiditis Does Not Affect Ultrasonographical, Cytological, and Histopathological Features in Patients with Papillary Thyroid Carcinoma. Endocr Pathol 2015; 26:356-64. [PMID: 26481630 DOI: 10.1007/s12022-015-9401-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) is controversial. In this study, we aimed to compare preoperative thyroid functions, ultrasonography (US) features, fine-needle aspiration biopsy (FNAB) results, and histopathological characteristics of PTC in patients with and without HT. Data of 919 PTC patients were reviewed retrospectively. The diagnosis of HT was based on histopathological examination and patients were grouped as HT and non-HT. There were 1321 PTC lesions in 919 patients among which 317 (34.5 %) had coexistent HT. There were no significant differences in nodule volume, longitudinal diameter, texture, echogenicity, marginal regularity, presence of microcalcification and hypoechoic halo, and peripheral vascularization in patients with and without HT (p > 0.05, for all parameters). Macrocalcification was observed more frequently in the non-HT group (p = 0.021). FNAB results were similar in the two groups (p = 0.105). Distribution of variants, capsule invasion, vascular invasion, and extrathyroidal extension were observed with similar rates in the HT and non-HT groups. Lymph node metastasis was significantly higher in patients without HT (p = 0.012). Of the carcinomas, 66.1 % (n = 874) were papillary thyroid microcarcinoma (PTMC). Tumor size was lower in PTMC lesions coexistent with HT (p = 0.026). We observed lower rates of capsule invasion, extrathyroidal extension, and lymph node metastases in PTMC with HT compared to without HT (p = 0.007, p = 0.003, and p = 0.015, respectively). This study showed that US features, FNAB results, and histopathological findings of PTC lesions are not influenced by the presence of HT. However, PTMC seems to be related with less aggressive histopathological behavior in HT.
Collapse
Affiliation(s)
- Husniye Baser
- Department of Endocrinology and Metabolism, Ataturk Education and Research Hospital, Ovecler, 1297 Sokak, No: 1/22, 06460, Ankara, Turkey.
| | - Didem Ozdemir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Neslihan Cuhaci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Cevdet Aydin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Reyhan Ersoy
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Aydan Kilicarslan
- Department of Pathology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Bekir Cakir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| |
Collapse
|
36
|
Kim SJ, Myong JP, Jee HG, Chai YJ, Choi JY, Min HS, Lee KE, Youn YK. Combined effect of Hashimoto's thyroiditis and BRAF(V600E) mutation status on aggressiveness in papillary thyroid cancer. Head Neck 2015; 38:95-101. [PMID: 25213729 DOI: 10.1002/hed.23854] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the association between Hashimoto's thyroiditis and BRAF(V600E) mutation status in patients with papillary thyroid cancer (PTC) and to determine their combined association with tumor aggressiveness in PTC. METHODS A total of 1780 patients with PTC who underwent surgery were enrolled in this study. Simple and multiple analyses were performed to determine the association between Hashimoto's thyroiditis and the BRAF(V600E) mutation in PTC. RESULTS Hashimoto's thyroiditis was present in 11.5% of patients (204/1780) with PTC. Multiple logistic regressions showed that BRAF(V600E) (odds ratio [OR] = 0.493; 95% confidence interval [CI] = 0.360-0.678) and the female sex (OR = 7.146; 95% CI = 3.408-18.347) were independent factors associated with Hashimoto's thyroiditis in PTC. BRAF(V600E) mutation and the Hashimoto's thyroiditis-negative PTC group were associated with aggressive disease (OR = 3.069; 95% CI = 1.654-5.916). CONCLUSION Hashimoto's thyroiditis was associated less frequently with BRAF(V600E) , and frequently with the female sex in patients with PTC. Hashimoto's thyroiditis and BRAF(V600E) status may help to predict clinical outcome of PTC.
Collapse
Affiliation(s)
- Su-jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Jun Pyo Myong
- Department of Occupational and Environmental Medicine & Center for Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Gun Jee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Bundang Seoul National University Hospital, Seoul, Korea
| | - Hye Sook Min
- Department of Pathology, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Division of Surgery, Thyroid Center, Seoul National University Cancer Hospital, Seoul, Korea
| |
Collapse
|
37
|
Durfee SM, Benson CB, Arthaud DM, Alexander EK, Frates MC. Sonographic appearance of thyroid cancer in patients with Hashimoto thyroiditis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:697-704. [PMID: 25792586 DOI: 10.7863/ultra.34.4.697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To determine whether the sonographic appearance of thyroid cancer differs in patients with and without Hashimoto thyroiditis. METHODS Patients with histologically proven thyroid cancer who had thyroid peroxidase (TPO) antibodies measured and sonography performed preoperatively were included. We evaluated each nodule for size, echogenicity, composition, margins, halo, and vascularity and evaluated the background heterogeneity of the gland. RESULTS There were 162 thyroid cancers in 145 patients. Forty-two patients (29.0%) had Hashimoto thyroiditis with positive TPO antibodies, and 103 patients (71.0%) had negative TPO antibodies. The background echogenicity was more often heterogeneous in TPO antibody-positive patients compared to those who had negative TPO antibodies (57.1% versus 26.2%; P= .0005). Comparing cancers in TPO antibody-positive to TPO antibody-negative patients, there was no significant difference in the size, echogenicity, composition, margins, halo presence, calcification presence and type, or vascularity of the cancerous nodule (P > .05). Among TPO antibody-positive patients, comparing thyroid cancerous nodules in patients with heterogeneous glands to those with homogeneous glands, there was no significant difference in any sonographic characteristic except the margin of the nodule, which was more often irregular or poorly defined in heterogeneous glands and more often smooth in homogeneous glands (P< .05). CONCLUSIONS Sonographic features of thyroid cancer are similar in patients with and without Hashimoto thyroiditis. Among patients with Hashimoto thyroiditis and thyroid cancer, the sonographic appearance of the cancerous nodule is similar, except that cancerous nodule margins are more likely to be irregular or poorly defined when the gland is heterogeneous.
Collapse
Affiliation(s)
- Sara M Durfee
- Department of Radiology (S.M.D., C.B.B., M.C.F.) and Department of Medicine, Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (D.M.A., E.K.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA.
| | - Carol B Benson
- Department of Radiology (S.M.D., C.B.B., M.C.F.) and Department of Medicine, Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (D.M.A., E.K.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Dylan M Arthaud
- Department of Radiology (S.M.D., C.B.B., M.C.F.) and Department of Medicine, Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (D.M.A., E.K.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Erik K Alexander
- Department of Radiology (S.M.D., C.B.B., M.C.F.) and Department of Medicine, Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (D.M.A., E.K.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Mary C Frates
- Department of Radiology (S.M.D., C.B.B., M.C.F.) and Department of Medicine, Thyroid Section, Division of Endocrinology, Hypertension, and Diabetes (D.M.A., E.K.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA
| |
Collapse
|
38
|
|
39
|
Yang Y, Chen C, Chen Z, Jiang J, Chen Y, Jin L, Guo G, Zhang X, Ye T. Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma. Clin Endocrinol (Oxf) 2014; 81:282-8. [PMID: 24483297 DOI: 10.1111/cen.12417] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 11/17/2013] [Accepted: 01/27/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES We aimed to determine the predictive factors for central compartment lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). DESIGN AND PATIENTS We undertook a retrospective study of 291 patients treated for PTMC. The following criteria were assessed to predict the presence of central compartment LNM: sex, age, tumour multifocality, tumour size, tumour bilaterality, extracapsular spread (ECS), lateral neck LNM, coexistence of chronic lymphocytic thyroiditis, BRAF(V) (600E) mutation and ultrasonography (US) features. Univariate and multivariate analyses were performed to identify clinicopathological characteristics and US findings in predicting central compartment LNM from PTMC. RESULTS The central compartment LNM affected 133 (45.7%) of 291 patients. With use of univariate and multivariate analyses, male gender (OR 2.020; P = 0.039), tumour size (>5 mm) (OR 3.687; P = 0.015), ESC (OR 2.330; P = 0.044), lateral LNM (OR 15.075; P = 0.000) and BRAF(V) (600E) mutation (OR 2.464; P = 0.000) were independently correlated with central compartment LNM. Age, tumour multifocality, tumour bilaterality, coexistence of chronic lymphocytic thyroiditis and US characteristics were not significantly related to the presence of central compartment LNM. We have also developed a nomogram to predict the probability of central compartment LNM for an individual patient. The sensitivity was 71.9% and specificity was 70.3%, with an under the receiver operating characteristic (ROC) curve of 0.772. CONCLUSIONS A prophylactic neck dissection of the central compartment should be considered particularly in PTMC patients with male gender, a >5 mm tumour size, ECS of the tumours, lateral LNM and positive BRAF(V) (600E) mutation.
Collapse
Affiliation(s)
- Yinlong Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Kim HG, Kim EK, Han KH, Kim H, Kwak JY. Pathologic spectrum of lymphocytic infiltration and recurrence of papillary thyroid carcinoma. Yonsei Med J 2014; 55:879-85. [PMID: 24954314 PMCID: PMC4075390 DOI: 10.3349/ymj.2014.55.4.879] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the prognosis of papillary thyroid carcinoma (PTC) patients according to different pathologic grades of lymphocytic thyroiditis (LT). MATERIALS AND METHODS This study included 144 PTC patients who underwent total thyroidectomy with radioactive iodine remnant ablation therapy. Pathologic grades of LT were separated at two points, chronic lymphocytic thyroiditis (CLT) and Hashimoto thyroiditis (HT). Patients were divided into two groupings according to the presence of the diseases (Grouping 1; patients with CLT or HT and without CLT or HT, Grouping 2; patients with HT and without HT). The groupings were compared according to recurrence, clinicopathologic and ultrasound (US) characteristics, and disease free survival. RESULTS Of 144 patients, 41 had CLT and 19 had HT. There were 10 patients (6.9%) with tumor recurrence. In both groupings, the presence of calcification was more frequently associated with patients with LT (p=0.041 and 0.047, respectively). In Grouping 2, the mean age at diagnosis was older in patients without HT compared to patients with HT (p=0.032). On multivariate analysis, the presence of LT was not an independent predictor of recurrence in both groupings. For both groupings, pathologic tumor size and taller than wide shape on US were independent predictors of recurrence. The presence of LT in PTC patients did not affect recurrence. CONCLUSION There was no relationship between PTC prognosis and different grades of LT. Pathologic tumor size and taller than wide shape on ultrasound were independent predictors of PTC recurrence regardless of concurrent LT.
Collapse
Affiliation(s)
- Hyun Gi Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwa Han
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunki Kim
- Department of Pathology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
41
|
Jara SM, Carson KA, Pai SI, Agrawal N, Richmon JD, Prescott JD, Dackiw A, Zeiger MA, Bishop JA, Tufano RP. The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in North American patients with papillary thyroid carcinoma. Surgery 2014; 154:1272-80; discussion 1280-2. [PMID: 24238047 DOI: 10.1016/j.surg.2013.07.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several studies have reported that concurrent chronic lymphocytic thyroiditis (CLT) with papillary thyroid carcinoma (PTC) is associated with improved prognosis of the PTC, including decreased lymph node metastasis. We sought to assess the incidence of central nodal metastasis (CNM) in patients with PTC and concurrent CLT. METHODS We studied 495 consecutive patients who underwent thyroidectomy with nodal excision for PTC. Pathology reports identified the presence of CLT and the extent of CNM. RESULTS There were 226 patients (46%) with CLT and 220 (44%) with CNM. Patients with CLT were more often female (88% vs. 71%; P < .001) and had a younger median age (43 vs. 47 years; P = .03), a lesser incidence of CNM (35% vs. 52.4%; P < .001), and a greater incidence of pT1a (40% vs. 25%; P < .001) and pT1b (38% vs. 29%; P < .001) tumors. Multivariate analysis showed that the presence of CLT was associated with a 39% decreased odds of CNM after adjusting for age, gender, tumor size, PTC histopathologic subtype, and presence of lymphovascular invasion (odds ratio, 0.61; 95% confidence interval, 0.38-0.99; P = .046). Predicted probability modeling showed that all females with CLT and no suspicious nodal findings on ultrasonography had a 9-11% risk of CNM with pT1a tumors. CONCLUSION Female patients of all ages with CLT and small PTCs have the least incidence of CNM.
Collapse
Affiliation(s)
- Sebastian M Jara
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, MD
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Yoo YH, Kim JA, Son EJ, Youk JH, Kwak JY, Kim EK, Park CS. Sonographic findings predictive of central lymph node metastasis in patients with papillary thyroid carcinoma: influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:2145-2151. [PMID: 24277897 DOI: 10.7863/ultra.32.12.2145] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To analyze sonographic findings suggesting central lymph node metastasis of papillary thyroid carcinoma and to evaluate the influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography for predicting central lymph node metastasis. METHODS A total of 124 patients (101 female and 23 male; mean age, 47.5 years; range, 21-74 years) underwent sonographically guided fine-needle aspiration in central lymph nodes from January 2008 to July 2011. Sonographic features of size, shape, margin, thickening of the cortex, cortical echogenicity, presence of a hilum, cystic changes, calcification, and vascularity of enlarged lymph nodes were analyzed before fine-needle aspiration and classified into 2 categories (probably benign and suspicious). Sonographic findings were correlated with the pathologic diagnosis and associated chronic lymphocytic thyroiditis. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance of sonography for predicting central lymph node metastasis according to the associated thyroiditis. RESULTS Fifty-one lymph nodes (39.5%) were malignant, and 73 (60.5%) were benign. On univariate analysis, size, shape, margin, cortical thickening, cortical echogenicity, cystic changes, calcification, and vascularity were significantly different between the benign and metastatic nodes (P < .05). On multivariate analysis, eccentric cortical thickening (odds ratio, 26.59; 95% confidence interval [CI], 3.26-216.66) and hyper echogenicity of the cortex (odds ratio, 18.46; 95% CI, 2.44-139.64) were significantly associated with malignant nodes (P < .05). The area under the curve values for sonography for predicting metastasis were 0.756 (95% CI, 0.618-0.894) in chronic lymphocytic thyroiditis-positive patients and 0.971 (95% CI, 0.938-1.000) in negative patients. CONCLUSIONS Eccentric cortical thickening and cortical hyperechogenicity were the sonographic findings predictive of central lymph node metastasis from papillary thyroid carcinoma. The diagnostic performance of sonography for predicting metastasis was superior in chronic lymphocytic thyroiditis-negative patients than in positive patients.
Collapse
Affiliation(s)
- Yeon Hwa Yoo
- Department of Radiology, Gangnam Severance Hospital, 211 Eunjo-Ro, Gangnam-Gu, Seoul 135-720, Korea.
| | | | | | | | | | | | | |
Collapse
|
43
|
Kim YS, Choi HJ, Kim ES. Papillary thyroid carcinoma with thyroiditis: lymph node metastasis, complications. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:20-4. [PMID: 23833756 PMCID: PMC3699683 DOI: 10.4174/jkss.2013.85.1.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 04/13/2013] [Accepted: 05/06/2013] [Indexed: 11/30/2022]
Abstract
Purpose The aim of this study was to evaluate the clinicopathologic characteristics of papillary thyroid cancer with thyroiditis, and to determine the rate of its complications for it. Methods A retrospective review of 1,247 patients with papillary thyroid cancer who underwent primary thyroidectomy was performed. Among them, 316 patients had thyroiditis (group I) while 931 patients had no thyroiditis (group II), as reflected in the final pathologic reports. The two groups' clinicopathologic results and rate of complications were compared. Results Female gender, preoperative hypothyroidism, total thyroidectomy, no extrathyroid extension, no lymphovascular invasion, and no perineural invasion were associated with group I. More central lymph nodes were removed in group I than in group II, but there were fewer central lymph nodes with metastasis in group I than in group II. For the lateral lymph nodes, the two groups had the same numbers of removed nodes and nodes with metastatic tumor. Multivariate analysis revealed female predominance, more cases of preoperative hypothyroidism, more dissected lymph nodes, and fewer lymph nodes with metastasis in group I. Among the patients who underwent lobectomy, postoperative hypothyroidism occurred more in group I than in group II (P < 0.001). There was no difference in postoperative complications between the two groups. Conclusion Papillary thyroid cancer with thyroiditis showed less aggressive features. Postoperative hypothyroidism occurred more in the patients with thyroiditis.
Collapse
Affiliation(s)
- Yon Seon Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | | | | |
Collapse
|
44
|
Giagourta I, Evangelopoulou C, Papaioannou G, Kassi G, Zapanti E, Prokopiou M, Papapostolou K, Karga H. Autoimmune thyroiditis in benign and malignant thyroid nodules: 16-year results. Head Neck 2013; 36:531-5. [DOI: 10.1002/hed.23331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Irene Giagourta
- Second Division of Endocrinology; Alexandra Hospital; Athens Greece
| | | | | | - Georgia Kassi
- Second Division of Endocrinology; Alexandra Hospital; Athens Greece
| | | | - Maria Prokopiou
- Second Division of Endocrinology; Alexandra Hospital; Athens Greece
| | | | - Helen Karga
- Second Division of Endocrinology; Alexandra Hospital; Athens Greece
| |
Collapse
|
45
|
Lee JH, Kim Y, Choi JW, Kim YS. The association between papillary thyroid carcinoma and histologically proven Hashimoto's thyroiditis: a meta-analysis. Eur J Endocrinol 2013; 168:343-9. [PMID: 23211578 DOI: 10.1530/eje-12-0903] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE No consensus exists on the association between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT). To resolve this controversy, this study aimed to evaluate the relationship between the two conditions using a meta-analysis. METHODS We searched relevant published studies using citation databases including PubMed, Embase, and ISI Web of Science. The effect sizes of clinicopathologic parameters were calculated by odds ratio (OR), weighted mean difference, or hazard ratio (HR). The effect sizes were combined using a random-effects model. RESULTS Thirty-eight eligible studies including 10 648 PTC cases were selected. Histologically proven HT was identified in 2471 (23.2%) PTCs. HT was more frequently observed in PTCs than in benign thyroid diseases and other carcinomas (OR=2.8 and 2.4; P<0.001). PTCs with coexisting HT were significantly related to female patients (OR=2.7; P<0.001), multifocal involvement (OR=1.5; P=0.010), no extrathyroidal extension (OR=1.3; P=0.002), and no lymph node metastasis (OR=1.3; P=0.041). Moreover, PTCs with HT were significantly associated with long recurrence-free survival (HR=0.6; P=0.001). CONCLUSIONS Our meta-analysis showed that PTC is significantly associated with pathologically confirmed HT. PTC patients with HT have favorable clinicopathologic characteristics compared with PTCs without HT. However, patients with HT need to be carefully monitored for the development of PTC.
Collapse
Affiliation(s)
- Ju-Han Lee
- Department of Pathology, Korea University Ansan Hospital, 516, Gojan-1 Dong, Danwon-Gu, Ansan-Si, Gyeonggi-Do 425-707, Republic of Korea
| | | | | | | |
Collapse
|
46
|
Jankovic B, Le KT, Hershman JM. Clinical Review: Hashimoto's thyroiditis and papillary thyroid carcinoma: is there a correlation? J Clin Endocrinol Metab 2013; 98:474-82. [PMID: 23293329 DOI: 10.1210/jc.2012-2978] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The link between Hashimoto's thyroiditis (HT) and papillary thyroid cancer (PTC) has long been a topic of controversy. There are conflicting reports; some suggest that these two are positively correlated, whereas other studies report no relationship. EVIDENCE ACQUISITION We performed a systematic literature review of original studies that investigated the correlation between HT and PTC. The two main search engines used to identify articles were OVID Medline and PubMed. The included studies were categorized into a fine-needle aspiration biopsy (FNAB) group and an archival thyroidectomy specimen group. EVIDENCE SYNTHESIS There is no clear evidence to support the correlation between HT and PTC. Population-based FNAB studies report no linkage, whereas many of the studies of thyroidectomy specimens report a positive relationship. The average prevalence rate of PTC in patients with HT was 1.20% in 8 FNA studies of 18 023 specimens and 27.56% in 8 archival thyroidectomy studies of 9 884 specimens. The relative risk ratio of finding evidence of PTC in HT specimens ranged from .39 to 1.00 in the FNA group (average RR = .69) in contrast to 1.15 to 4.16 from the archival thyroidectomy studies (average RR = 1.59). In addition, there are many studies in the literature that propose a genetic link between HT and PTC involving the PI3K/Akt pathway and RET/PTC gene rearrangements. CONCLUSION Although limited by the lack of definitive pathology, population-based FNA studies did not find a statistically significant correlation between HT and PTC. Thyroidectomy studies, which reported a statistically significant positive correlation, are subject to selection bias. More prospective studies with longer follow-up are needed to further elucidate this relationship.
Collapse
Affiliation(s)
- Bojana Jankovic
- Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
| | | | | |
Collapse
|
47
|
Makhdoomi R, Mustafa F, Malik R, Bhat S, Alam K, Bashir H, Samoon N, Rasool M, Baba KM. Coexistent Papillary Carcinoma of Thyroid and Hashimoto's Thyroiditis - Diagnosis on Fine Needle Aspiration Cytology. Int J Endocrinol Metab 2013; 11:191-4. [PMID: 24348592 PMCID: PMC3860114 DOI: 10.5812/ijem.7453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 08/12/2012] [Accepted: 09/13/2012] [Indexed: 11/28/2022] Open
Abstract
Hashimoto's thyroiditis is associated with an increased risk of developing papillary carcinoma of thyroid. We hereby report a case of Hashimoto's thyroiditis with papillary carcinoma in a 45-year-old ear old female diagnosed on fine needle aspiration cytology (FNAC) which was later confirmed on histopathological examination .Such an occurrence, when both lesions are picked up on FNAC in a patient with no palpable thyroid nodule is rare. The case is presented here for its rarity.
Collapse
Affiliation(s)
- Rumana Makhdoomi
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
- Corresponding author: Rumana Makhdoomi, Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India. Tel: +94-19081223, Fax:+94-1942426958, E-mail:
| | - Farhat Mustafa
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Rais Malik
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Salma Bhat
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Khurshid Alam
- Department of Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Humaira Bashir
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Nuzhat Samoon
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Mohsin Rasool
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| | - Khalil Mohammed Baba
- Department of Pathology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar-190 011, India
| |
Collapse
|
48
|
Paulson LM, Shindo ML, Schuff KG. Role of chronic lymphocytic thyroiditis in central node metastasis of papillary thyroid carcinoma. Otolaryngol Head Neck Surg 2012; 147:444-9. [PMID: 22547555 DOI: 10.1177/0194599812445727] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE (1) To investigate the role of chronic lymphocytic thyroiditis (CLT) in central node metastasis of papillary thyroid carcinoma (PTC) and (2) to evaluate the presence of chronic lymphocytic thyroiditis according to PTC-specific molecular markers. STUDY DESIGN Historical cohort study. SETTING Academic medical center. SUBJECTS AND METHODS All patients who underwent total thyroidectomy with central neck dissection for PTC at Oregon Health & Science University between 2005 and 2010 were screened for the presence of CLT and reviewed for clinical prognostic factors. Patients with inadequate central neck dissections were excluded. Molecular markers for PTC were analyzed on archived tumor samples. RESULTS A total of 139 patients met selection criteria. The rate of CLT was 43.8%. The rate of central node positivity was 63%. Presence of CLT was associated with a significantly lower proportion of central node metastases (49% vs 74%, P = .003) and angiolymphatic invasion (31% vs 15%, P = .03). There was no significant difference in mean age, tumor size, and extracapsular extension. Molecular genotyping did not reveal a significant difference in the types of mutations found in both groups. CONCLUSION The data indicate a lower incidence of central compartment lymph node metastasis in those with CLT in this patient population, suggesting a potential protective role in tumor spread. The equal distribution of tumor mutations between the carcinomas with and without evidence of CLT argues against a mutation-specific antigen as the immunologic stimulus. Further research is needed to characterize the role of autoimmunity in thyroid cancer.
Collapse
Affiliation(s)
- Lorien M Paulson
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon 97239, USA.
| | | | | |
Collapse
|
49
|
Brown R, Francis GL. Autoimmune thyroid disorders. J Thyroid Res 2011; 2011:432890. [PMID: 22254147 PMCID: PMC3255311 DOI: 10.4061/2011/432890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/01/2011] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rosalind Brown
- Pediatrics, Harvard Medical School, Boston, MA 02115, USA
| | | |
Collapse
|
50
|
Huang BY, Hseuh C, Chao TC, Lin KJ, Lin JD. Well-differentiated thyroid carcinoma with concomitant Hashimoto's thyroiditis present with less aggressive clinical stage and low recurrence. Endocr Pathol 2011; 22:144-9. [PMID: 21647844 DOI: 10.1007/s12022-011-9164-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are the most common differentiated thyroid cancers. Previous studies report that Hashimoto's thyroiditis (HT) concomitant with PTC is unusual and improves prognosis compared to classical PTC. Few previous studies address FTC concomitant with HT. In this study, we retrospectively analyzed data from one institution and compared clinical presentations and results of treatment of PTC and FTC with and without HT. In addition, studies comparing presentation and long term follow-up prognosis in classical PTC and FTC were conducted. A total of 1,788 PTC patients and 209 FTC patients underwent thyroidectomy with or without lymph node dissection and follow-up at Chang Gung Medical Center in Linkou, Taiwan. All thyroid carcinomas were pathologically classified according to World Health Organization criteria. Histological patterns of PTC were categorized as classical PTC, or PTC with HT. Follicular thyroid carcinoma patients were categorized as FTC or FTC with HT. The dataset contained a total of 1,703 PTC cases categorized as classical PTC, 85 cases of PTC with HT, 201 cases of FTC and eight cases of FTC with HT. Analysis of Classification of Malignant Tumors (TNM) stage revealed a higher percentage of classical PTC in stage IV than HT group (12.03% vs. 4.70%). Mean tumor size of classical PTC was larger than HT group. Although 42.3% of FTC cases presented with distant metastases, no cases of FTC with HT presented with distant metastasis. Cancer-specific mortality was higher in classical PTC group than in PTC with HT. There was 53.2% of FTC without HT assigned recurrent status, and six of them died of thyroid cancer. No cancer mortality or recurrence in HT with FTC. PTC and FTC with HT presented with better clinical stage and better prognosis after same therapeutic modality. In conclusions, both PTC and FTC with HT have less aggressive clinical presentation and better prognosis.
Collapse
Affiliation(s)
- Bie-Yu Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keelung and Linkou Chang Gung Memorial Hospitals, Chang Gung University, 5, Fu-Shin St. Kweishan county, Taoyuan Hsien, Taiwan, Republic of China
| | | | | | | | | |
Collapse
|