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Madrigal JM, Troisi R, Surcel HM, Öhman H, Kivelä J, Kiviranta H, Rantakokko P, Koponen J, Medgyesi DN, Kitahara CM, McGlynn KA, Sampson J, Albert PS, Ward MH, Jones RR. Prediagnostic serum concentrations of per- and polyfluoroalkyl substances and risk of papillary thyroid cancer in the Finnish Maternity Cohort. Int J Cancer 2024; 154:979-991. [PMID: 37902275 PMCID: PMC11286200 DOI: 10.1002/ijc.34776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 10/31/2023]
Abstract
Human exposure to per- and polyfluoroalkyl substances (PFAS) occurs globally through contaminated food, dust, and drinking water. Studies of PFAS and thyroid cancer have been limited. We conducted a nested case-control study of prediagnostic serum levels of 19 PFAS and papillary thyroid cancer (400 cases, 400 controls) in the Finnish Maternity Cohort (pregnancies 1986-2010; follow-up through 2016), individually matched on sample year and age. We used conditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for log2 transformed and categorical exposures, overall and stratified by calendar period, birth cohort, and median age at diagnosis. We adjusted for other PFAS with Spearman correlation rho = 0.3-0.6. Seven PFAS, including perfluoroctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS), N-ethyl-perfluorooctane sulfonamidoacetic acid (EtFOSAA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorohexane sulfonic acid (PFHxS) were detected in >50% of women. These PFAS were not associated with risk of thyroid cancer, except for PFHxS, which was inversely associated (OR log2 = 0.82, 95% CI: 0.70-0.97). We observed suggestive but imprecise increased risks associated with PFOA, PFOS, and EtFOSAA for those diagnosed at ages <40 years, whereas associations were null or inverse among those diagnosed at 40+ years (P-interaction: .02, .08, .13, respectively). There was little evidence of other interactions. These results show no clear association between PFAS and papillary thyroid cancer risk. Future work would benefit from evaluation of these relationships among those with higher exposure levels and during periods of early development when the thyroid gland may be more susceptible to environmental harms.
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Affiliation(s)
- Jessica M. Madrigal
- Occupational & Environmental Epidemiology Branch, Division of Cancer Epidemiology & Genetics (DCEG), National Cancer Institute (NCI), Rockville, Maryland, USA
| | | | - Heljä-Marja Surcel
- Biobank Borealis of Northern Finland, Oulu University Hospital, Oulu, Finland
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Hanna Öhman
- Biobank Borealis of Northern Finland, Oulu University Hospital, Oulu, Finland
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Juha Kivelä
- Biobank Borealis of Northern Finland, Oulu University Hospital, Oulu, Finland
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Hannu Kiviranta
- Finnish Institute for Health and Welfare /Environmental Health Unit, Kuopio, Finland
| | - Panu Rantakokko
- Finnish Institute for Health and Welfare /Environmental Health Unit, Kuopio, Finland
| | - Jani Koponen
- Finnish Institute for Health and Welfare /Environmental Health Unit, Kuopio, Finland
| | - Danielle N. Medgyesi
- Occupational & Environmental Epidemiology Branch, Division of Cancer Epidemiology & Genetics (DCEG), National Cancer Institute (NCI), Rockville, Maryland, USA
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | | | | | | | - Mary H. Ward
- Occupational & Environmental Epidemiology Branch, Division of Cancer Epidemiology & Genetics (DCEG), National Cancer Institute (NCI), Rockville, Maryland, USA
| | - Rena R. Jones
- Occupational & Environmental Epidemiology Branch, Division of Cancer Epidemiology & Genetics (DCEG), National Cancer Institute (NCI), Rockville, Maryland, USA
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Dunn BK, Woloshin S, Xie H, Kramer BS. Cancer overdiagnosis: a challenge in the era of screening. JOURNAL OF THE NATIONAL CANCER CENTER 2022; 2:235-242. [PMID: 36568283 PMCID: PMC9784987 DOI: 10.1016/j.jncc.2022.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 12/30/2022] Open
Abstract
"Screening" is a search for preclinical, asymptomatic disease, including cancer. Widespread cancer screening has led to large increases in early-stage cancers and pre-cancers. Ubiquitous public messages emphasize the potential benefits to screening for these lesions based on the underlying assumption that treating cancer at early stages before spread to other organs should make it easier to treat and cure, using more tolerable interventions. The intuition is so strong that public campaigns are sometimes launched without conducting definitive trials directly comparing screening to usual care. An effective cancer screening test should not only increase the incidence of early-stage preclinical disease but should also decrease the incidence of advanced and metastatic cancer, as well as a subsequent decrease in cancer-related mortality. Otherwise, screening efforts may be uncovering a reservoir of non-progressive and very slowly progressive lesions that were not destined to cause symptoms or suffering during the person's remaining natural lifespan: a phenomenon known as "overdiagnosis." We provide here a qualitative review of cancer overdiagnosis and discuss specific examples due to extensive population-based screening, including neuroblastoma, prostate cancer, thyroid cancer, lung cancer, melanoma, and breast cancer. The harms of unnecessary diagnosis and cancer therapy call for a balanced presentation to people considering undergoing screening, even with a test of accepted benefit, with a goal of informed decision-making. We also discuss proposed strategies to mitigate the adverse sequelae of overdiagnosis.
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Affiliation(s)
- Barbara K. Dunn
- US National Cancer Institute, Division of Cancer Prevention, Bethesda, Maryland, USA
- Member, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
| | - Steven Woloshin
- The Center for Medicine in the Media, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Director, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
| | - Heng Xie
- Beijing Biostar Pharmaceuticals Co., Ltd, Beijing, China
| | - Barnett S. Kramer
- Member, The Lisa Schwartz Foundation for Truth in Medicine, Norwich, Vermont, USA
- Rockville, Maryland, USA
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Kwon H, Lee J, Hong SW, Kwon HJ, Kwak JY, Yoon JH. Fine Needle Aspiration Cytology vs. Core Needle Biopsy for Thyroid Nodules: A Prospective, Experimental Study Using Surgical Specimen. TAEHAN YONGSANG UIHAKHOE CHI 2022; 83:645-657. [PMID: 36238513 PMCID: PMC9514511 DOI: 10.3348/jksr.2021.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/30/2021] [Accepted: 09/11/2021] [Indexed: 06/16/2023]
Abstract
PURPOSE To evaluate and compare the diagnostic outcomes of ultrasonography (US)-guided fine needle aspiration (FNA) and core needle biopsy (CNB) performed on the same thyroid nodule using a surgical specimen for direct comparison. MATERIALS AND METHODS We included 89 thyroid nodules from 88 patients from February 2015 to January 2016. The inclusion criterion was thyroid nodules measuring ≥ 20 mm (mean size: 40.0 ± 15.3 mm). Immediately after surgical resection, FNA and subsequent CNB were performed on the surgical specimen under US guidance. FNA and CNB cytopathologic results on the specimen were compared with the surgical diagnosis. RESULTS Among the 89 nodules, 30 were malignant and 59 were benign. Significantly higher inconclusive rates were seen in FNA for malignant than benign nodules (80.0% vs. 39.0%, p < 0.001). For CNB, conclusive and inconclusive rates did not differ between benign and malignant nodules (p = 0.796). Higher inconclusive rates were seen for FNA among cancers regardless of US features, and in the subgroup of size ≥ 40 mm (62.5% vs. 22.9%, p = 0.028). Eleven cancers were diagnosed with CNB (36.7%, 11/30), while none was diagnosed using FNA. CONCLUSION In this experimental study using surgical specimens, CNB showed a potential to provide improved diagnostic sensitivity for thyroid cancer, especially when a conclusive diagnosis is limited with FNA.
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Horiguchi K, Yoshida Y, Iwaku K, Emoto N, Kasahara T, Sato J, Shimura H, Shindo H, Suzuki S, Nagano H, Furuya F, Makita N, Matsumoto F, Manaka K, Mitsutake N, Miyakawa M, Yokoya S, Sugitani I. Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults. Endocr J 2021; 68:763-780. [PMID: 33762511 DOI: 10.1507/endocrj.ej20-0692] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The incidence of thyroid carcinoma has been increasing worldwide. This is interpreted as an increase in the incidental detection of papillary thyroid microcarcinomas (PTMCs). However, mortality has not changed, suggesting overdiagnosis and overtreatment. Prospective clinical trials of active surveillance for low-risk PTMC (T1aN0M0) have been conducted in two Japanese institutions since the 1990s. Based on the favorable outcomes of these trials, active surveillance has been gradually adopted worldwide. A task force on the management of PTMC in adults organized by the Japan Thyroid Association therefore conducted a systematic review and has produced the present position paper based on the scientific evidence concerning active surveillance. This paper indicates evidence for the increased incidence of PTMC, favorable surgical outcomes for low-risk PTMC, recommended criteria for diagnosis using fine needle aspiration cytology, and evaluation of lymph node metastasis (LNM), extrathyroidal extension (ETE) and distant metastasis. Active surveillance has also been reported with a low incidence of disease progression and no subsequent recurrence or adverse events on survival if conversion surgery was performed at a slightly advanced stage. Active surveillance is a safe and valid strategy for PTMC, because it might preserve physical quality of life and reduce 10-year medical costs. However, some points should be noted when performing active surveillance. Immediate surgery is needed for PTMC showing high-risk features, such as clinical LNM, ETE or distant metastasis. Active surveillance should be performed under an appropriate medical team and should be continued for life.
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Affiliation(s)
- Kazuhiko Horiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kenji Iwaku
- Sapporo Thyroid Clinic (Ito Hospital), Sapporo 060-0042, Japan
| | - Naoya Emoto
- Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Sakura 285-0014, Japan
| | | | - Junichiro Sato
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroki Shimura
- Department of Laboratory Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan
| | - Satoru Suzuki
- Department of Thyroid and Endocrinology, Division of Internal Medicine, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Hidekazu Nagano
- Department of Molecular Diagnosis, Graduate school of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Fumihiko Furuya
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi 409-3998, Japan
| | - Noriko Makita
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Katsunori Manaka
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Norisato Mitsutake
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
| | - Megumi Miyakawa
- Department of Internal Medicine, Miyakawa Hospital, Kawasaki 210-0802, Japan
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo 113-8603, Japan
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Zhao J, Zhao Y, Ling Y, Kang H. Risk Factors of Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma and the Value of Sentinel Lymph Node Biopsy. Front Surg 2021; 8:680493. [PMID: 34222321 PMCID: PMC8241923 DOI: 10.3389/fsurg.2021.680493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: The present study aims to investigate the risk factors of central lymph node metastasis (CNM) in papillary thyroid microcarcinoma (PTMC) and evaluate the predictive value of sentinel lymph node biopsy (SLNB) during surgery. Methods: The clinicopathological data of 179 patients with PTMC staging in cN0 and with SLNB performed were analyzed retrospectively. Positive sentinel lymph node ratio (PSLNR) and additional positive lymph node (APLN) were analyzed in cases with positive SLNB. The efficiency of SLNB was investigated. ROC curves were plotted to evaluate the predictive value of PSLNR for APLN. Results: Cumulative maximum diameter of tumors (CMD) (P = 0.041) and capsule involvement (CI) (P = 0.014) were independent risk factors for central lymph node metastasis. The SLNB success rate was 97.28%, and the incidence of CNM was 31.28%. The sensitivity, specificity, false positive rate (FPR), false negative rate (FNR), positive predictive value (PPV), and negative predictive value (NPV) of SLNB to evaluate CNM and APLN were 82.14 vs. 61.54%, 100 vs. 80.39%, 0 vs. 19.61%, 17.86 vs. 38.46%, 100 vs. 34.78%, and 92.48 vs. 92.48%, respectively. For cases with positive SLNB, subgroup analysis was performed according to APLN. The PSLNRs of true and false positive groups were 0.4620 ± 0.1744 and 0.2425 ± 0.1355, respectively (P < 0.001). Analyzing the predictive value of PSLNR by the ROC curve, the optimal diagnostic cutoff point was 0.2917 [AUC = 0.861 (95% CI: 0.757, 0.966), P < 0.001], and the sensitivity, specificity, FPR, FNR, PPV, and NPV of PSLNR were 87.50, 73.33, 26.67, 12.50, 63.64, and 91.67%, respectively. Conclusion: CMD and CI are independent risk factors for central lymph node metastasis in PTMC. SLNB has good predictive value for CNM. For cases with positive SLNB, PSLNR could be used to predict the presence of APLN, which may provide a theoretical basis for intraoperative lymph node dissection.
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Affiliation(s)
- Jing Zhao
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ye Zhao
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuwei Ling
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hua Kang
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Shimizu T, Oba T, Chino T, Soma A, Ono M, Ito T, Kanai T, Maeno K, Sato Y, Uehara T, Ito KI. Papillary thyroid microcarcinoma with lung metastases: a case report and review of the literature. Thyroid Res 2021; 14:15. [PMID: 34116701 PMCID: PMC8193893 DOI: 10.1186/s13044-021-00106-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/01/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Distant metastasis from papillary thyroid microcarcinoma (PTMC) is rare. Here we report a case of PTMC with multiple lung metastases. CASE PRESENTATION A 64-year-old man presented to our hospital with abdominal pain. Computed tomography incidentally revealed multiple lung nodules. The lung tumor was histologically diagnosed as metastasis of papillary thyroid carcinoma (PTC) by core needle biopsy via thoracoscopy. The patient was referred to our department for further examination. Neck ultrasonography revealed a 0.9 cm hypoechoic nodule in the right lobe of the thyroid gland, which was diagnosed as PTC by fine-needle aspiration cytology. Subsequently, total thyroidectomy was performed, followed by radioiodine therapy. Iodine-131 (131-I) scintigraphy showed a strong accumulation in the lung metastasis. The patient presented no evidence of progression of lung metastasis for 25 months after the operation. CONCLUSIONS Lymph node metastasis or extraglandular extension has been reported in the few published cases of metastatic PTMC, including the present case, and the average age of these cases was 58.8 ± 12.0 years. Although active surveillance without surgical resection is expected to become a standard of care for PTMC, this case indicates that a subset of PTMC patients with risk factors may develop distant metastases. Hence, careful preoperative screening is required to avoid complications associated with completion thyroidectomy.
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Affiliation(s)
- Tadafumi Shimizu
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takaaki Oba
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tatsunori Chino
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ai Soma
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Mayu Ono
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tokiko Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Toshiharu Kanai
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kazuma Maeno
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yoshinori Sato
- Division of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Takeshi Uehara
- Division of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
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Samargandy S, Qari R, Aljadani A, Assaqaf D, Etaiwi A, Alghamdi D, Marzouki H, Alhozali A, Merdad M, Al-Hajeili M. Clinicopathological Characteristics of Thyroid Cancer in a Saudi Academic Hospital. Cureus 2020; 12:e8044. [PMID: 32528780 PMCID: PMC7282375 DOI: 10.7759/cureus.8044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The global incidence of thyroid cancer (TC) has increased significantly over the past decades. In Saudi Arabia, it is the third most common cancer among adults. This study aims to review the clinical and histopathological characteristics of TC in Saudi Arabia and analyze the size trend over the years. Methods We conducted a retrospective chart review of all differentiated and poorly differentiated TC patients following up at a tertiary care center in the Western region of Saudi Arabia. All patients 11 years and older, diagnosed between 2004 - 2018, and with sufficient histopathological data were included. Follicular and poorly differentiated TC were categorized and tumor stage was allocated. We performed descriptive and size trend analysis. Results We had a total of 285 patients who qualified for inclusion. The mean age at diagnosis was 40.6 years, and 81.05% of patients were females. Papillary TC comprised 88.07% of these neoplasms, and most patients (89.12%) were at Stage I. Only papillary TC showed a gender difference in the age of the diagnosis. In men, the mean age at diagnosis of papillary TC was 46.98 ± 15.4 years, while in female patients, it was 39.02 ± 12.8 years (p-value = 0.0001). We did not find a trend toward smaller tumours in the more recent years in comparison to the early years (r = -0.083, p-value = 0.168). Conclusions TC is diagnosed at a younger age and larger sizes in Saudi Arabia in comparison to other countries. A gender difference was only noted with papillary TC in regard to the age of diagnosis. There was no trend toward smaller sizes of TC over the years.
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Affiliation(s)
| | - Rahaf Qari
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Arwa Aljadani
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Doaa Assaqaf
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Abdulaziz Etaiwi
- Internal Medicine, King Abdulaziz University Hospital, Jeddah, SAU
| | - Doaa Alghamdi
- Head and Neck Pathology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Hani Marzouki
- Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Amani Alhozali
- Endocrinology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mazin Merdad
- Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, SAU
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Salamanca-Fernández E, Rodriguez-Barranco M, Chang-Chan YL, Redondo-Sánchez D, Domínguez-López S, Bayo E, Narankiewicz D, Expósito J, Sánchez MJ. Thyroid Cancer Epidemiology in South Spain: a population-based time trend study. Endocrine 2018; 62:423-431. [PMID: 30043094 DOI: 10.1007/s12020-018-1681-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 07/09/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Thyroid cancer (TC) is the most common malignant disease of the endocrine system. The aim of this study was to analyze incidence and mortality trends of TC (C73 according to ICD-O-3) in Granada (Southern Spain) during the period 1985-2013, by sex, age, and histological type. METHODS This is a population-based cross-sectional study. Incidence data were obtained from the population-based Cancer Registry of Granada. All newly diagnosed cases of thyroid cancer over the period 1985-2013 were included. Joinpoint regression analysis with age-standardized rates were used to estimate annual percentage change (APC), CI 95% and turning points in trends. Results are presented by sex, age group, and histological type. RESULTS During the study period there were 1265 diagnosed cases of TC in Granada (72.6% in women). Incidence trends significantly increased in both men (APC: + 5.4%) and women (APC: + 4.7%). The most common histological types in both sexes were papillary (74.8%) and follicular (16.8%). The incidence has increased during the study period mainly due to papillary carcinoma, which has increased annually around 6% in both sexes. TC mortality trend during this period decreased in men (APC: -0.3%) and women (APC: -2.3%). CONCLUSION Our data showed an increasing trend in incidence of thyroid cancer in Granada, especially in women between 55-64 years. Mortality showed a slight decrease trend during the study period in both sexes. Papillary carcinoma was the most common histological type, with an increase of the relative weight of papillary microcarcinomas. Our study is in accordance with the European and worldwide trends in thyroid cancer incidence and mortality and sex differences.
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Affiliation(s)
- Elena Salamanca-Fernández
- Andalusian School of Public Health (EASP), Granada, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain
- Biosanitary Investigation Institute ibs, Granada, Spain
| | - Miguel Rodriguez-Barranco
- Andalusian School of Public Health (EASP), Granada, Spain.
- CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain.
- Biosanitary Investigation Institute ibs, Granada, Spain.
| | - Yoe-Ling Chang-Chan
- Andalusian School of Public Health (EASP), Granada, Spain
- Biosanitary Investigation Institute ibs, Granada, Spain
| | - Daniel Redondo-Sánchez
- Andalusian School of Public Health (EASP), Granada, Spain
- Biosanitary Investigation Institute ibs, Granada, Spain
| | | | - Eloísa Bayo
- Radiation Oncology Department, University Hospital Virgen Macarena, Sevilla, Spain
| | - Dariusz Narankiewicz
- Preventive Medicine and Public Health Department, Hospital Virgen de la Victoria of Málaga, Málaga, Spain
| | - José Expósito
- Biosanitary Investigation Institute ibs, Granada, Spain
- Radiotherapy and Oncology Department, University Hospital Virgen de las Nieves Granada, Granada, Spain
| | - María José Sánchez
- Andalusian School of Public Health (EASP), Granada, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain
- Biosanitary Investigation Institute ibs, Granada, Spain
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Gu Y, Yang N, Yin L, Feng C, Liu T. Inhibitory roles of miR‑9 on papillary thyroid cancer through targeting BRAF. Mol Med Rep 2018; 18:965-972. [PMID: 29767243 DOI: 10.3892/mmr.2018.9010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/24/2017] [Indexed: 11/06/2022] Open
Abstract
MicroRNA‑9 (miR‑9) is reported to be underexpressed in papillary thyroid carcinoma (PTC) tissues; however, the molecular mechanisms underlying the implication of miR‑9 in PTC have yet to be elucidated. The present study aimed to explore the potential roles of miR‑9 in PTC. PTC tissue samples and paired non‑cancerous adjacent tissues were collected from 60 patients with PTC. The human TPC‑1 thyroid gland papillary carcinoma cell line was used to investigate the molecular mechanisms underlying the roles of miR‑9 in PTC. The levels of miR‑9 and its downstream target gene BRAF were detected through reverse transcription‑quantitative polymerase chain reaction. MTT assay and flow cytometry were performed to evaluate cell viability and apoptosis, respectively. A mouse xenograft tumor model was established to observe the effects of miR‑9 on thyroid gland tumorigenesis in vivo. The present study revealed that the expression of miR‑9 was significantly reduced in PTC tissues compared with paired normal tissues. In addition, miR‑9 upregulation suppressed the expression of BRAF in TPC‑1 cells in vitro. Luciferase reporter assay demonstrated that BRAF may be a direct target gene of miR‑9 in TPC‑1 cells. In addition, following transfection with miR‑9 mimics, the viability of TPC‑1 cells was suppressed and their apoptosis was enhanced; conversely, transfection with miR‑9 inhibitor exerted the opposite effects in vitro. miR‑9 overexpression or downregulation also affected in vivo PTC tumorigenesis in athymic mice. The present findings suggested that miR‑9 may suppress the viability of PTC cells and inhibit tumor growth through directly targeting the expression of BRAF in PTC.
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Affiliation(s)
- Yi Gu
- Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Nan Yang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, P.R. China
| | - Leping Yin
- Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Chao Feng
- Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Tong Liu
- Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
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Pajamäki N, Metso S, Hakala T, Ebeling T, Huhtala H, Ryödi E, Sand J, Jukkola-Vuorinen A, Kellokumpu-Lehtinen PL, Jaatinen P. Long-term cardiovascular morbidity and mortality in patients treated for differentiated thyroid cancer. Clin Endocrinol (Oxf) 2018; 88:303-310. [PMID: 29154445 DOI: 10.1111/cen.13519] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/02/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Thyroid hormone suppression therapy has been widely used in the treatment of thyroid cancer, but concerns have been raised about the cardiovascular risks of this treatment. The objective of this study was to evaluate long-term cardiovascular morbidity and mortality in patients treated for differentiated thyroid cancer (DTC) and to assess the effect of TSH suppression and radioiodine (RAI) treatment on the cardiovascular outcome. DESIGN Retrospective cohort study. PATIENTS AND MEASUREMENTS Patients (n = 901) treated for DTC between 1981 and 2002 at 2 Finnish University hospitals were compared with a randomly chosen reference group (n = 4485) matched for age, gender and the place of residence. Kaplan-Meier and Cox regression analyses were used to estimate the risk of morbidity or death due to different cardiovascular diseases (CVD) after the diagnosis of DTC. RESULTS Morbidity due to any CVD (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.05-1.28) and due to all arrhythmias (HR 1.25, CI 1.06-1.48) and atrial fibrillation (AF) (HR 1.29, CI 1.06-1.57) was more frequent in the DTC patients than in the controls. The increased cardiovascular morbidity was confined to patients with a mean TSH level below 0.1 mU/L (HR 1.27, CI 1.03-1.58) and to those treated with RAI (HR 1.18, CI 1.05-1.31). Cardiovascular mortality, however, was lower among the patients than the controls (HR 0.73, CI 0.58-0.92), due to a lower mortality from coronary artery disease. CONCLUSIONS Differentiated thyroid cancer patients have an increased CVD morbidity, which is mostly accountable to AF and to TSH suppression below 0.1 mU/L.
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Affiliation(s)
- Nelli Pajamäki
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Tipotie Health Centre, Social and Health Services, City of Tampere, Tampere, Finland
| | - Saara Metso
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Tommi Hakala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Tapani Ebeling
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Essi Ryödi
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Heart Center Co., Tampere University Hospital, Tampere, Finland
| | - Juhani Sand
- Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Pia Jaatinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Division of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Paajanen I, Metso S, Jaatinen P, Kholová I. Thyroid FNA diagnostics in a real-life setting: Experiences of the implementation of the Bethesda system in Finland. Cytopathology 2017; 29:189-195. [DOI: 10.1111/cyt.12513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2017] [Indexed: 12/30/2022]
Affiliation(s)
- I. Paajanen
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
| | - S. Metso
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
| | - P. Jaatinen
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
- Department of Internal Medicine; Tampere University Hospital; Tampere Finland
- Division of Internal Medicine; Seinäjoki Central Hospital; Seinäjoki Finland
| | - I. Kholová
- Faculty of Medicine and Life Sciences; University of Tampere; Tampere Finland
- Department of Pathology; Fimlab Laboratories; Tampere Finland
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12
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Affiliation(s)
- Tommi Hakala
- 1 Department of Surgery, Fimlab Laboratories; Tampere University Hospital , Tampere, Finland
| | - Ivana Kholová
- 2 Department of Pathology, Fimlab Laboratories; Tampere University Hospital , Tampere, Finland
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13
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Vlassopoulou V, Vryonidou A, Paschou SA, Ioannidis D, Koletti A, Klonaris N, Katsoulis K, Rontogianni D, Vasilopoulos C, Tsagarakis S, Tzavara I. No considerable changes in papillary thyroid microcarcinoma characteristics over a 30-year time period. BMC Res Notes 2016; 9:252. [PMID: 27129971 PMCID: PMC4850716 DOI: 10.1186/s13104-016-2018-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of papillary thyroid microcarcinoma (PTMC) is continuously increasing but its clinical significance and management is still debatable. The aim of this study was to investigate possible changes in the clinical presentation, tumor characteristics, treatment modalities and long-term outcome during the last three decades in patients with PTMC. Methods We studied 335 patients with PTMC who were followed up for at least 5 years, from 1982 to 2015, and treated in accordance with the current literature or guidelines at each time-period. Patients were classified according to year of diagnosis into two time periods, TP1 from 1982–2000 and TP2 from 2001–2010. Results The mean follow-up of the whole cohort was 10.6 ± 5.3 (median 9) years. No change was noted in the mean age at diagnosis or the female to male ratio during the two time periods. In regard to tumor characteristics, multifocality and non-encapsulated follicular variant of PTMC was more often present while classic PTMC was less common in patients in the TP2, compared to patients in the TP1 (p = 0.007, p < 0.001 and p = 0.043 respectively). The prevalence of incidental PTMC was high but similar in both time periods (84.6 vs 80 %, p = 0.286). The majority of patients in TP2 underwent a total or near total thyroidectomy compared to patients in TP1 (91.7 vs 80 %, p = 0.001). However, more patients underwent thyroidectomy for toxic multinodular disease and less for Graves’ disease during TP1 compared to patients in the TP2 (p = 0.02 and 0.043 respectively). A significant percentage of patients underwent adjuvant radioiodine ablation, yet no difference was found between the two time periods (73.8 vs 79.5 %, p = 0.228). The rate of persistence was very low and not significant (3.1 vs 6.6 %, p = 0.165), while disease recurrence was observed in only 2 (0.6 %) patients, one from each time period. Conclusions We did not observe any important changes regarding the clinical presentation or tumor characteristics of PTMCs during a 30-year period. With applied interventions a favorable course was confirmed in the majority of patients without differences in recurrence or persistence during the last three decades.
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Affiliation(s)
- Varvara Vlassopoulou
- Department of Endocrinology, Diabetes and Metabolism, "Evangelismos" Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece.
| | - Andromachi Vryonidou
- Department of Endocrinology, Diabetes and Metabolism, Hellenic Red Cross Hospital, Athens, Greece
| | - Stavroula A Paschou
- Department of Endocrinology, Diabetes and Metabolism, Hellenic Red Cross Hospital, Athens, Greece
| | - Dimitrios Ioannidis
- Department of Endocrinology, Diabetes and Metabolism, "Amalia Fleming" Hospital, Athens, Greece
| | - Angeliki Koletti
- Department of Endocrinology, Diabetes and Metabolism, "Evangelismos" Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece
| | - Nikolaos Klonaris
- Department of Endocrinology, Diabetes and Metabolism, Hellenic Red Cross Hospital, Athens, Greece
| | - Konstantinos Katsoulis
- Department of Endocrinology, Diabetes and Metabolism, "Amalia Fleming" Hospital, Athens, Greece
| | | | - Charalampos Vasilopoulos
- Department of Endocrinology, Diabetes and Metabolism, "Evangelismos" Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, "Evangelismos" Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece
| | - Ioanna Tzavara
- Department of Endocrinology, Diabetes and Metabolism, "Amalia Fleming" Hospital, Athens, Greece
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Hakala TT, Sand JA, Jukkola A, Huhtala HS, Metso S, Kellokumpu-Lehtinen PL. Increased risk of certain second primary malignancies in patients treated for well-differentiated thyroid cancer. Int J Clin Oncol 2015; 21:231-239. [DOI: 10.1007/s10147-015-0904-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/09/2015] [Indexed: 10/23/2022]
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Albasri A, Sawaf Z, Hussainy AS, Alhujaily A. Histopathological patterns of thyroid disease in Al-Madinah region of Saudi Arabia. Asian Pac J Cancer Prev 2015; 15:5565-70. [PMID: 25081665 DOI: 10.7314/apjcp.2014.15.14.5565] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed to characterize the histopathological pattern of thyroid lesions among Saudi patients and to highlight the age and gender variations of these lesions as base line data. MATERIALS AND METHODS We retrospectively analyzed the data from thyroid specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. RESULTS The 292 thyroidectomy specimens received during the study period came from 230 (78.8%) females and 62 (21.2%) males giving a female: male ratio of 3.7:1. Age of the patients ranged from 14 to 95 years with a mean age 39.7 years. Two hundred and eleven (72.3%) cases were found to be non-neoplastic and 81 (27.7%) cases were neoplastic. The non-neoplastic group included: colloid goiter, including both diffuse and nodular goiter (170 cases; 58.2%), nodular hyperplasia (28 cases; 9.6%), Hashimoto/chronic lymphocytic thyroiditis (12 cases; 4.1%), and Grave's disease (1 case; 0.3%). In neoplastic lesions, there were 7 benign tumors and 74 malignant tumors. Among the benign tumors, 5 were follicular adenomas and 2 were Hurthle cell adenomas. Papillary carcinoma was the commonest malignant tumor accounting for 87.8% of all thyroid malignancies, followed by lymphoma, follicular carcinoma and medullary carcinoma. The size of papillary carcinoma was more than 2 cm in 40 cases (76.9%). CONCLUSIONS Non-neoplastic thyroid lesions were more common than neoplastic ones. Colloid goiter was the most common lesion. Follicular adenoma was the commonest benign tumor and papillary carcinoma was the commonest malignant lesion. There appears to be a slightly increased trend of papillary carcinoma diagnosis, most being diagnosed at an advanced stage.
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Affiliation(s)
- Abdulkader Albasri
- Department of Pathology, Taibah University, Madinah, Saudi Arabia E-mail :
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16
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Hakala T, Sand J, Kellokumpu-Lehtinen PL, Huhtala H, Leinonen R, Kholová I. Recurrent thyroid cancers have more peritumoural lymphatic vasculature than nonrecurrent thyroid cancers. Eur J Clin Invest 2014; 44:825-32. [PMID: 25047155 DOI: 10.1111/eci.12301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The goal of the study was to evaluate angiogenesis and lymphangiogenesis in differentiated thyroid cancer and recurrences. METHODS Twenty-seven patients with recurrent differentiated thyroid cancer (20 papillary and seven follicular thyroid carcinomas) and 24 nonrecurrent thyroid cancers were included in this study. Additionally, 24 thyroid adenomas were included as benign controls. All thyroid cancer recurrences were operatively managed, and local recurrences in cervical lymph nodes or cervical soft tissue were histologically confirmed. Altogether, a total of 108 samples were evaluated using CD31 and D2-40 immunohistochemical staining and microscopy. RESULTS As measured in primary tumours, the median density of CD31-positive vascular structures was 327 vessels (v)/mm(2) for recurrent cancers, 362 v/mm(2) for nonrecurrent cancers and 484 v/mm(2) for thyroid adenomas (P = 0·017). Among the subgroups, the lowest median vascular density of 316 v/mm(2) was found in recurrent papillary cancers and the highest vascular density of 604 v/mm(2) was observed in nonrecurrent follicular cancers (P = 0·018). The median density of D2-40-positive peritumoural lymphatic vessels was 101/mm(2) in recurrent cancers, 56·1/mm(2) in nonrecurrent cancers and 53·9/mm(2) for adenomas (P = 0·015). In the subgroups, peritumoural lymphatic vascular density was 102 v/mm(2) in recurrent papillary cancers and 56·0 v/mm(2) in nonrecurrent papillary cancers (P = 0·044). CONCLUSIONS Recurrent thyroid cancers expressed less intratumoural microvessels than thyroid adenomas. A high density of peritumoural lymphatic vessels was found in recurrent papillary cancers. High blood vessel density may be a marker for less aggressive tumours, while high peritumoural lymphatic vasculature is a marker for more aggressive and recurrence-prone tumours.
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Affiliation(s)
- Tommi Hakala
- Department of Surgery, Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
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17
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Nam YJ, Kim BH, Lee SK, Jeon YK, Kim SS, Jung WJ, Kahng DH, Kim IJ. Co-occurrence of papillary thyroid carcinoma and mucosa-associated lymphoid tissue lymphoma in a patient with long-standing hashimoto thyroiditis. Endocrinol Metab (Seoul) 2013; 28:341-5. [PMID: 24396701 PMCID: PMC3871033 DOI: 10.3803/enm.2013.28.4.341] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 05/24/2013] [Indexed: 11/21/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is a common affliction of the thyroid gland, accounting for 70% to 80% of all thyroid cancers, whereas mucosa-associated lymphoid tissue (MALT) lymphoma of the thyroid gland is uncommon. The simultaneous occurrence of both malignancies is extremely rare. We report the case of a patient with both PTC and MALT lymphoma in the setting of Hashimoto thyroiditis. An 81-year-old female patient was first admitted with goiter and hoarseness, which was attributed to an ultrasonographic thyroid nodule. Subsequent fine-needle aspirate, interpreted as suspicious of papillary thyroid cancer, prompted total thyroidectomy. MALT lymphoma was an incidental postsurgical finding, coexisting with PTC in the setting of Hashimoto thyroiditis. Although the development of MALT lymphoma is very rare, patients with longstanding Hashimoto thyroiditis should undergo careful surveillance for both malignancies.
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Affiliation(s)
- Yoon Jeong Nam
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | | | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Woo Jin Jung
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Dong Hwahn Kahng
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - In Ju Kim
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Hakala T, Kholová I, Sand J, Saaristo R, Kellokumpu-Lehtinen P. A core needle biopsy provides more malignancy-specific results than fine-needle aspiration biopsy in thyroid nodules suspicious for malignancy. J Clin Pathol 2013; 66:1046-50. [PMID: 23863219 DOI: 10.1136/jclinpath-2013-201559] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS The most commonly used diagnostic method for the preoperative diagnosis of thyroid nodules is ultrasound-guided fine-needle aspiration biopsy (FNA), which often yields non-diagnostic or non-definitive results and seldom produces definite malignant diagnoses. To improve upon the malignancy-specific sensitivity, we tested core needle biopsies (CNBs) of thyroid lesions taken from surgical specimens. MATERIAL AND METHODS 52 consecutive patients with malignant or malignant-suspicious thyroid nodules were referred to Tampere University Hospital between May 2010 and December 2011. Preoperative FNAs were categorised as follicular neoplasm (48%), suspicion for malignancy (46%) or malignancy (6%). Intraoperative FNA and CNB samples were acquired from surgical specimens removed during surgery. The results of the needle biopsies were compared with the final pathological diagnosis. RESULTS CNBs had a high definitive sensitivity for malignancy (61%, CI 41% to 78%) whereas the definitive sensitivity for malignancy of FNAs was significantly lower (22%, CI 10% to 42%). CNB was not beneficial in the diagnosis of follicular thyroid lesions. When all suspected follicular tumours were excluded, the definitive sensitivity of CNB rose to 70% (CI 48% to 86%). CONCLUSIONS CNB may be beneficial for the diagnosis of papillary thyroid carcinoma and other non-follicular thyroid lesions. CNB may be considered as an additional diagnostic procedure in cases with FNA suspicious for malignancy.
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Affiliation(s)
- T Hakala
- Department of Surgery, Tampere University Hospital, , Tampere, Finland
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