Diagnostic pitfall of thyroid fine-needle aspiration induced fibrosis: follicular adenoma mimicking medullary thyroid carcinoma in frozen section

Is desmoplastic stromal reaction useful to modulate lymph node dissection in sporadic medullary thyroid carcinoma?

BACKGROUND

Guiding surgical extent of sporadic medullary thyroid carcinoma on the basis of solely basal calcitonin levels has been questioned because of the potential postoperative complications and uncertain oncologic benefit. Desmoplastic stromal reaction has re-emerged as a promising marker of nodal metastases. We aimed to analyze the value of desmoplastic stromal reaction in tailoring surgical strategy as well as revisit the role of known predictive factors such as basal calcitonin.

METHODS

We retrospectively analyzed operations for medullary thyroid carcinoma between 1997 and 2022, including patients whose specimens were available for desmoplastic stromal reaction evaluation (2018-2022). Risk factors for nodal metastases were assessed using univariable and multivariable analyses. Predictors of nodal metastases and potential basal calcitonin thresholds with optimal sensitivity, specificity, positive predictive value, and negative predictive value were evaluated.

RESULTS

Among 246 medullary thyroid carcinomas, 139 sporadic unifocal cases were eligible and 57 patients were retrospectively evaluated for desmoplastic stromal reaction. After univariable analysis, desmoplastic stromal reaction positivity (P = .002), basal calcitonin >113 pg/mL (P = .004), and lesion size >20 mm (P = .042) were significantly associated with nodal metastases. After backward stepwise logistic regression, desmoplastic stromal reaction positivity and basal calcitonin >113 pg/mL resulted in being independent risk factors for nodal metastases. Desmoplastic stromal reaction positivity showed a 100% sensitivity, an 82.5% specificity, an 18.4% positive predictive value, and a 100% negative predictive value for nodal metastases.

CONCLUSION

Our results suggest that for minimal desmoplastic stromal reaction- disease, prophylactic lateral neck dissection could be avoided. In contrast, lateral neck dissection should be strongly considered in cases of advanced disease (desmoplastic stromal reaction positivity and basal calcitonin >500 pg/mL). In case of desmoplastic stromal reaction positivity and bCT <500 pg/mL, the extension of lymph node dissection should be tailored to patient and lesion features.

Holomics and Artificial Intelligence-Driven Precision Oncology for Medullary Thyroid Carcinoma: Addressing Challenges of a Rare and Aggressive Disease

Background/Objective: Medullary thyroid carcinoma (MTC) is a rare yet aggressive form of thyroid cancer comprising a disproportionate share of thyroid cancer-related mortalities, despite its low prevalence. MTC differs from other differentiated thyroid malignancies due to its heterogeneous nature, presenting complexities in both hereditary and sporadic cases. Traditional management guidelines, which are designed primarily for papillary thyroid carcinoma (PTC), fall short in providing the individualized care required for patients with MTC. In recent years, the sheer volume of data generated from clinical evaluations, radiological imaging, pathological assessments, genetic mutations, and immunological profiles has made it humanly impossible for clinicians to simultaneously analyze and integrate these diverse data streams effectively. This data deluge necessitates the adoption of advanced technologies to assist in decision-making processes. Holomics, which is an integrated approach that combines various omics technologies, along with artificial intelligence (AI), emerges as a powerful solution to address these challenges. Methods: This article reviews how AI-driven precision oncology can enhance the diagnostic workup, staging, risk stratification, management, and follow-up care of patients with MTC by processing vast amounts of complex data quickly and accurately. Articles published in English language and indexed in Pubmed were searched. Results: AI algorithms can identify patterns and correlations that may not be apparent to human clinicians, thereby improving the precision of personalized treatment plans. Moreover, the implementation of AI in the management of MTC enables the collation and synthesis of clinical experiences from across the globe, facilitating a more comprehensive understanding of the disease and its treatment outcomes. Conclusions: The integration of holomics and AI in the management of patients with MTC represents a significant advancement in precision oncology. This innovative approach not only addresses the complexities of a rare and aggressive disease but also paves the way for global collaboration and equitable healthcare solutions, ultimately transforming the landscape of treatment and care of patients with MTC. By leveraging AI and holomics, we can strive toward making personalized healthcare accessible to every individual, regardless of their economic status, thereby improving overall survival rates and quality of life for MTC patients worldwide. This global approach aligns with the United Nations Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being at all ages.

Thyroglossal Duct Cyst Located in the Thyroid Gland Misdiagnosed With Thyroid Carcinoma: A Case Report and Literature Review

The clinicopathologic features of thyroglossal duct cyst when it develops ectopically in the thyroid gland remain unclear because of its rarity, which makes diagnosis difficult. Clinical diagnosis and treatment should not disregard the possibility of thyroglossal cysts located in the thyroid gland. We here report the current case to prepare others and provide data for the diagnosis and treatment of this kind of disease.

The Accuracies of Fine-Needle Aspiration Biopsy without Ultrasound Guidance versus Frozen-Section Examination of Thyroid Nodule Diagnosis in Teaching Hospital Universitas Sumatera Utara: Single-Center Experience

BACKGROUND: The urgency to determine the most applicable methodological approach in thyroid nodules diagnosis workup is unquestionably important due to a significant increase in its prevalence globally. To date, fine-needle aspiration biopsy (FNAB) is the most recommended procedure to diagnose preoperatively even though the certain role of frozen-section examination (FSE) intraoperatively were significant as well to be administered at some circumstances. AIM: This study aims to measure the diagnostic accuracies of FNAB and FSE and determine the role of each procedure in the current thyroid nodules’ workup. MATERIALS AND METHODS: This retrospective study was conducted at teaching hospital of Universitas Sumatera Utara, Indonesia. We included and investigated both FNAB and FSE in 106 patients; the results were compared to the final histopathological report, in which statistical analyses were conducted. RESULTS: Most of the nodules are malignant after histopathological confirmation. From the fourfold contingency table, we were able to subtract several diagnostic parameters of the procedures. The FSE substantially disclosed better performance in sensitivity, specificity, positive predictive value (PPV), negative predictive value, and remarkably the accuracy. After several in-depth analyses, it is apparent that a higher rate of false-negative in FNAB is inducing its substandard performance, especially when the guidance of ultrasonography was not applied in this study. Furthermore, an analysis toward the concordance between both procedures results is revealing a significant improvement on almost every parameter, indicated by 100.0% specificity and PPV. CONCLUSION: Although the outcomes in this study are not corresponding to the current guidelines, we acknowledged several limitations in this study, However, the role of FSE in thyroid nodule workup should be reconsidered since we found that the procedure is exhibiting a potential to assist the current method, even though the influence of its certain pitfall remained questionable.

Follicular Thyroid Adenoma Showing Avid Uptake on 68Ga-DOTA-FAPI-04 PET/CT

ABSTRACT

We describe the case of a 48-year-old man suspected to have recurrent colon carcinoma who underwent 68Ga-DOTA-FAPI-04 PET/CT, revealing the presence of an incidentaloma with intense FAPI uptake in the left thyroid lobe. Based on PET/CT findings, malignancy was suspected. Biopsy confirmed the diagnosis of follicular thyroid adenoma with fibrosis and calcification. This case emphasizes the need to increase awareness of this benign lesion in the differential diagnosis of incidental thyroid nodules with high FAPI activity.