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Perumal PV, Siddaraju N, Saxena SK, Rajendiran S, Bhat RV. Utility of the Growth Differentiation Factor-15 in the Differential Diagnosis of Follicular-Patterned Lesions of the Thyroid on Cytopathologic and Histopathologic Samples. Cureus 2023; 15:e46206. [PMID: 37905271 PMCID: PMC10613452 DOI: 10.7759/cureus.46206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Background Follicular-patterned lesions are a major gray zone in thyroid cytopathology. The recently introduced 2022 World Health Organization (WHO) classification emphasizes the importance of genetic alterations in thyroid neoplasms with the introduction of certain newer terminologies that are expected to cause remarkable changes in cytopathologic and histopathologic reporting. Although molecular assays such as the Afirma gene expression classifier and the ThyroSeq are already in use, there has been an ongoing search for further reliable molecular markers. The growth differentiation factor-15 (GDF-15) is one among them. This study aimed to determine the diagnostic utility of GDF-15 mRNA expression in frozen tissue and fine-needle aspiration (FNA) samples from follicular-patterned thyroid lesions and neoplasms. Methodology The real-time quantitative polymerase chain reaction was performed on 75 frozen tissue and FNA samples each from 19 cases of follicular thyroid hyperplasia (FTH), 10 nodular goiters (NGs), 17 follicular thyroid adenomas (FTAs), eight follicular thyroid carcinomas (FTCs), 12 follicular variant of papillary thyroid carcinomas (FVPTCs), and nine classic papillary thyroid carcinomas (CPTCs) that were diagnosed according to the 2017 WHO classification of thyroid neoplasms. The GDF-15 mRNA expression in all these cases was assessed and compared with the control thyroid tissue samples. One-way analysis of variance and the Kruskal-Wallis test were performed using GraphPad Prism 8 software to determine the significance of differences in the GDF-15 mRNA levels among various thyroid lesions. Results A higher GDF-15 mRNA expression was noted in the malignant thyroid neoplasms including FTC, FVPTC, and CPTC in comparison to FTA, with a fold change between the malignant and benign groups being more than 244.18 times. A difference in the fold change was noted between FTH and FTA with an increase in GDF-15 mRNA level in the latter, which was statistically not significant. Conclusions The fact that GDF-15 mRNA was studied both on fine-needle aspiration cytologic and the frozen tissue material and that the majority of the lesions studied were follicular-patterned establishes the GDF-15 as a potential marker not only for diagnosing malignant thyroid neoplasms of the follicular epithelium but also in distinguishing benign and malignant follicular-patterned neoplasms of the thyroid.
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Affiliation(s)
- Prasanna V Perumal
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Neelaiah Siddaraju
- Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Sunil K Saxena
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Soundravally Rajendiran
- Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Ramachandra V Bhat
- Pathology, Indira Gandhi Medical College and Research Institute (IGMC & RI), Puducherry, IND
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2
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Wang S, Liu W, Ye Z, Xia X, Guo M. Development of a joint diagnostic model of thyroid papillary carcinoma with artificial neural network and random forest. Front Genet 2022; 13:957718. [PMID: 36276977 PMCID: PMC9585230 DOI: 10.3389/fgene.2022.957718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Papillary thyroid carcinoma (PTC) accounts for 80% of thyroid malignancy, and the occurrence of PTC is increasing rapidly. The present study was conducted with the purpose of identifying novel and important gene panels and developing an early diagnostic model for PTC by combining artificial neural network (ANN) and random forest (RF). Methods and results: Samples were searched from the Gene Expression Omnibus (GEO) database, and gene expression datasets (GSE27155, GSE60542, and GSE33630) were collected and processed. GSE27155 and GSE60542 were merged into the training set, and GSE33630 was defined as the validation set. Differentially expressed genes (DEGs) in the training set were obtained by "limma" of R software. Then, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis as well as immune cell infiltration analysis were conducted based on DEGs. Important genes were identified from the DEGs by random forest. Finally, an artificial neural network was used to develop a diagnostic model. Also, the diagnostic model was validated by the validation set, and the area under the receiver operating characteristic curve (AUC) value was satisfactory. Conclusion: A diagnostic model was established by a joint of random forest and artificial neural network based on a novel gene panel. The AUC showed that the diagnostic model had significantly excellent performance.
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Affiliation(s)
| | | | | | | | - Minggao Guo
- Department of Thyroid, Parathyroid, Breast, and Hernia Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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3
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Li P, Pan X, Zheng Z, Sun Y, Han Y, Dong J. LINC00271 inhibits epithelial-mesenchymal transition of papillary thyroid cancer cells by downregulating trefoil factor 3 expression. ACTA ACUST UNITED AC 2020. [DOI: 10.31491/apt.2020.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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4
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Weiner J, Kranz M, Klöting N, Kunath A, Steinhoff K, Rijntjes E, Köhrle J, Zeisig V, Hankir M, Gebhardt C, Deuther-Conrad W, Heiker JT, Kralisch S, Stumvoll M, Blüher M, Sabri O, Hesse S, Brust P, Tönjes A, Krause K. Thyroid hormone status defines brown adipose tissue activity and browning of white adipose tissues in mice. Sci Rep 2016; 6:38124. [PMID: 27941950 PMCID: PMC5150531 DOI: 10.1038/srep38124] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 11/07/2016] [Indexed: 12/28/2022] Open
Abstract
The present study aimed to determine the effect of thyroid hormone dysfunction on brown adipose tissue activity and white adipose tissue browning in mice. Twenty randomized female C57BL/6NTac mice per treatment group housed at room temperature were rendered hypothyroid or hyperthyroid. In-vivo small animal 18F-FDG PET/MRI was performed to determine the effects of hypo- and hyperthyroidism on BAT mass and BAT activity. Ex-vivo14C-acetate loading assay and assessment of thermogenic gene and protein expression permitted analysis of oxidative and thermogenic capacities of WAT and BAT of eu-, hyper and hypothyroid mice. 18F-FDG PET/MRI revealed a lack of brown adipose tissue activity in hypothyroid mice, whereas hyperthyroid mice displayed increased BAT mass alongside enhanced 18F-FDG uptake. In white adipose tissue of both, hyper- and hypothyroid mice, we found a significant induction of thermogenic genes together with multilocular adipocytes expressing UCP1. Taken together, these results suggest that both the hyperthyroid and hypothyroid state stimulate WAT thermogenesis most likely as a consequence of enhanced adrenergic signaling or compensation for impaired BAT function, respectively.
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Affiliation(s)
- Juliane Weiner
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
| | - Mathias Kranz
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Research Site Leipzig, Department of Neuroradiopharmaceuticals, Leipzig, Germany
| | - Nora Klöting
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany.,University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Anne Kunath
- German Center for Diabetes Research (DZD), Leipzig, Germany
| | - Karen Steinhoff
- Department of Nuclear Medicine, University Hospital, Leipzig, Germany
| | - Eddy Rijntjes
- Institute of Experimental Endocrinology, Charité University Hospital, Berlin, Germany
| | - Josef Köhrle
- Institute of Experimental Endocrinology, Charité University Hospital, Berlin, Germany
| | - Vilia Zeisig
- Department of Nuclear Medicine, University Hospital, Leipzig, Germany
| | - Mohammed Hankir
- University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Claudia Gebhardt
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
| | - Winnie Deuther-Conrad
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Research Site Leipzig, Department of Neuroradiopharmaceuticals, Leipzig, Germany
| | - John T Heiker
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
| | - Susan Kralisch
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany.,University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Michael Stumvoll
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany.,University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Matthias Blüher
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany.,University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany
| | - Osama Sabri
- University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital, Leipzig, Germany
| | - Swen Hesse
- University of Leipzig, IFB Adiposity Diseases, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital, Leipzig, Germany
| | - Peter Brust
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Research Site Leipzig, Department of Neuroradiopharmaceuticals, Leipzig, Germany
| | - Anke Tönjes
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
| | - Kerstin Krause
- Department of Endocrinology and Nephrology, University Hospital, Leipzig, Germany
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Ting S, Synoracki S, Bockisch A, Führer D, Schmid KW. [Clinical importance of thyroid gland cytology]. DER PATHOLOGE 2016; 36:543-52. [PMID: 26462485 DOI: 10.1007/s00292-015-0093-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The cytological evaluation of fine needle biopsies (FNB) of the thyroid gland crucially depends on a close cooperation between clinicians and cytopathologists. Scintigraphy, sonography as well as clinical data and patient history are necessary for a correct interpretation of the indications for FNB; moreover, these data are of outstanding importance for cytopathologists for the correct interpretation of the cytomorphological findings. This overview describes the present standards in the acquisition, technical workup and cytopathological interpretation of thyroid gland tissue obtained by FNB, particularly focusing on the rapidly growing relevance of additional molecular pathological investigations to increase the diagnostic accuracy of thyroid FNB.
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6
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Krause K, Weiner J, Hönes S, Klöting N, Rijntjes E, Heiker JT, Gebhardt C, Köhrle J, Führer D, Steinhoff K, Hesse S, Moeller LC, Tönjes A. The Effects of Thyroid Hormones on Gene Expression of Acyl-Coenzyme A Thioesterases in Adipose Tissue and Liver of Mice. Eur Thyroid J 2015; 4:59-66. [PMID: 26601074 PMCID: PMC4640296 DOI: 10.1159/000437304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 06/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Thyroid hormones (TH) exert pleiotropic effects on glucose and lipid homeostasis. However, it is as yet unclear how TH regulate lipid storage and utilization in order to adapt to metabolic needs. Acyl-CoA thioesterases (ACOTs) have been proposed to play a regulatory role in the metabolism of fatty acids. OBJECTIVES We investigated the interaction between thyroid dysfunction and Acot expression in adipose tissues and livers of thyrotoxic and hypothyroid mice. METHODS Ten-week-old female C57BL/6NTac mice (n = 10/group) were made hyperthyroid by the application of L-thyroxine (2 µg/ml in drinking water) for 4 weeks. Hypothyroidism was induced in 10-week-old mice by feeding an iodine-free chow supplemented with 0.15% PTU for 4 weeks. We measured mRNA expression levels of Acot8, 11 and 13 in the liver and epididymal and inguinal white and brown adipose tissues (BAT). Furthermore, we investigated hepatic Acot gene expression in TRα- and TRβ-deficient mice. RESULTS We showed that the expression of Acot8, 11 and 13 is predominantly stimulated by a thyrotoxic state in the epididymal white adipose tissue. In contrast, hypothyroidism predominantly induces the expression of Acot8 in BAT in comparison with BAT of thyrotoxic and euthyroid mice (p < 0.01). However, no significant changes in Acot expression were observed in inguinal white adipose tissue. In liver, Acot gene expression is collectively elicited by a thyrotoxic state. CONCLUSIONS These data suggest that ACOTs are targets of TH and are likely to influence 3,5,3'-triiodo-L-thyronine-orchestrated mechanisms of lipid uptake, storage and utilization to adapt the regulation of metabolic demands.
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Affiliation(s)
- Kerstin Krause
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
- *Kerstin Krause, Division of Endocrinology and Nephrology, Department of Medicine, University of Leipzig, Liebigstrasse 21, DE-04103 Leipzig (Germany), E-Mail
| | - Juliane Weiner
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
| | - Sebastian Hönes
- Department of Endocrinology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Nora Klöting
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
- IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Eddy Rijntjes
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - John T. Heiker
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
| | - Claudia Gebhardt
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
| | - Josef Köhrle
- Institute for Experimental Endocrinology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dagmar Führer
- Department of Endocrinology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Karen Steinhoff
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
- IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Lars C. Moeller
- Department of Endocrinology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Anke Tönjes
- Division of Endocrinology and Nephrology, Department of Medicine, Leipzig, Germany
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7
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Carbonic anhydrase 4 and crystallin α-B immunoreactivity may distinguish benign from malignant thyroid nodules in patients with indeterminate thyroid cytology. J Surg Res 2014; 190:565-74. [PMID: 24880201 DOI: 10.1016/j.jss.2014.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/07/2014] [Accepted: 03/14/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Thyroid nodules are present in 19%-67% of the population and carry a 5%-10% risk of malignancy. Unfortunately, fine-needle aspiration biopsies are indeterminate in 20%-30% of patients, often necessitating thyroid surgery for diagnosis. Numerous DNA microarray studies including a recently commercialized molecular classifier have helped to better distinguish benign from malignant thyroid nodules. Unfortunately, these assays often require probes for >100 genes, are expensive, and only available at a few laboratories. We sought to validate these DNA microarray assays at the protein level and determine whether simple and widely available immunohistochemical biomarkers alone could distinguish benign from malignant thyroid nodules. METHODS A tissue microarray (TMA) composed of 26 follicular thyroid carcinomas (FTCs) and 53 follicular adenomas (FAs) from patients with indeterminate thyroid nodules was stained with 17 immunohistochemical biomarkers selected based on prior DNA microarray studies. Antibodies used included galectin 3, growth and differentiation factor 15, protein convertase 2, cluster of differentiation 44 (CD44), glutamic oxaloacetic transaminase 1 (GOT1), trefoil factor 3 (TFF3), Friedreich Ataxia gene (X123), fibroblast growth factor 13 (FGF13), carbonic anhydrase 4 (CA4), crystallin alpha-B (CRYAB), peptidylprolyl isomerase F (PPIF), asparagine synthase (ASNS), sodium channel, non-voltage gated, 1 alpha subunit (SCNN1A), frizzled homolog 1 (FZD1), tyrosine related protein 1 (TYRP1), E cadherin, type 1 (ECAD), and thyroid hormone receptor associated protein 220 (TRAP220). Of note, two of these biomarkers (GOT1 and CD44) are now used in the Afirma classifier assay. We chose to compare specifically FTC versus FA rather than include all histologic categories to create a more uniform immunohistochemical comparison. In addition, we have found that most papillary thyroid carcinoma could often be reasonably distinguished from benign disease by morphological cytology findings alone. RESULTS Increased immunoreactivity of CRYAB was associated with thyroid malignancy (c-statistic, 0.644; negative predictive value [NPV], 0.90) and loss of immunoreactivity of CA4 was also associated with malignancy (c-statistic, 0.715; NPV, 0.90) in indeterminate thyroid specimens. The combination of CA4 and CRYAB for discriminating FTC from FA resulted in a better c-statistic of 0.75, sensitivity of 0.76, specificity of 0.59, positive predictive value (PPV) of 0.32, and NPV of 0.91. When comparing widely angioinvasive FTC from FA, the resultant c-statistic improved to 0.84, sensitivity of 0.75, specificity of 0.76, PPV of 0.11, and NPV of 0.99. CONCLUSIONS Loss of CA4 and increase in CRYAB immunoreactivity distinguish FTC from FA in indeterminate thyroid nodules on a thyroid TMA with an NPV of 91%. Further studies in preoperative patient fine needle aspiration (FNAs) are needed to validate these results.
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8
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Cerutti JM. Employing genetic markers to improve diagnosis of thyroid tumor fine needle biopsy. Curr Genomics 2012; 12:589-96. [PMID: 22654558 PMCID: PMC3271311 DOI: 10.2174/138920211798120781] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 09/02/2011] [Accepted: 09/02/2011] [Indexed: 12/18/2022] Open
Abstract
Fine-Needle Aspiration (FNA) is the most widely used and cost-effective preoperative test for the initial evaluation of a thyroid nodule, although it has limited diagnostic accuracy for several types of tumors. Patients will often receive cytological report of indeterminate cytology and are referred to surgery for a more accurate diagnosis. An improved test would help physicians rapidly focus treatment on true malignancies and avoid some unnecessary treatment of benign tumors. This review will discuss current molecular markers that may improve thyroid nodule diagnosis.
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Affiliation(s)
- Janete M Cerutti
- Genetic Bases of Thyroid Tumor Laboratory, Division of Genetics, Department of Morphology and Genetics and Division of Endocrinology, Department of Medicine, Federal University of São Paulo, SP, Brazil
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Karger S, Krause K, Engelhardt C, Weidinger C, Gimm O, Dralle H, Sheu-Grabellus SY, Schmid KW, Fuhrer D. Distinct pattern of oxidative DNA damage and DNA repair in follicular thyroid tumours. J Mol Endocrinol 2012; 48:193-202. [PMID: 22331172 DOI: 10.1530/jme-11-0119] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Increased oxidative stress has been linked to thyroid carcinogenesis. In this paper, we investigate whether oxidative DNA damage and DNA repair differ in follicular adenoma (FA) and follicular thyroid carcinoma (FTC). 7,8-Dihydro-8-oxoguanine (8-OxoG) formation was analysed by immunohistochemistry in 46 FAs, 52 FTCs and 18 normal thyroid tissues (NTs). mRNA expression of DNA repair genes OGG1, Mut Y homologue (MUTYH) and endonuclease III (NTHL1) was analysed by real-time PCR in 19 FAs, 25 FTCs and 19 NTs. Induction and repair of oxidative DNA damage were studied in rat FRTL-5 cells after u.v. irradiation. Moreover, activation of DNA damage checkpoints (ataxia telangiectasia mutated (ATM) and H2A histone family, member X (H2AFX (H2AFX))) and proliferation index (MIB-1) were quantified in 28 non-oxyphilic and 24 oxyphilic FTCs. Increased nuclear and cytosolic 8-OxoG formation was detected in FTC compared with follicular adenoma, whereby cytosolic 8-OxoG formation was found to reflect RNA oxidation. Significant downregulation of DNA repair enzymes was detected in FTC compared with FA. In vitro experiments mirrored the findings in FTC with oxidative stress-induced DNA checkpoint activation and downregulation of OGG1, MUTYH and NTHL1 in FRTL-5 cells, an effect that, however, was reversible after 24 h. Further analysis of FTC variants showed decreased oxidative DNA damage, sustained checkpoint activation and decreased proliferation in oxyphilic vs non-oxyphilic FTC. Our data suggest a pathophysiological scenario of accumulating unrepaired DNA/RNA damage in FTC vs counterbalanced DNA/RNA damage and repair in FA. Furthermore, this study provides the first evidence for differences in oxidative stress defence in FTC variants with possible implications for therapeutic response and prognostic outcome.
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Affiliation(s)
- Stefan Karger
- Clinic of Endocrinology and Nephrology, Department of Internal Medicine, Neurology and Dermatology, University of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
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10
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Chung KW, Kim SW, Kim SW. Gene expression profiling of papillary thyroid carcinomas in Korean patients by oligonucleotide microarrays. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:271-80. [PMID: 22563533 PMCID: PMC3341475 DOI: 10.4174/jkss.2012.82.5.271] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 03/15/2012] [Accepted: 03/21/2012] [Indexed: 12/12/2022]
Abstract
Purpose The incidence of papillary thyroid carcinomas (PTCs) is rapidly increasing in Korea. Analyzing the gene expression profiling (GEP) of PTCs will facilitate the advent of new methods in diagnosis, prognostication, and treatment. We performed this study to find the GEP of Korean PTCs. Methods We performed oligonucleotide microarray analysis with 19 PTCs and 7 normal thyroid glands. Differentially expressed genes were selected using a t-test (|fold| >3) and adjusted Benjamini-Hochberg false discovery rate P-value < 0.01. Quantitative reverse transcription-polymerase chain reaction (QRT-PCR) was used to validate microarray data. A classification model was developed by support vector machine (SVM) algorithm to diagnose PTCs based on molecular signatures. Results We identified 79 differentially expressed genes (70 up-regulated and 9 down-regulated) according to the criteria. QRT-PCR for five genes (CDH3, NGEF, PROS1, TGFA, MET) was confirmatory of the microarray data. Hierarchical cluster analysis and a classification model by the SVM algorithm accurately differentiated PTCs from normal thyroid gland based on GEP. Conclusion A disease classification model showed excellent accuracy in diagnosing PTCs, thus showing the possibility of molecular diagnosis in the future. This GEP could serve as baseline data for further investigation in the management of PTCs based on molecular signatures.
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Affiliation(s)
- Ki-Wook Chung
- Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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11
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Karger S, Krause K, Gutknecht M, Schierle K, Graf D, Steinert F, Dralle H, Führer D. ADM3, TFF3 and LGALS3 are discriminative molecular markers in fine-needle aspiration biopsies of benign and malignant thyroid tumours. Br J Cancer 2012; 106:562-8. [PMID: 22223087 PMCID: PMC3273347 DOI: 10.1038/bjc.2011.578] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Previously, we reported a six-marker gene set, which allowed a molecular discrimination of benign and malignant thyroid tumours. Now, we evaluated these markers in fine-needle aspiration biopsies (FNAB) in a prospective, independent series of thyroid tumours with proven histological outcome. Methods: Quantitative RT–PCR was performed (ADM3, HGD1, LGALS3, PLAB, TFF3, TG) in the needle wash-out of 156 FNAB of follicular adenoma (FA), adenomatous nodules, follicular and papillary thyroid cancers (TC) and normal thyroid tissues (NT). Results: Significant expression differences were found for TFF3, HGD1, ADM3 and LGALS3 in FNAB of TC compared with benign thyroid nodules and NT. Using two-marker gene sets, a specific FNAB distinction of benign and malignant tumours was achieved with negative predictive values (NPV) up to 0.78 and positive predictive values (PPV) up to 0.84. Two FNAB marker gene combinations (ADM3/TFF3; ADM3/ACTB) allowed the distinction of FA and malignant follicular neoplasia with NPV up to 0.94 and PPV up to 0.86. Conclusion: We demonstrate that molecular FNAB diagnosis of benign and malignant thyroid tumours including follicular neoplasia is possible with recently identified marker gene combinations. We propose multi-centre FNAB studies on these markers to bring this promising diagnostic tool closer to clinical practice.
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Affiliation(s)
- S Karger
- Department of Internal Medicine, Neurology and Dermatology, Clinic for Endocrinology and Nephrology, University of Leipzig, Liebigstr. 18, 04103 Leipzig, Germany
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12
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Yamada H, Takano T, Kihara M, Hirokawa M, Yoshida H, Watanabe M, Iwatani Y, Hidaka Y, Miyauchi A. Measurement of TFF3 mRNA in aspirates from thyroid nodules using mesh filtration: the first clinical trial in 130 cases. Endocr J 2012; 59:621-30. [PMID: 22572548 DOI: 10.1507/endocrj.ej12-0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Measurement of gene expression levels in thyroid tumor cells in aspirates was difficult because it is interfered with peripheral blood cells or infiltrating lymphocytes. In this study, we established a novel method to separate thyroid tumor cells from blood cells efficiently with mesh filtration. The expression level of trefoil factor 3 (TFF3) mRNA was estimated using LGALS3 mRNA as an internal control (T/G ratio) in 148 preoperative thyroid aspirates. Intra-assay coefficients of variation (CV) of T/G ratio for high, moderate, and low samples were 6.5%, 2.5%, and 9.7%, respectively, and inter-assay CV for high, moderate, and low samples were 27.7%, 21.9%, and 38.2%, respectively. Nondiagnostic samples in terms of T/G ratio and cytology were 12.2% and 16.9%, respectively. We observed no interference with the data by contaminating blood cells. Among these patients, 12 patients received more than two repeated aspirations. We did not observe a marked day-to-day variation except in two cases. All 13 preoperative aspirates diagnosed as malignant by cytology showed an extremely low T/G ratio, whereas 93 aspirates diagnosed as benign by cytology showed extremely varied T/G ratios and 21.5% of them showed a T/G ratio below the cut-off value. Eleven cases underwent surgery. All nodules showing a low T/G ratio were diagnosed as papillary carcinoma by pathological diagnosis. However, one nodule diagnosed as follicular adenoma after surgery showed a high T/G ratio. Our present method may be a promising preoperative test for measuring mRNAs in thyroid aspirates.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Biopsy, Fine-Needle
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/surgery
- Diagnosis, Differential
- Filtration/instrumentation
- Filtration/methods
- Humans
- Micropore Filters/statistics & numerical data
- Molecular Diagnostic Techniques/standards
- Peptides/analysis
- Peptides/genetics
- Peptides/metabolism
- Preoperative Period
- RNA, Messenger/analysis
- RNA, Messenger/metabolism
- Real-Time Polymerase Chain Reaction
- Reference Values
- Surgical Mesh
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Nodule/diagnosis
- Thyroid Nodule/genetics
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Trefoil Factor-3
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Affiliation(s)
- Hiroya Yamada
- Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan
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Krause K, Prawitt S, Eszlinger M, Ihling C, Sinz A, Schierle K, Gimm O, Dralle H, Steinert F, Sheu SY, Schmid KW, Fuhrer D. Dissecting molecular events in thyroid neoplasia provides evidence for distinct evolution of follicular thyroid adenoma and carcinoma. THE AMERICAN JOURNAL OF PATHOLOGY 2011; 179:3066-74. [PMID: 21983636 DOI: 10.1016/j.ajpath.2011.08.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 08/22/2011] [Accepted: 08/26/2011] [Indexed: 12/24/2022]
Abstract
Benign hypofunctional cold thyroid nodules (CTNs) are a frequent scintiscan finding and need to be distinguished from thyroid carcinomas. The origin of CTNs with follicular morphologic features is unresolved. The DNA damage response might act as a physiologic barrier, inhibiting the progression of preneoplastic lesions to neoplasia. We investigated the following in hypofunctional follicular adenoma (FA) and follicular thyroid cancer (FTC): i) the mutation rate of frequently activated oncogenes, ii) the activation of DNA damage response checkpoints, and iii) the differential proteomic pattern between FA and FTC. Both FTC and FA, which did not harbor RAS, phosphoinositide-3-kinase, or PAX/peroxisome proliferator activated receptor-γ mutations, express various proteins in common and others that are more distinctly expressed in FTC rather than in FA or normal thyroid tissue. This finding is in line with the finding of constitutive DNA damage checkpoint activation (p-Chk2, γ-H2AX) and evidence for replicative stress causing genomic instability (increased cyclin E, retinoblastoma, or E2F1 mRNA expression) in FTC but not FA. We discuss the findings of the increased expression of translationally controlled tumor protein, phosphatase 2A inhibitor, and DJ-1 in FTC compared with FA identified by proteomics and their potential implication in follicular thyroid carcinogenesis. Our present findings argue for the definition of FA as a truly benign entity and against progressive development of FA to FTC.
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Affiliation(s)
- Kerstin Krause
- Clinic for Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
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Weidinger C, Krause K, Mueller K, Klagge A, Fuhrer D. FOXO3 is inhibited by oncogenic PI3K/Akt signaling but can be reactivated by the NSAID sulindac sulfide. J Clin Endocrinol Metab 2011; 96:E1361-71. [PMID: 21752881 DOI: 10.1210/jc.2010-2453] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Overactivation of the phosphatidylinositol 3-kinase (PI3K)/Akt pathway has emerged as a pivotal trigger of thyroid carcinogenesis. Recent findings from other tumor entities revealed that PI3K/Akt-driven carcinogenesis critically involves the inactivation of the tumor-suppressive transcription factor Forkhead box O (FOXO)-3. However, little is known about FOXO3 in the thyroid context. AIMS We sought to investigate the influence of the thyroid oncogenes BRAFV600E, H-RASV12, and p110α (H1074R) on the regulation of the PI3K downstream target FOXO3 in vitro. Furthermore, the impact of the expression of phosphatase and tensin homolog deleted from chromosome 10 (PTEN) on the transcriptional activity of FOXO3 was assessed in a panel of 44 human thyroid tumors. Finally, we tried to modulate FOXO3 activity pharmacologically with help of the nonsteroidal antiinflammatory drug sulindac sulfide (SS). RESULTS We found that the overexpression of p110α H1074R results in the inactivation of FOXO3 via its nuclear exclusion. In vivo, we observed a direct correlation between PTEN expression and the transcriptional activation of FOXO3. In vitro, we found that stimulation with SS reversed PI3K/Akt-driven inactivation of FOXO3, resulting in its nuclear relocation and a combined induction of the antiproliferative FOXO target genes Gadd45α and p27(kip1) and the proapoptotic FOXO target gene Bim in benign (FRTL-5) and malignant human thyrocytes (FTC-133). In agreement with this, SS promoted the cell cycle arrest and apoptosis in thyroid cells, which could be amplified by the transfection of exogenous FOXO3. CONCLUSION Our data suggest that deregulation of proapoptotic FOXO3 represents a central step in PI3K/Akt-mediated thyroid carcinogenesis. Thus, SS might represent an attractive pharmacological tool for targeting thyroid neoplasia with aberrant PI3K/Akt/FOXO3 signaling.
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Affiliation(s)
- Carl Weidinger
- Clinic of Endocrinology, Department of Medicine, University Hospital Essen, Hufelandstr 55, D-45147 Essen, Germany
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15
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Ducena K, Abols A, Vilmanis J, Narbuts Z, Tārs J, Andrējeva D, Linē A, Pīrāgs V. Validity of multiplex biomarker model of 6 genes for the differential diagnosis of thyroid nodules. Thyroid Res 2011; 4:11. [PMID: 21707985 PMCID: PMC3155827 DOI: 10.1186/1756-6614-4-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/27/2011] [Indexed: 11/10/2022] Open
Abstract
Background Currently the cytological examination of fine needle aspiration (FNA) biopsies is the standard technique for the pre-operative differential diagnosis of thyroid nodules. However, the results may be non-informative in ~20% of cases due to an inadequate sampling and the lack of highly specific, measurable cytological criteria, therefore ancillary biomarkers that could aid in these cases are clearly needed. The aim of our study was to evaluate the mRNA expression levels of 8 candidate marker genes as the diagnostic biomarkers for the discrimination of benign and malignant thyroid nodules and to find a combination of biomarkers with the highest diagnostic value. Materials and methods mRNA expression levels of eight candidate marker genes - BIRC5, CCND1, CDH1, CITED1, DPP4, LGALS3, MET and TFF3 was measured by real-time RT-PCR in paired nodular and surrounding normal thyroid tissue specimens of 105 consecutive patients undergoing thyroid surgery and compared between different types of thyroid lesions. Results Significant differences in the mRNA expression levels between the normal and malignant thyroid tissues and between benign and malignant nodules were found for BIRC5, CCND1, CITED1, DPP4, LGALS3, MET and TFF3, but not CDH1. On a single gene basis, relative quantity (RQ) of LGALS3 had the highest diagnostic value for the discrimination of malignant and benign thyroid nodules (AUC = 0.832, P < 0.0001 and 90.9% sensitivity and 65.6% specificity at the optimal cut-off on ROC curve). The only two-marker set that outperformed LGALS3 was RQ sum of LGALS3 and BIRC5 (AUC = 0.841, P < 0.0001). An application of multivariate logistic regression analysis resulted in the generation of a multiplex biomarker model based on LGALS3, BIRC5, TFF3, CCND1, MET and CITED1 that had considerably higher specificity than a single marker or two marker gene-based models (AUC = 0.895, P < 0.0001, 70.5% sensitivity and 93.4% specificity). Conclusions This study confirmed that mRNA expression levels of 7 out of 8 candidate genes analysed have a diagnostic value for the distinction of benign and malignant thyroid nodules. The multiplex biomarker model based on 6 genes outperformed a single marker or two marker-based models and warrants feasibility studies on FNA biopsies and the validation in a larger cohort of patients.
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Affiliation(s)
- Kristine Ducena
- Faculty of Medicine, University of Latvia, Raina Bulvaris 19, Riga, LV1586, Latvia.
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17
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Abstract
Thyroid nodular disease is highly frequent and affects 20-23% of the adult population in Germany. Differential diagnosis of thyroid nodules is directed at exclusion of thyroid autonomy and thyroid cancer. In addition, large nodules/nodular goiters may cause oesophageal and/or tracheal compression. Besides the patient's history and clinical examination, laboratory investigations (TSH-level, calcitonin screening), functional (scintiscan) and morphological imaging (ultrasound, in rare cases also CT without contrast media and MRI), as well as fine needle aspiration biopsy are useful tools in the differential diagnosis. In the past years, major advances have been made in the understanding of the molecular pathogenesis of thyroid tumors. This has led to the possibility of a molecular classification of thyroid tumors and may have prognostic as well as therapeutic impact.
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Affiliation(s)
- D Führer
- Klinik für Endokrinologie und Nephrologie,Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Liebigstrasse 18, 04103, Leipzig, Deutschland.
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18
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Freitas BCG, Cerutti JM. Genetic markers differentiating follicular thyroid carcinoma from benign lesions. Mol Cell Endocrinol 2010; 321:77-85. [PMID: 19932149 DOI: 10.1016/j.mce.2009.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 11/09/2009] [Accepted: 11/12/2009] [Indexed: 01/21/2023]
Abstract
Thyroid nodules are commonly encountered during routine medical care. The main problem established by a discovery of a thyroid nodule is to discriminate between a benign and malignant lesion. Fine-needle aspiration (FNA) is the most widely used and cost-effective preoperative test for initial evaluation of a thyroid nodule. While the overall accuracy of FNA for classical papillary thyroid carcinoma (PTC) approaches 100%, it has limited accuracy with follicular lesions. Patients with a cytological report of indeterminate or follicular lesions are referred to surgery for a more accurate diagnosis. A more acute molecular-based test for thyroid nodules is needed not only to improve treatment decisions, but also to potentially reduce the long-term health costs. Several studies have looked into biologic markers that could be used as an adjuvant to distinguish the benign from malignant nodules. This review will focus on those biomarkers that are potentially useful in the diagnosis of thyroid lesions commonly classified as indeterminate.
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Affiliation(s)
- Beatriz C G Freitas
- Genetic Bases of Thyroid Tumor Laboratory, Division of Genetics, Department of Morphology and Genetics, Federal University of São Paulo, SP, Brazil
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Abstract
Since the introduction of fine needle aspiration biopsy (FNAB) in the 1970's, a preoperative diagnostic technique for thyroid follicular carcinoma has long been awaited. Many markers that distinguish follicular carcinomas from adenomas have been reported; however, most of them have not been confirmed to be beneficial for clinical use. Trefoil factor 3 (TFF3) is a relatively new family of peptides that bears the three-loop trefoil domain. Several groups have reported that the suppression of TFF3 mRNA expression is related to malignant characteristics of thyroid follicular cell-derived tumors and the expression level of TFF3 mRNA is the most promising indicator for diagnosing follicular carcinoma. Development of TFF3-based diagnostic methods is now ongoing and it may not be long before thyroid follicular carcinoma can be diagnosed preoperatively using an aspirated sample from the tumor.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adenoma/diagnosis
- Adenoma/genetics
- Adenoma/pathology
- Adenoma/surgery
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Biomarkers, Tumor/physiology
- Biopsy, Fine-Needle
- Diagnosis, Differential
- Humans
- Models, Biological
- Peptides/genetics
- Peptides/metabolism
- Peptides/physiology
- Preoperative Care/methods
- Prognosis
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Trefoil Factor-3
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Affiliation(s)
- Toru Takano
- Department of Laboratory Medicine, Osaka University Graduate School of Medicine, Japan
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Eszlinger M, Krohn K, Hauptmann S, Dralle H, Giordano TJ, Paschke R. Perspectives for improved and more accurate classification of thyroid epithelial tumors. J Clin Endocrinol Metab 2008; 93:3286-94. [PMID: 18593772 DOI: 10.1210/jc.2008-0201] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
CONTEXT Histologic examination of thyroid nodules is the current standard to distinguish benign from malignant thyroid epithelial tumors and to classify histologic subtypes. This review analyzes the problems in histological differential diagnosis as well as contradictions between histology and molecular data and describes possibilities to combine histology with molecular data in an effort to more accurately classify thyroid epithelial tumors. EVIDENCE ACQUISITION Published literature, addressing the current recommendations for thyroid tumor classification, as well as literature on the application of histology and molecular studies on the etiology of thyroid tumors is analyzed. EVIDENCE SYNTHESIS The current histologic criteria to classify thyroid tumors, especially follicular-patterned tumors, are hampered by considerable interobserver variability. The detection of somatic mutations via genotyping and the definition of potentially informative gene expression signatures by microarray analyses, which can distinguish cancer subtypes as well as low- and high-risk cohorts, have recently demonstrated significant diagnostic potential. Moreover, in a routine diagnostic setting, micro-RNA profiling appears most promising due to their relative stability and the high accuracy of their expression profiles. CONCLUSIONS It is very likely that molecular definitions of thyroid tumors mentioned in the current World Health Organization classification will be further developed, leading to future progress in defining thyroid tumor types by an integrated histologic and molecular approach. These integrated classifications need to be evaluated for their specific impact on thyroid tumor diagnosis and prognosis.
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Affiliation(s)
- Markus Eszlinger
- Third Medical Department, University of Leipzig, D-04103 Leipzig, Germany
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