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Kulkarni AM, Gayam PKR, Aranjani JM. Advances in Understanding and Management of Erdheim-Chester Disease. Life Sci 2024; 348:122692. [PMID: 38710283 DOI: 10.1016/j.lfs.2024.122692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Erdheim Chester Disease (ECD) is a rare histiocytic disorder marked by infiltration of organs with CD68+ histiocytes. ECD stems from mutations of BRAF and MAP2K1 in hematopoietic stem and progenitor cells (HSPCs), which further differentiate into monocytes and histiocytes. Histopathology reveals lipid-containing histiocytes, which test positive for CD68 and CD133 in immunohistochemistry. Signs and symptoms vary and depend on the organ/s of manifestation. Definitive radiological results associated with ECD include hairy kidney, coated aorta, and cardiac pseudotumor. Treatment options primarily include anti-cytokine therapy and inhibitors of BRAF and MEK signaling.
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Affiliation(s)
- Aniruddha Murahar Kulkarni
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prasanna Kumar Reddy Gayam
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jesil Mathew Aranjani
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Mendes JM, Elsheikh TM, Di Marco J, Russell J, Gladkaya T, Nicolas MM, Clapacs E, Bena JF, McAfee JL, Policarpio-Nicolas MLC. Are there specific cytologic features that can predict BRAF V600E mutational status of papillary thyroid carcinoma in fine-needle aspiration specimens? Diagn Cytopathol 2024; 52:295-302. [PMID: 38372437 DOI: 10.1002/dc.25290] [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: 09/25/2023] [Revised: 01/19/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND BRAFV600E mutation is the most common molecular alteration found in papillary thyroid carcinoma (PTC) and has been linked to recurrent disease or possibly more aggressive behavior. Some studies have reported sickle-shaped nuclei (SSN) and plump pink cells (PPC) to be predictive markers of BRAF mutation in FNA cytology. We aimed to evaluate the reproducibility of the aforementioned cytologic features. METHODS A computerized search for diagnosed PTC surgical pathology cases tested for BRAFV600E mutation by Sanger DNA sequencing was performed. Blinded to BRAF results, the corresponding cytology was reviewed for presence of SSN and PPC. Classic nuclear PTC (CNPTC) features, cystic change, and psammoma bodies were also evaluated. The results were correlated with BRAFV600E mutational status and histologic subtypes. RESULTS Study cohort consisted of 113 cases (74 BRAFV600E mutated, 39 BRAFV600E wild type). SSN and combined CNPTC /SSN had positive predictive value of 74% and 75%, respectively. CNPTC showed 92% sensitivity and 20% specificity. Psammoma bodies had 92% specificity and 5% sensitivity. The presence of combined PPC/SSN showed 80% specificity, 27% sensitivity, and diagnostic accuracy of 45%. CNPTC was seen in 60/61 (98%) SSN and 45/45 (100%) PPC. There was no significant statistical association between SSN, PPC, and CNPTC with specific histologic subtypes and BRAF mutational status. CONCLUSION CNPTC is sensitive but not specific for BRAF mutational status. SSN, PPC, and CNPTC are not predictive markers for the presence of BRAF mutation or histologic subtypes. Additional studies may be needed to further corroborate these findings.
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Affiliation(s)
- Juliann M Mendes
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tarik M Elsheikh
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica Di Marco
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jennifer Russell
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tatyana Gladkaya
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marlo M Nicolas
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elisha Clapacs
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - James F Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - John L McAfee
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Cervical exenteration and its variants for locally advanced thyroid cancer: when, why, and how? Curr Opin Otolaryngol Head Neck Surg 2023; 31:65-72. [PMID: 36912217 DOI: 10.1097/moo.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW To describe the modern surgical approach for management of advanced thyroid cancers infiltrating the cervicovisceral axis with special attention to well differentiated tumors not amenable to organ-sparing techniques. In particular, cervical exenteration, herein defined as the sum of total thyroidectomy, central compartment and lateral neck dissections, variously associated with total laryngectomy and possible partial or total pharyngoesophagectomy, represents an extreme surgical procedure that, in properly selected cases, allows for reasonable palliation of central compartment life-threatening signs/symptoms if not cure for an advanced oncologic condition. RECENT FINDINGS Cervical exenteration is not contraindicated by the presence of limited distant metastases at presentation. Even though it requires that the patient is in general good health as it can be associated with a number of complications and long in-hospital stay, when appropriately planned and performed according to the most recent reconstructive nuances, it allows good oncologic outcomes that are not inferior to those described for similarly advanced primaries of the upper aerodigestive tract. In addition, quality of life and functional results are not significantly different from those described after total laryngectomy for primary laryngeal squamous cell carcinomas. SUMMARY Cervical exenteration requires a tertiary, expert, multidisciplinary effort in terms of diagnosis, surgical performance, and postoperative care. A patient-centered decision process is strongly warranted taking into consideration alternative therapeutic and symptom-based palliative strategies.
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Muacevic A, Adler JR, Sebeih H, Alessa MA, Alkaf HH, Bahaj A, Abdelmonim SK. Noninvasive Follicular Thyroid Neoplasm With Papillary-Like Nuclear Features: What a Surgeon Should Know. Cureus 2023; 15:e33649. [PMID: 36788866 PMCID: PMC9912993 DOI: 10.7759/cureus.33649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
The inclusion of the less aggressive follicular form of papillary thyroid cancer (PTC) is associated with an increase in the incidence of the condition, with the follicular variant of PTC being the most common of all variants. The majority of individuals with the encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) are treated as though they have classic thyroid cancer, despite the availability of mounting evidence to contradict the aforementioned. According to numerous research, a certain type of noninvasive-EFVPTC (NI-EFVPTC) demonstrated poor histopathologic diagnostic reproducibility and has received aggressive treatment similar to that of a classical thyroid neoplasm. Therefore, to replace the term NI-EFVPC, a new nomenclature for these tumors, called "noninvasive follicular thyroid neoplasm with papillary-like nuclear characteristics" (NIFTP), was introduced in the year 2016. The present paper explores this recently introduced terminology, clinical, histologic, and molecular features, and diagnostic criteria.
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Association of BRAF V600E Mutation with the Aggressive Behavior of Papillary Thyroid Microcarcinoma: A Meta-Analysis of 33 Studies. Int J Mol Sci 2022; 23:ijms232415626. [PMID: 36555268 PMCID: PMC9779545 DOI: 10.3390/ijms232415626] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
An association between the BRAFV600E mutation and the clinicopathological progression of papillary thyroid microcarcinoma (PTMC) has been suggested. We aimed to summarize the relevant literature and determine the predictive value of BRAFV600E mutation in predicting clinical outcomes and risk stratification in patients with PTMC. A systematic search using PubMed, Cochrane, and Embase up to February 2020 was performed. A total of 33 studies met the inclusion criteria, resulting in a pool of 8838 patients, of whom 5043 (57.1%) patients were positive for BRAFV600E mutation. Tumors with positive BRAFV600E mutation had a higher tendency for multifocality (RR = 1.09, 95%CI = 1.03-1.16), extrathyroidal extension (RR = 1.79, 95%CI = 1.37-2.32), and lymph node metastasis (RR = 1.43, 95%CI = 1.19-1.71). Patients with BRAFV600E mutation were at increased risk of disease recurrence (RR = 1.90, 95%CI = 1.43-2.53). PTMC in patients positive for the BRAFV600E mutation is more aggressive than wild-type BRAF PTMC. Since BRAF-mutated PTMC is generally more resistant to radioiodine treatment, patients with BRAFV600E-mutated PTMC may require earlier management, such as a minimally invasive ablative intervention. Conservative management by active surveillance may be suitable for patients with wild-type BRAFV600E PTMC.
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Sharma AK, Jain K, Singhal P, Rawat DS, Jain SK, Sharma S. Encapsulated Follicular Variant of Papillary Thyroid Carcinoma: A review on Surgical Treatment. Indian J Otolaryngol Head Neck Surg 2022; 74:6384-6390. [PMID: 36742493 PMCID: PMC9895742 DOI: 10.1007/s12070-022-03107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023] Open
Abstract
Differentiated thyroid carcinoma is one of the commonest malignancies in head and neck region. Among differentiated thyroid carcinoma, papillary carcinoma is the commonest. Encapsulated follicular variant of papillary thyroid carcinoma tumors are very indolent tumors which behave like benign tumors. Many tumors have been over diagnosed and over treated in spite of their indolent nature. We aimed to find out if total thyroidectomy is really required for very low grade tumors like encapsulated FVPTC. We operated 672 patients of thyroid disease during 2012 to 2020 in SMS Medical College, Jaipur. Out of 256 patients, 199 patients (78%) had papillary carcinoma of thyroid. Classical variant was present in 40% and follicular variant was present in 35% (N-69). Out of 69 patients with follicular variant of PTC, 59 patients had well encapsulated type of follicular variant of PTC while 10 patients had invasive type of follicular variant of PTC. Encapsulated FVPTC are less aggressive and indolent tumors. They should be treated more conservatively. Hemithyroidectomy is sufficient treatment for its complete cure. Out of 69 patients with Follicular variant of PTC, 59 patients had encapsulated disease. Out of 59 patients, 14 (24%) had bilateral nodular disease. 45 (77%) patients had unilateral disease; multicentric in one lobe in 9 (15%) patients and unicentric in 36 (61%) patients. However, encapsulated FVPTC was only found in predominant lobe and the non dominant lobe had benign disease.
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Affiliation(s)
- Anjani Kumar Sharma
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
| | - Khushboo Jain
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
| | - Pawan Singhal
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
| | | | - Shailesh Kumar Jain
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
| | - Shivam Sharma
- Department of Otorhinolaryngology, SMS Medical College, B-43, Krishnapuri, Old Ramgarh Mod, Jaipur, 302002 India
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Sabán M, Tolaba N, Orlandi AM, Deutsch S, Pitoia F, Lowenstein A, Calabrese MC, Cavallo A, Iotti A, Monteros Alvi M, Nallar M, Jaén A, Figurelli S, Carrizo F, Colobraro A, García Tascón G, Saccoliti M, Paes de Lima A, Lencioni M, Califano I, Cabezón C. Non-invasive follicular neoplasm with papillary-like nuclear features: a challenging and infrequent entity in Argentina. Endocrine 2022; 77:493-499. [PMID: 35799079 DOI: 10.1007/s12020-022-03115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/12/2022] [Indexed: 04/17/2023]
Abstract
PURPOSE Non-invasive encapsulated follicular variant of papillary thyroid cancer was reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). These neoplasms have an extremely low malignant potential. The aim of this study was (1) to assess the prevalence of NIFTP in patients with papillary thyroid carcinoma, (2) to evaluate their outcomes, and (3) to determine their molecular profile. METHODS Multicenter, descriptive, retrospective study. Patients with papillary thyroid cancer diagnosed from January 2006 to December 2016 from 11 referral centers were included. Diagnosis of NIFTP was based on criteria described by Nikiforov et al. in 2018. At least two pathologists agreed on the diagnosis. Two thousand six hundred and seventy-seven papillary thyroid cancer patients were included; 456 (17%) of them were follicular variant papillary thyroid cancer, and 30 (1.12%) fulfilled diagnostic criteria for NIFTP. RESULTS Each of the 30 included patients underwent a total thyroidectomy, and 50% were treated with radioiodine (median dose 100 mCi). After a median follow-up of 37 months, 84% of patients had an excellent response, 3% had an indeterminate response and data was missing in the remaining 13%. No metastatic lymph nodes, distant metastases or recurrences were found. RAS mutations were detected in 4 patients (13%). CONCLUSION The prevalence of NIFTP in our series is amongst the lowest reported. Excellent outcomes of patients underscore their low malignant potential. Molecular findings differ from other series, probably related to environmental or ethnic features of our population and the meticulous criteria for diagnosing NIFTP.
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Affiliation(s)
| | | | | | | | - Fabián Pitoia
- Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | | | | | | | | | | | | | - Ana Jaén
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Inés Califano
- Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Carmen Cabezón
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Avagliano A, Fiume G, Bellevicine C, Troncone G, Venuta A, Acampora V, De Lella S, Ruocco MR, Masone S, Velotti N, Carotenuto P, Mallardo M, Caiazza C, Montagnani S, Arcucci A. Thyroid Cancer and Fibroblasts. Cancers (Basel) 2022; 14:cancers14174172. [PMID: 36077709 PMCID: PMC9455043 DOI: 10.3390/cancers14174172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Thyroid cancer is the most common type of endocrine cancer, and its prevalence continue to rise. Non-metastatic thyroid cancer patients are successfully treated. However, looking for new therapeutic strategies is of great importance for metastatic thyroid cancers that still lead to death. With respect to this, the tumor microenvironment (TME), which plays a key role in tumor progression, should be considered as a new promising therapeutic target to hamper thyroid cancer progression. Indeed, thyroid tumors consist of cancer cells and a heterogeneous and ever-changing niche, represented by the TME, which contributes to establishing most of the features of cancer cells. The TME consists of extracellular matrix (ECM) molecules, soluble factors, metabolites, blood and lymphatic tumor vessels and several stromal cell types that, by interacting with each other and with tumor cells, affect TME remodeling, cancer growth and progression. Among the thyroid TME components, cancer-associated fibroblasts (CAFs) have gained more attention in the last years. Indeed, recent important evidence showed that thyroid CAFs strongly sustain thyroid cancer growth and progression by producing soluble factors and ECM proteins, which, in turn, deeply affect thyroid cancer cell behavior and aggressiveness. Hence, in this article, we describe the thyroid TME, focusing on the desmoplastic stromal reaction, which is a powerful indicator of thyroid cancer progression and an invasive growth pattern. In addition, we discuss the origins and features of the thyroid CAFs, their influence on thyroid cancer growth and progression, their role in remodeling the ECM and their immune-modulating functions. We finally debate therapeutic perspectives targeting CAFs.
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Affiliation(s)
- Angelica Avagliano
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
- Correspondence: (A.A.); (A.A.); Tel.: +39-081-7463422 (A.A. & A.A.)
| | - Giuseppe Fiume
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Alessandro Venuta
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Vittoria Acampora
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Sabrina De Lella
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Maria Rosaria Ruocco
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - Stefania Masone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Pietro Carotenuto
- TIGEM, Telethon Institute of Genetics and Medicine, 80078 Naples, Italy
- Medical Genetics, Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy
| | - Massimo Mallardo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - Carmen Caiazza
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - Stefania Montagnani
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Alessandro Arcucci
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
- Correspondence: (A.A.); (A.A.); Tel.: +39-081-7463422 (A.A. & A.A.)
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Wang K, Liu S, Tian Y, Liu C, Gui Z, Yu T, Zhang L. PDZK1 Interacting Protein 1 Promotes the Progression of Papillary Thyroid Cancer. J Clin Endocrinol Metab 2022; 107:2449-2461. [PMID: 35727731 DOI: 10.1210/clinem/dgac376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The incidence of papillary thyroid cancer (PTC) has increased rapidly in recent decades, and tumor progression events are common in PTC. The purpose of our study is to identify the differentially expressed genes (DEGs) correlated with PTC progression and investigate the function of PDZK1IP1 (PDZK1 interacting protein 1) in PTC. METHODS We first analyzed DEGs associated with PTC progression between paired PTC and normal thyroid tissues in 3 Gene Expression Omnibus data sets (GSE29265, GSE33630, and GSE60542) and The Cancer Genome Atlas (TCGA) database. Data from the TCGA database and our institution were utilized to explore the relationship between PDZK1IP1 expression and clinicopathological characteristics of PTC. The CCK8 cell proliferation assay, clone formation assay, flow cytometry assay, and the xenograft model were used to investigate the function of PDZK1IP1 in PTC. RESULTS Thirty-nine DEGs associated with PTC progression were identified, in which only PDZK1IP1 was upregulated in PTC tissue at both messenger RNA and protein levels. In addition, we found that high expression of PDZK1IP1 in the TCGA database was associated with poor progression-free survival, extrathyroidal extension, high stage, tall cell variant, and BRAFV600E mutation of the PTC (P < 0.001). In our collected samples, high expression of PDZK1IP1 was only related to lymph node metastasis (P < 0.05). Overexpression of PDZK1IP1 significantly promoted proliferation and inhibited apoptosis of PTC cells. Knockdown of PDZK1IP1 significantly inhibited proliferation, promoted apoptosis, and prevented xenograft formation of PTC cells. CONCLUSION PDZK1IP1 is an oncogene for tumorigenesis and development of PTC and might be a potential therapeutic target.
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Affiliation(s)
- Kun Wang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
- Department of Breast Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China
| | - Shiyang Liu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yao Tian
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Chenguang Liu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhengwei Gui
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Tianyao Yu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Lin Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Li Y, Wang Y, Li L, Qiu X. The clinical significance of BRAFV600E mutations in pediatric papillary thyroid carcinomas. Sci Rep 2022; 12:12674. [PMID: 35879379 PMCID: PMC9314322 DOI: 10.1038/s41598-022-16207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to review the clinical significance of BRAFV600E mutations in pediatric papillary thyroid carcinoma (PTC). From 2018 to 2021, 392 pediatric thyroid operations were performed in the first affiliated Hospital of Zhengzhou University. Of these, 169 patients underwent their first operation in our hospital and were histopathologically diagnosed as papillary thyroid carcinoma. BRAFV600E gene mutation detection was performed in these 169 pediatric patients to investigate the correlation between BRAF gene mutations and clinicopathological features. Ninety-seven of our 169 patients had a BRAFV600E mutation, with a mutation rate of 57.4%. The incidence of BRAFV600E was higher in boys than in girls, and in the 13-18-year age group as compared with the 6-12-year age group (P < 0.05). The positivity rate of BRAFV600E in unilateral PTC (67.7%) was significantly higher than the ones in bilateral PTC (28.9%). The occurrence of diffuse microcalcification of the thyroid negatively correlated with the presence of BRAFV600E mutations. BRAFV600E mutations were found more frequently in patients with smaller tumor size, a lack of multifocality, lower TSH levels and central lymph node metastasis. During the follow-up time, 70 patients were treated with iodine-131. Eight patients required a second surgery (All had cervical lymph node recurrence). BRAFV600E mutations do not suggest a more aggressive course in papillary thyroid carcinoma in pediatric patients in the short term.
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Affiliation(s)
- Yangsen Li
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yuanyuan Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Liwen Li
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xinguang Qiu
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
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Risk and Prognostic Factors for BRAFV600E Mutations in Papillary Thyroid Carcinoma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9959649. [PMID: 35647194 PMCID: PMC9132653 DOI: 10.1155/2022/9959649] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/20/2022] [Indexed: 12/29/2022]
Abstract
Background Over the past ten years, the incidence rate of papillary thyroid carcinoma (PTC) worldwide has been increasing rapidly year by year, with the incidence rate increasing 6% annually. PTC has become the malignant tumor with the highest growth rate in the world that fourteen PTC-related mutant genes have been identified. Whether the BRAFV600E mutation related to more aggressive clinicopathologic features and worse outcome in PTC remains variable and controversial. We aim to investigate the risk factors that may predict the BRAFV600E mutation potential of these lesions and new prevention strategies in PTC patients. Methods A total of 9,908 papillary thyroid carcinoma patients with average 74.6% BRAFV600E mutations were analyzed (RevMan 5.3 software) in this study. The PubMed, Embase, and ISI Web of Science databases were systematically searched for works published through December 15, 2021. Results The following variables were associated with an increased risk of BRAFV600E mutation in PTC patients: age ≥ 45 years (OR = 1.39, 95%CI = 1.21–1.60, p < 0.00001), male gender (OR = 1.13, 95%CI = 0.99–1.28, p = 0.06), multifocality (OR = 1.22, 95%CI = 1.07–1.40, p = 0.004), lymph node metastasis (OR = 1.33, 95%CI = 0.79–2.23, p = 0.28), extrathyroidal extension + (OR = 1.61, 95%CI = 1.06–2.44, p = 0.03), vascular invasion + (OR = 2.04, 95%CI = 1.32–3.15, p = 0.001), and tumor node metastasis stage (OR = 1.61, 95%CI = 1.38–1.88, p < 0.00001). In addition, tumor size (>1 cm) (OR = 0.51, 95%CI = 0.32–0.81, p = 0.005) and distant metastasis (OR = 0.69, 95%CI = 0.22–2.21, p = 0.54) had no association or risk with BRAFV600E mutation in PTC patients. Conclusion Our systematic review identified the following significant risk factors of BRAFV600E mutation in PTC patients: age (≥45 years), gender (male), multifocality, lymph node metastasis, vascular invasion, extrathyroidal extension, and advanced tumor node metastasis stage (stages III and IV). Tumor size (>1 cm) and distant metastasis do not appear to be correlated with BRAFV600E mutation in PTC patients.
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Role of STAT3 Expression in Thyroid Cancer: A Meta-Analysis and Systematic Review Based on the Chinese Population. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1116535. [PMID: 35463085 PMCID: PMC9033348 DOI: 10.1155/2022/1116535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/12/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022]
Abstract
Background Signal transduction and activator of transcription 3 (STAT3) is an oncogene with transcriptional activity. In recent years, there have been several studies concerning the clinicopathological significance of the expression of the STAT3 protein in thyroid cancer. However, the results are still inconsistent. In this study, we conducted a meta-analysis to evaluate the relationship between the expression of STAT3 protein and thyroid cancer susceptibility and its clinicopathological characteristics. Methods We searched the China National Knowledge Infrastructure (CNKI) database, Chinese Biomedical Literature Database (CBM), Chinese Scientific and Journal Database (VIP), Wanfang, PubMed, and EMBASE. The time frame of the publication search was from the establishment of each of the databases until December 2021. We performed a meta-analysis to quantitatively evaluate the relationship between the expression of the STAT3 protein in thyroid cancer and its clinicopathological characteristics. Results A total of eight articles were included in the meta-analysis, covering 448 thyroid cancer patients and 227 controls. Results indicated that the expression of STAT3 protein in thyroid cancer tissue is highly expressed (OR = 14.41, 95% CI (6.94, 29.91), p < 0.001). Besides, we also discovered that STAT3 protein is negatively correlated with thyroid cancer tumor diameter and TNM stage (OR = 0.13, 95% CI (0.05, 0.33), p < 0.001; OR = 0.40, 95% CI (0.24, 0.67), p < 0.001) and positively correlated with lymph node metastasis (OR = 2.83, 95% CI (1.08, 7.46), p = 0.035). However, STAT3 expression is not related to gender (OR = 0.88, 95% CI (0.54, 1.44), p = 0.609), age (OR = 0.54, 95% CI (0.21, 1.36), p = 0.191), capsular invasion (OR = 2.98, 95% CI (0.23, 38.29), p = 0.403), or tumor multiplicity (OR = 0.25, 95% CI (0.003, 19.28), p = 0.533). Conclusions This study reveals that STAT3 protein expression is significantly related to the susceptibility and clinicopathological characteristics of thyroid cancer. It also suggests that STAT3 may be a potential predictor of the clinical progression of thyroid cancer.
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Tan LC, Huang NS, Yu PC, Han PZ, Liu WL, Lu ZW, Shi RL, Shi X, Wang Y, Ji QH, Qu N, Wei WJ, Wang YL. Different clinicopathologic features predispose to different patterns of distant metastasis with heterogeneous short-term prognosis in patients with differentiated thyroid cancer. Clin Endocrinol (Oxf) 2022; 96:402-412. [PMID: 34592016 DOI: 10.1111/cen.14602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited studies have focused on the associated clinicopathologic features and short-term prognostic impacts of metastatic patterns at initial diagnosis in differentiated thyroid cancer (DTC). METHODS Overall, 530 individuals with distant DTC diagnosed between 2010 and 2014 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Multinomial logistic regression model was used to assess the clinicopathologic factors influencing the pattern of distant metastasis. Kaplan-Meier method and multivariable Cox regression were used to estimate the short-term effects of metastatic patterns on overall (OS) and thyroid cancer-specific survival (TCSS). RESULTS Fifty, 111, 263, 59 and 47 patients presented with distant lymph node (LN)-only, bone-only, lung-only, bone plus lung, and liver and/or brain metastases (Mets), respectively. Regional lymph node metastasis (LNM) and follicular histotype were the only confirmed risk factors for distant LN-only Mets and bone-only Mets, respectively. Larger tumour size, extrathyroidal extension (ETE) and papillary histotype were associated with lung-only Mets. Synchronous bone and lung Mets were more likely to occur in older patients. In addition, patients with distant LN-only Mets had hardly any negative effect on OS and TCSS, whereas those with synchronous bone and lung or liver/brain Mets predicted unfavourable short-term outcomes, regardless of whether they received total thyroidectomy and radioisotopes. CONCLUSIONS Different clinicopathologic factors predispose to different patterns of metastases with profound short-term survival differences among DTC patients. Our findings may help to determine effective pretreatment screening for aggressive metastatic patterns at initial diagnosis, and thus to provide additional treatment or access of clinical trials for these patients.
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Affiliation(s)
- Li-Cheng Tan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Nai-Si Huang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Peng-Cheng Yu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Pei-Zhen Han
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wan-Lin Liu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhong-Wu Lu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Rong-Liang Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Jun Wei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Long Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Kannan S. Molecular Markers in the Diagnosis of Thyroid Cancer in Indeterminate Thyroid Nodules. Indian J Surg Oncol 2022; 13:11-16. [PMID: 35462643 PMCID: PMC8986925 DOI: 10.1007/s13193-020-01112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 05/28/2020] [Indexed: 10/24/2022] Open
Abstract
The Bethesda System for the Reporting of Thyroid Cytology recognises six diagnostic categories of thyroid nodule cytology with an incremental risk of malignancy. Although the Bethesda system created a much-needed handhold by standardising the cytological diagnosis and management of thyroid nodules worldwide, the system does not provide a clear answer to the heterogeneous group of nodules with indeterminate cytology. Improvement in the assessment of indeterminate fine-needle aspiration (FNA) results with molecular testing allows better risk stratification and reduces the need for diagnostic thyroid surgery. The molecular markers are classified as a "rule out" test, which has a high negative predictive value and helpful in cases with a low pre-test probability of cancer to rule out thyroid cancer. The "rule in" test has a high positive predictive value and helps in confirming malignancy in those with a high pre-test probability of cancer. This review summarises the commonly used molecular studies in thyroid FNAC aspirates and their current role in clinical practice.
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Affiliation(s)
- Subramanian Kannan
- grid.416504.20000 0004 1796 819XDepartment of Endocrinology Diabetis & Metabolism, Narayana Health City, 258/A, Bommasandra Industrial Area Anekal Taluk, Hosur Rd, Bangalore, 560099 India
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15
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Rashid FA, Bhat GH, Khan MS, Tabassum S, Bhat MH. Variations in MAP kinase gladiators and risk of differentiated thyroid carcinoma. Mol Clin Oncol 2022; 16:45. [PMID: 35003743 PMCID: PMC8739702 DOI: 10.3892/mco.2021.2478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Thyroid carcinoma (TC) accounts for ~2.1% of newly diagnosed cancer cases. Mutations in KRAS, HRAS, NRAS and BRAF are primary participants in the development and progression of various types of malignancy, including differentiated TC (DTC). Therefore, the present prospective cohort study aimed to screen patients with DTC for variations in RAS gene family and BRAF gene. Exon 1 and 2 of KRAS, HRAS, NRAS and exon 15 of BRAF gene were screened for hotspot mutations in 72 thyroid tumor and adjacent normal tissue samples using di-deoxy Sanger sequencing. HRAS T81C mutation was found in 21% (15 of 72) of DTC tissue samples, therefore this mutation was investigated in blood samples from patients with DTC and controls as a genetic polymorphism. In addition, HRAS T81C genotypes were determined in 180 patients with DTC and 220 healthy controls by performing restriction fragment length polymorphism. BRAFV600E mutation was confined to classical variant of papillary thyoid cancer (CPTC; 44.4%) and was significantly associated with multifocality and lymph node (LN) metastasis. No mutation was found in exons 1 and 2 of KRAS and NRAS and exon 2 of HRAS genes, however, mutation was detected in exon 1 of HRAS gene (codon 27) at nucleotide position 81 in 21% (15 of 72) of DTC tumor tissue samples. Furthermore, HRAS T81C single nucleotide polymorphism was significantly associated with the risk of DTC with variant genotypes more frequently detected in cases compared with controls (P≤0.05). Moreover, frequency of variant genotypes (TC+CC) was significantly higher among DTC cases with no history of smoking, males, greater age, multifocality and LN metatasis compared with healthy controls (P<0.05). BRAFV600E mutation was primarily present in CPTC and associated with an aggressive tumor phenotype but mutations in RAS gene family were not present in patients with DTC. HRAS T81C polymorphism may be involved in the etiopathogenesis of DTC in a Pakistani cohort. Furthermore, testing for the BRAFV600E mutation may be useful for selecting initial therapy and follow-up monitoring.
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Affiliation(s)
- Faiza A Rashid
- Department of Biological Sciences, International Islamic University, Islamabad 1243, Pakistan
| | - Ghulam Hassan Bhat
- Department of Biochemistry, Government Medical College and Associated Shri Maharaja Hari Singh and Super Speciality Hospital, Srinagar, Jammu and Kashmir 190010, India
| | - Mosin S Khan
- Department of Biochemistry, Government Medical College and Associated Shri Maharaja Hari Singh and Super Speciality Hospital, Srinagar, Jammu and Kashmir 190010, India
| | - Sobia Tabassum
- Department of Biological Sciences, International Islamic University, Islamabad 1243, Pakistan
| | - Mohammad Hayat Bhat
- Department of Endocrinology, Government Medical College and Associated Shri Maharaja Hari Singh and Super Speciality Hospital, Srinagar, Jammu and Kashmir 190010, India
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16
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Zurnadzhy L, Bogdanova T, Rogounovitch TI, Ito M, Tronko M, Yamashita S, Mitsutake N, Chernyshov S, Masiuk S, Saenko VA. The BRAFV600E Mutation Is Not a Risk Factor for More Aggressive Tumor Behavior in Radiogenic and Sporadic Papillary Thyroid Carcinoma at a Young Age. Cancers (Basel) 2021; 13:cancers13236038. [PMID: 34885148 PMCID: PMC8656579 DOI: 10.3390/cancers13236038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Analysis of the groups of young Ukrainian patients (aged ≤28 years) with radiogenic and sporadic papillary thyroid carcinomas (PTCs) showed that the frequency of BRAFV600E was increasing with patient age, consistently remaining lower in radiogenic PTCs. In both etiopathogenic groups, the BRAFV600E-positive PTCs more frequently had a dominant papillary growth pattern, smaller tumor size, higher Ki67 labeling index, and a frequency of the major indicators of tumor invasiveness that is lower than or equal to that of the BRAFV600E-negative tumors. Comparison of the BRAFV600E-positive PTCs across the groups found a virtual absence of differences, while the BRAFV600E-negative tumors differed markedly and displayed a higher frequency of invasive tumor features in the radiogenic PTCs. Hence, there is evidence that BRAFV600E does not confer a more aggressive course of PTC in young patients regardless of tumor etiology. Abstract Histopathological changes in the fusion oncogene-driven papillary thyroid carcinomas (PTCs) from children and adolescents exposed to Chernobyl fallout have been extensively studied. However, characteristics of the radiogenic BRAFV600E-positive PTCs, whose proportion is growing with time, are not well described yet. We analyzed the relationship between the BRAFV600E status (determined immunohistochemically with the VE1 antibody) and the clinicopathological features of 247 radiogenic and 138 sporadic PTCs from young Ukrainian patients aged ≤28 years. The frequency of BRAFV600E was increasing with patient age, consistently remaining lower in radiogenic PTCs. In both etiopathogenic groups, the BRAFV600E-positive PTCs more frequently had a dominant papillary growth pattern, smaller tumor size, higher Ki67 labeling index, and a frequency of the major indicators of tumor invasiveness that is lower than or equal to that of the BRAFV600E-negative tumors. Comparison of the BRAFV600E-positive PTCs across the groups found a virtual absence of differences. In contrast, the BRAFV600E-negative radiogenic PTCs displayed less frequent dominant papillary and more frequent solid growth patterns, lower Ki67 labeling index, and higher invasiveness than the BRAFV600E-negative sporadic tumors. Thus, BRAFV600E is not associated with a more aggressive course of PTC in young patients regardless of etiology. The major clinicopathological differences between the radiogenic and sporadic PTCs are observed among the BRAFV600E-negative tumors.
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Affiliation(s)
- Liudmyla Zurnadzhy
- State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, 69 Vyshgorodska Str., 04114 Kyiv, Ukraine; (L.Z.); (T.B.); (M.T.); (S.C.)
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan;
| | - Tetiana Bogdanova
- State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, 69 Vyshgorodska Str., 04114 Kyiv, Ukraine; (L.Z.); (T.B.); (M.T.); (S.C.)
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan;
| | - Tatiana I. Rogounovitch
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan;
- Correspondence: ; Tel.: +81-(0)95-819-7116
| | - Masahiro Ito
- Nagasaki Medical Center, 2-1001-1 Kubara, Omura 856-8562, Japan;
| | - Mykola Tronko
- State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, 69 Vyshgorodska Str., 04114 Kyiv, Ukraine; (L.Z.); (T.B.); (M.T.); (S.C.)
| | - Shunichi Yamashita
- Fukushima Medical University, Hikarigaoka 1, Fukushima 960-1295, Japan;
- National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, 4-9-1 Anagawa, Chiba 263-8555, Japan
| | - Norisato Mitsutake
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan;
| | - Serhii Chernyshov
- State Institution “V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, 69 Vyshgorodska Str., 04114 Kyiv, Ukraine; (L.Z.); (T.B.); (M.T.); (S.C.)
| | - Sergii Masiuk
- State Institution “National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine”, 53 Illienka Str., 04050 Kyiv, Ukraine;
| | - Vladimir A. Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan;
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Silver JA, Bogatchenko M, Pusztaszeri M, Forest VI, Hier MP, Yang JW, Tamilia M, Payne RJ. BRAF V600E mutation is associated with aggressive features in papillary thyroid carcinomas ≤ 1.5 cm. J Otolaryngol Head Neck Surg 2021; 50:63. [PMID: 34742355 PMCID: PMC8572458 DOI: 10.1186/s40463-021-00543-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/10/2021] [Indexed: 12/28/2022] Open
Abstract
Background While some studies suggest that the BRAF V600E mutation correlates with a high-risk phenotype in papillary thyroid microcarcinoma (PTMC), more evidence is necessary before this mutation can be used to help guide decision making in the management of small thyroid nodules. This study investigated whether BRAF V600E mutation is associated with aggressive features in PTMC (≤ 1 cm) and small PTC (1–1.5 cm).
Methods Retrospective chart review was performed on 121 patient cases. Patients who underwent thyroid surgery for PTMC (≤ 1 cm) or small PTC (1–1.5 cm) were included if molecular testing was done for BRAF V600E mutation. Two study groups were created based on tumour size: PTMC (n = 55) and small PTC (n = 66). The groups were analysed for the presence of a BRAF V600E mutation and aggressive features, including macroscopic extrathyroidal extension (ETE), lymph node metastasis (LNM), and high-risk histological features (tall cell, columnar cell, hobnail, solid/trabecular, and diffuse sclerosing). The Fischer exact test was used to calculate statistical significance.
Results BRAF V600E mutations were detected in 43.6% of PTMC and 42.4% of small PTC. Of the mutated PTMC nodules, 54.1% demonstrated aggressive characteristics as compared to 19.4% of the non-mutated PTMCs (p = 0.010). Of the mutated small PTC tumours, 82.1% had aggressive features. In contrast, 28.9% of the non-mutated small PTCs showed aggressive features (p < 0.001).
Conclusions Our findings demonstrate an association between a BRAF V600E mutation and aggressive features in PTMC (≤ 1 cm) and small PTC (1–1.5 cm). Therefore, determining the molecular status of these thyroid nodules for the presence of BRAF V600E can help guide patient management. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-021-00543-9.
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Affiliation(s)
- Jennifer A Silver
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | | | - Marc Pusztaszeri
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Department of Pathology, McGill University, Montreal, QC, Canada.,Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Véronique-Isabelle Forest
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Division of Endocrinology, McGill University, Montreal, QC, Canada.,Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.,Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Ji Wei Yang
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Division of Endocrinology, McGill University, Montreal, QC, Canada.,Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michael Tamilia
- Faculty of Medicine, McGill University, Montreal, QC, Canada.,Department of Pathology, McGill University, Montreal, QC, Canada.,Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Faculty of Medicine, McGill University, Montreal, QC, Canada. .,Department of Otolaryngology-Head and Neck Surgery, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada. .,Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada.
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Rana C, Vuong HG, Nguyen TQ, Nguyen HC, Jung CK, Kakudo K, Bychkov A. The Incidence of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: A Meta-Analysis Assessing Worldwide Impact of the Reclassification. Thyroid 2021; 31:1502-1513. [PMID: 34060946 DOI: 10.1089/thy.2021.0158] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification has significantly influenced the field of thyroidology. However, the extent of this impact depends upon the incidence of NIFTP in a given population. In this meta-analysis, we aimed to obtain robust information about the actual incidence of NIFTP worldwide by reviewing the published data. Methods: Comprehensive literature search was performed using electronic databases of PubMed and Web of Science over a five-year period (January 1, 2016, to January 30, 2021). The incidence of NIFTP was calculated by dividing the number of NIFTPs by the number of papillary thyroid carcinomas (PTCs). Meta-analysis of proportion and their 95% confidence interval [CI] were pooled using the random-effect model. Heterogeneity across the included studies was assessed using I2 statistics. Egger's regression test and funnel plot of estimates were used to evaluate the publication bias. p-Value <0.05 was considered significant. Results: From 505 publications, we included 50 studies, all retrospective, with 100,780 PTCs and 3990 NIFTP from 92 institutions worldwide. The overall incidence of NIFTP was 6.0% [CI 4.4-8.2] among PTCs or thyroid malignancies with a high level of heterogeneity among the included studies (I2 = 98.6%). NIFTP incidence was largely similar in North America and Europe (9.3% vs. 9.6%), with a significantly lower overall rate in Asia (2.1%). There was a significant decline in the reported incidence of NIFTP in non-Asian studies published after 2017 (p = 0.002). On applying our data on global thyroid cancer statistics, this reclassification would affect ∼30,881 patients annually, with a lower impact in Asia compared with North America and Europe. Conclusions: This comprehensive meta-analysis confirms that the worldwide NIFTP incidence is much lower than estimated initially. The NIFTP rates are significantly lower in Asian compared with North American and European countries. Apart from geography, NIFTP rates are significantly influenced by the nature of study, type of database used for sample collection, and the diagnostic criteria used. Introduction of NIFTP may potentially spare over 30,000 patients worldwide annually from clinical and psychological consequences of a thyroid cancer diagnosis.
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Affiliation(s)
- Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Huy Gia Vuong
- Department of Neurosurgery, Oklahoma University of Health Sciences Center, Oklahoma City, Oklahoma, USA
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Thu Quynh Nguyen
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Hoang Cong Nguyen
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Izumi, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Abi-Raad R, Prasad ML, Zheng J, Hui P, Ustun B, Schofield K, Cai G, Adeniran AJ. Prognostic Assessment of BRAF Mutation in Preoperative Thyroid Fine-Needle Aspiration Specimens. Am J Clin Pathol 2021; 156:100-108. [PMID: 33527115 DOI: 10.1093/ajcp/aqaa213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We investigate the potential role of BRAF testing in guiding surgical intervention in papillary thyroid carcinoma (PTC). METHODS Thyroid fine-needle aspiration (FNA) cases with available BRAF result and follow-up thyroidectomy for PTC were included in the study. Cytology and surgical diagnoses were correlated with BRAF status. RESULTS There were 151 cases of thyroid FNA specimens with BRAF testing (70 mutant and 81 wild-type BRAF) and histologically confirmed unilateral, unifocal PTCs. There were no differences in age, sex, tumor size, or lymphovascular invasion on thyroidectomy specimens between mutant and wild-type BRAF cases. BRAF mutation was significantly associated with cytology diagnosis (P < .001), PTC subtype (P < .001), extrathyroidal extension (ETE) (P = .006), and higher tumor (T) stage (P = .04). However, an analysis within the histologic subtypes of PTC revealed no significant association between BRAF mutation and ETE or higher T stage. There was also no difference in central (P = .847) or lateral (p = 1) neck lymph node (LN) metastasis. CONCLUSIONS BRAF mutation identified in thyroid FNA specimens correlates with histologic subtypes but is not an independent factor for predicting PTC biological behavior and should not be used to guide the extent of LN dissection.
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Affiliation(s)
- Rita Abi-Raad
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Manju L Prasad
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Jingwei Zheng
- Clinical Research Center, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Berrin Ustun
- Department of Pathology, Montefiore Medical Center, New York, NY, USA
| | - Kevin Schofield
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
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20
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Gene Polymorphism of MUC15, MMP14, BRAF, and COL1A1 Is Associated with Capsule Formation in Hepatocellular Carcinoma. Can J Gastroenterol Hepatol 2021; 2021:9990305. [PMID: 34007838 PMCID: PMC8100414 DOI: 10.1155/2021/9990305] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The presence of a capsule is an important prognostic factor in hepatocellular carcinoma (HCC). Capsule formation is affected by tumor-host interaction, which may include collagen deposition and extracellular matrix (ECM) degradation. PURPOSE This study aimed to examine whether single-nucleotide polymorphisms (SNPs) in the genes for COL1A1 MUC15, MMP14, CD97, SMYD3, BRAF, and transforming growth factor beta 1 (TGF-β) are related to capsule formation. METHODS We prospectively recruited and analyzed 185 patients with HCC with or without a capsule between 2019 and 2020. The SNPs involved were analyzed by polymerase chain reaction. Differences in the allele and genotype frequency between the cases and controls were evaluated using the chi-square test. Odds ratios and 95% confidence intervals were calculated by logistic regression analysis with adjustment for age and sex. Stratification analyses were also performed with preselected variables. RESULTS The single-locus analysis showed that the presence of a capsule was significantly associated with five SNPs : MUC15 rs17309195 (P=0.01), rs12271124 (P= 0.02), rs10430847 (P=0.04), MMP14 rs17884816 (P=0.01), and BRAF rs74512895 (P=0.03). Adjusted logistic regression revealed that the decreased capsule formation was statistically significantly associated with BRAF rs76603725, COL1A1 rs2269336, and MUC15 rs17309195, while MMP14 rs17884816 and MUC15 rs10430847, rs2063278, and rs967490 were associated with increased capsule formation. The MUC15 block 2 haplotype was associated with increased capsule formation. CONCLUSIONS MUC15, MMP14, BRAF, and COL1A1 gene polymorphisms are associated with capsule formation in HCC. Studies involving larger samples are needed to confirm our results.
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Machine learning-based prediction model using clinico-pathologic factors for papillary thyroid carcinoma recurrence. Sci Rep 2021; 11:4948. [PMID: 33654166 PMCID: PMC7925610 DOI: 10.1038/s41598-021-84504-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/15/2021] [Indexed: 01/18/2023] Open
Abstract
This study analyzed the prognostic significance of clinico-pathologic factors, including the number of metastatic lymph nodes (LNs) and lymph node ratio (LNR), in patients with papillary thyroid carcinoma (PTC), and attempted to construct a disease recurrence prediction model using machine learning techniques. We retrospectively analyzed clinico-pathologic data from 1040 patients diagnosed with PTC between 2003 and 2009. We analyzed clinico-pathologic factors related to recurrence through logistic regression analysis. Among the factors that we included, only sex and tumor size were significantly correlated with disease recurrence. Parameters such as age, sex, tumor size, tumor multiplicity, ETE, ENE, pT, pN, ipsilateral central LN metastasis, contralateral central LNs metastasis, number of metastatic LNs, and LNR were input for construction of a machine learning prediction model. The performance of five machine learning models related to recurrence prediction was compared based on accuracy. The Decision Tree model showed the best accuracy at 95%, and the lightGBM and stacking model together showed 93% accuracy. Among those factors mentioned above, LNR and contralateral LN metastasis were used as important features in all machine learning prediction models. We confirmed that all machine learning prediction models showed an accuracy of 90% or more for predicting disease recurrence in PTC. LNR and contralateral LN metastasis were used as important features for constructing a robust machine learning prediction model. In the future, we have a plan to perform large-scale multicenter clinical studies to improve the performance of our prediction models and verify their clinical effectiveness.
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Run L, Wang L, Nong X, Li N, Huang X, Xiao Y. Involvement of HMGB1 in vemurafenib resistance in thyroid cancer cells harboring BRAF (V600E) mutation by regulating excessive autophagy. Endocrine 2021; 71:418-426. [PMID: 32666385 DOI: 10.1007/s12020-020-02417-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Thyroid carcinoma is the most frequent endocrine malignancy with high occurrence of BRAFV600E mutations. Though targeted therapy by vemurafenib, a specific inhibitor for BRAFV600E, has achieved great advance in therapeutic landscape, resistance occurrence is still a clinical challenge. Here, we sought to elucidate the function of high mobility group box 1 (HMGB1) in vemurafenib resistance in thyroid cancer harboring BRAF mutation. METHODS The expression of HMGB1 in BRAF-mutant BCPAP and BRAF-wild CAL-62 cells were determined by qRT-PCR and western. Then, BCPAP cells were transfected with recombinant HMGB1 plasmids, and vemurafenib-resistant BCPAP-R cells were treated with si-HMGB1. The efficacy of HMGB1 on vemurafenib resistance was evaluated by detecting cell viability, apoptosis, and caspase-3 activity. In addition, the involvement of autophagy pathway was investigated. RESULTS Lower expression of HMGB1 was observed in BRAF-mutant BCPAP cells that had high sensitivity to vemurafenib. Overexpression of HMGB1 attenuated BCPAP cell sensitivity to vemurafenib by increasing cell viability and decreasing cell apoptosis and caspase-3 activity. Intriguingly, higher expression of HMGB1 was confirmed in vemurafenib-resistant BCPAP-R cells. Moreover, knockdown of HMGB1 sensitized BCPAP-R cells to vemurafenib resistance. Mechanistically, vemurafenib exposure induced autophagy by enhancing LC3II, Beclin-1 expression, and reducing autophagy substrate p62 expression. Importantly, targeting HMGB1 suppressed vemurafenib-induced autophagy. Blocking autophagy pathway with its inhibitor 3-MA offset BCPAP-R cell resistance to vemurafenib. CONCLUSIONS These findings highlight that HMGB1-mediated autophagy may account for vemurafenib resistance in thyroid cancer harboring BRAF mutation, implying a promising approach to overcome vemurafenib resistance in vemurafenib-mutant thyroid carcinomas.
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Affiliation(s)
- Lin Run
- Department of Endocrinology, Xi'an Central Hospital, Xi'an JiaoTong University, Xi'an, 710003, Shannxi, PR China
| | - Liping Wang
- Department of Endocrinology, Xi'an Central Hospital, Xi'an JiaoTong University, Xi'an, 710003, Shannxi, PR China
| | - Xiting Nong
- Department of Endocrinology, Xi'an Central Hospital, Xi'an JiaoTong University, Xi'an, 710003, Shannxi, PR China
| | - Nan Li
- Department of Endocrinology, Xi'an Central Hospital, Xi'an JiaoTong University, Xi'an, 710003, Shannxi, PR China
| | - Xin Huang
- Department of General Surgery, Xi'an Central Hospital, Xi'an JiaoTong University, Xi'an, 710003, Shannxi, PR China.
| | - Yang Xiao
- Department of Endocrinology, Shaanxi Traditional Chinese Medicine Hospital, Xi'an, 710003, Shannxi, PR China.
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Zhang R, Dong L, Yu J. Concomitant Pathogenic Mutations and Fusions of Driver Oncogenes in Tumors. Front Oncol 2021; 10:544579. [PMID: 33520689 PMCID: PMC7844084 DOI: 10.3389/fonc.2020.544579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 11/27/2020] [Indexed: 01/01/2023] Open
Abstract
Driver oncogene alterations have always been one of leading causes in the process of occurrence and development of tumors. And the effects of driver oncogene alterations on tumorigenesis and progression in different kinds of tumors have been studied heatedly. And the roles that the driver oncogenes alterations play have been elucidated clearly in previous studies. The phenomenon of concomitant driver oncogenes mutations and driver genes fusions has gained much concentration in the past two decades. And a growing number of studies reported this phenomenon, either coexistence or mutually exclusivity. Here we reviewed on the phenomenon of concomitant mutations in three common types of carcinomas—lung cancer, thyroid cancer, and leukemia, which have been studied relatively more detailed and more general compared with others.
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Affiliation(s)
- Runjiao Zhang
- Cancer Molecular Diagnostics Core, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Caner, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Li Dong
- Cancer Molecular Diagnostics Core, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Caner, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, China
| | - Jinpu Yu
- Cancer Molecular Diagnostics Core, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Caner, Key Laboratory of Cancer Prevention and Therapy, Key Laboratory of Cancer Immunology and Biotherapy, Tianjin, China.,Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Samà MT, Grosso E, Mele C, Laurora S, Monzeglio O, Marzullo P, Boldorini R, Aluffi Valletti P, Aimaretti G, Scatolini M, Pagano L. Molecular characterisation and clinical correlation of papillary thyroid microcarcinoma. Endocrine 2021; 71:149-157. [PMID: 32621051 DOI: 10.1007/s12020-020-02380-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Papillary thyroid microcarcinoma (mPTC) is defined as a papillary thyroid cancer sized 10 mm or less. Despite their generally indolent clinical course and good prognosis, a subset of mPTCs shows potentially aggressive behaviour. METHODS To search for predictors of clinical outcome of mPTCs, we retrospectively evaluated the genetic tumour profile of 100 patients (23 M/77 F, mean age ± SD 53.8 ± 13.4 years) with histologically confirmed mPTCs through analysis of BRAF, NRAS and TERT promoter mutations as well as RET/PTC translocations. RESULTS Mean follow-up period was 8.4 ± 3.6 years. In 55 cases, mPTC were detected incidentally after surgery. Capsular invasion, bilateralism and multifocality were found in 11/100, 17/100 and 24/100 cases, respectively, while lymph-nodes metastases were present at diagnosis in 9/100 cases. After 3.5 ± 2.0 years, tumour relapse occurred in 6/100 cases and was locoregional in five (two in the thyroid bed, three in laterocervical lymph-nodes), while lung metastasis occurred in one case. Biochemical persistence of disease was seen in 1/100 case. Mutations occurred in 55/100 cases; BRAFV600E was the most frequently detected (49/100) and was associated with higher tumour size, bilateralism and follicular variant but not with capsular invasion. RET/PTC rearrangements were found in 2/100 cases, NRASQ61R in 4/100, while no mutations of TERT promoter gene were detected. Despite the observed association between BRAFV600E mutation and unfavourable histopathological features, we found no direct association with tumour recurrence, distant metastases and mortality. CONCLUSION In our study, the search for the most frequent genetic alterations as prognostic markers in mPTCs would not have changed the therapeutic strategy.
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Affiliation(s)
- Maria Teresa Samà
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.
| | - Enrico Grosso
- Laboratory of Molecular Oncology, Fondazione Edo ed Elvo Tempia, Ponderano, Biella, Italy
| | - Chiara Mele
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Sara Laurora
- Laboratory of Molecular Oncology, Fondazione Edo ed Elvo Tempia, Ponderano, Biella, Italy
| | - Oriana Monzeglio
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Paolo Marzullo
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Renzo Boldorini
- Pathology Department, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Paolo Aluffi Valletti
- ENT Division, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Maria Scatolini
- Laboratory of Molecular Oncology, Fondazione Edo ed Elvo Tempia, Ponderano, Biella, Italy
| | - Loredana Pagano
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Torino, Italy
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Romanelli K, Wells J, Patel A, Mendonca Torres M, Costello J, Jensen K, Vasko V. Clinical and molecular characterization of thyroid cancer when seen as a second malignant neoplasm. Ther Adv Endocrinol Metab 2021; 12:20420188211058327. [PMID: 35154635 PMCID: PMC8832328 DOI: 10.1177/20420188211058327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Second malignant neoplasms (SMN) are among the most serious long-term adverse health conditions in cancer survivors. The aim of this study was to characterize clinical findings of patients who developed thyroid cancers as SMN, and to examine genomic alterations in thyroid cancer tissue. METHODS Retrospective analysis of medical records from patients seen for management of thyroid cancer over 10-year period was performed. Clinical and pathologic data were retrieved from their medical charts. Tumor DNA and RNA were extracted from formalin-fixed, paraffin-embedded tissue and subjected to next-generation sequencing (NGS) using Ion Torrent Oncomine Focus Assay. Microfluidic digital polymerase chain reactions (PCRs) were performed using QIAcuity Digital PCR System to identify BRAF V600E mutations and RET/PTC fusions. RESULTS Sixteen of 620 patients operated for thyroid cancer had history of previously diagnosed malignancy. Eight patients were male and eight patients were female, with a median age at diagnosis of 58.5 years (range, 4-78). Four patients had history of pediatric malignancy (PedCa), and 12 patients had a history of prior malignancy as an adult (AdCa). The latency periods for development of SMN in PedCa and AdCa patients were 10.8 (±5.2) years and 9.5 (±5.2) years, respectively. Histopathology revealed papillary thyroid cancers in 15 cases, and follicular thyroid cancer in 1 case. All tumors were classified as T1 or T2, and there were no patients presenting with metastases at the time of surgery. Genomic alterations were detected in 13/16 (81.2%) tumors including eight gene mutations (BRAF V600E (N = 4), RAS (N = 2), PI3CA (N = 2) and five gene fusions (RET/PTC1 (N = 4) and STRN/ALK (N = 1). In patients with PedCa and AdCa, mutations were detected in 1/4 (25%) and 7/12 (58.3%), respectively, p = 0.56; and fusions were detected in 3/4 (75%) and 2/12 (16.6%), respectively, p = 0.06. In patients with and without history of therapeutic irradiation, mutations were detected with the same frequencies (5/10 (50%), and 3/6 (50%), respectively, p = 1.0). Gene fusions were detected in patients with and without history of irradiation in 5/10 (55.5%) and 0/6 (0%), respectively, p = 0.09. CONCLUSIONS Monitoring of cancer survivors for thyroid disorders allowed diagnosis of second thyroid cancers at early stages. Second thyroid cancers harbor genomic alterations that are typical for sporadic as well as for radio-induced thyroid cancers.
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Affiliation(s)
- Kristen Romanelli
- Department of Pediatric, Hematology/Oncology,
Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Justin Wells
- Department of Pathology, Walter Reed National
Military Medical Center, Bethesda, MD, USA
| | - Aneeta Patel
- Department of Pediatrics, Uniformed Services
University of Health Sciences, Bethesda, MD, USA
| | - Maria Mendonca Torres
- Department of Pediatrics, Uniformed Services
University of Health Sciences, Bethesda, MD, USA
| | - John Costello
- Department of Pediatrics, Uniformed Services
University of Health Sciences, Bethesda, MD, USA
| | - Kirk Jensen
- Department of Pediatrics, Uniformed Services
University of Health Sciences, Bethesda, MD, USA
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Association between BRAF V600E mutation and the clinicopathological features in incidental papillary thyroid microcarcinoma: A single-center study in Turkish patients. North Clin Istanb 2020; 7:321-328. [PMID: 33043255 PMCID: PMC7521097 DOI: 10.14744/nci.2020.69586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/24/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE: In this study, we evaluated the influences of BRAFV600E mutation on clinicopathological features in incidentally found papillary thyroid microcarcinomas (PTMCs). METHODS: This retrospective cohort study included 72 patients with PTMC who underwent surgery from 2008 to 2012. The mean follow-up of the whole cohort was three years. DNA was isolated using QIAamp DNA formalin-fixed, paraffin-embedded (FFPE) tissue kit. BRAF gene was amplified by the polymerase chain reaction-restriction fragment length (PCR-RFL) polymorphism method with the following primers. The clinicopathologic features (age, gender, histologic subtype, tumor size, presence of tumor capsule, bilaterality, multifocality, extrathyroidal extension (ETE), thyroid capsular invasion, presence of Hashimoto’s thyroiditis, lymph node metastasis (LNM) and distant metastasis) were compared between the BRAF (+) and BRAF (-) patient groups. RESULTS: BRAFV600E mutation was detected in 30 of the 72 patients (41.6%). The presence of the mutation was statistically significantly associated with classic variant (p=0.046), invasion of thyroid capsule (p=0.002) and absence of tumor capsule (p=0.003). CONCLUSION: Although incidental PTMCs positive for the BRAFV600E mutation had more invasive behavior, the presence of the mutation was not associated with recurrences within three years of follow-up.
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Rashid FA, Munkhdelger J, Fukuoka J, Bychkov A. Prevalence of BRAFV600E mutation in Asian series of papillary thyroid carcinoma-a contemporary systematic review. Gland Surg 2020; 9:1878-1900. [PMID: 33224863 PMCID: PMC7667088 DOI: 10.21037/gs-20-430] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/04/2020] [Indexed: 12/30/2022]
Abstract
Papillary thyroid carcinoma (PTC), the most common malignancy of the endocrine system, is frequently driven by BRAFV600E mutation, which was reported in 35-60% cases in Western series. Numerous studies have recently emerged from Asian countries and regions; however sufficient summary is lacking to date. BRAF mutation serves as a diagnostic and prognostic tool in thyroid cancer, therefore establishing a rate of BRAF on the national scale could be of practical significance. We performed systematic reviews of available literature to investigate the prevalence of BRAF mutation in series of PTC from various Asian countries and regions. Out of the total 3,966 reports identified via initial screening, 138 studies encompassing over 40,000 PTCs were included for the final analysis. A vast majority (90.2%) of PTCs with known BRAF status were from East Asia, including China, South Korea, and Japan, with BRAF mutation rates of 71.2%, 75.5%, and 70.6%, respectively. Less abundant Indian and Saudi Arabian series found 45.6% and 46.3% prevalence of BRAFV600E in PTC, respectively. Much limited evidence was available from Thailand, Iran, Kazakhstan, Taiwan, Singapore, Indonesia, Hong Kong, Philippines, Vietnam, Iraq, and Myanmar. No relevant publications were found from other highly populated countries, such as Pakistan, Bangladesh, and Malaysia. After grouping by geographic region, we found that the highest rate of BRAFV600E was reported in the PTC series from East Asia (76.4%). Much lower rate (45-48%) was seen in PTC cohorts from South Asia, Central Asia, and the Middle East while the Southeast Asian series were in between (57%). Further subgroup analysis revealed that studies employing fresh frozen tissue and fine-needle aspirates showed higher rates of BRAF compared to those used formalin-fixed paraffin-embedded tissues. We found that the PTC series enrolled patients' cohorts after 2010 demonstrated a higher rate of BRAF compared to the earlier series. Finally, pediatric PTCs had lower BRAF prevalence compared to the baseline rate for the country. In conclusion, despite considerable among and within countries heterogeneity, the Asian PTC series showed a higher prevalence of BRAFV600E mutation than that in Western series. Causes of geographic heterogeneity, whether genuine (etiology, genetics) or methodology-related should be further investigated.
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Affiliation(s)
- Faiza Abdul Rashid
- Department of Biological Sciences, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad, Pakistan
| | | | - Junya Fukuoka
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Abi-Raad R, Prasad ML, Adeniran AJ, Cai G. Fine-needle aspiration cytomorphology of papillary thyroid carcinoma with NTRK gene rearrangement from a case series with predominantly indeterminate cytology. Cancer Cytopathol 2020; 128:803-811. [PMID: 32931153 DOI: 10.1002/cncy.22353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Neurotrophic tyrosine kinase receptor (NTRK) rearrangement has been reported in a subset of papillary thyroid carcinoma (PTC) cases. Little is known about the cytomorphologic features of NTRK-rearranged PTC. METHODS We report an institutional series of 13 fine-needle aspiration (FNA) specimens of NTRK-rearranged PTC with a predominantly indeterminate cytology diagnosis. NTRK3 or NTRK1 rearrangements were detected on FNA or surgical specimens by next-generation sequencing. RESULTS The 13 patients had a median age of 18 years; 10 patients were female and 3 patients were male. In 10 (77%) cases, cytology was indeterminate, and histopathologic follow-up was predominantly the follicular variant of PTC (n = 8 [62%]), mostly infiltrative subtype. Of 12 FNA specimens available for review, a predominant loosely cohesive group pattern was the most commonly encountered architectural pattern (n = 5 [41%]), followed by single cell (n = 3 [25%]), thick cord (n = 2 [17%]), and microfollicular pattern (n = 2 [17%]). Background lymphocytic thyroiditis was observed in 9 cases. At the cellular level, the cytoplasm was moderate and granular, occasionally vacuolated. Classic PTC nuclear features (eg, nuclear enlargement, elongation, grooves, and nuclear membrane irregularity) were present but were often focal and subtle. Chromatin was often granular. Intranuclear pseudoinclusions were absent or rare. CONCLUSION Our study demonstrates that most cases of NTRK rearrangement lack classic PTC cytomorphologic characteristics. Loosely cohesive groups and single cells with granular, sometimes vacuolated cytoplasm and subtle nuclear features are often seen on FNA specimens. Recognizing these characteristics may be helpful to preoperatively prompt molecular testing, including NTRK rearrangement analysis.
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Affiliation(s)
- Rita Abi-Raad
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Manju L Prasad
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Guoping Cai
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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Dong SY, Chen J, Xia EJ, Lin RX, Du HY, Wang OC, Zhang XH, Hao RT. Clinical Analysis of BRAF V600E Mutation and Its Correlation With Sonographic Image Characteristics in Papillary Thyroid Carcinoma in Chinese Coastal Areas. Am Surg 2020; 86:450-457. [PMID: 32684022 DOI: 10.1177/0003134820919734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study analyzed the characteristics of BRAFV600E mutation in papillary thyroid carcinoma (PTC) in Chinese coastal areas. We intended to identify noninvasive methods to determine BRAFV600E status in thyroid nodules prior to surgery. BRAFV600E mutation and the sonographic characteristics of thyroid nodules were investigated in 670 PTC patients in our hospital. We aimed to determine the relationship between BRAFV600E mutation and the clinicopathological and sonographic imaging characteristics of PTC. The mutation rate of the BRAFV600E was 78.2%. BRAFV600E mutation was significantly associated with central node (univariate analyses, P = .005; multivariate analyses, P < .001, odds ratio [OR] = 10.255) and lateral node metastases (univariate analyses, P = .001; multivariate analyses, P < .001, OR = 22). It was less frequent in PTC coexisting with Hashimoto's thyroiditis (univariate analyses, P = .016; multivariate analyses, P < .001, OR = .034). Nodules without blood flow had a significantly higher mutation rate of BRAFV600E in PTC patients (univariate analyses, P = .026). BRAFV600E mutation was significantly associated with high suspicion in the Thyroid Imaging Reporting and Data System 5 (univariate analyses, P = .004; multivariate analyses, P = .014, OR = 6.456). Our results strongly suggest that BRAFV600E mutation plays a potential role in lymph node metastasis (central node metastasis, OR = 10.225; lateral node metastasis, OR = 22). Some sonographic imaging features might be helpful in estimating the status of BRAFV600E preoperatively.
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Affiliation(s)
- Si-Yang Dong
- 89657 Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Jie Chen
- 89657 Operating Room, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Er-Jie Xia
- 89657 Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Ri-Xu Lin
- 89657 Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Hai-Yan Du
- 89657 Department of Medical Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Ou-Chen Wang
- 89657 Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xiao-Hua Zhang
- 89657 Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Ru-Tian Hao
- 89657 Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
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30
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Espiritu GAM, Malana JT, Dumasis AJGV, Ang DC. High Preponderance of BRAF V600E Mutation in Papillary Thyroid Carcinoma Among Filipinos: A Clinicopathologic Study. J Glob Oncol 2020; 5:1-6. [PMID: 30694737 PMCID: PMC6426509 DOI: 10.1200/jgo.18.00085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose BRAF mutation in papillary thyroid carcinoma (PTC) is associated with an aggressive phenotype, with varying incidence. We evaluated the prevalence of BRAF mutations in PTC among Filipino patients and their correlation with clinicopathologic characteristics. Patients and Methods Clinicopathologic data were retrieved from 64 sequential patients who underwent thyroidectomy from June 2016 to December 2016. BRAF mutation testing was performed using Sanger sequencing. Results Eighteen (28%) of 64 patients were diagnosed with PTC; 12 (70.59%) of 17 harbored a BRAF V600E mutation (no amplification in one patient). Demographics of patients with PTC were as follows: 13 women and five men, with median age of 46 years (range, 25 to 74 years). Fourteen patients had conventional subtype PTC; two, follicular variant; one, oncocytic variant; and one, tall-cell features. Tumor size ranged from 0.8 to 7.0 cm (median, 2.4 cm); extrathyroidal extension was present in seven (38.9%) of 18 patients, multifocality in six (33.33%) of eight, and lymph node involvement in eight (44.4%) of 18. Significant association between presence of a BRAF mutation and presence of extrathyroidal extension or lymph node involvement was not determined due to the limited sample size. Conclusion The high preponderance of BRAF mutation (70.59%) suggests some correlation with the previously reported lower 5-year survival among Filipinos. This warrants further investigation in a larger-cohort prospective study.
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Affiliation(s)
- Gerard Anthony M Espiritu
- Gerard Anthony M. Espiritu, Joemarie T. Malana, and Daphne C. Ang, Makati Medical Center, Makati; and Arlie Jean Grace V. Dumasis and Daphne C. Ang, St Luke's Medical Center, Taguig, Philippines
| | - Joemarie T Malana
- Gerard Anthony M. Espiritu, Joemarie T. Malana, and Daphne C. Ang, Makati Medical Center, Makati; and Arlie Jean Grace V. Dumasis and Daphne C. Ang, St Luke's Medical Center, Taguig, Philippines
| | - Arlie Jean Grace V Dumasis
- Gerard Anthony M. Espiritu, Joemarie T. Malana, and Daphne C. Ang, Makati Medical Center, Makati; and Arlie Jean Grace V. Dumasis and Daphne C. Ang, St Luke's Medical Center, Taguig, Philippines
| | - Daphne C Ang
- Gerard Anthony M. Espiritu, Joemarie T. Malana, and Daphne C. Ang, Makati Medical Center, Makati; and Arlie Jean Grace V. Dumasis and Daphne C. Ang, St Luke's Medical Center, Taguig, Philippines
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Ozisik H, Yurekli BS, Demir D, Ertan Y, Simsir IY, Ozdemir M, Erdogan M, Cetinkalp S, Ozgen G, Saygili F. Langerhans cell histiocytosis of the thyroid together with papillary thyroid carcinoma. Hormones (Athens) 2020; 19:253-259. [PMID: 32314308 DOI: 10.1007/s42000-020-00181-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Hatice Ozisik
- Division of Endocrinology and Metabolism, Ege University, İzmir, Turkey.
| | | | - Derya Demir
- Division of Pathology, Ege University, İzmir, Turkey
| | - Yesim Ertan
- Division of Pathology, Ege University, İzmir, Turkey
| | | | - Murat Ozdemir
- Division of General Surgery, Ege University, İzmir, Turkey
| | - Mehmet Erdogan
- Division of Endocrinology and Metabolism, Ege University, İzmir, Turkey
| | - Sevki Cetinkalp
- Division of Endocrinology and Metabolism, Ege University, İzmir, Turkey
| | - Gokhan Ozgen
- Division of Endocrinology and Metabolism, Ege University, İzmir, Turkey
| | - Fusun Saygili
- Division of Endocrinology and Metabolism, Ege University, İzmir, Turkey
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32
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Al-Salam S, Sharma C, Afandi B, Al Dahmani K, Al-Zahrani AS, Al Shamsi A, Al Kaabi J. BRAF and KRAS mutations in papillary thyroid carcinoma in the United Arab Emirates. PLoS One 2020; 15:e0231341. [PMID: 32315324 PMCID: PMC7173769 DOI: 10.1371/journal.pone.0231341] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/22/2020] [Indexed: 01/09/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) is the most common malignant thyroid neoplasm comprising 80–90% of all thyroid malignancies. Molecular changes in thyroid follicular cells are likely associated with the development of PTC. Mutations in serine/threonine-protein kinase (BRAF) and Rat sarcoma viral oncogene homolog (RAS) are commonly seen in PTC. Methods In total, 90 cases of PTC are randomly selected from archive paraffin blocks and 10μm sections were cut and processed for DNA extraction. BRAFV600E mutation and 8 types of KRAS mutations were investigated using Real Time PCR. Results BRAFV600E mutation was identified in 46% of PTC while KRAS mutations were seen in 11% of PTC. There was significant correlation between BRAFV600E mutation and PTC larger than 5cm in diameter, positive surgical margin and lymph node metastasis. BRAFV600E mutation was significantly higher in patients with less than 55-year of age than those more than 55-year of age. BRAFV600E mutation was significantly higher in patients with family history of thyroid cancer than those without. There was no significant difference in BRAFV600E mutation between males and females, PTC classic and follicular variants, unifocal and multifocal PTC. There was a significant higher percentage of BRAFV600E mutation in classic PTC than papillary microcarcinoma variant. There was no significant age, gender, histologic type, tumor size, lymph node metastasis, tumor focality, and surgical margin status differences between KRAS mutated and non-mutated PTC. Conclusion BRAFV600E and KRAS mutation are seen in a significant number of PTC in the UAE. BRAF mutation is significantly correlated with large tumor size, positive surgical margins and lymph node metastasis suggesting an association between BRAFV600E mutation and tumor growth and spread.
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Affiliation(s)
- Suhail Al-Salam
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Bachar Afandi
- Endocrine Division, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Ali S. Al-Zahrani
- Department of Medicine, Molecular Endocrinology Division, Alfaisal University, Riyadh, Saudi Arabia
- Department of Molecular Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amal Al Shamsi
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Juma Al Kaabi
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
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33
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Lan X, Bao H, Ge X, Cao J, Fan X, Zhang Q, Liu K, Zhang X, Tan Z, Zheng C, Wang A, Chen C, Zhu X, Wang J, Xu J, Zhu X, Wu X, Wang X, Shao Y, Ge M. Genomic landscape of metastatic papillary thyroid carcinoma and novel biomarkers for predicting distant metastasis. Cancer Sci 2020; 111:2163-2173. [PMID: 32187423 PMCID: PMC7293069 DOI: 10.1111/cas.14389] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/28/2020] [Accepted: 03/01/2020] [Indexed: 12/19/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common malignancy of the thyroid gland, with a relatively high cure rate. Distant metastasis (DM) of PTC is uncommon, but when it occurs, it significantly decreases the survival of PTC patients. The molecular mechanisms of DM in PTC have not been systematically studied. We performed whole exome sequencing and GeneseeqPrime (425 genes) panel sequencing of the primary tumor, plasma and matched white blood cell samples from 20 PTC with DM and 46 PTC without DM. We identified somatic mutations, gene fusions and copy number alterations and analyzed their relationships with DM of PTC. BRAF‐V600E was identified in 73% of PTC, followed by RET fusions (14%) in a mutually exclusive manner (P < 0.0001). We found that gene fusions (RET, ALK or NTRK1) (P < 0.01) and chromosome 22q loss (P < 0.01) were independently associated with DM in both univariate and multivariate analyses. A nomogram model consisting of chromosome 22q loss, gene fusions and three clinical variables was built for predicting DM in PTC (C‐index = 0.89). The plasma circulating tumor DNA (ctDNA) detection rate in PTC was only 38.9%; however, it was significantly associated with the metastatic status (P = 0.04), tumor size (P = 0.001) and invasiveness (P = 0.01). In conclusion, gene fusions and chromosome 22q loss were independently associated with DM in PTC and could serve as molecular biomarkers for predicting DM. The ctDNA detection rate was low in non–DM PTC but significantly higher in PTC with DM.
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Affiliation(s)
- Xiabin Lan
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Hua Bao
- Translational Medicine Research Institute, Geneseeq Technology, Toronto, ON, Canada
| | - Xinyang Ge
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China.,Heartland Christian School, Columbiana, OH, USA
| | - Jun Cao
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Xiaojun Fan
- Translational Medicine Research Institute, Geneseeq Technology, Toronto, ON, Canada
| | - Qihong Zhang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Kaihua Liu
- Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Xian Zhang
- Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Zhuo Tan
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Chuanming Zheng
- Department of Head, Neck and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Ao Wang
- Translational Medicine Research Institute, Geneseeq Technology, Toronto, ON, Canada
| | - Chao Chen
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Xin Zhu
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Jiafeng Wang
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Jiajie Xu
- Department of Head, Neck and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xuhang Zhu
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.,Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China
| | - Xue Wu
- Translational Medicine Research Institute, Geneseeq Technology, Toronto, ON, Canada
| | - Xiaonan Wang
- Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Yang Shao
- Nanjing Geneseeq Technology Inc., Nanjing, China.,School of Public Health, Nanjing Medical University, Nanjing, China
| | - Minghua Ge
- Department of Head, Neck and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Borda A, Zahan AE, Piciu D, Barbuș E, Berger N, Nechifor-Boilă A. A 15 year institutional experience of well-differentiated follicular cell-derived thyroid carcinomas; impact of the new 2017 TNM and WHO Classifications of Tumors of Endocrine Organs on the epidemiological trends and pathological characteristics. Endocrine 2020; 67:630-642. [PMID: 31838728 DOI: 10.1007/s12020-019-02158-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/09/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE Our study aimed to describe the evolution of the rate of pathological subtypes of well-differentiated follicular-cell derived thyroid carcinomas (DTCs) in the Department of Pathology, Emergency County Hospital Targu-Mures, Romania over a 15 year period and to assess the impact the new 2017 WHO and TNM classifications of thyroid tumors had on our cases. METHODS The pathological data were retrieved from the original pathological reports. After applying the exclusion criteria the remaining cases were reviewed on a double-headed microscope and reclassified according to the 2017 WHO and TNM staging system. The follow-up data were collected from the Institute of Oncology Cluj-Napoca, Romania. RESULTS Our study included 396 cases of DTCs (375 papillary, 11 follicular, and 10 Hürthle cell carcinomas). PTCs revealed a significant increasing trend over the study period, whereas follicular and Hurthle cell carcinomas remain rare; 125/131 of noninvasive encapsulated follicular variant PTC (EFVPTC) were reclassified as noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs), resulting in a 33.3% reduction in the number of PTCs. According to 2017 TNM stage-grouping 31% of 271 patients with DTC were downstaged. Follow-up data were available for most of the patients (65.7%, mean period 58.1 months). All patients with noninvasive EFVPTC were disease free at the last clinical assessment. CONCLUSIONS The increasing rate of PTC was maintained even after exclusion of NIFTP. By applying 2017 TNM criteria, a significant number of DTC cases were downstaged into a more favorable group. Follow-up data highlight the indolent behavior of noninvasive EFVPTCs reclassified as NIFTPs.
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Affiliation(s)
- Angela Borda
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology of Targu-Mureş, 38 Gh. Marinescu Street, 540139, Targu-Mureş, Romania
- Department of Pathology, Targu-Mureş Emergency County Hospital, 50 Gh. Marinescu Street, 540136, Targu-Mureş, Romania
| | - Ancuța-Elena Zahan
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology of Targu-Mureş, 38 Gh. Marinescu Street, 540139, Targu-Mureş, Romania.
| | - Doina Piciu
- Department of Nuclear Medicine, "Ion Chiricuţă" Institute of Oncology, 34-36 Republicii Street, Cluj-Napoca, 400015, Romania
| | - Elena Barbuș
- Department of Nuclear Medicine, "Ion Chiricuţă" Institute of Oncology, 34-36 Republicii Street, Cluj-Napoca, 400015, Romania
| | - Nicole Berger
- Department of Pathology Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495, Pierre Bénite, France
| | - Adela Nechifor-Boilă
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology of Targu-Mureş, 38 Gh. Marinescu Street, 540139, Targu-Mureş, Romania
- Department of Pathology, Targu-Mureş County Hospital, 28 December 1/1918 Boulevard, 540061, Targu-Mureş, Romania
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35
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Khatami F, Larijani B, Heshmat R, Nasiri S, Haddadi-Aghdam M, Teimoori-Toolabi L, Tavangar SM. Hypermethylated RASSF1 and SLC5A8 promoters alongside BRAF V600E mutation as biomarkers for papillary thyroid carcinoma. J Cell Physiol 2020; 235:6954-6968. [PMID: 32017063 DOI: 10.1002/jcp.29591] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Circulating cell-free DNA (cfDNA) has been considered as a diagnostic source to track genetic and epigenetic alterations in cancer. We aimed to study mutation in addition to the methylation status in the promoter regions of RASSF1 and SLC5A8 genes in tissues and circulating free DNA samples of patients affected with papillary thyroid carcinoma (PTC) and thyroid nodules as controls. BRAFV600E mutation was studied by ARMS-scorpion real-time polymerase chain reaction method in 57 PTC and 45 thyroid nodule cases. Methylation status of RASSF1 and SLC5A8 promoter regions was analyzed by methylation-specific high-resolution melting curve analysis. BRAFV600E mutation was found in 39 (68.4%) out of 57 PTC tissue samples, while in 33 (49.1%) cases of cfDNA, this mutation was detected. The frequency of BRAFV600E mutation in cfDNA was significantly different between metastatic and nonmetastatic PTC cases (22 of 33 PTC cases vs. 5 of 34 thyroid nodule samples). Methylation levels of three promoter regions of SLC5A8 and proximal promoter region of RASSF1 was significantly different between PTC and thyroid nodule cases in both cfDNA and tissue DNA. In addition, the methylation status of these two genes in tissue DNA was reflected in methylation status observed in cfDNA. This study confirmed that BRAFV600E mutation is better for discrimination between papillary thyroid carcinoma and thyroid nodules. On the other hand, hypermethylation in the more proximal promoter regions to RASSF1 and SLC5A8 genes showed higher sensitivity and more acceptable specificity for this discrimination.
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Affiliation(s)
- Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirzad Nasiri
- Departments of Surgery, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Haddadi-Aghdam
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Ladan Teimoori-Toolabi
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed M Tavangar
- Department of Pathology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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36
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Russell MD, Kamani D, Randolph GW. Modern surgery for advanced thyroid cancer: a tailored approach. Gland Surg 2020; 9:S105-S119. [PMID: 32175251 DOI: 10.21037/gs.2019.12.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Surgical treatment of advanced thyroid malignancy can be morbid, compromising normal functions of the upper aerodigestive tract. There is a paucity of guidelines dedicated to the management of advanced disease. In fact, there is not even a uniform definition for advanced thyroid cancer currently. The presence of local invasion, bulky cervical nodes, distant metastases or recurrent disease should prompt careful preoperative evaluation and planning. Surgical strategy should evolve from multidisciplinary discussion that integrates individual disease characteristics and patient preference. Intraoperative neuromonitoring has important applications in surgery for advanced disease and should be used to guide surgical strategy and intraoperative decision-making. Recent paradigm shifts, including staged surgery and use of neoadjuvant targeted therapy hold potential for decreasing surgical morbidity and improving clinical outcomes. Modern surgical planning provides optimal treatment for each patient through a tailored approach based on exact extent and type of disease as well as incorporating appreciation of surgical complications, patient preferences and intraoperative findings.
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Affiliation(s)
- Marika D Russell
- Department of Otolaryngology & Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.,Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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37
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Ma H, Wang R, Fang J, Zhong Q, Chen X, Hou L, Feng L, Chen X, Huang Z, Zhao H. A meta-analysis evaluating the relationship between B-type Raf kinase mutation and cervical lymphatic metastasis in papillary thyroid cancer. Medicine (Baltimore) 2020; 99:e18917. [PMID: 32000400 PMCID: PMC7004699 DOI: 10.1097/md.0000000000018917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND B-type Raf kinase (BRAF) mutation is proved to be a critical predictive factor in papillary thyroid cancer (PTC) with aggressive characteristics. However, the association between BRAF mutation and cervical lymphatic metastasis in PTC is controversial. METHODS We searched papers on the study of BRAF mutation and cervical lymphatic metastasis in PTC patients through PubMed, Web of Science, Embase, and Cochranelibrary. The BRAF (+) cases, BRAF (-) cases, and cervical lymphphatic metastatic cases in both BRAF (+) and BRAF (-) groups were collected. After Quality assessment, statistical Analysis (funnel plot and Harbord evaluation, Random-effect model, heterogeneity, subgroup analysis, sensitivity analysis, and metacum analysis) were done by the Review Manager (RevMan) 5.3 and stata14 statistical software. RESULTS There were 78 cross-section studies which met our inclusion criteria. And all of them had no selection bias, publication bias, or any other bias. A significant association existed between BRAF mutation and cervical lymph node metastasis (LNM) (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.44-1.84; P < .05). Overall, 46 studies were conducted among East Asians. Twenty four articles had provided the data of central lymph node metastasis (CLNM), 11 articles with the data of lateral lymph node metastasis (LLNM), and classic/conventional PTC (CPTC) was analyzed in 10 studies. Subgroup analyses were performed based on ethnicity, metastatic site, and subtype of PTC. Significant association between BRAF (+) mutation and cervical LNM were indicated in East Asians (OR = 1.73; 95% CI: 1.49-2.02; P < .05), in non-East Asians (OR = 1.57; 95% CI: 1.26-1.96; P < .05), and in CLNM (OR = 1.80; 95% CI: 1.56-2.07; P < .05). While no significant association was found in LLNM (OR = 1.37; 95% CI: 0.76-2.48; P = .29 > .05) and in CPTC (OR = 1.32; 95% CI: 0.97-1.80; P = .08 > .05). We did not find any other major changes when sensitivity analysis was performed. The metacum analysis showed no significant association existed before 2012. While a significant association began to exist between BRAF mutation and LNM from 2012, and this association became stable from 2017. CONCLUSIONS We consider that a significant association exists between BRAF mutation and cervical LNM. Further meta-analysis on subgroup may reveal some valuable factors between BRAF gene mutation and LNM. And we do not recommend that BRAF (+) as the biomarker for LNM in PTC.
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Affiliation(s)
- Hongzhi Ma
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Ru Wang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Jugao Fang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Qi Zhong
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Xiao Chen
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Lizhen Hou
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Ling Feng
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Xiaohong Chen
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Zhigang Huang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Huanhu Zhao
- School of Pharmacy, Minzu University of China, China
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38
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Botezatu A, Iancu IV, Plesa A, Manda D, Popa O, Bostan M, Mihaila M, Albulescu A, Fudulu A, Vladoiu SV, Huica I, Dobrescu R, Anton G, Badiu C. Methylation of tumour suppressor genes associated with thyroid cancer. Cancer Biomark 2019; 25:53-65. [PMID: 31006665 DOI: 10.3233/cbm-182265] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thyroid carcinoma is the most common endocrine malignancy worldwide. Changes in DNA methylation can cause silencing of normally active genes, especially tumour suppressor genes (TSG) or activation of normally silent genes. OBJECTIVE The aim of this study is to evaluate the degree of promoter methylation for a panel of markers for thyroid neoplasms and to establish their relationship with thyroid oncogenesis. METHODS To generate a comprehensive DNA methylation signature of TSGs involved in thyroid neoplasia, we use Human TSG EpiTect Methyl II Signature PCR Array-Qiagen for 24 samples (follicular adenomas and papillary thyroid carcinomas) compared with normal thyroid tissue. We extended the evaluation for three TSGs (TP73, WIF1, PDLIM4) using qMS-PCR. Statistical analysis was performed with GraphPad Prism. RESULTS We noted four important genes NEUROG1, ESR1, RUNX3, MLH1, which presented methylated promoter in tumour samples compared to normal. We found new characteristic of thyroid tumours: methylation of TP73, WIF1 and PDLIM4 TSGs, which can contribute to thyroid neoplasia. A significant correlation between BRAF V600E mutation and RET/PTC rearrangements with TIMP3 and CDH13, RARB methylation, respectively was observed. CONCLUSIONS TSGs promoter hypermethylation is a hallmark of cancer and a test that uses methylation quantification method is suitable for diagnosis and prognosis of thyroid cancer.
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Affiliation(s)
- Anca Botezatu
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania
| | - Iulia V Iancu
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania
| | - Adriana Plesa
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania
| | - Dana Manda
- 'CI Parhon' National Institute of Endocrinology, Bucharest, Romania
| | - Oana Popa
- 'CI Parhon' National Institute of Endocrinology, Bucharest, Romania
| | - Marinela Bostan
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania
| | - Mirela Mihaila
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania
| | - Adrian Albulescu
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania.,National Institute for Chemical pharmaceutical Research and Development, Calea Vitan, Romania
| | - Alina Fudulu
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania
| | - Susana V Vladoiu
- 'CI Parhon' National Institute of Endocrinology, Bucharest, Romania
| | - Irina Huica
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania
| | - Ruxandra Dobrescu
- 'CI Parhon' National Institute of Endocrinology, Bucharest, Romania.,'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
| | - Gabriela Anton
- 'Stefan S. Nicolau' Institute of Virology, Bucharest, Romania
| | - Corin Badiu
- 'CI Parhon' National Institute of Endocrinology, Bucharest, Romania.,'Carol Davila' University of Medicine and Pharmacy, Bucharest, Romania
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39
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Kure S, Ishino K, Kudo M, Wada R, Saito M, Nagaoka R, Sugitani I, Naito Z. Incidence of BRAF V600E mutation in patients with papillary thyroid carcinoma: a single-institution experience. J Int Med Res 2019; 47:5560-5572. [PMID: 31533501 PMCID: PMC6862924 DOI: 10.1177/0300060519873481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/12/2019] [Indexed: 11/25/2022] Open
Abstract
Objective Papillary thyroid carcinoma (PTC) accounts for 95% of all thyroid carcinomas. PTC is an epithelial tumor characterized by the proliferation of follicular cells with distinctive nuclear features, and is heterogeneous in terms of its carcinogenesis and behavior. PTC has been associated with several genetic abnormalities, of which the BRAF V600E mutation is the most common. However, reported incidences of this mutation have varied depending on the patient background, population size, or methods. In this study, we investigated the incidence of BRAF V600E mutation and its relationships with clinicopathological characteristics in patients with PTC. Methods Surgical specimens were obtained from 40 patients with PTC who underwent surgery at Nippon Medical School Hospital between 2009 and 2017. DNA from exon 15 of the BRAF gene was extracted and amplified by polymerase chain reaction, followed by direct sequencing. Results The frequency of BRAF V600E mutation increased with age. However, there were no correlations between BRAF V600E mutation and other clinicopathological features including sex, Hashimoto disease, family history of thyroid disease, tumor size, pathological T stage, pathological N stage, lymphovascular invasion, extrathyroidal extension, and metastasis. Conclusions This study demonstrated that PTCs harboring the BRAF V600E mutation increased in an age-dependent manner.
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Affiliation(s)
- Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
- Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Kousuke Ishino
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Mitsuhiro Kudo
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Ryuichi Wada
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
- Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Marie Saito
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Zenya Naito
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
- Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
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40
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Perera D, Ghossein R, Camacho N, Senbabaoglu Y, Seshan V, Li J, Bouvier N, Boucai L, Viale A, Socci ND, Untch BR, Gonen M, Knauf J, Fagin JA, Berger M, Tuttle RM. Genomic and Transcriptomic Characterization of Papillary Microcarcinomas With Lateral Neck Lymph Node Metastases. J Clin Endocrinol Metab 2019; 104:4889-4899. [PMID: 31237614 PMCID: PMC6733494 DOI: 10.1210/jc.2019-00431] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/19/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT Most papillary microcarcinomas (PMCs) are indolent and subclinical. However, as many as 10% can present with clinically significant nodal metastases. OBJECTIVE AND DESIGN Characterization of the genomic and transcriptomic landscape of PMCs presenting with or without clinically important lymph node metastases. SUBJECTS AND SAMPLES Formalin-fixed paraffin-embedded PMC samples from 40 patients with lateral neck nodal metastases (pN1b) and 71 patients with PMC with documented absence of nodal disease (pN0). OUTCOME MEASURES To interrogate DNA alterations in 410 genes commonly mutated in cancer and test for differential gene expression using a custom NanoString panel of 248 genes selected primarily based on their association with tumor size and nodal disease in the papillary thyroid cancer TCGA project. RESULTS The genomic landscapes of PMC with or without pN1b were similar. Mutations in TERT promoter (3%) and TP53 (1%) were exclusive to N1b cases. Transcriptomic analysis revealed differential expression of 43 genes in PMCs with pN1b compared with pN0. A random forest machine learning-based molecular classifier developed to predict regional lymph node metastasis demonstrated a negative predictive value of 0.98 and a positive predictive value of 0.72 at a prevalence of 10% pN1b disease. CONCLUSIONS The genomic landscape of tumors with pN1b and pN0 disease was similar, whereas 43 genes selected primarily by mining the TCGA RNAseq data were differentially expressed. This bioinformatics-driven approach to the development of a custom transcriptomic assay provides a basis for a molecular classifier for pN1b risk stratification in PMC.
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Affiliation(s)
- Dilmi Perera
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Yasin Senbabaoglu
- Department of Bioinformatics & Computational Biology, Genentech, South San Francisco, California
| | | | - Juan Li
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Bouvier
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Boucai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Agnes Viale
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brian R Untch
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mithat Gonen
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeffrey Knauf
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A Fagin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Berger
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - R Michael Tuttle
- Memorial Sloan Kettering Cancer Center, New York, New York
- Correspondence and Reprint Requests: R. Michael Tuttle, MD, Endocrinology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10021. E-mail:
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BRAF Inhibitors in Thyroid Cancer: Clinical Impact, Mechanisms of Resistance and Future Perspectives. Cancers (Basel) 2019; 11:cancers11091388. [PMID: 31540406 PMCID: PMC6770736 DOI: 10.3390/cancers11091388] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 01/07/2023] Open
Abstract
The Kirsten rat sarcoma viral oncogene homolog (RAS)/v-raf-1 murine leukemia viral oncogene homolog 1 (RAF)/mitogen-activated protein kinase 1 (MAPK) signaling cascade is the most important oncogenic pathway in human cancers. Tumors leading mutations in the gene encoding for v-raf murine sarcoma viral oncogene homolog B (BRAF) serine-threonine kinase are reliant on the MAPK signaling pathway for their growth and survival. Indeed, the constitutive activation of MAPK pathway results in continuous stimulation of cell proliferation, enhancement of the apoptotic threshold and induction of a migratory and metastatic phenotype. In a clinical perspective, this scenario opens to the possibility of targeting BRAF pathway for therapy. Thyroid carcinomas (TCs) bearing BRAF mutations represent approximately 29–83% of human thyroid malignancies and, differently from melanomas, are less sensitive to BRAF inhibitors and develop primary or acquired resistance due to mutational events or activation of alternative signaling pathways able to reactivate ERK signaling. In this review, we provide an overview on the current knowledge concerning the mechanisms leading to resistance to BRAF inhibitors in human thyroid carcinomas and discuss the potential therapeutic strategies, including combinations of BRAF inhibitors with other targeted agents, which might be employed to overcome drug resistance and potentiate the activity of single agent BRAF inhibitors.
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Clinical Value of Lymph Node Ratio Integration with the 8 th Edition of the UICC TNM Classification and 2015 ATA Risk Stratification Systems for Recurrence Prediction in Papillary Thyroid Cancer. Sci Rep 2019; 9:13361. [PMID: 31527831 PMCID: PMC6746784 DOI: 10.1038/s41598-019-50069-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/02/2019] [Indexed: 12/12/2022] Open
Abstract
Recently, the 2015 American Thyroid Association (ATA) risk stratification and the 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system were released. This study was conducted to assess the clinical value of the lymph node ratio (LNR) as a predictor of recurrence when integrated with these newly released stratification systems, and to compare the predictive accuracy of the modified systems with that of the newly released systems. The optimal LNR threshold value for predicting papillary thyroid cancer (PTC) recurrence was 0.17857 using the Contal and O'Quigley method. The 8th edition of the AJCC/UICC TNM staging system with the LNR and the 2015 ATA risk stratification system with the LNR were significant predictors of recurrence. Furthermore, calculation of the proportion of variance explained (PVE), the Akaike information criterion (AIC), Harrell's c index, and the incremental area under the curve (iAUC) revealed that the 8th edition of the TNM staging system with the LNR, and the 2015 ATA risk stratification system with the LNR, showed the best predictive performance. Integration of the LNR with the TNM staging and the ATA risk stratification systems should improve prediction of recurrence in patients with PTC.
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Zhao CK, Zheng JY, Sun LP, Xu RY, Wei Q, Xu HX. BRAF V600E mutation analysis in fine-needle aspiration cytology specimens for diagnosis of thyroid nodules: The influence of false-positive and false-negative results. Cancer Med 2019; 8:5577-5589. [PMID: 31397092 PMCID: PMC6745841 DOI: 10.1002/cam4.2478] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/19/2019] [Accepted: 07/26/2019] [Indexed: 01/17/2023] Open
Abstract
Background The accurate evaluation of BRAFV600E mutation in preoperative fine‐needle aspiration cytology (FNAC) specimens is important for making management decisions in thyroid nodules (TNs). The aim of this study was to assess the false‐positive and false‐negative BRAFV600E mutations in thyroid FNAC specimens and their influence on diagnosis of TN. Methods This prospective study enrolled 292 nodules in 269 patients who underwent BRAFV600E mutation analysis using amplification refractory mutation system‐quantitative real‐time polymerase chain reaction (ARMS‐qPCR) both in FNAC specimens and formalin‐fixed, paraffin‐embedded (FFPE) tissue samples after surgery. The false‐positive and false‐negative mutations for BRAFV600E analysis using ARMS‐qPCR in FNAC specimens were recorded, with reference to the results of BRAFV600E mutation analysis using ARMS‐qPCR in FFPE tissue sample. Diagnostic performances of FNAC, BRAFV600E mutation analysis in FNAC specimens, BRAFV600E mutation analysis in FFPE tissue sample, and the combination of FNAC and BRAFV600E mutation analysis for predicting thyroid malignancy were assessed. Results The false‐positive and false‐negative mutations for BRAFV600E analysis using ARMS‐qPCR in FNAC specimens were 10.1% (19/189) and 7.1% (7/98), respectively. FNAC combined with preoperative BRAFV600E mutation analysis significantly increased the diagnostic sensitivity from 75.7% to 92.3%, and accuracy from 78.7% to 90.6% in comparison with FNAC alone (both P < .001). No significant differences were found between the combination of FNAC and BRAFV600E mutation analysis in FNAC specimens and the combination of FNAC and BRAFV600E mutation analysis in FFPE tissue sample (sensitivity: 92.3% vs 91.9%; accuracy: 90.6% vs 91.3%; both P > .05). Conclusions FNAC combined with preoperative BRAFV600E mutation analysis can significantly increase the diagnostic performance in comparison with FNAC alone. False‐positive and false‐negative BRAFV600E mutation results are found in preoperative FNAC specimens, whereas it does not affect the overall auxiliary diagnosis of TNs.
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Affiliation(s)
- Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Jia-Yi Zheng
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
| | - Rong-Ying Xu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qing Wei
- Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China.,Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China.,Thyroid Institute, Tongji University School of Medicine, Shanghai, China.,Shanghai Center for Thyroid Diseases, Shanghai, China
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Russell MD, Kamani D, Randolph GW. Surgical management of the compromised recurrent laryngeal nerve in thyroid cancer. Best Pract Res Clin Endocrinol Metab 2019; 33:101282. [PMID: 31230919 DOI: 10.1016/j.beem.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Surgical management of thyroid cancer requires careful consideration of the recurrent laryngeal nerve and its impact on glottic function. Management of the compromised recurrent laryngeal nerve is a complex task, requiring synthesis of multiple elements. The surgeon must have an appreciation for preoperative recurrent laryngeal nerve function, intraoperative anatomic and electromyographic information, disease characteristics, and relevant patient factors. Preoperative clinical evaluation including preoperative laryngoscopy and assessment of recurrent laryngeal nerve risk is essential to formulating a surgical plan and providing appropriate patient counseling. Intraoperative neuromonitoring information has significant implications for surgical management of the injured or invaded recurrent laryngeal nerve and informs strategy with respect to staging of bilateral surgery. Disease characteristics and patient-related factors, including patient preference, must be considered with intraoperative decision-making. Multidisciplinary discussion and patient communication are essential for effective management and successful surgical outcome.
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Affiliation(s)
- Marika D Russell
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA.
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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45
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Jeong JH, Oh JM, Jeong SY, Lee SW, Lee J, Ahn BC. Combination Treatment with the BRAF V600E Inhibitor Vemurafenib and the BH3 Mimetic Navitoclax for BRAF-Mutant Thyroid Carcinoma. Thyroid 2019; 29:540-548. [PMID: 30869573 DOI: 10.1089/thy.2018.0511] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Vemurafenib is a selective BRAF inhibitor (BRAFi) that has shown promising activity in BRAFV600E-positive papillary thyroid cancer (PTC). However, adverse events and resistance to a single-agent BRAFi often require discontinuation of the targeted therapy in BRAFV600E-positive PTC. Thus, this study investigated the expression of anti-apoptotic B-cell lymphoma 2 (BCL-2) family members, which are frequently overexpressed in many human cancers to inhibit apoptosis, in PTC harboring the BRAFV600E mutation after BRAFi treatment, and then evaluated the cytotoxic effects of a homology 3 domain (BH3)-mimetic in combination with a BRAFi. METHODS K1 cells (BRAFV600E-positive human PTC) were treated with various concentrations of vemurafenib to investigate the effect of the BRAFi. In addition, the study analyzed the protein expression profiles of phosphorylated ERK1/2 (p-ERK 1/2) and anti-apoptotic BCL-2 family after vemurafenib treatment and selected the target anti-apoptotic protein. Antitumor effects were measured by cell counting, and effects on apoptosis were determined by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay and Western blot analysis. RESULTS At a concentration of 10 μM, vemurafenib inhibited the growth of K1 cells by 49.4%. Western blot analysis following exposure to 10 μM vemurafenib revealed that p-ERK1/2 gradually decreased over 24 hours, but the expression of B-cell lymphoma-extralarge (BCL-XL) and BCL-2 increased after 12 hours of treatment. Based on this result, the K1 cells were treated with navitoclax (BCL-2/BCL-XL inhibitor) for 24 hours up to a concentration of 4 μM, which resulted in negligible effects on cell survival. However, a combination treatment of 0.5 μM navitoclax with 1 μM vemurafenib resulted in significantly enhanced cell growth inhibition and increased apoptosis. CONCLUSIONS The results of the present study show that vemurafenib increased the expression of anti-apoptotic proteins of the BCL-2 family. Thus, the combination of vemurafenib with navitoclax may be effective in BRAFV600E-positive PTC treatment.
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Affiliation(s)
- Ju Hye Jeong
- 1 Department of Nuclear medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ji Min Oh
- 2 Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Shin Young Jeong
- 1 Department of Nuclear medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- 2 Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- 3 Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang-Woo Lee
- 1 Department of Nuclear medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
- 2 Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- 3 Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jaetae Lee
- 2 Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- 3 Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Byeong-Cheol Ahn
- 2 Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- 3 Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
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Means C, Clayburgh DR, Maloney L, Sauer D, Taylor MH, Shindo ML, Coussens LM, Tsujikawa T. Tumor immune microenvironment characteristics of papillary thyroid carcinoma are associated with histopathological aggressiveness and BRAF mutation status. Head Neck 2019; 41:2636-2646. [PMID: 30896061 DOI: 10.1002/hed.25740] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/19/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) follows an indolent course; however, up to 30% of patients develop recurrent disease requiring further treatment. Profiling PTC immune complexity may provide new biomarkers for improved risk prediction. METHODS Immune complexity profiles were quantitatively evaluated by multiplex immunohistochemistry (mIHC) in archived tissue sections from 39 patients with PTC, and were assessed for correlations with aggressive histopathological features based on the presence of lymphovascular invasion and/or extrathyroidal extension, and BRAF V600E mutational status. RESULTS mIHC revealed two distinct immune clusters stratifying patients: a lymphoid-inflamed group (higher CD8+ T cells, reduced dendritic and mast cells) and a myeloid/hypo-inflamed group that correlated with aggressive pathological features. BRAF mutation was not associated with aggressive pathological features but did correlate with increased mast cell density. CONCLUSIONS Distinct immune microenvironments exist in PTC correlating with pathological aggressiveness. Immune-based biomarkers associated with possible tumor-immune interactions may be used for risk stratification.
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Affiliation(s)
- Casey Means
- Department of Cell, Developmental & Cancer Biology, Oregon Health and Science University, Portland, Oregon.,Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Daniel R Clayburgh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.,Department of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon.,Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.,Operative Care Division, Portland Veterans' Affairs Health Care System, Portland, Oregon
| | - Lauren Maloney
- Department of Cell, Developmental & Cancer Biology, Oregon Health and Science University, Portland, Oregon
| | - David Sauer
- Department of Pathology, Oregon Health and Science University, Portland, Oregon
| | - Matthew H Taylor
- Department of Hematology and Medical Oncology, Oregon Health and Science University, Portland, Oregon.,Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Maisie L Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
| | - Lisa M Coussens
- Department of Cell, Developmental & Cancer Biology, Oregon Health and Science University, Portland, Oregon.,Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Takahiro Tsujikawa
- Department of Cell, Developmental & Cancer Biology, Oregon Health and Science University, Portland, Oregon.,Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon.,Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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47
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Are BRAF V600E and K-Ras Mutations Associated With Tumor Aggressiveness in Well-Differentiated Thyroid Cancer? Int Surg 2019. [DOI: 10.9738/intsurg-d-14-00145.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim:
Many clinical studies have shown an association between B-type rapidly growing fibrosarcoma kinase [BRAF(V600E)] mutation and aggressive clinicopathologic features, although some results from others are controversial. Besides, Kirsten rat sarcoma (K-Ras) mutations are more common in endemic iodine deficiency regions, as our country is. However, use of the biologic markers are questioned in clinical practice; they are beginning to be used for the management of patients with thyroid nodules and cancers. The aim of the present study was to evaluate the prevalence of the BRAF(V600E) mutation in tumor samples and its relationship to high-risk clinicopathologic features.
Methods:
From 2000 to 2007, 82 patients with well-differentiated thyroid cancer (WDTC) who underwent surgery in Ege University were enrolled retrospectively in the study. Univariate and multivariate analyses were performed to analyze associations between BRAF(V600E) and K-Ras mutations and clinicopathologic features. We identified 82 patients with WDTC (male:female = 1:3.2).
Results:
The median follow-up was 96 months. The mean age was 46.4 (16–80). None of the all analyzed prognostic factors—age; sex; lymph node metastasis; multifocality; multicentricity; invasion; tumor diameter; and tumor, node, metastasis staging—were correlated with BRAF(V600E) mutation status in the univariate analysis. Meanwhile, none of the analyzed prognostic factors were correlated with K-Ras mutation status.
Discussion:
Although many studies suggest BRAF(V600E) and K-Ras mutations as prognostic factors in WDTC, our results are controversial. BRAF(V600E) and K-Ras mutations have no significant effects on tumor aggressiveness in Turkish patients with WDTC. Our results underline that it is too early to reach a conclusion that BRAF(V600E) and K-Ras mutations are involved with poor clinical outcomes.
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48
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Legesse T, Parker L, Heath J, Staats PN. Distinguishing non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) from classic and invasive follicular-variant papillary thyroid carcinomas based on cytologic features. J Am Soc Cytopathol 2019; 8:11-17. [PMID: 30929754 DOI: 10.1016/j.jasc.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/18/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION An international panel recently recommended reclassification of non-invasive follicular variant of papillary thyroid carcinoma (PTC) to non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). NIFTPs have little or no risk of recurrence and can be treated with lobectomy alone. Preoperative distinction of NIFTP from PTC will help avoid overtreatment. MATERIALS AND METHODS All thyroid tumors with a histologic diagnosis of PTC and preceding diagnostic cytology (n = 299) over a 5-year period were identified. Cases meeting criteria for NIFTP were reclassified as such. All NIFTP cases with available cytology (n = 6) and a similar number of randomly selected invasive follicular variant of papillary thyroid carcinoma (IFVPTC; n = 9) and classic PTC (cPTC, n = 11) were evaluated for 18 cytologic features. RESULTS A total of 35 (12%) lesions were reclassified as NIFTP, 194 (65%) were cPTC, and 70 (23%) were IFVPTC. The NIFTPs had a preceding cytologic interpretation of benign (31%), atypia of undetermined significance (34%), follicular neoplasm (9%), suspicious for malignancy (12%), or malignant (14%). Cytologically, NIFTP was distinguished from cPTC by absence of any architectural features in all 6 cases, and by absence of pseudoinclusions (P < 0.001) and multinucleated giant cells (P = 0.027) in nearly all. Nuclear pseudoinclusions (P = 0.001), marginal micronucleoli (P = 0.018), irregular branching sheets (P = 0.025), and linear arrangement (P = 0.025) favored IFVPTC over NIFTP. CONCLUSIONS NIFTPs were originally assigned to a variety of cytologic categories. There are several cytologic differences between NIFTP and cPTC or IFVPTC. Our findings support restricting the definitive diagnosis of PTC to cases with architectural features of PTC and/or intranuclear pseudoinclusions.
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Affiliation(s)
- Teklu Legesse
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Lynnette Parker
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathon Heath
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Paul N Staats
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
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Zhang Z, Chhieng D, Harshan M, Zheng X, Zakowski M. Cytological features of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). J Am Soc Cytopathol 2019; 8:5-10. [PMID: 30929759 DOI: 10.1016/j.jasc.2018.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/29/2018] [Accepted: 07/31/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The noninvasive encapsulated follicular variant of papillary carcinoma (EFVPC) was recently renamed a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) because of its unique genetic alterations and biological behavior. The objective of this report is to help cytopathologists and cytotechnologists improve diagnostic accuracy and determine the need for cytogenetic studies during adequacy evaluation of thyroid fine-needle aspirations. MATERIALS AND METHODS Fifty-five cases of surgery-proven noninvasive EFVPC with corresponding cytology material were reviewed. These cases were collected over 17 years, from 1999 to 2016. RESULTS Thirty-four of 55 (61.8%) cases were diagnosed as follicular neoplasm or suspicious for follicular neoplasm on cytology. Eighty to ninety percent of cases showed scant colloid, cellular smears with small clusters of follicular cells with nuclear atypia including enlarged nuclei, oval-shaped nuclei, nuclear grooves, mild chromatin powdering, and rare nuclear pseudo-inclusions. CONCLUSIONS NIFTP has unique features: cytologically similar to follicular neoplasms, and nuclear atypia falling between atypia of undetermined significance (category III) and suspicious for/and papillary thyroid carcinoma (category V/VI) (The Bethesda System for Reporting Thyroid Cytopathology).
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Affiliation(s)
- Zesong Zhang
- Department of Pathology, Mount Sinai Health System, New York, New York.
| | - David Chhieng
- Department of Pathology, University of Washington Medical Center, Seattle, Washington
| | - Manju Harshan
- Department of Pathology, Mount Sinai Health System, New York, New York
| | - Xiaoyong Zheng
- Department of Pathology, Mount Sinai Health System, New York, New York
| | - Maureen Zakowski
- Department of Pathology, Mount Sinai Health System, New York, New York
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50
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Henke LE, Pfeifer JD, Baranski TJ, DeWees T, Grigsby PW. Long-term outcomes of follicular variant vs classic papillary thyroid carcinoma. Endocr Connect 2018; 7:1226-1235. [PMID: 30352402 PMCID: PMC6240143 DOI: 10.1530/ec-18-0264] [Citation(s) in RCA: 12] [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: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023]
Abstract
The majority of papillary thyroid carcinoma (PTC) cases comprise classic papillary (C-PTC) and follicular variant (FV-PTC) histologic sub-types. Historically, clinical equivalency was assumed, but recent data suggest C-PTC may have poorer outcomes. However, large single-institution series with long-term outcomes of C-PTC and FV-PTC, using modern pathologic criteria for FV-PTC, are needed. Our objective was to compare prevalence and impact of clinicopathologic factors, including BRAF mutation status, on long-term outcomes of C-PTC and FV-PTC. We hypothesized that patients with C-PTC would have higher risk disease features and worse survival outcomes. This retrospective study included 1293 patients treated at a single, US academic institution between 1943 and 2009 with mean follow-up of 8.6 years. All patients underwent either partial or total thyroidectomy and had invasive C-PTC or FV-PTC per modern pathology criteria. Primary study measurements included differences in recurrence-free survival (RFS), disease-specific survival (DSS) and associations with clinicopathologic factors including the BRAF mutation. Compared to FV-PTC, C-PTC was associated with multiple features of high-risk disease (P < 0.05) and significantly reduced RFS and DSS. Survival differences were consistent across univariate, multivariate and Kaplan-Meier analyses. BRAF mutations were more common in C-PTC (P = 0.002). However, on Kaplan-Meier analysis, mutational status did not significantly impact RFS or DSS for patients with either histologic sub-type. C-PTC therefore indicates higher-risk disease and predicts for significantly poorer long-term outcomes when compared to FV-PTC. The nature of this difference in outcome is not explained by traditional histopathologic findings or by the BRAF mutation.
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Affiliation(s)
- Lauren E Henke
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John D Pfeifer
- Department of Pathology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Thomas J Baranski
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Todd DeWees
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, Arizona, USA
| | - Perry W Grigsby
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
- Correspondence should be addressed to P W Grigsby:
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