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Nesari Javan F, Askari E, Shafiei S, Roshanravan V, Aghaei A, Ayati N, Zakavi SR. The Prognostic Power of Preablation Stimulated Thyroglobulin in Children With Differentiated Thyroid Cancer. Endocr Pract 2024; 30:209-217. [PMID: 38092290 DOI: 10.1016/j.eprac.2023.12.005] [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: 08/22/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To analyze prognostic factors in children with differentiated thyroid carcinoma (DTC) who have been treated in a single center in the last 27 years. METHODS We studied 126 children (≤18 years old) who have been treated with near-total thyroidectomy followed by radioiodine therapy and thyroid hormone replacement. Follow-up of the patients was done 2, 6, and 12 months after treatment and then by yearly evaluation. Response to treatment was defined according to the American Thyroid Association guidelines. RESULTS Papillary thyroid cancer was the main pathology (93.7%), and 52.4% of the patients had lymph node metastasis at presentation, which was extensive (>5) in 30% of the patients. Distant metastasis was seen in 8.8%. The mean initial dose of I-131 was 74 ± 42.2 MBq/kg. The median follow-up was 59 months and the median time to achieve an excellent response was 29 months. The preablation stimulated thyroglobulin (psTg) level was 202.4 ± 301.8 ng/mL in patients with first-year incomplete response compared with 11.2 ± 17.5 ng/mL in others (P =.001). Furthermore, using logistic regression, the psTg level was found to be the only significant predictor of distant metastasis, and psTg ≥ 13.75 ng/mL was the most powerful predictor of first-year incomplete response. Moreover, distant metastasis was more common in boys than in girls, and it took longer time for boys to achieve an excellent response. CONCLUSION The psTg level was the only significant predictor of distant metastases in children with DTC, and psTg ≥ 13.75 ng/mL was the most powerful predictor of first-year incomplete response.
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Affiliation(s)
- Farnaz Nesari Javan
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Emran Askari
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Shafiei
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid Roshanravan
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atena Aghaei
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narjess Ayati
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Seyed Rasoul Zakavi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Ozgen Kiratli P, Volkan-Salanci B. Current approach to pediatric differentiated thyroid cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:32-39. [PMID: 38445831 DOI: 10.23736/s1824-4785.24.03551-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Differentiated thyroid cancers (DTC) is a rare cancer in children and adolescents, having features of different clinical presentation, biological behavior, and treatment from adult population. Most of the patient management guidelines are based on literature on adult population and the literature on children and adolescents still limited. There are still unsettled issues regarding both patient management and the therapy. However, the current approach for treatment of DTC includes thyroidectomy, lymph node dissection in patients with nodal metastases and possible use of Iodine-131 radiotherapy. The incidence of DTC is low in pediatric population, and the characteristics of the disease vary among different age groups within this population. Therefore, the literature depends on small cohorts and heterogeneous retrospective studies. This paper aims to review the current literature and give an overview to the approach in the management of DTC in pediatric population. DTC in pediatric population, has an aggressive nature, however the patient's overall survival is excellent. A multidisciplinary approach in the management of pediatric DTC patients would yield fewer side effects and a better life quality.
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Affiliation(s)
- Pinar Ozgen Kiratli
- Department of Nuclear Medicine, Hacettepe University Medical Center, Ankara, Türkiye
| | - Bilge Volkan-Salanci
- Department of Nuclear Medicine, Hacettepe University Medical Center, Ankara, Türkiye -
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Sandy JL, Titmuss A, Hameed S, Cho YH, Sandler G, Benitez-Aguirre P. Thyroid nodules in children and adolescents: Investigation and management. J Paediatr Child Health 2022; 58:2163-2168. [PMID: 36382588 PMCID: PMC10099987 DOI: 10.1111/jpc.16257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/19/2022] [Accepted: 10/09/2022] [Indexed: 11/17/2022]
Abstract
Clinically detectable thyroid nodules are less common in children than adults. However, they are associated with an increased risk of malignancy. Therefore, thorough evaluation of paediatric thyroid nodules is necessary, and an understanding of the features associated with a higher risk of malignancy is important to guide management and referral. Thyroid cancer in children differs significantly from that seen in adults in terms of genetics, presentation, response to treatment and prognosis. Children often present with more advanced disease, but the vast majority have excellent long-term prognosis. Evaluation and management of thyroid nodules and thyroid cancer require a multidisciplinary team approach and involvement of specialists with experience in this field. This review summarises investigative pathways for thyroid nodules in children and outlines current management strategies for paediatric thyroid nodules and cancer.
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Affiliation(s)
- Jessica L Sandy
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Angela Titmuss
- Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Shihab Hameed
- Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Paediatric Endocrinology, Sydney Children's Hospital Network, New South Wales, Australia.,School of Women and Children, University of New South Wales, New South Wales, Australia
| | - Yoon Hi Cho
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gideon Sandler
- Department of Surgery, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,School of Health Sciences, University of Sydney, New South Wales, Australia
| | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Child & Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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4
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Lebbink CA, Links TP, Czarniecka A, Dias RP, Elisei R, Izatt L, Krude H, Lorenz K, Luster M, Newbold K, Piccardo A, Sobrinho-Simões M, Takano T, Paul van Trotsenburg AS, Verburg FA, van Santen HM. 2022 European Thyroid Association Guidelines for the management of pediatric thyroid nodules and differentiated thyroid carcinoma. Eur Thyroid J 2022; 11:e220146. [PMID: 36228315 PMCID: PMC9716393 DOI: 10.1530/etj-22-0146] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022] Open
Abstract
At present, no European recommendations for the management of pediatric thyroid nodules and differentiated thyroid carcinoma (DTC) exist. Differences in clinical, molecular, and pathological characteristics between pediatric and adult DTC emphasize the need for specific recommendations for the pediatric population. An expert panel was instituted by the executive committee of the European Thyroid Association including an international community of experts from a variety of disciplines including pediatric and adult endocrinology, pathology, endocrine surgery, nuclear medicine, clinical genetics, and oncology. The 2015 American Thyroid Association Pediatric Guideline was used as framework for the present guideline. Areas of discordance were identified, and clinical questions were formulated. The expert panel members discussed the evidence and formulated recommendations based on the latest evidence and expert opinion. Children with a thyroid nodule or DTC require expert care in an experienced center. The present guideline provides guidance for healthcare professionals to make well-considered decisions together with patients and parents regarding diagnosis, treatment, and follow-up of pediatric thyroid nodules and DTC.
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Affiliation(s)
- Chantal A Lebbink
- Wilhelmina Children’s Hospital and Princess Máxima Center, Utrecht, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Renuka P Dias
- Department of Paediatric Endocrinology and Diabetes, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Louise Izatt
- Department of Clinical Genetics, Guy's and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Heiko Krude
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin, Berlin, Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Kate Newbold
- Thyroid Therapy Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, EO Ospedali Galliera, Genoa, Italy
| | - Manuel Sobrinho-Simões
- University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Toru Takano
- Thyroid Center, Rinku General Medical Center, Osaka, Japan
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanneke M van Santen
- Wilhelmina Children’s Hospital and Princess Máxima Center, Utrecht, The Netherlands
- Correspondence should be addressed to H M van Santen;
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Howard SR, Freeston S, Harrison B, Izatt L, Natu S, Newbold K, Pomplun S, Spoudeas HA, Wilne S, Kurzawinski TR, Gaze MN. Paediatric differentiated thyroid carcinoma: a UK National Clinical Practice Consensus Guideline. Endocr Relat Cancer 2022; 29:G1-G33. [PMID: 35900783 PMCID: PMC9513650 DOI: 10.1530/erc-22-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
This guideline is written as a reference document for clinicians presented with the challenge of managing paediatric patients with differentiated thyroid carcinoma up to the age of 19 years. Care of paediatric patients with differentiated thyroid carcinoma differs in key aspects from that of adults, and there have been several recent developments in the care pathways for this condition; this guideline has sought to identify and attend to these areas. It addresses the presentation, clinical assessment, diagnosis, management (both surgical and medical), genetic counselling, follow-up and prognosis of affected patients. The guideline development group formed of a multi-disciplinary panel of sub-speciality experts carried out a systematic primary literature review and Delphi Consensus exercise. The guideline was developed in accordance with The Appraisal of Guidelines Research and Evaluation Instrument II criteria, with input from stakeholders including charities and patient groups. Based on scientific evidence and expert opinion, 58 recommendations have been collected to produce a clear, pragmatic set of management guidelines. It is intended as an evidence base for future optimal management and to improve the quality of clinical care of paediatric patients with differentiated thyroid carcinoma.
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Affiliation(s)
- Sasha R Howard
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
- Department of Paediatric Endocrinology, Barts Health NHS Trust, London, UK
| | - Sarah Freeston
- Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | | | - Louise Izatt
- Department of Clinical and Cancer Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Sonali Natu
- Department of Pathology, University Hospital of North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
| | - Kate Newbold
- Department of Clinical Oncology, Royal Marsden Hospital Foundation Trust, London, UK
| | - Sabine Pomplun
- Department of Pathology, University College London Hospital NHS Foundation Trust, London, UK
| | - Helen A Spoudeas
- Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sophie Wilne
- Department of Paediatric Oncology, Nottingham University Hospital’s NHS Trust, Nottingham, UK
| | - Tom R Kurzawinski
- Department of Endocrine Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Paediatric Endocrine Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mark N Gaze
- Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Clinical Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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6
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van de Berg DJ, Kuijpers AMJ, Engelsman AF, Drukker CA, van Santen HM, Terwisscha van Scheltinga SCEJ, van Trotsenburg ASP, Mooij CF, Vriens MR, Nieveen van Dijkum EJM, Derikx JPM. Long-Term Oncological Outcomes of Papillary Thyroid Cancer and Follicular Thyroid Cancer in Children: A Nationwide Population-Based Study. Front Endocrinol (Lausanne) 2022; 13:899506. [PMID: 35600573 PMCID: PMC9114695 DOI: 10.3389/fendo.2022.899506] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pediatric thyroid carcinoma is a rare malignancy and data on long-term oncological outcomes are sparse. The aim of this study was to describe the long-term oncological outcomes of pediatric papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) in a national cohort, and to identify risk factors for recurrence. METHODS We conducted a nationwide, retrospective cohort study, in which we combined two national databases. Patients aged <18 years, diagnosed with PTC or FTC in the Netherlands between 2000 and 2016, were included. pT-stage, pN-stage, multifocality and angioinvasion were included in a Cox-regression analysis for the identification of risk factors for recurrence. RESULTS 133 patients were included: 110 with PTC and 23 with FTC. Patients with PTC most often presented with pT2 tumors (24%) and pN1b (45%). During a median follow-up of 11.3 years, 21 patients with PTC developed a recurrence (19%). Nineteen recurrences were regional (91%) and 2 were pulmonary (9%). No risk factors for recurrence could be determined. One patient who developed pulmonary recurrence died two years later. Cause of death was not captured. Patients with FTC most often presented with pT2 tumors (57%). One patient presented with pN1b (4%). In 70%, no lymph nodes were collected. None of the patients with FTC developed a recurrence or died. CONCLUSION Pediatric PTC and FTC are two distinct diseases. Recurrence in pediatric PTC is common, but in FTC it is not. Survival for both pediatric PTC and FTC is very good.
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Affiliation(s)
- Daniël J. van de Berg
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Joep P. M. Derikx, ; Daniël J. van de Berg,
| | - Anke M. J. Kuijpers
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Anton F. Engelsman
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Caroline A. Drukker
- Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Hanneke M. van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, Utrecht University Medical Center, University of Utrecht, Utrecht, Netherlands
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, Netherlands
| | | | - A. S. Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Christiaan F. Mooij
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Menno R. Vriens
- Department of Surgery, Utrecht University Medical Center, University of Utrecht, Utrecht, Netherlands
| | | | - Joep P. M. Derikx
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Joep P. M. Derikx, ; Daniël J. van de Berg,
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7
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Shimura H, Matsuzuka T, Suzuki S, Iwadate M, Suzuki S, Yokoya S, Ohira T, Yasumura S, Suzuki S, Ohto H, Kamiya K. Fine Needle Aspiration Cytology Implementation and Malignancy Rates in Children and Adolescents Based on Japanese Guidelines: The Fukushima Health Management Survey. Thyroid 2021; 31:1683-1692. [PMID: 34762538 DOI: 10.1089/thy.2021.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The thyroid ultrasound examination (TUE) program was initiated among the residents of Fukushima Prefecture aged ≤18 years at the time of the Fukushima Dai-ichi Nuclear Power Plant accident. In this program, fine needle aspiration cytology (FNAC) was performed only in cases that conformed to the Japanese guidelines for the management of thyroid nodules. To analyze the suitability of the protocol in the TUE, we analyzed the implementation rate of FNAC and the detection rate of thyroid malignancy. Methods: There were 299,939 and 269,659 voluntary participants in the Preliminarily Baseline Survey (PLBS), first-round survey, and the first Full-scale Survey (FSS), second-round survey, of the TUE, respectively. FNAC is recommended for nodules with diameters 5.1-10.0 mm showing sonographic characteristics that are strongly suspicious for thyroid carcinoma; diameters 10.1-20.0 mm with characteristics that are suspicious for carcinoma; and all nodules with diameters >20 mm. Results: In the PLBS and the first FSS, 1362 and 1382 cases with thyroid nodules sized ≥5.1 mm in diameter were found, respectively. The implementation rates of FNAC in the PLBS were 20.1%, 63.2%, and 87.7% of subjects with nodules sized 5.1-10.0, 10.1-20.0, and ≥20.1 mm in diameter, respectively. In the first FSS, the FNAC implementation rates were 7.3%, 26.0%, and 50.0% in the subjects with nodules with diameters 5.1-10.0, 10.1-20.0, and ≥20.1 mm, respectively. In the subjects who underwent FNAC, the detection rates of malignant and suspected malignant nodules were 21.4% and 34.1% in the PLBS and first FSS, respectively. In the first FSS, malignant or suspected malignant nodules were found in 0.63% and 0.40% of subjects who had nodules of diameters ≤5.0 mm and 5.1-10.0 mm in the PLBS, respectively. In contrast, in the subjects with nodules measuring ≥10.0 mm in diameter in the PLBS, no malignancies were detected. Conclusions: The use of a protocol that conformed to the Japanese guidelines led to a reduction in the FNAC implementation rate and an increase in the malignancy detection rate in smaller nodules. In addition, the use of this strategy enabled us to avoid detection failure of thyroid carcinomas >10.0 mm.
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Affiliation(s)
- Hiroki Shimura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Laboratory Medicine; Fukushima Medical University, Fukushima, Japan
| | - Takashi Matsuzuka
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Manabu Iwadate
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Thyroid and Endocrinology; Fukushima Medical University, Fukushima, Japan
| | - Satoshi Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Thyroid and Endocrinology; Fukushima Medical University, Fukushima, Japan
| | - Susumu Yokoya
- Department of Thyroid and Endocrine Center, Fukushima Global Medical Science Center; Fukushima Medical University, Fukushima, Japan
| | - Tetsuya Ohira
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Epidemiology, and Fukushima Medical University, Fukushima, Japan
| | - Seiji Yasumura
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Public Health; School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology; Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Ohto
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Kenji Kamiya
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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Grønlund MP, Jensen JS, Hahn CH, Grønhøj C, Buchwald CV. Risk Factors for Recurrence of Follicular Thyroid Cancer: A Systematic Review. Thyroid 2021; 31:1523-1530. [PMID: 34102860 DOI: 10.1089/thy.2020.0921] [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] [Indexed: 01/17/2023]
Abstract
Background: In risk assessment of recurrence, papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) are often grouped together as differentiated thyroid cancer (DTC). However, while risk factors affecting recurrence of PTC are well established, risk factors for recurrence of FTC are not. This systematic review examines risk factors for recurrence of FTC and evaluates their significance. Methods: A systematic search on PubMed and Embase was performed in September 2020, including studies evaluating risk factors for recurrence of FTC. A quality assessment of the enrolled studies was performed. Results: Nine studies (n = 1544 patients) from eight countries were included. The average recurrence rate was 13.6%, and distant metastasis (DM) constituted 64.8% of the recurrent cases. The risk factors examined were sex, age at diagnosis, primary tumor size, degree of invasiveness, focality, positive resection margin, lymph node (LN) metastasis, and DM at diagnosis. Risk factors correlated with recurrence of FTC were age older than 45 years, primary tumor size above 40 mm, widespread invasion, multifocality, positive resection margin, LN metastasis, and DM at diagnosis. Sex was not a statistically significant risk factor. Conclusions: We identified seven risk factors associated with recurrence of FTC. Age and multifocality were found to be of greater impact regarding recurrence risk of FTC compared with PTC. Future research needs to address the impact of different risk factors for recurrence of FTC particularly including age, primary tumor size, angioinvasion, and mutational status.
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Affiliation(s)
- Mathias Peter Grønlund
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Schmidt Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Holst Hahn
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery, and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Nies M, Vassilopoulou-Sellin R, Bassett RL, Yedururi S, Zafereo ME, Cabanillas ME, Sherman SI, Links TP, Waguespack SG. Distant Metastases From Childhood Differentiated Thyroid Carcinoma: Clinical Course and Mutational Landscape. J Clin Endocrinol Metab 2021; 106:e1683-e1697. [PMID: 33382403 PMCID: PMC7993569 DOI: 10.1210/clinem/dgaa935] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Distant metastases (DM) from childhood differentiated thyroid carcinoma (DTC) are uncommon and published studies are limited. OBJECTIVE This work aimed to describe the outcomes of patients with DM from childhood DTC and to evaluate the molecular landscape of these tumors. METHODS A retrospective study was conducted at a tertiary cancer center including patients with pediatric DTC (diagnosed at age ≤ 18 years from 1946 to 2019) and DM. RESULTS We identified 148 patients; 144 (97%) had papillary thyroid carcinoma (PTC) and 104 (70%) were female. Median age at DTC diagnosis was 13.4 years (interquartile range [IQR], 9.9-15.9 years). Evaluable individuals received a median of 2 (IQR, 1-3) radioactive iodine (RAI) treatments at a median cumulative administered activity of 238.0 mCi (IQR, 147.5-351.0 mCi). The oncogenic driver was determined in 64 of 69 PTC samples: RET fusion (38/64; 59%), NTRK1/3 fusions (18/64; 28%), and the BRAF V600E mutation (8/64; 13%). At last evaluation, 93% had persistent disease. The median overall and disease-specific survival after DTC diagnosis were 50.7 and 52.8 years, respectively. Eight (5%) PTC patients died of disease after a median of 30.7 years (IQR, 20.6-37.6 years). CONCLUSION Childhood DTC with DM persists in most patients despite multiple courses of RAI, but disease-specific death is uncommon, typically occurring decades after diagnosis. Fusion genes are highly prevalent in PTC, and all identified molecular alterations have appropriate targeted therapies. Future studies should focus on expanding genotype-phenotype correlations, determining how to integrate molecularly targeted therapy into treatment paradigms, and relying less on repeated courses of RAI to achieve cure in patients with DM from childhood DTC.
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Affiliation(s)
- Marloes Nies
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, GZ Groningen, the Netherlands
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rena Vassilopoulou-Sellin
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roland L Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sireesha Yedururi
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria E Cabanillas
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Thera P Links
- Department of Endocrinology, Internal Medicine, University of Groningen, University Medical Center Groningen, GZ Groningen, the Netherlands
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Pediatrics–Patient Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Correspondence: Steven G. Waguespack, MD, The University of Texas MD Anderson Cancer Center, Department of Endocrine Neoplasia & Hormonal Disorders, 1400 Pressler St, Unit 1461, Houston, TX 77030, USA.
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Enomoto K, Hirayama S, Kumashiro N, Jing X, Kimura T, Tamagawa S, Matsuzaki I, Murata SI, Hotomi M. Synergistic Effects of Lenvatinib (E7080) and MEK Inhibitors against Anaplastic Thyroid Cancer in Preclinical Models. Cancers (Basel) 2021; 13:cancers13040862. [PMID: 33670725 PMCID: PMC7922355 DOI: 10.3390/cancers13040862] [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: 01/21/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/21/2022] Open
Abstract
E7080, known as lenvatinib, is an oral multitargeted tyrosine kinase inhibitor that has been shown to improve the survival rate of patients with radioiodine-refractory thyroid cancer. However, a majority of patients do not continue lenvatinib intake due to disease progression or significant toxicity. To improve treatment success rates, we propose the combination of lenvatinib with mitogen-activated protein kinase (MEK) inhibitors. To test this hypothesis, we tested the effects of lenvatinib with the MEK inhibitor U0126 in vitro using two human anaplastic thyroid cancer (ATC) cell lines, 8505C and TCO1, and with another MEK inhibitor, selumetinib (AZD6244), in an ATC mouse model. We found that the combination of lenvatinib with MEK inhibitors enhanced the antitumor effects of monotherapy with either agent in vitro and in vivo, and these effects may be through the AKT (Protein Kinase B) and extracellular signal-regulated kinase (ERK) signaling pathways. Furthermore, the combination does not have significant adverse effects in the ATC mouse models in terms of body weight, blood biochemical parameters, and histopathology. In conclusion, the combination of lenvatinib with an MEK inhibitor is a potentially viable therapeutic approach for ATC treatment.
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Affiliation(s)
- Keisuke Enomoto
- Department of Otolaryngology—Head and Neck Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (K.E.); (S.H.); (N.K.); (X.J.); (T.K.); (S.T.)
| | - Shun Hirayama
- Department of Otolaryngology—Head and Neck Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (K.E.); (S.H.); (N.K.); (X.J.); (T.K.); (S.T.)
| | - Naoko Kumashiro
- Department of Otolaryngology—Head and Neck Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (K.E.); (S.H.); (N.K.); (X.J.); (T.K.); (S.T.)
| | - Xuefeng Jing
- Department of Otolaryngology—Head and Neck Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (K.E.); (S.H.); (N.K.); (X.J.); (T.K.); (S.T.)
| | - Takahito Kimura
- Department of Otolaryngology—Head and Neck Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (K.E.); (S.H.); (N.K.); (X.J.); (T.K.); (S.T.)
| | - Shunji Tamagawa
- Department of Otolaryngology—Head and Neck Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (K.E.); (S.H.); (N.K.); (X.J.); (T.K.); (S.T.)
| | - Ibu Matsuzaki
- Department of Human Pathology, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (I.M.); (S.-I.M.)
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (I.M.); (S.-I.M.)
| | - Muneki Hotomi
- Department of Otolaryngology—Head and Neck Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan; (K.E.); (S.H.); (N.K.); (X.J.); (T.K.); (S.T.)
- Correspondence: ; Tel.: +81-73-441-0651; Fax: +81-73-446-3846
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Christison-Lagay E, Baertschiger RM. Management of Differentiated Thyroid Carcinoma in Pediatric Patients. Surg Oncol Clin N Am 2021; 30:235-251. [PMID: 33706898 DOI: 10.1016/j.soc.2020.11.013] [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] [Indexed: 11/18/2022]
Abstract
Differentiated thyroid carcinomas are rare in young children but represent almost 10% of all malignancies diagnosed in older adolescents. Differentiated thyroid carcinoma in children is more likely to demonstrate nodal involvement and is associated with higher recurrence rates than seen in adults. Decisions regarding extent of surgical resection are based on clinical and radiologic features, cytology, and risk assessment. Total thyroidectomy and compartment-based resection of involved lymph node basins form the cornerstone of treatment. The use of molecular genetics to inform treatment strategies and the use of targeted therapies to unresectable progressive disease is evolving.
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Affiliation(s)
- Emily Christison-Lagay
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street, PO Box 208062, New Haven, CT, USA.
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Room 1524, 555 University Ave, Toronto, ON M5G 1X8, Canada
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12
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Negre Busó M, García Burillo A, Simó Perdigó M, Galofré Mora P, Boronat de Ferrater M, Cuberas Borrós G, Sábado Álvarez C, Castell Conesa J. Long-term follow-up of differentiated thyroid carcinoma in children and adolescents. J Pediatr Endocrinol Metab 2020; 33:1431-1441. [PMID: 32877364 DOI: 10.1515/jpem-2020-0194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022]
Abstract
Objectives The aims were to analyze the clinical features, response to treatment, prognostic factors and long-term follow-up of children and adolescents with differentiated thyroid carcinoma (DTC). Methods Eighty patients with DTC were studied retrospectively. All underwent total or near-total thyroidectomy, and in 75 cases, ablative iodine therapy was recommended. Patients were assessed periodically by tests for serum thyroglobulin levels and whole-body iodine scans. Age, gender, initial clinical presentation, histology, tumor stage, postoperative complications, radioiodine treatment protocol, treatment response, thyroglobulin (Tg), recurrence and long-term disease progression were evaluated. Results Seventy patients completed >2 years of follow-up (23 males, 47 females; median age: 14 years; range: 3-18 years). Sixty-two patients showed papillary DTC and eight, follicular DTC. Sixty-five percent presented nodal metastasis and 16%, pulmonary metastasis at diagnosis. Six months after first radioiodine treatment, 36.2% of patients were free of disease. Seven recurrences were documented. At the end of follow-up, overall survival was 100%, and 87.2% of patients were in complete remission. Nine patients had persistent disease. We found a significant association between stage 4 and persistent disease. Hundred percent of patients with negative Tg values at 6 months posttreatment were documented free of disease at the end of the follow-up. The analysis of disease-free survival based on radioiodine treatment protocols used showed no statistically significant differences. Conclusions DTC in children and adolescents is frequently associated with presence of advanced disease at diagnosis. Despite this, complete remission was documented after treatment in most cases, with a good prognosis in the long-term follow-up. Negative posttreatment thyroglobulin and stage 4 at diagnosis were significant prognostic variables.
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Affiliation(s)
- Montserrat Negre Busó
- Nuclear Medicine Service-IDI, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Amparo García Burillo
- Nuclear Medicine Department, Hospital Universitari de la Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Marc Simó Perdigó
- Nuclear Medicine Department, Hospital Universitari de la Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pere Galofré Mora
- Nuclear Medicine Service-IDI, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Maria Boronat de Ferrater
- Nuclear Medicine Department, Hospital Universitari de la Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Gemma Cuberas Borrós
- Nuclear Medicine Department, Hospital Universitari de la Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Constantino Sábado Álvarez
- Pediatric Oncology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Castell Conesa
- Nuclear Medicine Department, Hospital Universitari de la Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
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13
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Pediatric differentiated thyroid carcinoma: An update from the APSA Cancer Committee. J Pediatr Surg 2020; 55:2273-2283. [PMID: 32553450 DOI: 10.1016/j.jpedsurg.2020.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/04/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Differentiated thyroid carcinomas (DTCs) are rare in young children but represent almost 10% of all malignancies diagnosed in older adolescents. METHODS This article reviews the recent literature describing surgical therapeutic approaches to pediatric DTC, associated complications, and long-term recurrence and survival outcomes. RESULTS Similar to adult thyroid cancers, pediatric DTCs are more common in females and are associated with thyroid nodules, family history of thyroid cancer, radiation exposure, iodine deficiency, autoimmune thyroid disease, and genetic syndromes. Management of thyroid cancers in children involves ultrasound imaging, fine needle aspiration, and surgical resection with treatment decisions based on clinical and radiological features, cytology and risk assessment. CONCLUSIONS Total thyroidectomy and compartment based resection of clinically involved lymph node basins form the cornerstone of treatment of DTC. There is an evolving literature regarding the use of molecular genetics to inform treatment strategies and the use of targeted therapies to treat iodine refractory and surgically unresectable progressive disease. TYPE OF STUDY Summary review. LEVEL OF EVIDENCE This is a review article of previously published Level 1-5 articles that includes expert opinion (Level 5).
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Lee YA, Im SW, Jung KC, Chung EJ, Shin CH, Kim JI, Park YJ. Predominant DICER1 Pathogenic Variants in Pediatric Follicular Thyroid Carcinomas. Thyroid 2020; 30:1120-1131. [PMID: 32228164 DOI: 10.1089/thy.2019.0233] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Pediatric thyroid cancer has characteristics that are distinct from adulthood thyroid cancer. Due to its very low prevalence, little is known about the genetic characteristics of pediatric follicular thyroid cancer (FTC). Methods: We investigated genetic alterations in tumor tissues from 15 patients aged <20 years (median: 14.3 years; range: 2.4 - 19.0 years) using multifaceted approaches. Whole-exome sequencing, targeted next-generation sequencing using a cancer gene panel, and Sanger sequencing of the major exons of the H/K/N-RAS and DICER1 genes and the promoter region of the TERT gene were performed. Normal tissues or blood of patients with DICER1- or PTEN-positive tumors was also evaluated to determine whether the variant is germ line. Results: The median tumor size was 3.1 cm (range: 0.6 - 6.4 cm). Four patients exhibited angioinvasion and one extensive capsular invasion; none showed evidence of disease over a median of 8.1 years. Eight patients (53.3%) had DICER1 variants, including four with DICER1 syndrome (three patients were <10 years of age). One patient had a germ line PTEN frameshift variant with the diagnosis of PTEN hamartoma tumor syndrome. One patient had a PAX8/PPARγ rearrangement, and two patients had no genetic driver alteration other than multiple loss of heterozygosity with or without copy number alterations in their tumors. No RAS or TERT variants were found. Nodular hyperplasia and follicular adenoma (FA) coexisted in DICER1 variant-positive FTCs more frequently than variant-negative FTCs (p = 0.026). All DICER1 variant-positive FTCs had a somatic missense variant at metal binding sites (six at codon p.E1813 and two at codon p.D1709) within the RNase IIIb domain; seven had other missense, nonsense, or frameshift variants in the DICER1 gene. Six coexisting FAs of two patients with DICER1 syndrome (three of each) had additional somatic variants at metal binding sites within the RNase IIIb domain (codon p.E1705, p.D1709, p.D1810, or p.E1813), different from each other and from the indexed FTC tumor. Conclusions: Pediatric FTCs have distinct genomic alterations and pathogenesis compared with adults, particularly those characterized by DICER1 variants. The DICER1 variant should be considered in pediatric FTCs, especially in cases <10 years of age. In all DICER1 variant-positive FTCs and FAs, recurrent hotspot variants were found at metal binding sites within the RNase IIIb domain, suggesting they impact tumorigenesis.
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Affiliation(s)
- Young Ah Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Wha Im
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Kyeong Cheon Jung
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Il Kim
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Young Joo Park
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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15
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Utria AF, Goffredo P, Belding-Schmitt M, Liao J, Shilyansky J, Lal G. Practice Patterns and Outcomes of Pediatric Thyroid Surgery: An NSQIP Analysis. J Surg Res 2020; 255:181-187. [PMID: 32563758 DOI: 10.1016/j.jss.2020.05.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/25/2020] [Accepted: 05/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric thyroid cancer rates are rising. The aim of this study was to determine the state of current practice and outcomes for pediatric thyroidectomies using the pediatric National Surgical Quality Improvement Program (NSQIP-P) with specific attention to differences based on surgeon type/specialty. METHODS All cases of pediatric thyroidectomies and neck dissections within the NSQIP-P database were identified from 2015 to 2017. Patient, disease, and treatment-related factors affecting 30-day outcomes were analyzed using univariate and multivariate analyses. RESULTS A total of 1300 cases were identified. Mean age at time of surgery was 14.0 (SD 3.5) years. The majority of patients were female (78%) and Caucasian (72%). Pediatric general surgeons performed the largest proportion of cases (42%) followed by pediatric otolaryngologists (33%). Malignancies were present in 29% of cases. The overall rate of complications was 3.0%. On multivariate analysis, non-pediatric surgeons were more likely to operate on Caucasian children, malignant pathology, and perform modified radical neck dissections. Pediatric surgeons were more likely to have longer operative times, have specialized in otolaryngology, and operate on sicker children (ASA>2). There were no differences in length of stay or overall complications rates. CONCLUSIONS This study shows that pediatric surgeons currently perform the majority of thyroid surgeries in children. While unable to assess surgeon volume, our data show that thyroid surgery is being safely performed at NSQIP-affiliated hospitals by both non-pediatric and pediatric surgeons. Further studies are needed to determine if there are differences in specific procedure-related complications and long-term outcomes between surgeon types.
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Affiliation(s)
- Alan F Utria
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Paolo Goffredo
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Mary Belding-Schmitt
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Junlin Liao
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Joel Shilyansky
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa; Division of Pediatric Surgery, Department of Surgery, University Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Geeta Lal
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
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A novel therapeutic approach for anaplastic thyroid cancer through inhibition of LAT1. Sci Rep 2019; 9:14616. [PMID: 31601917 PMCID: PMC6787004 DOI: 10.1038/s41598-019-51144-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022] Open
Abstract
A novel therapeutic approach is urgently needed for patients with anaplastic thyroid cancer (ATC) due to its fatal and rapid progress. We recently reported that ATC highly expressed MYC protein and blocking of MYC through its selective inhibitor, JQ1, decreased ATC growth and improved survival in preclinical models. One of the important roles of MYC is regulation of L-neutral amino acid transporter 1 (LAT1) protein and inhibition of LAT1 would provide similar anti-tumor effect. We first identified that while the human ATC expresses LAT1 protein, it is little or not detected in non-cancerous thyroidal tissue, further supporting LAT1 as a good target. Then we evaluated the efficacy of JPH203, a LAT1 inhibitor, against ATC by using the in vitro cell-based studies and in vivo xenograft model bearing human ATC cells. JPH203 markedly inhibited proliferation of three ATC cell lines through suppression of mTOR signals and blocked cell cycle progression from the G0/G1 phase to the S phase. The tumor growth inhibition and decrease in size by JPH203 via inhibition of mTOR signaling and G0/G1 cell cycle associated proteins were further confirmed in xenograft models. These preclinical findings suggest that LAT1 inhibitors are strong candidates to control ATC, for which current treatment options are highly limited.
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17
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Paulson VA, Rudzinski ER, Hawkins DS. Thyroid Cancer in the Pediatric Population. Genes (Basel) 2019; 10:genes10090723. [PMID: 31540418 PMCID: PMC6771006 DOI: 10.3390/genes10090723] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022] Open
Abstract
Thyroid cancer is rare in the pediatric population, but thyroid carcinomas occurring in children carry a unique set of clinical, pathologic, and molecular characteristics. In comparison to adults, children more often present with aggressive, advanced stage disease. This is at least in part due to the underlying biologic and molecular differences between pediatric and adult thyroid cancer. Specifically, papillary thyroid carcinoma (which accounts for approximately 90% of pediatric thyroid cancer) has a high rate of gene fusions which influence the histologic subtypes encountered in pediatric thyroid tumors, are associated with more extensive extrathyroidal disease, and offer unique options for targeted medical therapies. Differences are also seen in pediatric follicular thyroid cancer, although there are few studies of non-papillary pediatric thyroid tumors published in the literature due to their rarity, and in medullary carcinoma, which is most frequently diagnosed in the pediatric population in the setting of prophylactic thyroidectomies for known multiple endocrine neoplasia syndromes. The overall shift in the spectrum of histotypes and underlying molecular alterations common in pediatric thyroid cancer is important to recognize as it may directly influence diagnostic test selection and therapeutic recommendations.
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Affiliation(s)
- Vera A Paulson
- Dept. of Laboratory Medicine, University of Washington Medical Center, 1959 NE Pacific St, Box 357110, Seattle, WA 98105, USA.
| | - Erin R Rudzinski
- Dept. of Laboratories, Seattle Children's Hospital, OC.8.720; 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Douglas S Hawkins
- University of Washington Medical Center, Fred Hutchinson Cancer Research Center and Cancer and Blood Disorders Center, Seattle Children's Hospital, MB.8.501, Seattle, WA 98105, USA.
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18
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Spinelli C, Rallo L, Morganti R, Mazzotti V, Inserra A, Cecchetto G, Massimino M, Collini P, Strambi S. Surgical management of follicular thyroid carcinoma in children and adolescents: A study of 30 cases. J Pediatr Surg 2019; 54:521-526. [PMID: 29935896 DOI: 10.1016/j.jpedsurg.2018.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/24/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE The purpose of the study is to describe the anatomoclinical, diagnostic, therapeutic and prognostic aspects of pediatric follicular thyroid carcinoma (FTC) in order to choose the best therapeutic strategy. METHODS Our study includes patients ≤18 years old surgically treated for FTC in four Italian Pediatric Surgery Centers from January 2000 to March 2017. The collected data were compared with those of 132 patients matched for age with a histological diagnosis of papillary thyroid carcinoma (PTC) surgically treated in the same institutions during the same period and with the data of patients diagnosed with FTC found in the literature; p-values <0.05 were considered significant. RESULTS 21 (70%) of the 30 patients with a histological diagnosis of FTC underwent hemithyroidectomy while 9 (30%) underwent total thyroidectomy. 11 (55%) out of 21 patients were subjected to a completion of thyroidectomy. All patients are alive (OS = 100%) without recurrence or relapse of the disease. Compared with PTC, FTC is significant for capsule infiltration (p < 0.0001), vascular invasion (p = 0.0014) and T-stage T3-T4 (p = 0.013). However, multifocality (p < 0.001), extrathyroid extension (p < 0.0001) and lymph node metastasis (p < 0.0001) are more evident in PTC. CONCLUSION The conservative approach seems to be a valid surgical treatment for pediatric patients diagnosed with MI-FTC. For patients with wide vascular invasion and/or a tumor >4 cm, especially with high after-surgery Tg rate, a completion of thyroidectomy is recommended. In patients with multifocal neoplasia, and/or tumor size ≥4 cm, and/or extrathyroid extension, and/or lymph node metastasis, and/or distant metastasis, total thyroidectomy followed by radioiodine therapy is generally indicated. LEVELS OF EVIDENCE II.
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Affiliation(s)
- Claudio Spinelli
- Pediatric and Adolescent Surgery Division, University of Pisa, Italy.
| | - Leonardo Rallo
- Pediatric and Adolescent Surgery Division, University of Pisa, Italy
| | - Riccardo Morganti
- Statistical Support to Clinical Trials Department, University of Pisa, Italy
| | - Valentina Mazzotti
- Statistical Support to Clinical Trials Department, University of Pisa, Italy
| | | | | | - Maura Massimino
- Pediatric Oncology Unit, IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Soft Tissue and Bone Pathology, Histopathology and Pediatric Pathology Unit, IRCCS Istituto Nazionale dei, Tumori, Milan, Italy
| | - Silvia Strambi
- Pediatric and Adolescent Surgery Division, University of Pisa, Italy
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19
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Surgical Management of Thyroid Disease in Children. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0189-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Vuong HG, Kondo T, Oishi N, Nakazawa T, Mochizuki K, Miyauchi A, Hirokawa M, Katoh R. Paediatric follicular thyroid carcinoma - indolent cancer with low prevalence of RAS mutations and absence of PAX8-PPARG fusion in a Japanese population. Histopathology 2017. [PMID: 28621837 DOI: 10.1111/his.13285] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS Paediatric follicular thyroid carcinomas are uncommon, and their clinicopathological features and molecular profiles are still unknown. In the present study, we aimed to investigate the clinicopathological aspects of a large series of follicular thyroid carcinomas (FTCs) in paediatric patients and to analyse the point mutations in codons 12, 13 and 61 of NRAS, HRAS and KRAS genes and the rearrangements of PAX8-PPARG. METHODS AND RESULTS A total of 41 paediatric FTCs less than 21 years of age were enrolled into the present study. We used direct sequencing and reverse transcription-polymerase chain reaction (RT-PCR) to detect RAS mutations and PAX8-PPARG fusions, respectively. The paediatric FTCs were 6:1 in a female to male ratio, with a mean tumour size of 52.7 mm. Distant metastasis was found in one case at the time of presentation. During a median follow-up time of 69 months, two cases had lung metastasis and all patients were alive. Histologically, all cases were minimally invasive FTCs and varied in growth patterns: microfollicular (39%), follicular (14.6%), solid/trabecular (6%), oncocytic (4.9%) and mixed patterns (26.8%). The mean Ki67 index was 5.7% and it was not statistically different among the growth patterns. NRAS mutations were found in five cases (12.2%) and associated significantly with small tumour size (P = 0.014). PAX8-PPARG fusion was not detected in our series. CONCLUSION Paediatric FTCs are indolent in clinical course in spite of their large tumour size and have a distinct genetic background. RAS mutations and PAX8-PPARG fusions may not play major roles in the tumorigenesis of paediatric FTCs.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Tadao Nakazawa
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Kunio Mochizuki
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | | | | | - Ryohei Katoh
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
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21
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Vuong HG, Kondo T, Duong UNP, Pham TQ, Oishi N, Mochizuki K, Nakazawa T, Hassell L, Katoh R. Prognostic impact of vascular invasion in differentiated thyroid carcinoma: a systematic review and meta-analysis. Eur J Endocrinol 2017; 177:207-216. [PMID: 28566444 DOI: 10.1530/eje-17-0260] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/15/2017] [Accepted: 05/30/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND The role of vascular invasion (VI) as a prognostic marker in thyroid cancer is continuously debated among investigators. In this systematic review and meta-analysis, we aimed to investigate the association of VI with tumor recurrence and patient mortality in differentiated thyroid cancers (DTCs). METHODS We searched five electronic databases for cases of DTC matching our criteria. Data of tumor persistence, locoregional recurrence (LRR), distant recurrence (DR) and overall recurrence/persistence (RP) were extracted and pooled into odds ratios (OR) and corresponding 95% confidence intervals (CIs) using random effect model. Pooled hazard ratio (HR) for disease-specific survival (DSS) was calculated using random effect model weighted by inverse variance method. Publication bias was examined by using Egger's test and funnel plot. RESULTS From 1650 studies, we included 26 studies comprising 11 961 DTCs for meta-analyses. In DTC patients, we found significant associations of VI with tumor persistence (OR = 2.75; 95% CI = 1.46-5.18), LRR (OR = 4.44; 95% CI = 2.94-6.71), DR (OR = 5.08; 95% CI = 2.95-8.75), overall RP (OR = 3.53; 95% CI = 2.09-5.96) and worse DSS (HR = 2.47; 95% CI = 1.45-4.21). Our results also demonstrated that the presence of extensive VI is associated with a significantly higher risk for DR in follicular thyroid carcinomas as compared with focal VI. CONCLUSION Our study demonstrated a significant impact of VI on tumor recurrence and patient survival in DTC patients. The presence and extent of VI should be considered an adverse prognostic factor in DTCs.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
- Department of Pathology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Uyen N P Duong
- Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thong Quang Pham
- Department of Pathology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Kunio Mochizuki
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Tadao Nakazawa
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Lewis Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ryohei Katoh
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
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22
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Gertz RJ, Nikiforov Y, Rehrauer W, McDaniel L, Lloyd RV. Mutation in BRAF and Other Members of the MAPK Pathway in Papillary Thyroid Carcinoma in the Pediatric Population. Arch Pathol Lab Med 2016; 140:134-9. [PMID: 26910217 DOI: 10.5858/arpa.2014-0612-oa] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Papillary thyroid carcinoma (PTC) is an uncommon tumor in the pediatric population. A limited number of studies have examined genetic mutations affecting the mitogen-activated protein kinase (MAPK) pathway in the pediatric population. OBJECTIVE To examine mutations affecting this pathway in PTC in our pediatric population and compare the BRAF V600E mutation rates in pediatric and adult tumors. DESIGN Eighty-four patients, including 14 pediatric and 70 adult, with PTC were tested for the BRAF V600E mutation by using real-time polymerase chain reaction and sequencing. Additionally, we examined the rate of RAS point mutations with real-time polymerase chain reaction and rearrangements of RET/PTC1 and RET/PTC3 in the pediatric group with fluorescence in situ hybridization. Clinical and histologic data were compared as well. RESULTS Of 77 tumors that had an interpretable result, the BRAF V600E mutant was identified in 4 of 13 pediatric patients (31%) and 43 of 64 adult patients (67%), which was a significant difference (using Fisher exact test, P = .03). One pediatric and 6 adult cases did not reveal an interpretable result with melting curve analysis. One of these cases harbored a rare 3-base pair deletion mutation (c.1799_1801delTGA). Mutations in RAS genes were not seen in any pediatric tumors. One tumor with a RET/PTC1 rearrangement and another with RET/PTC3 were identified in the pediatric population (15%). CONCLUSIONS The rate of the BRAF V600E mutation in the pediatric population is significantly lower than that seen in the adult population. Mutations in RAS do not contribute significantly to pediatric PTC. This experience from our institution adds to the growing body of knowledge regarding tumor genetics in pediatric PTC.
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Affiliation(s)
- Ryan J Gertz
- From the Department of Pathology, MD Anderson Cancer Center, Houston, Texas (Dr Gertz)
| | - Yuri Nikiforov
- the Division of Molecular Genomic Pathology, University of Pittsburgh, Pennsylvania (Dr Nikiforov)
| | - William Rehrauer
- the Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison (Drs Lloyd and Rehrauer)
| | - Lee McDaniel
- and the School of Public Health, Louisiana State University, New Orleans (Dr McDaniel). Dr Gertz is now located at the Department of Pathology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio
| | - Ricardo V Lloyd
- the Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison (Drs Lloyd and Rehrauer)
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23
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Cipriani NA, Nagar S, Kaplan SP, White MG, Antic T, Sadow PM, Aschebrook-Kilfoy B, Angelos P, Kaplan EL, Grogan RH. Follicular Thyroid Carcinoma: How Have Histologic Diagnoses Changed in the Last Half-Century and What Are the Prognostic Implications? Thyroid 2015; 25:1209-16. [PMID: 26440366 PMCID: PMC4948203 DOI: 10.1089/thy.2015.0297] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Follicular thyroid carcinoma (FTC) comprises 10% of differentiated thyroid cancers. Diagnostic controversy and interobserver variability render the practical diagnosis of FTC difficult. Overall survival rates vary (46-97%). The aims of this study were to review FTC histologically at the authors' tertiary care institution and to evaluate long-term survival and recurrence. METHODS Diagnostic slides from 66 FTC cases (1965-2007) were reviewed by three pathologists from two institutions (blinded to clinical outcomes), and consensus was obtained. Patient demographics, tumor characteristics, and treatment, survival, and recurrence data were collected. Thyroid cancer-specific and recurrence-free survival were calculated by original and reclassified diagnoses. RESULTS Forty-seven cases (71%) were reclassified: 24 (36%) to papillary thyroid carcinoma (PTC), 18 (27%) to follicular adenoma (FA), and five (8%) to poorly differentiated carcinoma (PDC). Nineteen (29%) maintained a diagnosis of FTC. The extent of surgical resection and rates of radioiodine treatment did not differ by reclassification diagnosis. Pre-review FTC-specific survival was 83.5% and 75.1% at 10 and 20 years, respectively. Following contemporary reclassification, FTC-specific survival was 77% and 33.7% at 10 and 20 years, respectively. There were no cancer-specific deaths in the FA or PTC groups. CONCLUSIONS Over the past 50 years, changes in our understanding of the pathogenesis, histology, and behavior of thyroid carcinoma may partially account for the changes in histologic diagnosis. Elimination of PTC and FA "contaminants" led to decrease in survival following reclassification. Variability in histologic interpretation contributes to diagnostic challenges in follicular lesions. Histologic review of thyroid tumors for research studies is crucial, especially given the ever-changing diagnostic criteria.
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Affiliation(s)
| | - Sapna Nagar
- Department of Surgery, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Sharone P. Kaplan
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, Chicago, Illinois
| | - Michael G. White
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, Chicago, Illinois
| | - Tatjana Antic
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Peter M. Sadow
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Peter Angelos
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, Chicago, Illinois
| | - Edwin L. Kaplan
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, Chicago, Illinois
| | - Raymon H. Grogan
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, Chicago, Illinois
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24
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Enomoto K, Sakata Y, Izumi K, Takenaka Y, Nagai M, Takeda K, Enomoto Y, Uno A. Strong Neck Accumulation of 131I Is a Predictor of Incomplete Low-Dose Radioiodine Remnant Ablation Using Recombinant Human Thyroid-Stimulating Hormone. Medicine (Baltimore) 2015; 94:e1490. [PMID: 26426611 PMCID: PMC4616877 DOI: 10.1097/md.0000000000001490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/21/2015] [Accepted: 08/10/2015] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to identify the factors that predict incomplete low-dose radioiodine remnant ablation (RRA) with recombinant human thyroid-stimulating hormone (rhTSH) and to report the adverse events associated with this treatment. Between 2012 and 2014, 43 consecutive patients with thyroid cancer received low-dose RRA with rhTSH after total thyroidectomy. We retrospectively investigated the adverse events during low-dose RRA and during diagnostic whole body scan (DxWBS) using rhTSH, and analyzed the rate of RRA completion and the associations between RRA completion and various clinical/pathological factors. Complete RRA was seen in 33 (76.7%) patients, and incomplete RRA was observed in 10 (23.3%). Patients with incomplete RRA had stronger neck accumulation of 131I than those with complete RRA (P < 0.001). Adverse events at RRA and DxWBS were seen in 12 and 9 patients, respectively. All events at RRA were grade 1, with one exception (grade 2 vertigo after rhTSH administration). The rate of adverse events at DxWBS was significantly higher in patients with adverse events seen at RRA (risk ratio, 3.778, P = 0.008). Strong neck accumulation of 131I is significant independent predictor of incomplete low-dose RRA. The risk of adverse events at DxWBS was higher in patients who experienced adverse events at RRA than in those who did not.
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Affiliation(s)
- Keisuke Enomoto
- From the Otolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
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25
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Schoelwer MJ, Zimmerman D, Shore RM, Josefson JL. The Use of 123I in Diagnostic Radioactive Iodine Scans in Children with Differentiated Thyroid Carcinoma. Thyroid 2015; 25:935-41. [PMID: 25978106 DOI: 10.1089/thy.2014.0521] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adult studies have shown that iodine-123 ((123)I) is as effective as (131)I in detecting metastatic disease in patients with differentiated thyroid carcinoma. However, the type and administered activity of radioiodine used for diagnostic imaging of metastatic thyroid cancer has not been well studied in children. Here we describe our institution's experience with using (123)I in diagnostic radioiodine scans in children with differentiated thyroid carcinoma. METHODS Every patient with differentiated thyroid carcinoma who completed diagnostic scanning followed by radioiodine therapy at our institution over the past 8 years was included in this retrospective chart review. Patient age, sex, presentation of thyroid disease, past medical history, thyrotropin, thyroglobulin, and antithyroglobulin antibodies were recorded. A single nuclear medicine radiologist evaluated all scans. RESULTS Thirty-three subjects completed 37 pairs of scans at a mean age of 13.4 years (range 6-17 years). The majority of subjects were female (81%) and had papillary thyroid cancer (91%). For diagnostic scanning, 5 received 2 mCi of (131)I, 21 received 2 mCi of (123)I, and 11 received 3 mCi of (123)I. There was no statistically significant difference in rate of discordant scan pairs when comparing (131)I and (123)I (20% and 23% respectively, p=0.9). The detection of metastatic pulmonary disease on diagnostic scanning was not improved by increasing the dose of (123)I from 2 mCi to 3 mCi (10% rate of missed lung detection with 2 mCi (123)I vs. 20% with 3 mCi (123)I). CONCLUSIONS (123)I is effective for use in diagnostic radioactive iodine scans in children with differentiated thyroid cancer. The primary advantages of using (123)I include decreased radiation exposure and avoidance of stunning. However, in children there is a possibility of missed detection of metastatic pulmonary disease.
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Affiliation(s)
- Melissa J Schoelwer
- 1 Division of Endocrinology, Riley Hospital for Children, Department of Pediatrics, Indiana University School of Medicine Indianapolis , Indiana
| | - Donald Zimmerman
- 2 Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics and Radiology, Northwestern University Feinberg School of Medicine Chicago , Illinois
| | - Richard M Shore
- 3 Division of Radiology and Nuclear Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics and Radiology, Northwestern University Feinberg School of Medicine Chicago , Illinois
| | - Jami L Josefson
- 2 Division of Endocrinology, Ann and Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics and Radiology, Northwestern University Feinberg School of Medicine Chicago , Illinois
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26
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PAX genes in childhood oncogenesis: developmental biology gone awry? Oncogene 2014; 34:2681-9. [PMID: 25043308 DOI: 10.1038/onc.2014.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 01/27/2023]
Abstract
Childhood solid tumors often arise from embryonal-like cells, which are distinct from the epithelial cancers observed in adults, and etiologically can be considered as 'developmental patterning gone awry'. Paired-box (PAX) genes encode a family of evolutionarily conserved transcription factors that are important regulators of cell lineage specification, migration and tissue patterning. PAX loss-of-function mutations are well known to cause potent developmental phenotypes in animal models and underlie genetic disease in humans, whereas dysregulation and/or genetic modification of PAX genes have been shown to function as critical triggers for human tumorigenesis. Consequently, exploring PAX-related pathobiology generates insights into both normal developmental biology and key molecular mechanisms that underlie pediatric cancer, which are the topics of this review.
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27
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Markovina S, Grigsby PW, Schwarz JK, DeWees T, Moley JF, Siegel BA, Perkins SM. Treatment approach, surveillance, and outcome of well-differentiated thyroid cancer in childhood and adolescence. Thyroid 2014; 24:1121-6. [PMID: 24731094 DOI: 10.1089/thy.2013.0297] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Well-differentiated thyroid carcinoma in children and adolescents is a rare disease with favorable prognosis despite regional and distant metastasis at presentation in many patients. Treatment recommendations are varied and there is little consensus on follow-up guidelines for these patients. METHODS Medical records of patients less than 22 years of age treated at our institution were reviewed. One hundred twelve patients treated between 1969 and 2009 were selected for further analysis. Effects of patient and tumor characteristics on progression-free survival (PFS) were evaluated along with the predictive value of whole-body (131)I scintigraphy in the follow-up setting. RESULTS Overall survival at 20 years and 30 years was 100% and 94.4%, respectively. PFS at 10, 20, and 30 years was 71%, 62%, and 55%, respectively. Although male patients and younger patients presented with more advanced disease, sex, and age at diagnosis had no effect on risk of PFS. Additionally, neither the presence of vascular invasion, capsular extension, positive margins, nor soft tissue invasion had an effect on PFS. Mean time to recurrence in patients who underwent immediate postoperative (131)I therapy was 3.8 years compared to 14.1 years in patients who either never received (131)I therapy or were treated in the salvage setting (p<0.0001). Negative posttreatment whole-body (131)I scintigraphy was strongly predictive for decreased risk of recurrence, especially in patients with three consecutive negative scans. CONCLUSIONS Pediatric patients are more likely to present with advanced disease and for this reason, the majority of patients treated at our institution receive postoperative (131)I. Long-term surveillance is required in this population because of the risk of late recurrences. Whole-body (131)I scintigraphy is useful for risk stratification; after three consecutive negative scans, the risk of recurrence is low.
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Affiliation(s)
- Stephanie Markovina
- 1 Department of Radiation Oncology, Washington University School of Medicine , St. Louis, Missouri
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28
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 725] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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29
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Ito Y, Miyauchi A, Tomoda C, Hirokawa M, Kobayashi K, Miya A. Prognostic significance of patient age in minimally and widely invasive follicular thyroid carcinoma: investigation of three age groups. Endocr J 2014; 61:265-71. [PMID: 24390055 DOI: 10.1507/endocrj.ej13-0512] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Follicular thyroid carcinoma (FTC) is the second most common malignancy arising from follicular cells. It is classified into two categories based on the degree of invasion: widely and minimally invasive FTC. Here we focused on the prognostic value of patient age in FTC. We enrolled 292 minimally invasive and 79 widely invasive FTC patients who underwent initial surgery between 1983 and 2007. We classified these patients into three groups based on patient age: < 20 years (children and adolescents), 20-44 years (young adults) and ≥ 45 years (middle-aged or older), and compared their prognoses disease-free survival (DFS) and cause-specific survival (CSS). Among the minimally invasive FTC patients, those aged ≥ 45 years showed a poorer DFS and CSS than those < 45 years. In the subset of patients < 45 years, the DFS of patients < 20 years tended to be poorer than those aged 20-44 years, but none of the patients < 20 years died of FTC. Among the patients with widely invasive FTC, only three were younger than 20 years old. Two patients showed carcinoma recurrence, but neither died of FTC. In minimally invasive FTC, the DFS showed a biphasic pattern, but the CSS became poorer with increasing age. In widely invasive FTC, similar to minimally invasive FTC, patients < 20 years might be likely to show recurrence but are unlikely to die of FTC, although studies using larger number of patients are necessary before drawing any conclusions.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
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