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Sarli WM, Ricci S, Lodi L, Cavone F, Pacillo L, Giancotta C, Ubertini G, Baroncelli G, Cancrini C, Azzari C, Stagi S. Risk of thyroid neoplasms in patients with 22q11.2 deletion and DiGeorge-like syndromes: an insight for follow-up. Front Endocrinol (Lausanne) 2023; 14:1209577. [PMID: 37635986 PMCID: PMC10450035 DOI: 10.3389/fendo.2023.1209577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/14/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction The chromosome 22q11.2 deletion syndrome comprises phenotypically similar diseases characterized by abnormal development of the third and fourth branchial arches, resulting in variable combinations of congenital heart defects, dysmorphisms, hypocalcemia, palatal dysfunction, developmental or neuropsychiatric disorders, and impairment of the immune system due to thymic dysfunction. Other genetic syndromes, often called DiGeorge-like, share clinical and immunological features with 22q11.2 deletion syndrome. This syndrome has been rarely associated with malignancies, mainly hematological but also hepatic, renal, and cerebral. Rarely, malignancies in the head and neck region have been described, although no aggregate of data on the development of thyroid neoplasms in patients with this clinical phenotype has been conducted so far. Materials and methods To characterize this possible association, a multicenter survey was made. Thus, we present a case series of five pediatric patients with 22q11.2 deletion syndrome or DiGeorge-like syndrome who were occasionally found with confirmed or highly suspected neoplasms of the thyroid gland during their follow-up. In three cases, malignancies were histologically confirmed, but their outcome was good due to an early recognition of suspicious nodules and precocious surgery. Conclusions This study underlines for clinicians the higher risk of neoplasms in the head and neck district for patients affected by these syndromes. It also emphasizes the importance of a prolonged clinical and ultrasound follow-up for patients with this clinical and immunological phenotype.
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Affiliation(s)
- Walter Maria Sarli
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Lorenzo Lodi
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Federica Cavone
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lucia Pacillo
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Research Unit of Primary Immunodeficiency, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Carmela Giancotta
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Graziamaria Ubertini
- Unit of Endocrinology and Diabetology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Giampiero Baroncelli
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Caterina Cancrini
- Unit of Clinical Immunology and Vaccinology, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Research Unit of Primary Immunodeficiency, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy
- Paediatric Immunology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, Florence, Italy
- Auxoendocrinology Division, Meyer Children’s Hospital IRCCS, Florence, Italy
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Hess JR, Van Tassel DC, Runyan CE, Morrison Z, Walsh AM, Schafernak KT. Performance of ACR TI-RADS and the Bethesda System in Predicting Risk of Malignancy in Thyroid Nodules at a Large Children's Hospital and a Comprehensive Review of the Pediatric Literature. Cancers (Basel) 2023; 15:3975. [PMID: 37568791 PMCID: PMC10417028 DOI: 10.3390/cancers15153975] [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: 05/13/2023] [Revised: 06/24/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
While thyroid nodules are less common in children than in adults, they are more frequently malignant. However, pediatric data are scarce regarding the performance characteristics of imaging and cytopathology classification systems validated to predict the risk of malignancy (ROM) in adults and select those patients who require fine-needle aspiration (FNA) and possibly surgical resection. We retrospectively reviewed the electronic medical records of all patients 18 years of age or younger who underwent thyroid FNA at our institution from 1 July 2015 to 31 May 2022. Based on surgical follow-up from 74 of the 208 FNA cases, we determined the ROM for the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) ultrasound risk stratification system and The Bethesda System for Reporting Thyroid Cytopathology and added our results to those of pediatric cohorts from other institutions already published in the literature. We found the following ROMs for 1458 cases using ACR TI-RADS (TR): TR1. Benign: 2.2%, TR2. Not Suspicious: 9.3%, TR3. Mildly Suspicious: 16.6%, TR4. Moderately Suspicious: 27.0%, and TR5. Highly Suspicious 76.5%; and for 5911 cases using the Bethesda system: Bethesda I. Unsatisfactory: 16.8%, Bethesda II. Benign: 7.2%, Bethesda III: Atypia of Undetermined Significance: 29.6%, Bethesda IV. Follicular Neoplasm: 42.3%, Bethesda V. Suspicious for Malignancy: 90.8%, and Bethesda VI. Malignant: 98.8%. We conclude that ACR TI-RADS levels imply higher ROMs for the pediatric population than the corresponding suggested ROMs for adults, and, in order to avoid missing malignancies, we should consider modifying or altogether abandoning size cutoffs for recommending FNA in children and adolescents whose thyroid glands are smaller than those of adults. The Bethesda categories also imply higher ROMs for pediatric patients compared to adults.
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Affiliation(s)
- Jennifer R. Hess
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (J.R.H.); (A.M.W.)
| | - Dane C. Van Tassel
- Department of Radiology, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA;
| | - Charles E. Runyan
- Department of Radiology, Valleywise Hospital, Phoenix, AZ 85008, USA;
| | - Zachary Morrison
- Creighton Radiology Residency, Creighton University, Phoenix, AZ 85012, USA;
| | - Alexandra M. Walsh
- Center for Cancer and Blood Disorders, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (J.R.H.); (A.M.W.)
| | - Kristian T. Schafernak
- Division of Pathology, Laboratory Medicine, Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
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Rana C, Nigam N, Agarwal S, Mishra P, Singh A, Bychkov A. Cytological evaluation of thyroid nodules in children and young adults: a multi-institutional experience. Endocrine 2023; 80:580-588. [PMID: 36604406 DOI: 10.1007/s12020-022-03297-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The utility of the Bethesda system for reporting thyroid cytopathology is debatable in determining the risk of malignancy in pediatric patients. Moreover, the upper age limit for defining the pediatric group has varied across different studies. The aim of this study is to compare the risk of malignancy (ROM) and risk of neoplasia (RON) across different Bethesda categories between the pediatric, young adult, and adult patients. METHODS This is a retrospective multi-institutional study performed in three Indian hospitals. ROM was calculated and compared across Bethesda categories in adult (>18 years) and pediatric age groups (≤18 years), with a subgroup analysis in young adults (19-21 years). RESULTS Thyroid nodules from a total of 5958 patients were subjected to fine needle aspiration. Of these 199 were pediatric (3.3%) and follow-up histology was available in 2276. The ROM and RON rates, including overall ROM/RON, were significantly higher in pediatric age group as compared to adults. Overall ROM of suspicious for malignancy and malignant categories was higher in children as compared to adults. The overall surgical resection rates were also higher in pediatric patients (45.2% vs. 35.7%; p < 0.01). The similar trend of increased ROM, RON and resection rates was seen among young adults as compared to adult age group. CONCLUSION Thyroid nodules presenting in children are more likely to be malignant than those in adults. Importantly, the young adult group behaved in a similar manner with regard to surgical resection rates, ROM and RON to pediatric.
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Affiliation(s)
- Chanchal Rana
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neha Nigam
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Science, New Delhi, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Akanksha Singh
- Department of Pathology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan.
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Han L, Li W, Li Y, Wen W, Yao Y, Wang Y. Total thyroidectomy is superior for initial treatment of thyroid cancer. Asia Pac J Clin Oncol 2021; 17:e170-e175. [PMID: 32757466 PMCID: PMC8596583 DOI: 10.1111/ajco.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The incidence of thyroid cancer has increased annually, and has a heavy psychological and economic burden on the society and individuals. Based on thyroid cancer data from patients treated in Liaocheng People's Hospital in 2017, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy, or total thyroidectomy is the most effective. PATIENTS AND METHODS Clinical and pathological data from 552 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, 40 patients underwent endoscopic surgery, with resection, including lobectomy + central lymph node dissection of the affected lobe, while 512 cases underwent total thyroidectomy + central lymph node dissection. RESULTS The metastasis rate for all patients was 59.42%, with lymph node metastasis of papillary thyroid microcarcinoma of 46.92%; however, for patients with tumors >2 cm, the proportion developing metastasis was increased to 77.53%. CONCLUSION In thyroid cancer, rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. Our data suggest that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, at least in tumors larger than 1 cm, to avoid the risks associated with secondary surgery and effects on patient quality of life.
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Affiliation(s)
- Lin Han
- Department of PathologyLiaocheng People's HospitalAffiliated to Shandong First Medical UniversityLiaochengShandongChina
| | - Wenlei Li
- Department of Thyroid SurgeryLiaocheng People's HospitalAffiliated to Shandong First Medical UniversityLiaochengShandongChina
| | - Yingxue Li
- Department of PathologyLiaocheng People's HospitalAffiliated to Shandong First Medical UniversityLiaochengShandongChina
| | - Wenjuan Wen
- Department of PathologyLiaocheng People's HospitalAffiliated to Shandong First Medical UniversityLiaochengShandongChina
| | - Yumin Yao
- Department of Thyroid SurgeryLiaocheng People's HospitalAffiliated to Shandong First Medical UniversityLiaochengShandongChina
| | - Yongkun Wang
- Department of Thyroid SurgeryLiaocheng People's HospitalAffiliated to Shandong First Medical UniversityLiaochengShandongChina
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Cimbek EA, Polat R, Sönmez B, Beyhun NE, Dinç H, Saruhan H, Karagüzel G. Clinical, sonographical, and pathological findings of pediatric thyroid nodules. Eur J Pediatr 2021; 180:2823-2829. [PMID: 33772338 DOI: 10.1007/s00431-021-04032-z] [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] [Received: 02/06/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/12/2022]
Abstract
Thyroid nodules are less frequent in children than in adults. A higher rate of malignancy is highlighted in this group. We aimed to analyze the clinical, laboratory, and ultrasound (US) findings of children and adolescents with benign and malignant thyroid nodules. This was a retrospective review of children and adolescents evaluated at a tertiary pediatric institution between 2007 and 2019. Patients with autonomously functioning nodules, autoimmune thyroid diseases, and a history of oncohematological disorders were excluded. A total of 102 patients with 131 nodules were identified. The study population included 57 females (55.9%); the average age was 10.6 ±4 years. Thirty-five nodules (26.7%) ranging 4.5-36 mm had a fine-needle aspiration (FNA) done: 45.7% (n = 16) were benign, 11.4% (n = 4) were classified as atypia, and 8.5% (n = 3) were consistent with papillary carcinoma. Fourteen patients (13.7%) underwent surgery. Five (4.9%) were finally diagnosed with papillary thyroid cancer. Of the 6 patients with benign FNAs, all except one, which was initially reported as atypia by an earlier FNA but was later diagnosed with papillary carcinoma, had a colloid nodular goiter. Of the 3 patients with atypia FNAs, one was found to be papillary carcinoma. One hundred twenty-five benign nodules (21 based on cytology and/or histology, 104 on clinical and imaging follow-up) were diagnosed. Nodule size, microcalcifications, solid parenchyma, and pathologic lymph node alterations were associated with malignancy, but nodule growth was not.Conclusion: Diagnostic approach and management of children with thyroid nodules should be based on a stepwise evaluation including clinical, laboratory, and US findings. Of the 102 patients identified, 4.9% had thyroid carcinoma below the range described in previous literature. What is Known: • Thyroid nodules are less frequent in children than in adults but more frequently malignant. Research on factors associated with malignancy have mostly been conducted in adults; further studies in pediatric thyroid nodules are warranted. What is New: • Microcalcifications, pathologic lymph node alterations, solid parenchyma, and larger nodule size are associated with malignant nodules, but nodule growth is not always suggestive of thyroid malignancy. The incidence of thyroid malignancy in this population was below the reported worldwide incidence in children with thyroid nodules.
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Affiliation(s)
- Emine Ayça Cimbek
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Recep Polat
- Pediatric Endocrinology Clinic, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Bircan Sönmez
- Department of Nuclear Medicine, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nazım Ercüment Beyhun
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Hasan Dinç
- Department of Radiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Haluk Saruhan
- Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Gülay Karagüzel
- Department of Pediatric Endocrinology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
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Vuong HG, Chung DGB, Ngo LM, Bui TQ, Hassell L, Jung CK, Kakudo K, Bychkov A. The Use of the Bethesda System for Reporting Thyroid Cytopathology in Pediatric Thyroid Nodules: A Meta-Analysis. Thyroid 2021; 31:1203-1211. [PMID: 33504264 DOI: 10.1089/thy.2020.0702] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Little is known about the application of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. This meta-analysis was aimed to investigate the use of TBSRTC in the pediatric population. Methods: Relevant articles were searched in PubMed and Web of Science. Meta-analysis of proportion and its 95% confidence interval (CI) were computed utilizing the random-effect model. We used subgroup analyses and meta-regression to explore the sources of heterogeneities. Egger's regression test and funnel plot visualization were used to examine publication bias. Results: We included 17 articles comprising of 3687 pediatric thyroid nodules for meta-analyses. TBSRTC outputs including frequency and risk of malignancy (ROM) for the majority of categories were not statistically different from recently published meta-analysis of 145,066 thyroid nodules in adult patients. The resection rate (RR) in the pediatric group was significantly higher in most of the categories compared with published adult data: benign, 23.2% [CI = 18.6-27.9] vs. 13.0% [CI = 9.5-16.5]; atypia of undetermined significance/follicular lesion of undetermined significance, 62.6% [CI = 50.3-74.9] vs. 36.2% [CI = 29.9-42.5]; follicular neoplasm/suspicious for follicular neoplasm, 84.3% [CI = 75.2-93.4] vs. 60.5% [CI = 54.5-66.5]; and suspicious for malignancy, 93.8% [CI = 90.1-97.6] vs. 69.7% [CI = 64.0-75.5]. Conclusion: TBSRTC is a valuable tool to make clinical decisions for pediatric patients with thyroid nodules. Pediatric patients with benign and indeterminate thyroid nodules had a higher RR than adult counterpart, but ROM of these categories in adults and children was not statistically different suggesting a potential risk of overtreatment in pediatric patients. Determining the best treatment guidelines and additional tools for risk stratification must be a top priority to precisely identify the target patient groups for surgical intervention.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology; Oklahoma City, Oklahoma, USA
- Stephenson Cancer Center; Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Duy Giang Bao Chung
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Luan Minh Ngo
- Faculty of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Thien Quoc Bui
- Department of Preventive Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lewis Hassell
- Department of Pathology; Oklahoma City, Oklahoma, USA
| | - 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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Vuong HG, Suzuki A, Na HY, Tuyen PV, Khuy DM, Nguyen HC, Jitpasutham T, Abelardo A, Amano T, Park SY, Jung CK, Hirokawa M, Katoh R, Kakudo K, Bychkov A. Application of the Bethesda System for Reporting Thyroid Cytopathology in the Pediatric Population. Am J Clin Pathol 2021; 155:680-689. [PMID: 33269383 DOI: 10.1093/ajcp/aqaa182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES We aimed to provide the Asian experience with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. METHODS Consecutive thyroid fine-needle aspirates (patient age, ≤18 years) were retrospectively collected from 7 tertiary centers in 5 Asian countries. RESULTS Of 194,364 thyroid aspirates, 0.6% were pediatric cases (mean age, 15.0 years). Among 827 nodules with accessible follow-up, the resection rate and risk of malignancy (ROM) were 36.3% and 59.0%, respectively. Malignant nodules (n = 179) accounted for 59.7% of resected nodules and 21.6% of all thyroid nodules with available follow-up. Compared with the published adult series, pediatric nodules had a higher resection rate and ROM, particularly in the indeterminate categories. CONCLUSIONS Our study demonstrates that Asian pediatric thyroid nodules had higher ROM than those from adults. The prototypic outputs of TBSRTC may need to be adjusted in the pediatric population.
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Affiliation(s)
- Huy Gia Vuong
- Department of Pathology, Oklahoma University Health Sciences Center, Oklahoma City
- Stephenson Cancer Center, Oklahoma University Health Sciences Center, Oklahoma City
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Pham Van Tuyen
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Doan Minh Khuy
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Hiep Canh Nguyen
- Center of Pathology and Cytopathology, Bach Mai Hospital, Hanoi, Vietnam
| | - Tikamporn Jitpasutham
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Agustina Abelardo
- Department of Pathology, College of Medicine University of Philippines Manila, Manila, Philippines
- Department of Laboratories, Philippine General Hospital Medical Center, Manila, Phillipines
| | | | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, Catholic University of Korea, Seoul, Korea
| | | | - Ryohei Katoh
- Department of Pathology, Ito Hospital, Tokyo, Japan
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Center, Izumi City General Hospital, Osaka, 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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Wu Z, Han L, Li W, Wang W, Chen L, Yao Y, Wang Y. Which is preferred for initial treatment of papillary thyroid cancer, total thyroidectomy or lobotomy? Cancer Med 2021; 10:1614-1622. [PMID: 33512778 PMCID: PMC7940239 DOI: 10.1002/cam4.3743] [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: 07/24/2020] [Revised: 12/26/2020] [Accepted: 01/05/2021] [Indexed: 01/22/2023] Open
Abstract
Purposes The incidence of thyroid cancer has increased annually, and has a heavy psychological and economic burden on society and individuals. Based thyroid cancer data from patients treated in Liaocheng People's Hospital from 2015 to 2018, with Chinese national and regional characteristics, in this study, we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective. Methods Clinical and pathological data from 2108 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, there were 1001 cases who underwent open operation with total thyroidectomy + central lymph node dissection; meanwhile, 1107 cases were treated with neck lateral lymph node dissection at the same time. Results The overall metastasis rate of all patients was 57.23%. Even the lymph node metastasis of papillary thyroid microcarcinoma (PTMC) was as high as 48.97%. When the mass rose above 2 cm, the proportion of metastasis increased to 77.22%. When the tumor was complicated with bilateral and multiple high‐risk factors, the proportion of metastasis was 65.27% and 72.21%, respectively. When the tumor breaks through the capsule, the metastasis rate was 67.08%. With the increase of tumor diameter, the metastasis of cervical lymph nodes ranged from 22.54% to 73.33%, which showed positive correlation. 49.32% of patients had lymph node metastasis in the lateral cervical region. When the diameter of the tumor reached T1c level, the metastasis of the cervical lymph nodes was 56.91%, and the number of metastatic cases above T1c level accounted for 69.96% of the total metastatic cases. Conclusion The degree of malignancy of thyroid cancer depends on tumor genome evolution. Rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. It is recommended that initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life. When the tumor diameter exceeds 1 cm, the risk of cervical lymph node metastasis is high, and we recommended lateral lymph node dissection.
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Affiliation(s)
- Zhen Wu
- Department of Thyroid Surgery, Liaocheng People's Hospital, Clinical Hospital of Shandong First Medical University, Liaocheng, China
| | - Lin Han
- Department of Pathology, Liaocheng People's Hospital, Clinical Hospital of Shandong First Medical University, Liaocheng, China
| | - Wenlei Li
- Department of Thyroid Surgery, Liaocheng People's Hospital, Clinical Hospital of Shandong First Medical University, Liaocheng, China
| | - Wei Wang
- Department of Thyroid Surgery, Liaocheng People's Hospital, Clinical Hospital of Shandong First Medical University, Liaocheng, China
| | - Liqaing Chen
- Department of Thyroid Surgery, Liaocheng People's Hospital, Clinical Hospital of Shandong First Medical University, Liaocheng, China
| | - Yumin Yao
- Department of Thyroid Surgery, Liaocheng People's Hospital, Clinical Hospital of Shandong First Medical University, Liaocheng, China
| | - Yongkun Wang
- Department of Thyroid Surgery, Liaocheng People's Hospital, Clinical Hospital of Shandong First Medical University, Liaocheng, China
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Castro P, Patiño E, Fierro F, Rojas C, Buitrago G, Olaya N. Clinical characteristics, surgical approach, BRAFV600E mutation and sodium iodine symporter expression in pediatric patients with thyroid carcinoma. J Pediatr Endocrinol Metab 2020; 33:1457-1463. [PMID: 33031052 DOI: 10.1515/jpem-2020-0201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/28/2020] [Indexed: 11/15/2022]
Abstract
Objectives Thyroid cancer is the most common endocrine neoplasm in childhood. There are few studies characterizing pediatric population in Colombia. We intend to detail the clinical, histological characteristics, BRAFV600E mutational status and NIS (sodium-iodine symporter) expression of children with papillary thyroid carcinoma (PTC) managed at Hospital de La Misericordia. Methods Medical records of the Department of Pediatric Surgery and Pathology from 2009 to 2018 were scrutinized in search of cases of differentiated thyroid carcinoma. A descriptive analysis was made. Paraffin embedded tumoral tissue was recovered to assess BRAF V600E mutational status by PCR and NIS expression by immunohistochemistry. Results Sixteen patients were selected, 81.2% were girls. Average age of presentation was 11.8 years. Only one patient had previous radiation exposure. Most frequent symptom was cervical adenopathy with a mean time of 29.2 weeks before diagnosis. 93.7% underwent total thyroidectomy and lymphadenectomy. 62.5% were PTC combining both classic and follicular pattern. 6.25% cases had BRAFV600E mutation and 25% showed NIS focal reactivity. Conclusions We found greater female predominance, lower percentage of risk factors described and a high percentage of patients requiring aggressive surgical treatment. We consider important to contemplate thyroid cancer as a differential diagnosis of cervical lymph node enlargement in children. Diagnosis can be challenging in benign and indeterminate categories of the FNA cytology and biomolecular profiles such as BRAF and NIS could be determinant in guiding treatment. More studies with larger sample size, complete genetic analysis, evaluation to iodine response and long term follow up are required.
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Affiliation(s)
- Paula Castro
- Pediatric Surgery Resident, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Esteban Patiño
- Pathologist Fundación Hospital, Pediátrico La Misericordia, Bogotá, Colombia
| | - Fernando Fierro
- Pediatric Surgeon Fundación Hospital, Pediátrico La Misericordia, Department of Surgery, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Carolina Rojas
- Pediatric endocrinologist Fundación Hospital, Pediátrico La Misericordia, Bogotá, Colombia
| | - Giancarlo Buitrago
- Department of Surgery - Clinical Research Institute, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Natalia Olaya
- Pathologist Fundación Hospital Pediátrico La Misericordia, Department of Pathology, Universidad Nacional de Colombia, Bogotá, Colombia
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Han L, Li W, Li Y, Wen W, Yao Y, Wang Y. With High-Risk Factors, Total Thyroidectomy is Preferred for Thyroid Cancer. Cancer Manag Res 2020; 12:3713-3719. [PMID: 32547207 PMCID: PMC7246312 DOI: 10.2147/cmar.s249324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/05/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Based on thyroid cancer data from patients treated in Liaocheng People's Hospital in 2017, with Chinese national and regional characteristics, in this study we addressed the controversy of which initial thyroid surgical mode, lobectomy or total thyroidectomy, is most effective. PATIENTS AND METHODS Clinical and pathological data from 552 patients with thyroid cancer, who were initially diagnosed and treated surgically, were collected from the Department of Thyroid Surgery. Among them, 40 patients underwent endoscopic surgery, with resection including lobectomy + central lymph node dissection of the affected lobe, while 512 cases underwent total thyroidectomy + central lymph node dissection. RESULTS The metastasis rate for all patients was 59.42%. Further, among patients with bilateral or multiple tumors or capsule invasion, the proportions who developed metastatic disease were 63.54% and 71.19% and 67.46%, respectively. Meanwhile, the incidence of contralateral accidental malignancy was 7.25% after postoperative paraffin pathology. DISCUSSION Rates of neck lymph node metastasis are high, particularly among patients with risk factors for poor prognosis. It is recommended that, among patients with risk factors, initial treatment should comprise at least total thyroidectomy + central lymph node dissection in China, to avoid the risks associated with secondary surgery and effects on patient quality of life.
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Affiliation(s)
- Lin Han
- Department of Pathology, Liaocheng People’s Hospital, Affiliated to Shandong First Medical University, Liaocheng252000, Shandong, People’s Republic of China
| | - Wenlei Li
- Department of Thyroid Surgery, Liaocheng People’s Hospital, Affiliated to Shandong First Medical University, Liaocheng252000, Shandong, People’s Republic of China
| | - Yingxue Li
- Department of Pathology, Liaocheng People’s Hospital, Affiliated to Shandong First Medical University, Liaocheng252000, Shandong, People’s Republic of China
| | - Wenjuan Wen
- Department of Pathology, Liaocheng People’s Hospital, Affiliated to Shandong First Medical University, Liaocheng252000, Shandong, People’s Republic of China
| | - Yumin Yao
- Department of Thyroid Surgery, Liaocheng People’s Hospital, Affiliated to Shandong First Medical University, Liaocheng252000, Shandong, People’s Republic of China
| | - Yongkun Wang
- Department of Thyroid Surgery, Liaocheng People’s Hospital, Affiliated to Shandong First Medical University, Liaocheng252000, Shandong, People’s Republic of China
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