Angiogenesis as an indicator of metastatic potential in papillary thyroid carcinoma

Microvessel density in differentiated thyroid carcinoma: A systematic review and meta-analysis

BACKGROUND

Microvessel density (MVD) has been proposed as a direct quantification method of tumor neovascularization. However, the current literature regarding the role of MVD in differentiated thyroid carcinoma (DTC) remains inconclusive.

AIM

To appraise the effect of tumoral MVD on the survival of patients with DTC.

METHODS

This meta-analysis was based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic databases Medline, Web of Science, and Scopus were systematically screened. A fixed-effects or random-effects model was used, according to the Cochran Q test. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).

RESULTS

A total of nine studies were included in the present study. Superiority of low MVD tumors in terms of 10-year disease free survival (OR: 0.21, 95%CI: 0.08–0.53) was recorded. Lowly vascularized thyroid cancers had a lower recurrence rate (OR: 13.66, 95%CI: 3.03–61.48). Moreover, relapsing tumors [weighed mean difference (WMD): 11.92, 95%CI: 6.32–17.52] or malignancies with regional lymph node involvement (WMD: 8.53, 95%CI: 0.04–17.02) presented with higher tumoral MVD values.

CONCLUSION

MVD significantly correlates with the survival outcomes of thyroid cancer patients. However, considering several study limitations, further prospective studies of higher methodological and quality level are required.

Total Thyroidectomy with Central Node Dissection is a Valuable Option in Papillary Thyroid Cancer Treatment

Introduction

Papillary thyroid cancer is one of the cancers with favorable prognosis, although the long-term recurrence rate in the paratracheal region is reported to be as high as 30%. The use of ¹³¹I is considered to be a reliable treatment option for lymph node metastases in the paratracheal region. According to the majority of internationally accepted guidelines, it is not recommended to perform central node dissection (CND) routinely. Total thyroidectomy (TT) remains an adequate treatment for these patients. According to many studies, CND is associated with higher rates of hypoparathyroidism. However, CND improves staging.

Methods

We performed a retrospective study. We included 248 patients treated for papillary thyroid cancer during a 20-year period. Data were collected on patient (age, sex) and tumor (size, focality) characteristics, presence of metastases in the central neck compartment, incidence of postoperative hypoparathyroidism, and locoregional failure. We divided patients into two groups based on pathological analysis: those without positive lymph nodes (N0) and those with positive paratracheal lymph nodes (N1). We compared patient and tumor characteristics and risk of recurrence between the two groups. Results: There were 39.5% patients with central neck metastases in our series. In the central neck dissection specimen, 5.5 nodes were found on average. Hypoparathyroidism was found in 23.4% of patients and remained permanent in 3.2% of patients. Female and older patients had a lower chance of central compartment metastases, as did patients with smaller and unifocal tumors. Recurrence risk was doubled for the N1 group. All tested differences between the groups reached statistical significance.

Discussion and conclusion

In our hands, CND was a safe and effective surgical procedure. It improved staging and postsurgical management. Efforts should be made to improve the preoperative work-up in order to more accurately identify high-risk patients.

Molecular Imaging of Galectin-1 Expression as a Biomarker of Papillary Thyroid Cancer by Using Peptide-Functionalized Imaging Probes

Thyroid cancers are the most frequent endocrine cancers and their incidence is increasing worldwide. Thyroid nodules occur in over 19–68% of the population, but only 7–15% of them are diagnosed as malignant. Diagnosis relies on a fine needle aspiration biopsy, which is often inconclusive and about 90% of thyroidectomies are performed for benign lesions. Galectin-1 has been proposed as a confident biomarker for the discrimination of malignant from benign nodules. We previously identified by phage display two peptides (P1 and P7) targeting galectin-1, with the goal of developing imaging probes for non-invasive diagnosis of thyroid cancer. The peptides were coupled to ultra-small superparamagnetic particles of iron oxide (USPIO) or to a near-infrared dye (CF770) for non-invasive detection of galectin-1 expression in a mouse model of papillary thyroid cancer (PTC, as the most frequent one) by magnetic resonance imaging and fluorescence lifetime imaging. The imaging probes functionalized with the two peptides presented comparable image enhancement characteristics. However, those coupled to P7 were more favorable, and showed decreased retention by the liver and spleen (known for their galectin-1 expression) and high sensitivity (75%) and specificity (100%) of PTC detection, which confirm the aptitude of this peptide to discriminate human malignant from benign nodules (80% sensitivity, 100% specificity) previously observed by immunohistochemistry.

Comprehensive DNA Methylation Profiling Identifies Novel Diagnostic Biomarkers for Thyroid Cancer

Background: There are no reliable biomarkers to accurately differentiate indolent thyroid tumors from more aggressive thyroid cancers. This study aimed to develop new DNA methylation markers for diagnosis and recurrence risk stratification of papillary thyroid carcinoma (PTC). Methods: Thyroid tumor-specific DNA methylation profiling was investigated in 34 fresh frozen tissues, which included nontumor (n = 7), noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP, n = 6) and PTC (n = 21), using the Illumina HumanMethylation EPIC array. We performed a genome-wide assessment of thyroid tumor-specific differentially methylated CpG sites in the discovery set, then validated the top candidate markers in an independent set of 293 paraffin tissue samples comprised of follicular adenoma (FA, n = 61), Hürthle cell adenoma (HA, n = 24), NIFTP (n = 56), PTC (n = 120), follicular thyroid carcinoma (n = 27), and Hürthle cell carcinoma (n = 5), by pyrosequencing. Results: Three selected markers (cg10705422, cg17707274, and cg26849382) differentiated nonmalignant (FA, HA, and NIFTP) tumors from differentiated thyroid cancers with area under the receiver operating characteristic curve of 0.83, 0.83, and 0.80, respectively. Low DNA methylation levels for three markers were significantly associated with recurrent or persistent disease (odds ratio (OR) = 3.860 [95% confidence interval (CI) 1.194-12.475]) and distant metastasis (OR = 4.009 [CI 1.098-14.632]) in patients with differentiated thyroid cancer. A subgroup analysis for the validation set showed that PTC patients with low DNA methylation levels more frequently had aggressive histology, extrathyroidal extension, lymph node metastasis, BRAF^V600E mutations, and recurrent or persistent disease than those with high levels of methylation markers. All PTC patients who developed disease recurrence had low DNA methylation levels for three markers. Conclusions: DNA methylation levels of three markers can be useful for differentiating differentiated thyroid cancer from nonmalignant follicular thyroid lesions, and may serve as prognostic biomarkers for predicting recurrent or persistent disease after surgery for differentiated thyroid cancer.

A risk-based approach to identifying oligometastatic disease on imaging

Recognition of <3 metastases in <2 organs, particularly in cancers with a known predisposition to oligometastatic disease (OMD) (colorectal, prostate, renal, sarcoma and lung), offers the opportunity to focally treat the lesions identified and confers a survival advantage. The reliability with which OMD is identified depends on the sensitivity of the imaging technique used for detection and may be predicted from phenotypic and genetic factors of the primary tumour, which determine metastatic risk. Whole‐body or organ‐specific imaging to identify oligometastases requires optimization to achieve maximal sensitivity. Metastatic lesions at multiple locations may require a variety of imaging modalities for best visualisation because the optimal image contrast is determined by tumour biology. Newer imaging techniques used for this purpose require validation. Additionally, rationalisation of imaging strategies is needed, particularly with regard to timing of imaging and follow‐up studies. This article reviews the current evidence for the use of imaging for recognising OMD and proposes a risk‐based roadmap for identifying patients with true OMD, or at risk of metastatic disease likely to be OM.

Predicting lymph node metastasis in patients with papillary thyroid carcinoma by vascular index on power Doppler ultrasound

BACKGROUND

For patients with papillary thyroid carcinoma (PTC), lymph node metastasis is associated with an increased recurrence rate. The purpose of this study was to investigate whether the vascular endothelial growth factor (VEGF), microvessel density (MVD), and vascular index (VI) can predict lymph node metastasis in patients with PTC.

METHODS

From January 2011 to October 2011, 202 patients with PTCs underwent preoperative staging ultrasound evaluation. To evaluate vascularity, we measured the VI, VEGF expression, and MVD.

RESULTS

The VI was significantly correlated with MVD (p = .009). On multivariate analysis, young age showed a significant correlation with lymph node metastasis (p < .001; p < .001; p < .001). However, the other clinicopathologic features, VEGF, MVD, and VI failed to show any significant correlations with lymph node metastasis.

CONCLUSION

Although the VI showed significant correlation with MVD, it was not significantly correlated to lymph node metastasis. © 2016 Wiley Periodicals, Inc. Head Neck 39: 334-340, 2017.

Comparison Between Echo-Color Doppler Sonography Features and Angioarchitecture of Thyroid Nodules

This study compared echo-color Doppler sonography features of thyroid nodules with the 3-dimensional reconstruction to find parameters useful for the preoperative diagnosis. Forty nodules relative to 29 patients were examined with echo-color Doppler before surgery. After histologic diagnosis, blocks were deparaffinized and prepared for 3-dimensional examination using a stereomicroscope. Echo-color Doppler type I nodules (8 nodules) always corresponded to colloid goiter. Type II and III nodules corresponded to colloid goiter with intralesional hemorrhage or were associated with hyperplastic nodules, follicular adenoma, follicular carcinoma minimally invasive, papillary carcinoma, and medullary carcinoma. Of interest was that 9 of 11 follicular lesions were characterized by a large central vessel, which was also evident in echo-color Doppler images. This architectural pattern is not seen in benign nodules or in papillary carcinomas. Comparison with histology suggests that echo-color Doppler images can visualize vessels showing a muscular wall.

Thyroid Doppler US: Tips and tricks

Incidental diagnosis of thyroid nodules is very common on adult neck ultrasonography (US) examination. They are primarily assessed on size and greyscale ultrasound criteria such as hypoechogenicity, taller than wide, spiculated margins and calcifications. In difficult situations Doppler US features may improve tumour characterisation and staging.

[Typical pulmonary carcinoid tumor: evolution, related prognostic factors and lymphadenectomy indications]

The bronchopulmonary typical carcinoid tumors are often considered as non-metastatic neoplasia. The appearance of metastases is observed in 10% of the cases. We detail here studies based on the identification of the risk factors of metastases occurrence to adapt the lung surgery and lymph node dissection to the individual patient risk.

Early death from papillary thyroid carcinoma

PURPOSE

The natural history of papillary thyroid carcinoma (PTC) is characterized by a slow growth rate and an excellent prognosis at 20 and 30 years. However, there is a small subset of patients with poorer outcome.

METHODS

Twenty patients who died of PTC within 10 years of diagnosis were studied to identify prognostic indicators and biological markers of early death. Findings were statistically compared with a previous review of all patients with PTC treated in the same institute and studies in the literature.

RESULTS

The study group included 6 men and 14 women with a mean age of 65 years at diagnosis. Average tumor size was 3.6 cm; 16 patients had extracapsular extension. All tumor samples studied histologically stained poorly for p53, Ki67, and CD34. Regional metastases were present in half the patients, and distal metastases in all. All patients had an advanced disease stage (Tumor, Node, Metastases classification), and only 4 had a low score on the Metastases, Age, Completeness of resection, local Invasion, tumor Size risk stratification. Analysis of the findings against data in the literature for the whole population of patients with PTC, who had a considerably better survival (<8% mortality within 8-15 years vs 100% within 10 years in our sample), yielded significant differences for rates of extrathyroidal extension (P = .0001), regional metastases (P = .016), and distant metastases (P = .0001).

CONCLUSION

Extrathyroid extension, late regional metastases, and distant metastases may be risk factors for early death from PTC.

Angiogenesis in Malignant Thyroid Tumors

It is well known that radiation significantly impacts the morbidity of thyroid cancer and that is why Belarus has the highest incidence of the malignancy. Author describes statistical data, classification of angiogenesis, and typical pathological features of malignant thyroid diseases with regard to the vascular network.

Immunohistochemistry as an important tool in biomarkers detection and clinical practice

The immunohistochemistry technique is used in the search for cell or tissue antigens that range from amino acids and proteins to infectious agents and specific cellular populations. The technique comprises two phases: (1) slides preparation and stages involved for the reaction; (2) interpretation and quantification of the obtained expression. Immunohistochemistry is an important tool for scientific research and also a complementary technique for the elucidation of differential diagnoses which are not determinable by conventional analysis with hematoxylin and eosin. In the last couple of decades there has been an exponential increase in publications on immunohistochemistry and immunocytochemistry techniques. This review covers the immunohistochemistry technique; its history, applications, importance, limitations, difficulties, problems and some aspects related to results interpretation and quantification. Future developments on the immunohistochemistry technique and its expression quantification should not be disseminated in two languages—that of the pathologist and another of clinician or surgeon. The scientific, diagnostic and prognostic applications of this methodology must be explored in a bid to benefit of patient. In order to achieve this goal a collaboration and pooling of knowledge from both of these valuable medical areas is vital

Inhibition of pancreatic carcinoma growth by adenovirus-mediated human interleukin-24 expression in animal model

Interleukin-24 (IL-24) has been shown to be a tumor-suppressor gene and the protein product found to be constitutively expressed by melanocytes, nerve cells, and some primary melanomas. The potential effect of adenovirus (AdV)-mediated IL-24 gene therapy was explored on human pancreatic carcinoma by using a pancreatic carcinoma cell line, patu8988. A recombinant adenovirus, AdVGFP/IL-24, expressing the marker, green fluorescent protein (GFP), and the tumor-suppressor gene, IL-24, was constructed. AdVGFP/IL-24 treatment of pancreatic carcinoma cells in vitro significantly induced pancreatic carcinoma cell cytotoxicity and apoptosis, compared with AdVGFP without IL-24 expression. In nude mice bearing patu8988 tumors, intratumoral injections of AdVGFP/IL-24 significantly inhibited pancreatic carcinoma growth. In addition, the molecular mechanism of tumor suppression was elucidated by downregulating the expression of vascular endothelial growth factor, CD34, and Bcl-2, as well as inhibiting tumor angiogenesis. Therefore, AdVGFP/IL-24 has the potential to serve as a novel tool for pancreatic carcinoma gene therapy.

Dynamic contrast-enhanced magnetic resonance imaging for estimating tumor proliferation and microvessel density of oral squamous cell carcinomas

We evaluated the relationship between histopathological prognostic factors, tumor proliferation microvessel density (MVD), and enhancement parameters in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in oral squamous cell carcinoma (SCC). Twenty-eight T2 and T3 patients with primary oral SCC underwent DCE-MRI using three-dimensional fast imaging with a steady-state precession sequence. Tumor cell proliferation and MVD of all surgical specimens were evaluated using immunohistochemical staining with CD34 and the antibody for proliferating cell nuclear antigen (PCNA). Regression analysis was used to statistically analyze the relationship between the PCNA labeling index or MVD and each of three DCE-MRI parameters: maximum CI (CI-max), maximum CI gain (CI-gain) and the CI-gain / CI-max ratio). The PCNA labeling index and MVD showed significant correlations with the CI-gain/CI-max ratio (P=0.0012, r=0.581 and P=0.00141, r=0.574, respectively). The assessment of DCE-MRI parameters may prove to be a valuable non-invasive method for assessing tumor cell proliferation and MVD of patients with oral cancer.

Adenovirus-mediated Il-24 expression suppresses hepatocellular carcinoma growth via induction of cell apoptosis and cycling arrest and reduction of angiogenesis

Previous studies have shown that interleukin (IL)-24 as a novel tumor suppressor gene has tumor-suppressor activity in a broad spectrum of human cancer cells both in vitro and in vivo. In this study, we explored the potential effect of adenovirus-mediated IL-24 gene therapy on human hepatocellular carcinoma (HCC) by using a HCC cell line, SMMC-7721. We constructed a recombinant adenovirus, AdVGFP/IL-24 expressing the marker green fluorescent protein (GFP) and the tumor-suppressor gene, IL-24. We demonstrated that AdVGFP/IL-24 treatment of SMMC-7721 cells in vitro significantly induced HCC cell cytotoxicity and apoptosis, and altered HCC cell cycling with an S-phase reduction and G2/M phase arrest, compared with AdVGFP, without IL-24 expresssion (p < 0.05). Furthermore, we also showed that the treatment of SMMC-7721 tumors by an intratumoral injection of AdVGFP/IL-24 significantly suppressed in vivo HCC growth in athymic nude mice, compared with AdVGFP treatment (p < 0.05). In addition, we also elucidated the molecular mechanism responsible for AdVGFP/IL-24-associated tumor suppression. These include: (1) upregulation of p53-independent apoptosis-associated caspase-3 and (2) downregulation of angiogenesis-associated vascular endothelial growth factor and CD34. Therefore, this study will provide a framework for future clinical applications of AdVGFP/IL-24 in HCC gene therapy.

Preoperative assessment of thyroid nodules: role of ultrasonography and fine needle aspiration biopsy followed by cytology

PURPOSE

To evaluate the preoperative assessment of thyroid nodules using ultrasound studies and cytology of nodular aspirates.

SUBJECTS AND METHODS

2,468 patients with thyroid nodules were examined from 1999 to 2005. All patients were clinically examined and underwent ultrasonography followed by fine-needle aspiration biopsy (FNAB) and cytology.

RESULTS

Nodules larger than 10 mm were classified ultrasonographically in a 4-tier system and received a score according to the criterion of possible malignancy. Cytological examinations were conducted independently by 2 cytologists and classified as benign (score 1), indeterminate (score 2), suspicious (score 3), and malignant (score 6). Combining both scores, an index was generated that would indicate a higher probability of malignancy (benign, doubtful, suspicious, and malignant). Thyroid surgery was performed in 274 patients. Of those, 115 patients had a score of 2 to 5 and only 8 had a histological diagnosis of thyroid cancer (6.9%). For patients with a score of 5 (n = 51), 11.5% had a malignant lesion, and 51% of the 61 patients with a score of 6 had confirmed thyroid cancer. Of the 98 patients with a combined score of 7 to 10, 99% had a histological confirmation of malignancy.

CONCLUSIONS

The index score had a sensitivity of 94.1% and specificity of 77.5%. The overall accuracy was 85.8%. Therefore, we concluded that this methodology may improve the preoperative diagnosis of thyroid cancer in nodules larger than 10 mm. Association with other methods such as color Doppler echography, serum TSH concentration, galectin-3 expression analysis, and FDG/PET scan would be useful in avoiding the higher costs of thyroid surgical procedures.

Oncolytic adenovirus-mediated E1A gene therapy induces tumor-cell apoptosis and reduces tumor angiogenesis leading to inhibition of hepatocellular carcinoma growth in animal model

Oncolytic adenovirus (rAd)-mediated E1A gene therapy of cancer has become a novel therapeutic modality. In this study, we constructed a recombinant oncolytic adenovirus (rAd-E1A) expressing the tumor suppressor E1A gene. We demonstrated that the rAd-E1A replicated in HepG2 and SMMC-7721 human hepatocellular carcinoma (HCC) cells but attenuated in the normal liver cell line HL-7702. It induced HCC cell apoptosis through upregulation of apoptosis-associated Bax, caspase-3, and Fas and downregulation of survivin and Bcl-2 in a p53-dependent pathway. It also downregulated the expression of angiogenesis- associated vascular endothelial growth factor (VEGF) and CD34 genes and reduced tumor vessel formation and angiogenesis. In mice bearing SMMC-7721 tumors, intratumoral injections of rAd- E1A significantly inhibited HCC growth. Therefore, the oncolytic adenovirus-mediated E1A gene therapy may be a useful therapeutic approach for HCC treatment.