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Ortega CA, Gallant JN, Kilic I, Patel S, Chen SC, Wood CB, Adams R, Azer F, Wang H, Liang J, Duffus SH, Belcher RH, Andreotti RF, Krishnasarma R, Lim-Dunham JE, Barkan GA, Ye F, Weiss VL. Evaluation and application of American College of Radiology Thyroid Imaging Reporting and Data System for improved malignancy detection in paediatric thyroid nodules. Cytopathology 2024; 35:749-756. [PMID: 38946029 DOI: 10.1111/cyt.13414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 05/27/2024] [Accepted: 06/13/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE The American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) is a widely used method for the management of adult thyroid nodules. However, its use in paediatric patients is controversial because adult fine needle aspiration biopsy (FNAB) recommendations may lead to delayed diagnoses of cancer in children. The objectives of this study were to evaluate the performance of TI-RADS in paediatric thyroid nodules and to tailor FNAB recommendations for children. METHODS Consecutive surgically resected paediatric thyroid nodules from two tertiary care centres between 2003 and 2021 were reviewed. Ultrasounds were blindly scored by radiologists according to TI-RADS. Management recommendations based on TI-RADS were evaluated. Various modelling methodologies were used to determine the optimal cutoff for FNAB in children. RESULTS Of the 96 patients, 79 (82%) were female and the median age at surgery was 16.1 years. Fifty (52%) nodules were malignant on surgical pathology. The area under the receiver operating characteristic curve of TI-RADS for predicting malignancy was 0.78. Adult TI-RADS recommendations would have resulted in 4% of cancerous nodules being lost to follow-up. Modifications to TI-RADS (FNAB of all TR3 nodules ≥1.5 cm, FNAB of TR4 and TR5 nodules ≥0.5 cm, surveillance of nodules ≥1 cm, consider surgery for nodules >4 cm) reduced this missed malignancy rate to 0%. CONCLUSIONS TI-RADS can risk-stratify paediatric thyroid nodules. However, the system requires modifications to reduce the missed malignancy rate in paediatric thyroid nodules. Our data suggest that lower size thresholds for FNAB are warranted in children.
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Affiliation(s)
- Carlos A Ortega
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Jean-Nicolas Gallant
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Irem Kilic
- Department of Pathology, Loyola University Healthcare System, Maywood, Illinois, USA
| | | | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Burton Wood
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan Adams
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Fadi Azer
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Huiying Wang
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jiancong Liang
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara H Duffus
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ryan H Belcher
- Department of Pathology, Loyola University Healthcare System, Maywood, Illinois, USA
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rochelle F Andreotti
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rekha Krishnasarma
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer E Lim-Dunham
- Department of Radiology, Loyola University Healthcare System, Maywood, Illinois, USA
| | - Güliz A Barkan
- Department of Pathology, Loyola University Healthcare System, Maywood, Illinois, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vivian L Weiss
- Department of Pathology, Loyola University Healthcare System, Maywood, Illinois, USA
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Bahadir K, Ural S, Abdullayev J, Karaman A, Parlak M, Boz A, Karaguzel G. Thyroid surgery in children: a single-center experience of 20 years. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240001. [PMID: 39045933 PMCID: PMC11262313 DOI: 10.1590/1806-9282.20240001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/16/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Thyroidectomy is a relatively uncommon procedure in pediatric patients. We aimed to review our 20-year experience of thyroid surgery. METHODS A total of 39 patients who underwent thyroid surgery from 2003 to 2023 were retrospectively evaluated. All patients were followed preoperatively and postoperatively by our institutional multidisciplinary board. Patients were divided into two groups based on their pathologies: benign and malignant. RESULTS In total, 39 patients (27 girls and 12 boys) underwent 47 thyroid surgeries (total thyroidectomy in 19 patients and subtotal thyroidectomy in 20 patients, with 8 of them having completion thyroidectomy). Notably, 20 (51%) patients had benign and 19 (49%) patients had malignant pathologies. Median age at operation was 157 (9-223) months in the benign group and 182 (1-213) months in the malignant group. In the benign group, 12 (60%) patients had colloidal goiter and 8 (40%) patients had other conditions. In the malignant group, 12 (63%) patients had papillary thyroid carcinoma, 3 (16%) patients had follicular thyroid carcinoma, 2 (11%) had medullary thyroid carcinoma, and 2 patients had other thyroid malignancies. Overall permanent complication rate was 2 out of 39 (5%), which was similar for both groups (1 hypocalcemia in each group). The median follow-up was 38 months (1-179 months) with no local recurrence or distant metastasis. CONCLUSION Pediatric thyroidectomies are performed on a heterogeneous group of pediatric patients due to a diverse group of pathologies. A multidisciplinary approach is required for proper initial management and surgical strategy with decreased complication rate and event-free survival of these patients in experienced tertiary centers.
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Affiliation(s)
- Kutay Bahadir
- Akdeniz University, School of Medicine, Department of Pediatric Surgery – Antalya, Turkey
| | - Selin Ural
- Akdeniz University, School of Medicine, Department of Pediatric Surgery – Antalya, Turkey
| | - Javid Abdullayev
- Akdeniz University, School of Medicine, Department of Pediatric Surgery – Antalya, Turkey
| | - Abdurrahman Karaman
- Akdeniz University, School of Medicine, Department of Pediatric Surgery – Antalya, Turkey
| | - Mesut Parlak
- Akdeniz University, School of Medicine, Department of Pediatric Endocrinology – Antalya, Turkey
| | - Adil Boz
- Akdeniz University, School of Medicine, Department of Nuclear Medicine – Antalya, Turkey
| | - Gungor Karaguzel
- Akdeniz University, School of Medicine, Department of Pediatric Surgery – Antalya, Turkey
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Tirkaso BH, Mulugeta GA, Belete TD, Melak MM. Papillary thyroid carcinoma in an 8-year-old Ethiopian child: A case report with literature review. SAGE Open Med Case Rep 2024; 12:2050313X241248392. [PMID: 38680599 PMCID: PMC11047237 DOI: 10.1177/2050313x241248392] [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: 12/04/2023] [Accepted: 04/02/2024] [Indexed: 05/01/2024] Open
Abstract
Thyroid nodular disease can present in different forms, such as a solitary nodule, multinodular goiter, nodular goiter caused by autoimmune goiter, and nonpalpable thyroid nodules. Among children, thyroid cancer is the most common type of endocrine cancer. Pediatric thyroid cancer is usually detected as a neck mass without any symptoms, leading to variable stages of progression when diagnosed. Papillary thyroid carcinoma is the most common type of thyroid cancer in children with thyroid nodules. We are presenting a case of an 8-year-old male child who was referred to Jimma Medical Center after he developed swelling on the right side of his neck. On examination, multiple, matted 8 × 6 cm, firm to hard, non-tender right lateral neck masses were found, which moved with swallowing. Thyroid function tests were normal. An ultrasound diagnosis of thyroid carcinoma and a cytologic diagnosis of suspicion for papillary thyroid carcinoma (Bethesda V) was made, and an excisional biopsy was advised. A total thyroidectomy was done. A histopathology diagnosis of Papillary thyroid carcinoma (Classic variant) was made. This is an unusual case of Papillary thyroid carcinoma in an Ethiopian child, with plenty of examples previously recorded in the literature but no such report of its occurrence in our setup to our knowledge. When children under 10 have cervical masses, thyroid cancer should be considered. The evaluation of a palpable thyroid mass typically begins with a blood test to check thyroid function, along with ultrasound and fine-needle aspiration biopsy. Currently, fine-needle aspiration biopsy is the most reliable way to diagnose malignancy and determine the appropriate surgical approach. In most cases, treatment will involve a total thyroidectomy. Lymph node dissection is necessary only if lymph node disease is detected during preoperative evaluation.
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Jia S, Tang D, Peng W. Risk factors for recurrence of differentiated thyroid carcinoma in children and adolescents: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e36585. [PMID: 38115329 PMCID: PMC10727528 DOI: 10.1097/md.0000000000036585] [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: 09/20/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
This study aimed to provide a recent clinical evaluation of the outcome of treatment and the predictors of recurrence for Chinese children and adolescents with differentiated thyroid carcinoma (DTC). This is a retrospective cohort study at the Yunnan Cancer Hospital from May 2002 to August 2021. We analyzed several risk factors related to the recurrence of DTC in children and adolescents. The Chi-square test, Kaplan-Meier log-rank tests, and Cox regression analysis were used in the statistical analysis. A P-value <.05 was considered statistically significant. A total of 103 patients were enrolled, including 68 girls (66.0%) and 35 boys (34.0%) with a median age of 18 years (range: 7-20 years). All enrolled patients received standard treatment. Children (≤14years) tended to have multifocality and higher levels of thyroid imaging reporting and data system, higher pN stage, and higher American Thyroid Association (ATA) pediatric risk compared with adolescents (P < .05). The chief complaints and clinical treatment differed between children and adolescents. During a follow-up of 6 to 239 months (average 74.7 months, median 59 months), all patients survived, but recurrence occurred in 22 patients (22.4%). The disease-free survival rates at 1, 2, 5, and 10 years were 91.2%, 78.4%, 77.1%, and 77.1%, respectively. Univariate Cox regression and log-rank tests showed that positive preoperative thyroglobulin level, bilaterality, extrathyroidal extension, high pT/pN/pM stage, and high ATA pediatric risk were the risk factors for DTC recurrence in children and adolescents. Multivariate Cox regression found that extrathyroidal extension and ATA pediatric risk were independent risk factors for the recurrence of DTC in children and adolescents. Additionally, among the 38 cases with cN0 stage, one who had bilateral, and multifocal thyroid nodules experienced recurrence, while the remaining 37 cases with cN0 stage had no recurrence. In conclusion, compared with adolescents, children present with more highly malignant disease and are more prone to metastasis. The significant risk factors associated with the recurrence of DTC in children and adolescents were positive preoperative thyroglobulin level, bilaterality, high pT/pN/pM stage, extrathyroidal extension, and high ATA pediatric risk, with the latter 2 being independent risk factors. The surgical approach for cN0 patients should be personalized taking into account invasive features.
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Affiliation(s)
- Siyu Jia
- Department of Head and Neck Surgery, Yunnan Cancer Hospital, Kunming, Yunnan Province, China
| | - Dengpeng Tang
- Department of Head and Neck Surgery, Yunnan Cancer Hospital, Kunming, Yunnan Province, China
| | - Wen Peng
- Department of Head and Neck Surgery, Yunnan Cancer Hospital, Kunming, Yunnan Province, China
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Gallant JN, Weiss VL, Chen SC, Liang J, Belcher RH, Ye F, Correa H, Wang H. Hashimoto's Thyroiditis and the Risk of Papillary Thyroid Cancer in Children. Cancers (Basel) 2023; 15:4902. [PMID: 37835596 PMCID: PMC10572053 DOI: 10.3390/cancers15194902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023] Open
Abstract
The association between Hashimoto's thyroiditis (HT) and pediatric thyroid cancer is controversial. Most studies examining this connection have been based on adults, and larger studies in children are lacking. We performed a retrospective study of all sequential pediatric patients who underwent a thyroidectomy for a neoplasm at our institution over a twenty-year period in order to explore the link between HT and pediatric thyroid cancer. A total of 153 patients, median age 16.5 (interquartile range [IQR] 14.2-18.3) years, underwent thyroid surgery for a neoplasm. Patients were mainly female (80%) and White (84%). Median follow-up was 58.6 (IQR 20.7-105.4) months. Thirty-five (23%) patients had HT. Patients who underwent thyroid surgery and had HT were more likely to harbor a malignant neoplasm (p = 0.05); specifically, papillary thyroid carcinoma (PTC, p = 0.02). There was a difference in the distribution of HT among the subtypes of PTC (p = 0.03). Despite this, there was no difference in terms of survival between patients with/without HT. In conclusion, children with a thyroid malignancy, specifically, PTC, are more likely to have HT. The association between HT and pediatric PTC appears to be subtype-specific but does not seem to affect patient survival.
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Affiliation(s)
- Jean-Nicolas Gallant
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Vivian L. Weiss
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Sheau-Chiann Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Ryan H. Belcher
- Department of Otolaryngology—Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Hernan Correa
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Huiying Wang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Monroe Carell Jr. Children’s Hospital, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Zhang XY, Wei Q, Wu GG, Tang Q, Pan XF, Chen GQ, Zhang D, Dietrich CF, Cui XW. Artificial intelligence - based ultrasound elastography for disease evaluation - a narrative review. Front Oncol 2023; 13:1197447. [PMID: 37333814 PMCID: PMC10272784 DOI: 10.3389/fonc.2023.1197447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Ultrasound elastography (USE) provides complementary information of tissue stiffness and elasticity to conventional ultrasound imaging. It is noninvasive and free of radiation, and has become a valuable tool to improve diagnostic performance with conventional ultrasound imaging. However, the diagnostic accuracy will be reduced due to high operator-dependence and intra- and inter-observer variability in visual observations of radiologists. Artificial intelligence (AI) has great potential to perform automatic medical image analysis tasks to provide a more objective, accurate and intelligent diagnosis. More recently, the enhanced diagnostic performance of AI applied to USE have been demonstrated for various disease evaluations. This review provides an overview of the basic concepts of USE and AI techniques for clinical radiologists and then introduces the applications of AI in USE imaging that focus on the following anatomical sites: liver, breast, thyroid and other organs for lesion detection and segmentation, machine learning (ML) - assisted classification and prognosis prediction. In addition, the existing challenges and future trends of AI in USE are also discussed.
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Affiliation(s)
- Xian-Ya Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Wei
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ge-Ge Wu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Tang
- Department of Ultrasonography, The First Hospital of Changsha, Changsha, China
| | - Xiao-Fang Pan
- Health Medical Department, Dalian Municipal Central Hospital, Dalian, China
| | - Gong-Quan Chen
- Department of Medical Ultrasound, Minda Hospital of Hubei Minzu University, Enshi, China
| | - Di Zhang
- Department of Medical Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Jie Y, Ruan J, Cai Y, Luo M, Liu R. Comparison of ultrasonography and pathology features between children and adolescents with papillary thyroid carcinoma. Heliyon 2023; 9:e12828. [PMID: 36704282 PMCID: PMC9871215 DOI: 10.1016/j.heliyon.2023.e12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Objective To compare the ultrasonography and pathology features between children and adolescents with papillary thyroid carcinoma (PTC). Methods A total of 53 patients who were surgically diagnosed with childhood or adolescent PTC between 2017 and 2022 were included in this study. The pre-operative ultrasonography, post-operative histology, and molecular and clinical characteristics were retrospectively analyzed. Results No differences were observed in composition, echogenicity, and shape using ultrasonography. Moreover, there was a significantly higher rate of extrathyroidal extension, punctate echogenic foci, and lymph node metastases in children compared to adolescents. The molecular analysis showed that BRAFV600E mutations are the most prevalent abnormality in adolescent PTC (12/20, 60.0%). However, they are less in childhood PTC (7/23, 30.4%). In addition, using next-generation sequencing, three cases with oncogenic fusion (one TRIM33-RET case, one CCDC6-RET case, and one STRN-ALK case) were identified in childhood PTC. Conclusion The frequency of extrathyroidal extension, punctate echogenic foci, and lymph node metastases were higher in childhood PTC, while BRAFV600E mutations were higher in adolescent PTC.
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Key Words
- ACR, American College of Radiology
- AJCC, American Joint Committee on Cancer
- ATA, American thyroid association
- Adolescents
- CCDC6, Coiled-coil domain containing 6
- Childhood
- FNAC, Fine needle aspiration cytology
- Molecular characteristics
- NGS, Next-generation sequencing
- PTC, Papillary thyroid cancer
- Papillary thyroid carcinoma
- RET, Ret proto-oncogene
- TI-RADS, Thyroid imaging reporting and data system
- TRIM33, Tripartite motif-containing 33
- Ultrasonography
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Affiliation(s)
- Yue Jie
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou, China
| | - Jingliang Ruan
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou, China
| | - Yuechang Cai
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou, China
| | - Man Luo
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou, China
| | - Rongbin Liu
- Department of Ultrasound, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou, China,Corresponding author. Department of Ultrasound, Sun Yat-Sen Memorial Hospital, SunYat-Sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, China.
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8
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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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Singh A, Prasad P, Singh A. Pediatric Thyroid Lesions: Synergistic Role of Clinical and Cytological Features in Diagnosis. Discoveries (Craiova) 2023; 11:e164. [PMID: 37496709 PMCID: PMC10368207 DOI: 10.15190/d.2023.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Thyroid lesions in childhood and adolescence are uncommon, and the risk of malignancy widely varies. They require careful evaluation and more aggressive diagnostic approach. The present study aimed to evaluate the frequency of various pediatric thyroid lesions in pediatric cases with thyroid nodules and ascertain the utility of clinical, laboratory, ultrasonography, and fine-needle aspiration cytology (FNAC) findings to discriminate between benign and malignant lesions. METHODS A retrospective study where 95 consecutive cases of pediatric patients with thyroid nodules received over six years (January 2016-December 2021) were retrieved from the hospital information system. The differences in clinical, laboratory, ultrasonography, and cytological findings between benign and malignant lesions were analysed. Statistical analysis was performed using SPSS software (version 21.0). RESULTS The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was used to categorise the cases into: unsatisfactory (n=3), benign (n=66), intermediate (n=8) and suspicious/malignant (n=18). The specificity of cytopathology in diagnosing benign lesions (TBSRTC-II) was 90%, whereas sensitivity in diagnosing malignant lesions (TBSRTC-VI) was 100%. Colloid nodule (n=57) and papillary thyroid carcinoma (n=15) were the most common benign and malignant lesions encountered respectively. Malignant lesions more frequently showed the presence of palpable lymph nodes (p-value <0.001), microcalcifications (p-value 0.011) and intranodular vascularization (p-value <0.001). CONCLUSION The diagnosis of pediatric thyroid lesions should be based on a multistep evaluation that includes clinical, laboratory, and radiographic modalities. Thyroid function tests and ultrasonography can help identify clinically unapparent thyroid nodules and provide detailed nodule characterization for suspected malignant lesions. FNAC is a simple, less-invasive, and cost-effective technique that can differentiate between benign and malignant thyroid lesions.
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Affiliation(s)
- Anurag Singh
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Pallavi Prasad
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Alka Singh
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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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: 38] [Impact Index Per Article: 19.0] [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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11
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Ben-Skowronek I, Sieniawska J, Pach E, Wrobel W, Skowronek A, Tomczyk Z, Mlodawska A, Makuch M, Malka M, Cielecki C, Nachulewicz P. Thyroid Cancer Risk Factors in Children with Thyroid Nodules: A One-Center Study. J Clin Med 2021; 10:jcm10194455. [PMID: 34640473 PMCID: PMC8509812 DOI: 10.3390/jcm10194455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 12/16/2022] Open
Abstract
Thyroid nodules are common in the adult population (13%), but in childhood, they are relatively rarely diagnosed (0.2–5%). The risk factors and diagnostic and therapeutic algorithms are well-known and effectively used in adults, but no clear procedures supported by scientific research are available in the pediatric population. Our aim in this study was to identify predictive factors for thyroid cancer in a pediatric population. We retrospectively analyzed 112 children (80 girls and 32 boys, aged 0.6–18 years, with an average group age of 13.4 ± 4.5 years) with thyroid nodules who presented or were referred between 2010 and 2021. A total of 37 children qualified for partial or total thyroidectomy. After histopathological nodule examination, the most common cases were benign lesions in 23 patients (57.5%) and malignant lesions in 14 children (32.5%). Solitary benign thyroid nodules were found in 16 children (40%). Malignancy risk was higher in children with increased nodule diameter (greater than 7 mm; p = 0.018) or hypoechogenic lesions in ultrasound (p = 0.010), with no correlation between increased blood flow in the vessels and tumor diagnosis. The relative risk of developing thyroid cancer for class III was found to be higher in comparison to adults and 11.1 times higher than for classes I and II combined.
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Affiliation(s)
- Iwona Ben-Skowronek
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
- Correspondence: ; Tel.: +48-817185440
| | - Joanna Sieniawska
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
| | - Emilia Pach
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
| | - Wiktoria Wrobel
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
| | - Anna Skowronek
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
| | - Zaklina Tomczyk
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
| | - Anna Mlodawska
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
| | - Magdalena Makuch
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
| | - Magdalena Malka
- Department of Pediatric Endocrinology and Diabetology with the Endocrinology and Metabolic Laboratory, Medical University of Lublin, 20-093 Lublin, Poland; (J.S.); (E.P.); (W.W.); (A.S.); (Z.T.); (A.M.); (M.M.); (M.M.)
| | - Czeslaw Cielecki
- Department of Paediatric Surgery and Traumatology, Medical University of Lublin, 20-093 Lublin, Poland; (C.C.); (P.N.)
| | - Pawel Nachulewicz
- Department of Paediatric Surgery and Traumatology, Medical University of Lublin, 20-093 Lublin, Poland; (C.C.); (P.N.)
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12
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Bae JS, Jung SH, Hirokawa M, Bychkov A, Miyauchi A, Lee S, Chung YJ, Jung CK. High Prevalence of DICER1 Mutations and Low Frequency of Gene Fusions in Pediatric Follicular-Patterned Tumors of the Thyroid. Endocr Pathol 2021; 32:336-346. [PMID: 34313965 DOI: 10.1007/s12022-021-09688-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 12/14/2022]
Abstract
Follicular-patterned tumors of the thyroid in the adult population frequently harbor RAS mutations or PAX8-PPARG rearrangement, but little is known about molecular profiles in the pediatric patients with thyroid tumors, which is rare. To identify the molecular profile of pediatric follicular-patterned tumors, we enrolled 41 pediatric patients with follicular-patterned tumors from two institutions. We did next-generation sequencing using a mutation panel targeting 49 thyroid-tumor-related genes and a fusion panel targeting 88 types of thyroid-related gene fusions. We identified nonsynonymous mutations in at least one target gene in most of the tumors (28/41, 68%). Somatic DICER1 mutations (22%, n = 9) were the most common genetic alteration, followed by mutations of NRAS (15%), FGFR3 (15%), PTEN (12%), and STK11 (10%). Infrequent genetic alterations (≤ 5% of all cases) included mutations of HRAS, APC, TSHR, CTNNB1, TP53, EIF1AX, FGFR4, GNAS, RET, and SOS1, and gene fusion of THADA-IGF2BP3. DICER1 and RAS mutations were mutually exclusive. No patients had tumors related to the DICER1 syndrome or the Cowden syndrome. There was no significant difference in total mutation burden or distribution between follicular adenoma and follicular carcinoma. In the literature, the DICER1 mutation has been reported in 20 to 53% of pediatric patients with follicular-patterned tumors. In conclusion, our study reinforces the role of the DICER1 mutation in the development of pediatric thyroid tumors. Gene fusions rarely occur in pediatric follicular-patterned tumors. Mutation or gene fusion alone could not distinguish benign from malignant follicular-patterned tumors in pediatric patients.
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Affiliation(s)
- Ja-Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- College of Medicine, Cancer Research Institute, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Seung-Hyun Jung
- Departmen of Biochemistry, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- Cancer Evolution Research Center, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, 296-8602, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, 650-0011, Japan
| | - Sohee Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
- College of Medicine, Cancer Research Institute, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Yeun-Jun Chung
- Cancer Evolution Research Center, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
- College of Medicine, IRCGP, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Chan Kwon Jung
- College of Medicine, Cancer Research Institute, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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13
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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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14
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Ajani MA, Omenai SA, Nwadiokwu JI, Salami AA. Histopathological profile of childhood thyroid carcinoma in Ibadan, Southwestern Nigeria. Malawi Med J 2021; 32:213-217. [PMID: 34457206 PMCID: PMC8364793 DOI: 10.4314/mmj.v32i4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Thyroid carcinoma is a common endocrine malignancy. It is however rare in childhood and often occurs as a result of radiation exposure or inherited genetic mutations. Most childhood thyroid carcinomas are well differentiated. There are very few epidemiological studies of this disease in Nigeria and our study aimed to determine the frequency in a subset of our population. The study aimed to determine the prevalence and histopathological characteristics of childhood thyroid carcinoma in our environment. Methods This was a retrospective review of histopathologically diagnosed thyroid carcinoma in children less than 18 years of age in the Department of Pathology, University College Hospital, Ibadan over a 40-year period. Histopathological diagnosis, age, sex and other relevant clinical information were extracted from the hospital records and surgical pathology records of the department. All cases of patients under18 years old had their slides re-examined and reclassified by two pathologists according to the World Health Organization histopathological classification of thyroid tumours. Results There were 25 cases of thyroid carcinomas seen in children within the study period. Papillary thyroid carcinoma was the most common, accounting for 80% of the cases. Follicular carcinoma accounted for 12%, and medullary and anaplastic carcinoma accounted for 4% each. The mean age at presentation was 13 years. There was a female preponderance with females accounting for 60% of cases. Tumours with distant metastasis made up 20% of the cases. Conclusion Childhood thyroid carcinomas are rare in our environment, with a minority of cases presenting with metastases.
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Affiliation(s)
- Mustapha A Ajani
- Department of Pathology, University College Hospital, Ibadan, Oyo state, Nigeria.,Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria
| | - Sebastian A Omenai
- Department of Anatomical Pathology, Edo University, Iyamho, Edo state, Nigeria
| | - John I Nwadiokwu
- Department of Pathology, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Ayodeji A Salami
- Department of Pathology, University College Hospital, Ibadan, Oyo state, Nigeria.,Department of Pathology, College of Medicine, University of Ibadan, Ibadan, Oyo state, Nigeria
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15
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Diagnostic and Prognostic Performance of Liquid Biopsy-Derived Exosomal MicroRNAs in Thyroid Cancer Patients: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13174295. [PMID: 34503104 PMCID: PMC8428356 DOI: 10.3390/cancers13174295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023] Open
Abstract
Circulatory tumor-derived exosomal microRNAs (miRNAs) play key roles in cancer development/progression. We aimed to assess the diagnostic/prognostic value of circulating exosomal miRNA in thyroid cancer (TC). A search in PubMed, Scopus, Web of Science, and Science Direct up to 22 May 2021 was performed. The true/false positive (TP/FP) and true/false negative (TN/FN) rates were extracted from each eligible study to obtain the pooled sensitivity, specificity, positive/negative likelihood ratios (PLR/NLR), diagnostic odds ratio (DOR), and their 95% confidence intervals (95%CIs). The meta-analysis included 12 articles consisting of 1164 Asian patients and 540 controls. All miRNAs were quantified using qRT-PCR assays. The pooled sensitivity was 82% (95%CI = 77-86%), pooled specificity was 76% (95%CI = 71-80%), and pooled DOR was 13.6 (95%CI = 8.8-21.8). The best biomarkers with high sensitivity were miR-16-2-3p (94%), miR-223-5p (91%), miR-130a-3p (90%), and miR182-5p (94%). Similarly, they showed high specificity, in addition to miR-34c-5p. Six panels of two to four exosomal miRNAs showed higher diagnostic values with an area under the curve (AUC) ranging from 0.906 to 0.981. The best discriminative ability to differentiate between cancer and non-cancer individuals was observed for miR-146b-5p + miR-223-5p + miR-182-5p (AUC = 0.981, sensitivity = 93.8% (84.9-98.3), specificity = 92.9% (76.5-99.1)). In conclusion, the expression levels of exosomal miRNAs could predict TC.
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16
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Erbaş İC, Erbaş İM, Evliyaoğlu O. Clinical, biochemical, and radiological follow-up results of children and adolescents with Hashimoto's thyroiditis: a single-center experience. J Pediatr Endocrinol Metab 2021; 34:987-994. [PMID: 34126658 DOI: 10.1515/jpem-2021-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hashimoto's thyroiditis (HT) is the most common cause of goiter and acquired hypothyroidism in children and adolescents, especially in areas without endemic iodine deficiency. We aimed to evaluate the follow-up results of children and adolescents diagnosed with HT, including clinical, biochemical, and radiological findings and treatment approaches. METHODS HT patients, who were diagnosed between 2012 and 2018 years in a single-center, were assessed retrospectively. RESULTS Two hundred and twenty-four cases were included in the study, 75.9% of whom were girls (female/male ratio: 3.1) and 66.5% were pubertal. The median age of the cases at first admission was 12.5 (9.2-15) years. The median follow-up period of 196 patients, who continued their follow-up regularly, was 2.1 (0.7-4.8) years. When autoantibody levels were analyzed according to gender, mean anti-Tg levels were higher in girls (p=0.028), whereas anti-TPO levels were similar (p=0.372). A nodule was detected in the ultrasonographic follow-up of 29 (13%) patients. Papillary thyroid carcinoma was observed in 10.3% (n=3) of those with nodules. When the last ultrasonography findings of 188 patients with available radiological follow-up data were compared with their initial evaluation, the rate of heterogeneous parenchymal echogenicity increased significantly (p=0.008). The need for l-thyroxine dosage augmented over time. CONCLUSIONS Although HT is more common in adolescent girls, it can be encountered in both genders and at all ages in childhood. The incidence of malignancy was not higher in patients with nodules associated with HT than the reported incidences of malignancy in nodules not associated with HT.
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Affiliation(s)
- İrem Ceren Erbaş
- Department of Pediatrics, Faculty of Medicine, İstanbul University - Cerrahpaşa, İstanbul, Turkey
| | - İbrahim Mert Erbaş
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Olcay Evliyaoğlu
- Division of Pediatric Endocrinology, Faculty of Medicine, İstanbul University - Cerrahpaşa, İstanbul, Turkey
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17
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Abstract
Symptoms of thyroid nodules and differentiated thyroid cancer include those of hypo- or hyperthyroidism, voice changes, difficulty breathing when supine, globus sensation, dysphagia, and cervical adenopathy. Surgery has been the first-line mainstay treatment option for large thyroid nodules and thyroid carcinomas. This article highlights thyroid carcinoma in the pediatric population and reviews the current testing and management options. [Pediatr Ann. 2020;50(7):e282-e285.].
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18
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Shi LH, Zhou L, Lei YJ, Xia L, Xie L. Needle tract seeding of papillary thyroid carcinoma after fine-needle capillary biopsy: A case report. World J Clin Cases 2021; 9:3662-3667. [PMID: 34046467 PMCID: PMC8130087 DOI: 10.12998/wjcc.v9.i15.3662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/06/2021] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules. It includes two primary methods: Fine-needle capillary biopsy (FNCB) and fine-needle aspiration biopsy. Needle tract seeding (NTS) is a rare complication of thyroid fine-needle biopsy mainly caused by fine-needle aspiration biopsy rather than FNCB. Here, we present an extremely rare case of a papillary thyroid carcinoma (PTC) patient with FNCB-derived NTS.
CASE SUMMARY We report a 32-year-old woman with PTC who showed subcutaneous NTS 1 year after FNCB and thyroidectomy. NTS was diagnosed based on clinical manifestations, biochemistry indices, and imaging (computed tomography and ultrasound). Pathological identification of PTC metastases consistent with the puncture path is the gold standard for diagnosis. Surgical resection was the main method used to treat the disease. After surgery, thyroid function tests and ultrasound scans were performed every 3-6 mo. To date, no evidence of tumor recurrence has been observed.
CONCLUSION FNCB is a safe procedure as NTS is rare, and can be easily removed surgically with no recurrence. Accordingly, NTS should not limit the usefulness of FNCB.
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Affiliation(s)
- Liu-Hong Shi
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Liang Zhou
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Yin-Jiao Lei
- Department of Pathology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Lian Xia
- Department of Nursing, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Lei Xie
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
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A three-microRNA panel in serum as novel biomarker for papillary thyroid carcinoma diagnosis. Chin Med J (Engl) 2021; 133:2543-2551. [PMID: 33009019 PMCID: PMC7722608 DOI: 10.1097/cm9.0000000000001107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Accumulating evidence has revealed that circulating microRNAs (miRNAs) can serve as non-invasive biomarkers for cancer diagnosis. This study aimed to identify differentially expressed miRNAs in serum which might become potential biomarkers for non-invasive diagnosis of papillary thyroid carcinoma (PTC). Methods The experiment was carried out between 2015 and 2017. In the screening stage, the Exiqon miRNA quantitative real-time polymerase chain reaction (qPCR) panel was applied to select candidate miRNAs. In the following training, testing, and external validation stages, the serum samples of 100 patients and 96 healthy controls (HCs) were analyzed to compare the expression levels of the identified miRNAs. The areas under the receiver operating characteristic curves (AUCs) were calculated to assess the diagnostic value of the identified signature. Results Three miRNAs (miR-25-3p, miR-296-5p, and miR-92a-3p) in serum were consistently up-regulated in PTC patients compared with HCs. A three-miRNA panel was constructed by logistic regression analysis and showed better diagnostic performance than a single miRNA for PTC detection. The AUCs of the panel were 0.727, 0.771, and 0.862 for the training, testing, and external validation stage, respectively. Meanwhile, the panel showed stable capability in differentiating PTC patients from patients with benign goiters, with an AUC as high as 0.969. For further exploration, the three identified miRNAs were analyzed in tissue samples (23 PTC vs. 23 HCs) and serum-derived exosomes samples (24 PTC vs. 24 HCs), and the altered expression in the tumor also indicated their close relationship with PTC disease. Conclusion We identify a three-miRNA panel in serum which might serve as a promising biomarker for PTC diagnosis.
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Abstract
The thyroid plays a major role in growth and development, and the hormones it produces can affect many different systems of the body. For this reason, the thyroid should always be at the front of our minds when evaluating children and adolescents. The symptoms of thyroid abnormalities can often be subtle and evolve over time, so we must have a high index of suspicion when providing care for our patients. It is important to understand what can go wrong with the thyroid, how to diagnose thyroid disease, and how to manage thyroid abnormalities. Whether it is structural changes in the thyroid such as goiter or nodules, functional changes that lead to hyperthyroidism or hypothyroidism, or thyroid cancer, a thorough examination and appropriate treatment is essential to maintain optimal cognitive and physical growth throughout childhood and adolescence. This article will discuss the most common thyroid abnormalities, how to diagnose them, and how to treat and manage them in both the short and long term. [Pediatr Ann. 2021;50(4):e143-e147.].
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21
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Ozolek JA. Selected Topics in the Pathology of the Thyroid and Parathyroid Glands in Children and Adolescents. Head Neck Pathol 2021; 15:85-106. [PMID: 33723755 PMCID: PMC8010056 DOI: 10.1007/s12105-020-01274-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/11/2020] [Indexed: 01/09/2023]
Abstract
The goals of this chapter in keeping with the overall general themes of this special edition will be (1) to highlight aspects of development of the thyroid and parathyroid glands with particular focus on the role and contribution of the neural crest (or not) and how this may impact on the pathology that is seen, (2) to emphasize those lesions particularly more commonly arising in the pediatric population that actually generate specimens that the surgical pathologist would encounter, and (3) highlight more in depth specific lesions associated with heritable syndromes or specific gene mutations since the heritable syndromes tends to manifest in the pediatric age group. In this light, the other interesting areas of pediatric thyroid disease including medical thyroid diseases, congenital hypothyroidism, anatomic variants and aberrations of development that lead to structural anomalies will not be emphasized here.
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Affiliation(s)
- John A. Ozolek
- West Virginia University School of Medicine, Morgantown, WV USA
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22
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Lin AN, Lin WC, Cheng KL, Luo SD, Chiang PL, Chen WC, Chen YS, Wang CK, Kan NN, Su YY. Radiofrequency Ablation a Safe and Effective Treatment for Pediatric Benign Nodular Thyroid Goiter. Front Pediatr 2021; 9:753343. [PMID: 34900863 PMCID: PMC8662624 DOI: 10.3389/fped.2021.753343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/29/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose: To evaluate the effectiveness of radiofrequency ablation (RFA) for benign thyroid nodules in pediatric patients. Materials and Methods: Twelve pediatric patients (11 female, 1 male; mean age 15.54 ± 2.8 years, range 10-19 years) with benign thyroid nodules (mean longest diameter 4.1 ± 1.4 cm, range 1.5-5.9 cm) treated by RFA from 2017 to 2020 were evaluated. The inclusion criteria for RFA therapy were (i) age < 20 years; (ii) benign cytological confirmation by 2 separate ultrasound guided fine-needle aspiration cytology (FNAC) or core needle biopsies; (iii) pressure symptoms or cosmetic problems caused by thyroid nodules; (iv) absence of any sonographic suspicious feature; and (v) follow-up for >6 months. Under local anesthesia, RFA was performed with the use of an RF generator and an 18-gauge internally cooled electrode. Volume changes in nodules on follow-up ultrasonography (US), changes in symptomatic and cosmetic scores, and complications arising during or after RFA were evaluated. Results: Mean follow-up period was 24.9 ± 13.9 months (range 6-43 months). At the last follow-up visits, volume of the nodule had decreased significantly (15.34 ± 11.52 mL vs. 4.07 ± 4.99 mL; P < 0.05), whereas volume reduction rate was 74.31% ± 19.59%. Both cosmetic and compressive symptoms were also significantly improved (2.91 ± 0.79 vs. 0.92 ± 0.67 and 1.5 ± 1.93 vs. 0.17 ± 0.39; P < 0.05). The mean number of ablation sessions was 1.4 ± 0.6 (range 1-3 sessions), and one of the patients suffered from transient vocal cord palsy which was spontaneously resolved 53 days later. Conclusions: RFA is a safe and effective treatment for benign thyroid nodules in pediatric patients, and can thus serve as an alternative treatment for thyroidectomy.
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Affiliation(s)
- An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kai-Lun Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Sheng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Na-Ning Kan
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yan-Ye Su
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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23
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Piskunowicz M, Back SJ, Darge K, Humphries PD, Jüngert J, Ključevšek D, Lorenz N, Mentzel HJ, Squires JH, Huang DY. Contrast-enhanced ultrasound of the small organs in children. Pediatr Radiol 2021; 51:2324-2339. [PMID: 33830288 PMCID: PMC8566395 DOI: 10.1007/s00247-021-05006-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/17/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
In pediatric and adult populations, intravenous contrast-enhanced ultrasound (CEUS) remains off-label for imaging of organs other than the liver and heart. This limited scope inhibits potential benefits of the new modality from a more widespread utilization. Yet, CEUS is potentially useful for imaging small organs such as the thyroid gland, lymph nodes, testes, ovaries and uterus, with all having locations and vasculature favorable for this type of examination. In the adult population, the utility of CEUS has been demonstrated in a growing number of studies for the evaluation of these small organs. The aim of this article is to present a review of pediatric CEUS of the thyroid gland, lymph nodes, testes, ovaries and uterus as well as to draw from the adult literature indications for possible applications in children.
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Affiliation(s)
- Maciej Piskunowicz
- Department of Radiology, Medical University of Gdansk, M. Sklodowskiej-Curie 3a Street, 80-210, Gdansk, Poland.
| | - Susan J. Back
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Kassa Darge
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Paul D. Humphries
- grid.424537.30000 0004 5902 9895Department of Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Jörg Jüngert
- grid.5330.50000 0001 2107 3311Department of Pediatrics, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Damjana Ključevšek
- grid.29524.380000 0004 0571 7705Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Norbert Lorenz
- grid.4488.00000 0001 2111 7257Children’s Hospital, Dresden Municipal Hospital, Teaching-Hospital of Technical University Dresden, Dresden, Germany
| | - Hans-Joachim Mentzel
- grid.275559.90000 0000 8517 6224Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital, Jena, Germany
| | - Judy H. Squires
- grid.239553.b0000 0000 9753 0008Department of Radiology, University of Pittsburgh Medical Center, Children’s Hospital of Pittsburgh, Pittsburgh, PA USA
| | - Dean Y. Huang
- grid.46699.340000 0004 0391 9020Department of Radiology, King’s College Hospital, Denmark Hill, London, UK
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24
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Green O, Keisling M, Kambalapalli M, McDaniel J, Boulanger S, Fornwalt BE, Jeyakumar A. Unusual Thyroid Mass in an Adolescent Patient. EAR, NOSE & THROAT JOURNAL 2020; 101:654-656. [PMID: 33275026 DOI: 10.1177/0145561320973764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hurthle cell tumors are rare follicular-derived thyroid neoplasms. Hurthle cell tumors may be benign or malignant. Workup includes imaging, fine needle aspiration, and treatment usually consists of observation versus thyroidectomy. We describe a case of Hurthle cell adenoma in an adolescent; to the best of our knowledge, this represents only the third case described in the English literature of adolescent Hurthle cell adenoma.
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Affiliation(s)
- Olivia Green
- 6969Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Mamatha Kambalapalli
- 6969Northeast Ohio Medical University, Rootstown, OH, USA.,1079Akron's Children's Hospital, Akron, OH, USA
| | - Janice McDaniel
- 6969Northeast Ohio Medical University, Rootstown, OH, USA.,1079Akron's Children's Hospital, Akron, OH, USA
| | - Scott Boulanger
- 6969Northeast Ohio Medical University, Rootstown, OH, USA.,1079Akron's Children's Hospital, Akron, OH, USA
| | | | - Anita Jeyakumar
- 6969Northeast Ohio Medical University, Rootstown, OH, USA.,1079Akron's Children's Hospital, Akron, OH, USA
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25
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Hoang VT, Trinh CT. A Review of the Pathology, Diagnosis and Management of Colloid Goitre. EUROPEAN ENDOCRINOLOGY 2020; 16:131-135. [PMID: 33117444 DOI: 10.17925/ee.2020.16.2.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 11/24/2022]
Abstract
Colloid goitres are a common, benign lesion of the thyroid gland, that involve a diffuse or nodular pattern. An important feature of colloid goitre is the contained colloid material inside and the comet-tail artefacts, which show up on ultrasound. However, some cases of colloid goitre do not show a comet-tail sign and sometimes these artefacts need to be distinguished from microcalcifications in malignant lesions. This review discusses the epidemiology, pathophysiology, clinical manifestations, ultrasound features and management of colloid goitres.
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Affiliation(s)
- Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
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26
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A Survey of Deep-Learning Applications in Ultrasound: Artificial Intelligence-Powered Ultrasound for Improving Clinical Workflow. J Am Coll Radiol 2020; 16:1318-1328. [PMID: 31492410 DOI: 10.1016/j.jacr.2019.06.004] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 02/07/2023]
Abstract
Ultrasound is the most commonly used imaging modality in clinical practice because it is a nonionizing, low-cost, and portable point-of-care imaging tool that provides real-time images. Artificial intelligence (AI)-powered ultrasound is becoming more mature and getting closer to routine clinical applications in recent times because of an increased need for efficient and objective acquisition and evaluation of ultrasound images. Because ultrasound images involve operator-, patient-, and scanner-dependent variations, the adaptation of classical machine learning methods to clinical applications becomes challenging. With their self-learning ability, deep-learning (DL) methods are able to harness exponentially growing graphics processing unit computing power to identify abstract and complex imaging features. This has given rise to tremendous opportunities such as providing robust and generalizable AI models for improving image acquisition, real-time assessment of image quality, objective diagnosis and detection of diseases, and optimizing ultrasound clinical workflow. In this report, the authors review current DL approaches and research directions in rapidly advancing ultrasound technology and present their outlook on future directions and trends for DL techniques to further improve diagnosis, reduce health care cost, and optimize ultrasound clinical workflow.
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27
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Imaging and Imaging-Based Management of Pediatric Thyroid Nodules. J Clin Med 2020; 9:jcm9020384. [PMID: 32024056 PMCID: PMC7074552 DOI: 10.3390/jcm9020384] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/11/2022] Open
Abstract
Thyroid nodules are less frequent in children than adults. Childhood thyroid nodules carry specific features, including a higher risk of malignancy than nodules in adults, rendering them unique in terms of management. Subsequently, they should be considered a distinct clinical entity with specific imaging recommendations. Initial evaluation requires a thorough workup, including clinical examination, and a detailed personal and familial history to determine the presence of possible risk factors. Laboratory and radiologic evaluation play an integral part in the diagnostic algorithm, with ultrasonography (US) being the first diagnostic test in all patients. US elastography has been recently introduced as an incremental method, reducing the subjectivity of the clinical diagnosis of nodule firmness associated with increased malignancy risk. However, fine-needle aspiration biopsy (FNAB) remains the mainstay in the diagnostic work-up of thyroid nodules and is documented to be best method for differentiating benign from malignant thyroid nodules. In addition, thyroid scintigraphy provides functional imaging information, which has a role both in the diagnostic management of thyroid nodules and during follow up in malignancies. Finally, despite providing additional information in certain clinical scenarios, 18F-fludeoxyglucose Positron Emission Tomography (18F-FDG-PET), computed tomography (CT), and magnetic resonance imaging (MRI) imaging are not routinely recommended for the evaluation of patients with newly detected thyroid nodules or in all cases of thyroid cancer. The objective of this review is to summarize the concepts in imaging and imaging-based management of nodular thyroid disease in the pediatric population, acknowledging the unique features that this patient group carries and the specific approach it requires.
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28
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Teplitzky TB, Okonkwo N, Papadimitriou JC, Pereira KD. Adenochondroma of the Thyroid in a 3-Year-Old Female: A Case Report. EAR, NOSE & THROAT JOURNAL 2019; 100:412S-414S. [PMID: 31663367 DOI: 10.1177/0145561319881504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Follicular adenomas are the most common benign thyroid neoplasm but are unusual in children. However, other rare degenerative lesions and those of developmental origin can also present as thyroid masses. This article reports the first described pediatric thyroid adenochondroma. A 3-year-old female presented with a hard mass in the right lobe of her thyroid with nondiagnostic imaging and cytology findings. She underwent a right thyroid lobectomy uneventfully. Final histopathology examination confirmed an adenochondroma. To the best of our knowledge, an adenochondroma of the thyroid gland in a child has not been previously reported in literature. Though a rare and benign entity, thyroid adenochondromas present clinically with many features concerning for malignancy. Therefore, these lesions should be considered in the differential diagnosis of pediatric thyroid masses.
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Affiliation(s)
- Taylor B Teplitzky
- Department of Otorhinolarynology - Head and neck Surgery, 12264University of Maryland Medical Center, Baltimore, MD, USA
| | - Nkechi Okonkwo
- Department of Pathology, 12264University of Maryland Medical Center, Baltimore, MD, USA
| | - John C Papadimitriou
- Department of Pathology, 12264University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kevin D Pereira
- Department of Otorhinolarynology - Head and Neck Surgery, 12264University of Maryland School of Medicine, Baltimore, MD, USA
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29
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Dimachkieh AL, Kazahaya K, Chelius DC. Assessment and Management of Thyroid Disease in Children. Otolaryngol Clin North Am 2019; 52:957-967. [DOI: 10.1016/j.otc.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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30
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Polat YD, Öztürk VS, Ersoz N, Anık A, Karaman CZ. Is Thyroid Imaging Reporting and Data System Useful as an Adult Ultrasonographic Malignancy Risk Stratification Method ın Pediatric Thyroid Nodules? J Med Ultrasound 2019; 27:141-145. [PMID: 31867177 PMCID: PMC6905278 DOI: 10.4103/jmu.jmu_35_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023] Open
Abstract
Background Data on thyroid imaging reporting and data system (TI-RADS) generally belong to studies performed in adults. Therefore, we aimed to evaluate the performance and utility of TI-RADS in the pediatric group. Materials and Methods From January 2015 to 2018, 108 nodules were evaluated in 1028 thyroid ultrasound examinations. Images were retrospectively evaluated by two radiologists with 3 and 7 years of pediatric radiology experience, according to TI-RADS classification. Morphological findings of the detected nodules and their histopathological results were recorded. Histopathological findings and at least 12 months of follow-up imaging were taken as reference. Results Seventy-one patients were female (67%). The mean age was 11.4 ± 4.7, and the mean nodule size was 7.4 ± 8.3 mm. According to the histopathological assessment and at least 12 months' follow-up with clinical and sonographic stability 100 (95.2%) of the nodules were benign and 5 (4.8%) were malignant. Two nodules, nondiagnostic cytology and 1 nodule were found to be suspicious for malignancy. All malignant nodules were in the TI-RADS 5 category. The majority of benign nodules (79%) were found in low TI-RADS categories. About 80% of the malignant nodules were very hypoechoic and taller than wide in shape, also all malignant nodules had microcalcifications (P = 0.000). The sensitivity of TI-RADS was 100%, specificity was 78.8%, positive predictive value (PPV) was 19.2%, and negative predictive value (NPV) was 100%. Conclusion According to our study, TI-RADS system can be used to evaluate thyroid nodules in pediatric patients similar to adults.
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Affiliation(s)
- Yasemin Durum Polat
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Veli Süha Öztürk
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Nimet Ersoz
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Ahmet Anık
- Department of Pediatric Endocrinology and Diabetes, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Can Zafer Karaman
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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Wang H, Mehrad M, Ely KA, Liang J, Solórzano CC, Neblett WW, Coogan AC, Weiss VL. Incidence and malignancy rates of indeterminate pediatric thyroid nodules. Cancer Cytopathol 2019; 127:231-239. [DOI: 10.1002/cncy.22104] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Huiying Wang
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Mitra Mehrad
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Kim A. Ely
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Jiancong Liang
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Carmen C. Solórzano
- Division of Surgical Oncology and Endocrine Surgery Vanderbilt University Medical Center Nashville Tennessee
| | - Wallace W. Neblett
- Department of Pediatric Surgery Vanderbilt University Medical Center Nashville Tennessee
| | - Alice C. Coogan
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
| | - Vivian L. Weiss
- Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville Tennessee
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32
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Rah CS, Kim WW, Lee YM, Kim WG, Song DE, Chung KW, Kim SC, Hong SJ, Sung TY. Recent Trends in the Clinicopathological Features of Thyroid Nodules in Pediatric Patients: A Single Tertiary Center Experience over 25 Years. Int J Endocrinol 2019; 2019:1829043. [PMID: 31933637 PMCID: PMC6942841 DOI: 10.1155/2019/1829043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/21/2019] [Accepted: 12/06/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The trends in pediatric patients having thyroid nodules have not been well evaluated. Here, we analyzed the clinicopathological features of the children who have presented with thyroid nodules at our center over several decades in order to determine a change of trend. MATERIALS AND METHODS We analyzed 215 pediatric patients who had undergone a thyroidectomy between 1990 and 2014 at our single tertiary center. The clinicopathological features were analyzed according to age, sex, and the year of diagnosis. RESULTS The most common reason for hospital admission was a palpable anterior neck mass (76.7%). The males in the patient cohort were younger than the females (13 vs. 15 years old, p < 0.05). The female patients increased from 50.0% to 83.0% with age (p < 0.05). The rate of malignancy did not increase with age (p < 0.05). However, the malignancy rate was higher in the more recently seen patients (23.8% during the early study period and 86.8% in the late study period; p < 0.05). CONCLUSION Following a thyroidectomy in children with thyroid nodules, there was no change in the rate of detection of thyroid cancer over time with age, although the detected frequency of malignancy has increased in more recent patients. Therefore, early thyroid nodule detection for malignant screening is likely to be required for pediatric patients in the near future.
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Affiliation(s)
- Cheong-Sil Rah
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Won Woong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Yu-mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Seong Chul Kim
- Department of Pediatric Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Li W, Dim D, Paulson L, Rivard D. Diagnosis of intrathyroidal ectopic thymus in thyroid fine needle aspiration samples. J Clin Pathol 2018; 72:145-151. [DOI: 10.1136/jclinpath-2018-205424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/27/2018] [Accepted: 10/09/2018] [Indexed: 11/04/2022]
Abstract
AimsIntrathyroidal ectopic thymus (ITET) is a rare cause of paediatric thyroid nodules. Although ultrasonography of ITET demonstrates a characteristic appearance similar to that of normal thymus, accurate differentiation from other thyroid nodule etiologies by ultrasonography is difficult, and so that fine needle aspiration (FNA) is usually performed for further analysis. The aim of this study was to evaluate the utility of flow cytometry (FCM) in confirming the diagnosis of ITET in thyroid FNA samples.MethodsFive cases of ITET were retrieved from our thyroid FNA database within a 3-year period. Their clinical information, ultrasonographic features, cytology and FCM findings were retrospectively reviewed. The FCM results were compared with those of 22 T-cell acute lymphoblastic leukaemia/lymphoblastic lymphoma (T-ALL/LBL) cases.ResultsThe FNA smears of all five ITET cases demonstrated abundant lymphocytes of variable sizes, which included some immature lymphoid cells. No Hassall’s bodies or atypical epithelioid cells were recognised. By multicolour FCM analysis including antibodies against CD1a, CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD34, TDT and TCR, all ITET cases showed antigen expression patterns consistent with normal thymocyte maturation. All T-ALL/LBL cases exhibited significant immunophenotypic aberrancy.ConclusionsThe diagnosis of ITET based on FNA cytology is often inconclusive. The presence of immature lymphocytes often raises the concern for LBL. FCM with adequate antigen coverage can reliably distinguish ITET from T-ALL/LBL and make the diagnosis of ITET in FNA samples. Avoiding unnecessary further invasive procedures, providing reassurance to clinician and patient, the accurate diagnosis of ITET by FCM in FNA samples is clinically important.
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Dong Y, Mao M, Zhan W, Zhou J, Zhou W, Yao J, Hu Y, Wang Y, Ye T. Size and Ultrasound Features Affecting Results of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1367-1377. [PMID: 29120064 DOI: 10.1002/jum.14472] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 08/12/2017] [Accepted: 08/19/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Our goal was to assess the diagnostic efficacy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules according to size and US features. METHODS A retrospective correlation was made with 1745 whole thyroidectomy and hemithyroidectomy specimens with preoperative US-guided FNA results. All cases were divided into 5 groups according to nodule size (≤5, 5.1-10, 10.1-15, 15.1-20, and >20 mm). For target nodules, static images and cine clips of conventional US and color Doppler were obtained. Ultrasound images were reviewed and evaluated by two radiologists with at least 5 years US working experience without knowing the results of pathology, and then agreement was achieved. RESULTS The Bethesda category I rate was higher in nodules larger than 15 mm (P < .05). The diagnostic accuracy was best in nodules of 5 to 10 mm in diameter. The sensitivity, accuracy, PPV, and LR for negative US-guided FNA results were better in nodules with a size range of 5 to 15 mm. The specificity, negative predictive value (NPV), and LR for positive results and the Youden index rose with increasing nodule size. Seventeen false-positive and 60 false-negative results were found in this study. The false-negative rate rose with increasing nodule size. However, the false-positive rate was highest in the group containing the smallest nodules. Nodules with circumscribed margins and those that were nonsolid and nonhypoechoic and had no microcalcifications correlated with Bethesda I FNA results. Nodules with circumscribed margins and those that were nonsolid, heterogeneous, and nonhypoechoic and had increased vascularity correlated with false-negative FNA results. Borders correlated with Bethesda I false-negative and false-positive FNA results. CONCLUSIONS Tiny nodules (≤5 mm) with obscure borders tended to yield false-positive FNA results. Large nodules (>20 mm) with several US features tended to yield false-negative FNA results.
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Affiliation(s)
- YiJie Dong
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - MinJing Mao
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Departments of Laboratory, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - WeiWei Zhan
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - JianQiao Zhou
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Zhou
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - JieJie Yao
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - YunYun Hu
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yan Wang
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - TingJun Ye
- Departments of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Jang JH, Park SH, Cho KS, Cho WK, Suh YJ, Suh BK, Koh DK. Cancer in thyroid nodules with fine-needle aspiration in Korean pediatric populations. Ann Pediatr Endocrinol Metab 2018; 23:94-98. [PMID: 29969881 PMCID: PMC6057015 DOI: 10.6065/apem.2018.23.2.94] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/15/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To determine the prevalence and clinical findings of benign thyroid nodules and cancer in Korean pediatric patients with thyroid nodules. METHODS We investigated the medical records of 134 patients aged younger than 18 years who had a goiter, thyroid nodule, thyroid mass, or thyroid cancer who underwent fine needle aspiration biopsy (FNAB). RESULTS The study population included 113 females (84.3%) and 21 males (13.7%); the mean patient age was 16.1±2.3 years (range, 8-18 years). Of the 134 patients, 24 (18.0%) were finally diagnosed with thyroid cancer, of which 20 (83.3%) were papillary cancer and 4 (16.7%) were follicular cancer. No patient was exposed to radiation. FNAB revealed malignant cancer in 21 of the patients; 3 were initially reported as having benign tumors by FNAB, but were later diagnosed with follicular cancer. An additional 13 patients were suspected to have malignant tumors by FNAB, with a final diagnosis of nodular hyperplasia. Cystic nodules were more common in the benign group. The percentages of cervical lymphadenopathy and irregular nodular margins were higher in the malignant group compared to the benign group. Cervical lymphadenopathy and FNAB malignant findings were highly suggestive of malignant nodules. CONCLUSION Thyroid cancer prevalence in a Korean pediatric population is comparable to reported estimates of worldwide thyroid cancer prevalence. In this population, cancer predominates on the right thyroid lobe. Papillary thyroid cancers are dominant in the Korean pediatric population but are less prevalent than in Korean adults. As expected, FNAB was highly accurate in predicting malignant nodules.
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Affiliation(s)
- Joon Ho Jang
- Department of Pediatrics, St. Vincent’s Hospital, The Catholic University of Korea, Korea
| | - So Hyun Park
- Central Children’s Hospital, Hwasung, Korea,Address for correspondence: So Hyun Park, MD Central Children’s Hospital, 17 Dongtan-jisung-ro, Hwasung 18454, Korea Tel: +82-31-249-8220 Fax: +82-31-8060-5044 E-mail:
| | - Kyung soon Cho
- Department of Pediatrics, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Won Kyung Cho
- Department of Pediatrics, St. Vincent’s Hospital, The Catholic University of Korea, Korea
| | - Young Jin Suh
- Department of Surgery, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Byung Kyu Suh
- Department of Pediatrics, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Dae Kyun Koh
- Department of Pediatrics, St. Vincent’s Hospital, The Catholic University of Korea, Korea
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Pathak P, Sharma P, Daga A, Sharma S. Cyto-morphologic spectrum of thyroid lesions in children. Diagn Cytopathol 2018; 46:572-577. [DOI: 10.1002/dc.23934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Priya Pathak
- Department of Pathology; University College of Medical Sciences & GTB hospital; Dilshad Garden, Delhi 110095 India
| | - Pooja Sharma
- Department of Pathology; University College of Medical Sciences & GTB hospital; Dilshad Garden, Delhi 110095 India
| | - Aditi Daga
- Department of Pathology; University College of Medical Sciences & GTB hospital; Dilshad Garden, Delhi 110095 India
| | - Sonal Sharma
- Department of Pathology; University College of Medical Sciences & GTB hospital; Dilshad Garden, Delhi 110095 India
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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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Rossi ED, Bizzarro T, Martini M, Capodimonti S, Cenci T, Fadda G, Schmitt F, Larocca LM. Morphological features that can predict BRAF V600E -mutated carcinoma in paediatric thyroid cytology. Cytopathology 2016; 28:55-64. [PMID: 27256275 DOI: 10.1111/cyt.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE BRAFV600E represents the most common diagnostic marker in papillary thyroid carcinoma (PTC). A few papers have demonstrated the correlation between BRAFV600E and specific morphological findings on PTCs in the adult population. This is the first reported series investigating cytological morphological parameters in paediatric thyroid carcinoma. METHODS One hundred and nineteen paediatric samples (56 male and 63 female patients), diagnosed in the period between April 2013 and July 2015, were enrolled in the study. Fifteen patients with inadequate results were excluded. Cytological cases were processed with liquid-based cytology (LBC). BRAFV600E and immunocytochemistry for the VE1 antibody were performed on LBC. RESULTS The diagnostic series included 10 mutated and 94 wild-type (WT) cases. Twenty two percent surgical samples showed 96% cytohistological concordance. The morphological analysis revealed plump cells (abundant eosinophilic cytoplasm and PTC nuclei) in all 10 mutated cases with only four cases showing a focal (less than 20% of the cells) plump component. None of the WT showed plump cells. A sickle nuclear shape was seen only in the mutated cases. VE1 yielded 100% positivity on mutated cases with three cytohistological discrepancies. CONCLUSIONS The BRAFV600E mutation is also seen in paediatric cytology and the morphological features showed a high accuracy as both predictive mutational parameters and a helpful aid in management mainly of the aggressive BRAFV600E mutated carcinomas.
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Affiliation(s)
- E D Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - T Bizzarro
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - M Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - S Capodimonti
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - T Cenci
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - G Fadda
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
| | - F Schmitt
- Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Porto, Portugal.,Laboratorie National de Sante, Dudelange, Luxembourg
| | - L M Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, "Agostino Gemelli" School of Medicine, Rome, Italy
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Ladurner R, Beuschlein F, Hallfeldt K, Angele M, Werner J, Sommerey S. [Thyroid nodules--Indication for surgery?]. MMW Fortschr Med 2016; 158:51-4. [PMID: 27119700 DOI: 10.1007/s15006-016-7820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Roland Ladurner
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- u. Thoraxchirurgie, Klinikum der Univ. München, Campus Innenstadt, Nußbaumstr. 20, D-80336, München, Deutschland.
| | - Felix Beuschlein
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Campus Innenstadt, München, Deutschland
| | - Klaus Hallfeldt
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Campus Großhadern und Campus Innenstadt, München, Deutschland
| | - Martin Angele
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Campus Großhadern und Campus Innenstadt, München, Deutschland
| | - Jens Werner
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Campus Großhadern und Campus Innenstadt, München, Deutschland
| | - Sandra Sommerey
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Klinikum der Universität München, Campus Großhadern und Campus Innenstadt, München, Deutschland
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Solymosi T, Lukacs Toth G, Budai L, Gal I. The Clinical and Pathological Presentation of Thyroid Nodules in Children and the Comparison with Adult Population: Experience of a Single Institution. Int J Endocrinol 2016; 2016:1256189. [PMID: 27087807 PMCID: PMC4818840 DOI: 10.1155/2016/1256189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/18/2016] [Indexed: 12/03/2022] Open
Abstract
The clinical and pathological presentation of thyroid nodules among younger and adult patients was compared in an iodine-deficient (ID) region. Data of 3,010 consecutive patients younger than 20 years and 3,010 patients older than 20 years were compared. The proportion of nodular goiters (22.8% versus 39.3%), the ratio of surgically treated nodules (33.2% versus 15.2%), and the proportion of malignant nodules (4.3% versus 2.1%) among diseased patients differed significantly between the two groups (younger versus adult). Nine papillary and 1 medullary carcinoma were found among children, while 15 papillary, 2 follicular, 1 insular, 1 anaplastic, and 1 medullary carcinomas occurred among adults. The ratio of follicular adenoma to hyperplastic nodules (3 : 1 to 1 : 1.67), the proportion of follicular variant (77.8% versus 26.7%), T4 tumors (77.8% versus 33.3%), and tumors with lymph node metastasis (88.9% versus 66.7%) were significantly higher among younger papillary carcinoma patients. No malignancies occurred among spongiform and central type cysts. Similarly to iodine-sufficient regions, more nodules are malignant and carcinomas have a clinically more aggressive presentation in children in comparison with adult patients in ID. Taking the significantly greater proportion of adenomas and the lack of follicular carcinoma into account, a conservative approach has to be considered in follicular tumors among children.
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Affiliation(s)
- Tamas Solymosi
- Thyroid Outpatient Department, Bugat Hospital, 6 Fenyves Street, Matrafured, Gyongyos 3232, Hungary
- *Tamas Solymosi:
| | - Gyula Lukacs Toth
- Department of Pathology, Bugat Hospital, Dozsa Gyorgy Street, Gyongyos 3200, Hungary
| | - Laszlo Budai
- Department of Surgery, Bugat Hospital, Dozsa Gyorgy Street, Gyongyos 3200, Hungary
| | - Istvan Gal
- Department of Surgery, Robert Karoly Hospital, Lehel Street 59, Budapest 1136, Hungary
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