1
|
Teodoriu L, Ungureanu MC, Matei M, Grierosu I, Saviuc AI, Wael J, Ivanov I, Dragos L, Danila R, Cristian V, Costandache MA, Iftene A, Preda C, Stefanescu C. BRAF Detection in FNAC Combined with Semi-Quantitative 99mTc-MIBI Technique and AI Model, an Economic and Efficient Predicting Tool for Malignancy in Thyroid Nodules. Diagnostics (Basel) 2024; 14:1398. [PMID: 39001288 PMCID: PMC11241294 DOI: 10.3390/diagnostics14131398] [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: 06/07/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Technology allows us to predict a histopathological diagnosis, but the high costs prevent the large-scale use of these possibilities. The current liberal indication for surgery in benign thyroid conditions led to a rising frequency of incidental thyroid carcinoma, especially low-risk papillary micro-carcinomas. METHODS We selected a cohort of 148 patients with thyroid nodules by ultrasound characteristics and investigated them by fine needle aspiration cytology (FNAC)and prospective BRAF collection for 70 patients. Also, we selected 44 patients with thyroid nodules using semi-quantitative functional imaging with an oncological, 99mTc-methoxy-isobutyl-isonitrile (99mTc-MIBI) radiotracer. RESULTS Following a correlation with final histopathological reports in patients who underwent thyroidectomy, we introduced the results in a machine learning program (AI) in order to obtain a pattern. For semi-quantitative functional visual pattern imaging, we found a sensitivity of 33%, a specificity of 66.67%, an accuracy of 60% and a negative predicting value (NPV) of 88.6%. For the wash-out index (WOind), we found a sensitivity of 57.14%, a specificity of 50%, an accuracy of 70% and an NPV of 90.06%.The results of BRAF in FNAC included 87.50% sensitivity, 75.00% specificity, 83.33% accuracy, 75.00% NPV and 87.50% PPV. The prevalence of malignancy in our small cohort was 11.4%. CONCLUSIONS We intend to continue combining preoperative investigations such as molecular detection in FNAC, 99mTc-MIBI scanning and AI training with the obtained results on a larger cohort. The combination of these investigations may generate an efficient and cost-effective diagnostic tool, but confirmation of the results on a larger scale is necessary.
Collapse
Affiliation(s)
- Laura Teodoriu
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Maria-Christina Ungureanu
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Mioara Matei
- Preventive Medicine and Interdisciplinarity Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Irena Grierosu
- Biophysics and Medical Physics-Nuclear Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Alexandra Iuliana Saviuc
- Biophysics and Medical Physics-Nuclear Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Jalloul Wael
- Biophysics and Medical Physics-Nuclear Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Iuliu Ivanov
- Center of Fundamental Research and Experimental Development in Translational Medicine, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Loredana Dragos
- Center of Fundamental Research and Experimental Development in Translational Medicine, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Radu Danila
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Velicescu Cristian
- Department of Surgery, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | | | - Adrian Iftene
- Faculty of Computer Science, "Alexandru Ioan Cuza" University, 700506 Iasi, Romania
| | - Cristina Preda
- Endocrinology Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| | - Cipriana Stefanescu
- Biophysics and Medical Physics-Nuclear Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, 700111 Iasi, Romania
| |
Collapse
|
2
|
Slabaugh G, Beltran L, Rizvi H, Deloukas P, Marouli E. Applications of machine and deep learning to thyroid cytology and histopathology: a review. Front Oncol 2023; 13:958310. [PMID: 38023130 PMCID: PMC10661921 DOI: 10.3389/fonc.2023.958310] [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: 05/31/2022] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
This review synthesises past research into how machine and deep learning can improve the cyto- and histopathology processing pipelines for thyroid cancer diagnosis. The current gold-standard preoperative technique of fine-needle aspiration cytology has high interobserver variability, often returns indeterminate samples and cannot reliably identify some pathologies; histopathology analysis addresses these issues to an extent, but it requires surgical resection of the suspicious lesions so cannot influence preoperative decisions. Motivated by these issues, as well as by the chronic shortage of trained pathologists, much research has been conducted into how artificial intelligence could improve current pipelines and reduce the pressure on clinicians. Many past studies have indicated the significant potential of automated image analysis in classifying thyroid lesions, particularly for those of papillary thyroid carcinoma, but these have generally been retrospective, so questions remain about both the practical efficacy of these automated tools and the realities of integrating them into clinical workflows. Furthermore, the nature of thyroid lesion classification is significantly more nuanced in practice than many current studies have addressed, and this, along with the heterogeneous nature of processing pipelines in different laboratories, means that no solution has proven itself robust enough for clinical adoption. There are, therefore, multiple avenues for future research: examine the practical implementation of these algorithms as pathologist decision-support systems; improve interpretability, which is necessary for developing trust with clinicians and regulators; and investigate multiclassification on diverse multicentre datasets, aiming for methods that demonstrate high performance in a process- and equipment-agnostic manner.
Collapse
Affiliation(s)
- Greg Slabaugh
- Digital Environment Research Institute, Queen Mary University of London, London, United Kingdom
| | - Luis Beltran
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Hasan Rizvi
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Eirini Marouli
- Digital Environment Research Institute, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| |
Collapse
|
3
|
Mohorea I, Socea B, Carâp AC, Șerban D, Ceaușu Z, Ceauşu M. Morphometric study in thyroid tumors. Exp Ther Med 2023; 26:497. [PMID: 37745041 PMCID: PMC10515107 DOI: 10.3892/etm.2023.12196] [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: 12/06/2022] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Various morphonuclear studies using digital image analysis have been taken into account in order to establish the malignancy of thyroid lesions based on their size and on the chromatographic characteristics of tumor cell nuclei. Nuclear morphometry involves the measurement of nuclear parameters to obtain diagnostically important information in an objective and reproducible manner. The aim of the present study was to evaluate the detailed morphometric analysis of histopathological preparations with lesions of the thyroid gland and to investigate its role in differentiating between benign and malignant thyroid lesions. The present study included 10 benign and 26 malignant thyroid cases with different selected thyroid lesions. Using a microscope connected to a computerized video system, nuclear morphometric parameters including the nuclear area, perimeter, average intensity, red average, width and roundness, were measured and analyzed. The main parameters used in the statistical calculation were significant in distinguishing between benign and malignant thyroid lesions. The association of morphometry in cytological smears for suspected malignant follicular lesions led to increased accuracy in establishing a suspicious malignant diagnosis for follicular lesions. Nuclear morphometry provides an unbiased point of view that increases diagnosis accuracy. Computerized morphometry can positively influence diagnostic accuracy, allowing for a better correlation with clinical and imaging data.
Collapse
Affiliation(s)
- Iuliana Mohorea
- Department of Pathology, Brăila Emergency County Hospital, Brăila 810325, Romania
| | - Bogdan Socea
- Department of Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | | | - Dragoş Șerban
- Department of Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| | - Zenaida Ceaușu
- Department of Pathology, Saint Pantelimon Emergency Clinical Hospital Bucharest, Bucharest 021659, Romania
| | - Mihail Ceauşu
- Department of Histopathology, Alexandru Trestioreanu National Institute of Oncology, Bucharest 022328, Romania
- Department of Histopathology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 020021, Romania
| |
Collapse
|
4
|
Fumagalli C, Serio G. Molecular testing in indeterminate thyroid nodules: an additional tool for clinical decision-making. Pathologica 2023; 115:205-216. [PMID: 37711036 PMCID: PMC10688247 DOI: 10.32074/1591-951x-887] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 09/16/2023] Open
Abstract
Thyroid nodules are commonly encountered in clinical practice, affecting up to 50% of the population. The large majority of thyroid lumps are benign incidental findings detected by imaging, while approximately 5-15% harbor malignancy. For a target patient's care, it is of paramount importance to identify and treat thyroid malignancy, while preventing unnecessary invasive surgery in patients with benign lesions. Although fine needle aspiration (FNA) associated with cytological examination provides malignant risk information, 20-30% of diagnoses fall into the "indeterminate thyroid nodule" (ITN) category. ITN clinical management remains a challenging issue for physicians since the ITN risk of malignancy varies from 5% to 40% and most thyroid nodules undergo overtreatment with surgery procedures. ITN molecular testing may better define malignant risk in the single nodule and is able to discriminate with accuracy benign from malignant nodules. Nowadays there are different technologies and different molecular panels, each with its own specificity, sensitivity and predictive values. In view of widespread introduction of molecular testing , some outstanding questions remain and are addressed in the present review such as the presence of molecular panels acting as "rule in" or "rule out" tools, the effective impact of testing results in the clinical decision-making process, and the prohibitive cost of commercial assays associated with the lack of test reimbursement in national health systems.
Collapse
|
5
|
Bayraktaroğlu T, Barut F, Çakmak GK. Editorial: Subclassification of AUS/FLUS category for thyroid nodules: trials and evidence-based clinical management. Front Endocrinol (Lausanne) 2023; 14:1209776. [PMID: 37383392 PMCID: PMC10298178 DOI: 10.3389/fendo.2023.1209776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Taner Bayraktaroğlu
- Divison of Endocrinology and Metabolism, Department of Internal Medicine, Zonguldak, Türkiye
| | - Figen Barut
- Department of Pathology, Faculty of Medicine, Zonguldak, Türkiye
| | - Güldeniz Karadeniz Çakmak
- Department of General Surgery, Faculty of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Türkiye
| |
Collapse
|
6
|
Bernal-Tirapo J, Bayo Jiménez MT, Yuste-García P, Cordova I, Peñas A, García-Borda FJ, Quintela C, Prieto I, Sánchez-Ramos C, Ferrero-Herrero E, Monsalve M. Evaluation of Mitochondrial Function in Blood Samples Shows Distinct Patterns in Subjects with Thyroid Carcinoma from Those with Hyperplasia. Int J Mol Sci 2023; 24:ijms24076453. [PMID: 37047426 PMCID: PMC10094811 DOI: 10.3390/ijms24076453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/21/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023] Open
Abstract
Metabolic adaptations are a hallmark of cancer and may be exploited to develop novel diagnostic and therapeutic tools. Only about 50% of the patients who undergo thyroidectomy due to suspicion of thyroid cancer actually have the disease, highlighting the diagnostic limitations of current tools. We explored the possibility of using non-invasive blood tests to accurately diagnose thyroid cancer. We analyzed blood and thyroid tissue samples from two independent cohorts of patients undergoing thyroidectomy at the Hospital Universitario 12 de Octubre (Madrid, Spain). As expected, histological comparisons of thyroid cancer and hyperplasia revealed higher proliferation and apoptotic rates and enhanced vascular alterations in the former. Notably, they also revealed increased levels of membrane-bound phosphorylated AKT, suggestive of enhanced glycolysis, and alterations in mitochondrial sub-cellular distribution. Both characteristics are common metabolic adaptations in primary tumors. These data together with reduced mtDNA copy number and elevated levels of the mitochondrial antioxidant PRX3 in cancer tissue samples suggest the presence of mitochondrial oxidative stress. In plasma, cancer patients showed higher levels of cfDNA and mtDNA. Of note, mtDNA plasma levels inversely correlated with those in the tissue, suggesting that higher death rates were linked to lower mtDNA copy number. In PBMCs, cancer patients showed higher levels of PGC-1α, a positive regulator of mitochondrial function, but this increase was not associated with a corresponding induction of its target genes, suggesting a reduced activity in cancer patients. We also observed a significant difference in the PRDX3/PFKFB3 correlation at the gene expression level, between carcinoma and hyperplasia patients, also indicative of increased systemic metabolic stress in cancer patients. The correlation of mtDNA levels in tissue and PBMCs further stressed the interconnection between systemic and tumor metabolism. Evaluation of the mitochondrial gene ND1 in plasma, PBMCs and tissue samples, suggested that it could be a good biomarker for systemic oxidative metabolism, with ND1/mtDNA ratio positively correlating in PBMCs and tissue samples. In contrast, ND4 evaluation would be informative of tumor development, with ND4/mtDNA ratio specifically altered in the tumor context. Taken together, our data suggest that metabolic dysregulation in thyroid cancer can be monitored accurately in blood samples and might be exploited for the accurate discrimination of cancer from hyperplasia.
Collapse
|
7
|
Chu YH, Sadow PM. Kinase Fusion-Related Thyroid Carcinomas: Towards Predictive Models for Advanced Actionable Diagnostics. Endocr Pathol 2022; 33:421-435. [PMID: 36308634 PMCID: PMC10283356 DOI: 10.1007/s12022-022-09739-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 01/11/2023]
Abstract
The past decade has brought significant advances in our understanding of the molecular mechanisms of thyroid carcinogenesis. Among thyroid carcinomas, the most successful class of targeted therapeutics appears to be selective kinase inhibitors. Actionable kinase fusions arise in around 10-15% of cases of thyroid cancer, a significant subset. A cohort of molecular testing platforms, both commercial and laboratory-derived, has been introduced into clinical practice to identify patients with targetable tumors, requiring pathologists to develop an integrative approach that utilizes traditional diagnostic cytopathology and histopathology, immunohistochemistry, and cutting-edge molecular assays for optimal diagnostic, prognostic, and therapeutic efficiency. Furthermore, there has been increasing scrutiny of the clinical behavior of kinase fusion-driven thyroid carcinoma (KFTC), still regarded as papillary thyroid carcinomas, and in characterizing molecular predictors of kinase inhibitor resistance with an aim to establish standardized, evidence-based treatment regimens. This review presents an overview of the current literature on the clinicopathologic and molecular features of KFTC as well as the latest investigational progress and encountered challenges for this unique subset of thyroid neoplasias.
Collapse
Affiliation(s)
- Ying-Hsia Chu
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Peter M Sadow
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Pathology Service, WRN 219, 55 Fruit Street, MA, 02114, Boston, USA.
| |
Collapse
|
8
|
Davidoff AJ, Akif K, Halpern MT. Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature. J Natl Cancer Inst Monogr 2022; 2022:12-20. [PMID: 35788372 DOI: 10.1093/jncimonographs/lgac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/21/2022] [Indexed: 01/16/2023] Open
Abstract
We reviewed current literature reviews regarding economics of cancer-related health care to identify focus areas and gaps. We searched PubMed for systematic and other reviews with the Medical Subject Headings "neoplasms" and "economics" published between January 1, 2010, and April 1, 2020, identifying 164 reviews. Review characteristics were abstracted and described. The majority (70.7%) of reviews focused on cost-effectiveness or cost-utility analyses. Few reviews addressed other types of cancer health economic studies. More than two-thirds of the reviews examined cancer treatments, followed by screening (15.9%) and survivorship or end-of-life (13.4%). The plurality of reviews (28.7%) cut across cancer site, followed by breast (20.7%), colorectal (11.6%), and gynecologic (8.5%) cancers. Specific topics addressed cancer screening modalities, novel therapies, pain management, or exercise interventions during survivorship. The results indicate that reviews do not regularly cover other phases of care or topics including financial hardship, policy, and measurement and methods.
Collapse
Affiliation(s)
- Amy J Davidoff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Kaitlin Akif
- Office of the Associate Director, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Michael T Halpern
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| |
Collapse
|
9
|
Personalized Diagnosis in Differentiated Thyroid Cancers by Molecular and Functional Imaging Biomarkers: Present and Future. Diagnostics (Basel) 2022; 12:diagnostics12040944. [PMID: 35453992 PMCID: PMC9030409 DOI: 10.3390/diagnostics12040944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
Abstract
Personalized diagnosis can save unnecessary thyroid surgeries, in cases of indeterminate thyroid nodules, when clinicians tend to aggressively treat all these patients. Personalized diagnosis benefits from a combination of imagery and molecular biomarkers, as well as artificial intelligence algorithms, which are used more and more in our timeline. Functional imaging diagnosis such as SPECT, PET, or fused images (SPECT/CT, PET/CT, PET/MRI), is exploited at maximum in thyroid nodules, with a long history in the past and a bright future with many suitable radiotracers that could properly contribute to diagnosing malignancy in thyroid nodules. In this way, patients will be spared surgery complications, and apparently more expensive diagnostic workouts will financially compensate each patient and also the healthcare system. In this review we will summarize essential available diagnostic tools for malignant and benignant thyroid nodules, beginning with functional imaging, molecular analysis, and combinations of these two and other future strategies, including AI or NIS targeted gene therapy for thyroid carcinoma diagnosis and treatment as well.
Collapse
|
10
|
Yao K, Jing X, Cheng J, Balis UGJ, Pantanowitz L, Lew M. A Study of Thyroid Fine Needle Aspiration of Follicular Adenoma in the "Atypia of Undetermined Significance" Bethesda Category Using Digital Image Analysis. J Pathol Inform 2022; 13:100004. [PMID: 35242444 PMCID: PMC8864759 DOI: 10.1016/j.jpi.2022.100004] [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: 04/20/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background Originally designed for computerized image analysis, ThinPrep is underutilized in that role outside gynecological cytology. It can be used to address the inter/intra-observer variability in the evaluation of thyroid fine needle aspiration (TFNA) biopsy and help pathologists to gain additional insight into thyroid cytomorphology. Methods We designed and validated a feature engineering and supervised machine learning-based digital image analysis method using ImageJ and Python scikit-learn . The method was trained and validated from 400 low power (100x) and 400 high power (400x) images generated from 40 TFNA cases. Result The area under the curve (AUC) for receiver operating characteristics (ROC) is 0.75 (0.74–0.82) for model based from low-power images and 0.74 (0.69–0.79) for the model based from high-power images. Cytomorphologic features were synthesized using feature engineering and when performed in isolation, they achieved AUC of 0.71 (0.64–0.77) for chromatin, 0.70 (0.64–0.73) for cellularity, 0.65 (0.60–0.69) for cytoarchitecture, 0.57 (0.51–0.61) for nuclear size, and 0.63 (0.57–0.68) for nuclear shape. Conclusion Our study proves that ThinPrep is an excellent preparation method for digital image analysis of thyroid cytomorphology. It can be used to quantitatively harvest morphologic information for diagnostic purpose.
Collapse
Affiliation(s)
- Keluo Yao
- City of Hope National Medical Center, Department of Pathology, Bellaire, Texas, USA
| | - Xin Jing
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Jerome Cheng
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Ulysses G J Balis
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Liron Pantanowitz
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| | - Madelyn Lew
- Michigan Medicine, University of Michigan, Department of Pathology, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Jermain PR, Fischer AH, Joseph L, Muzikansky A, Yaroslavsky AN. Fluorescence Polarization Imaging of Methylene Blue Facilitates Quantitative Detection of Thyroid Cancer in Single Cells. Cancers (Basel) 2022; 14:cancers14051339. [PMID: 35267647 PMCID: PMC8908998 DOI: 10.3390/cancers14051339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Accurate diagnosis of thyroid fine-needle aspiration cytology is a significant clinical challenge. A method to detect thyroid cancer at the cellular level would be invaluable to reduce diagnostic uncertainty and improve clinical decision making. We studied the ability of confocal fluorescence polarization imaging of an exogenous fluorophore, methylene blue, to provide quantitative discrimination of cancerous cells in human samples. Our results indicate that fluorescence polarization imaging provides a reliable biomarker of thyroid cancer and holds the potential to shift the paradigm of cellular level cancer diagnosis from subjective visual assessment to objective measurement. Abstract Background: Diagnostic accuracy of the standard of care fine-needle aspiration cytology (FNAC) remains a significant problem in thyroid oncology. Therefore, a robust and accurate method for reducing uncertainty of cytopathological evaluation would be invaluable. Methods: In this double-blind study, we employed fluorescence emission and quantitative fluorescence polarization (Fpol) confocal imaging for sorting thyroid cells into benign/malignant categories. Samples were collected from malignant tumors, benign nodules, and normal thyroid epithelial tissues. Results: A total of 32 samples, including 12 from cytologically indeterminate categories, were stained using aqueous methylene blue (MB) solution, imaged, and analyzed. Fluorescence emission images yielded diagnostically relevant information on cytomorphology. Significantly higher MB Fpol was measured in thyroid cancer as compared to benign and normal cells. The results obtained from 12 indeterminate samples revealed that MB Fpol accurately differentiated benign and malignant thyroid nodules. Conclusions: The developed imaging approach holds the potential to provide an accurate and objective biomarker for thyroid cancer, improve diagnostic accuracy of cytopathology, and decrease the number of lobectomy and near-total thyroidectomy procedures.
Collapse
Affiliation(s)
- Peter R. Jermain
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA;
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Andrew H. Fischer
- Department of Pathology, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Lija Joseph
- Department of Pathology and Laboratory Medicine, Lowell General Hospital, Lowell, MA 01854, USA;
| | - Alona Muzikansky
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA;
| | - Anna N. Yaroslavsky
- Advanced Biophotonics Laboratory, University of Massachusetts Lowell, Lowell, MA 01854, USA;
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- Correspondence: ; Tel.: +1-978-934-3766
| |
Collapse
|
12
|
Chen H, Song A, Wang Y, He Y, Tong J, Di J, Li C, Zhou Z, Cai X, Zhong D, Da J. BRAF V600E mutation test on fine-needle aspiration specimens of thyroid nodules: Clinical correlations for 4600 patients. Cancer Med 2021; 11:40-49. [PMID: 34851044 PMCID: PMC8704181 DOI: 10.1002/cam4.4419] [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] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/08/2021] [Accepted: 10/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background The BRAFV600E mutation is valuable for the diagnosis, prognosis, and therapy of papillary thyroid cancer (PTC). However, studies related to this mutation have involved only a small number of patients. Therefore, we performed a large‐scale analysis from a single institute to evaluate the accuracy of combined fine‐needle aspiration (FNA) and BRAFV600E mutation tests for PTC diagnosis. Methods A total of 4600 patients with thyroid nodules who underwent both FNA cytology and BRAFV600E mutation analysis on FNA specimens were enrolled. The association between the BRAFV600E mutation and clinicopathological features was analyzed. A separate analysis was performed for the 311 patients who underwent repeated FNA for comparison of cytological evaluation and BRAFV600E mutation results. The diagnostic efficacy of the BRAFV600E mutation test and cytologic diagnoses was evaluated for 516 patients who underwent preoperative FNA tests in comparison with conclusive postoperative histopathologic results. Results The cytology results of all 4600 FNA samples were categorized according to The Bethesda System for Reporting Thyroid Cytology (TBSRTC) stages I–VI, which accounted for 11.76%, 60.02%, 6.46%, 3.61%, 6.71%, and 11.43% of the samples, respectively. The BRAFV600E mutation was detected in 762 (16.57%) FNA samples, with rates of 1.48%, 0.87%, 20.20%, 3.01%, 66.02%, and 87.81% for TBSRTC I–VI lesions, respectively. Among the 311 repeat FNA cases, 81.0% of the BRAFV600E‐positive and 4.3% of the BRAFV600E‐negative specimens with an initial indication of cytological non‐malignancy were ultimately diagnosed as malignant by repeat FNA (p < 0.001). Among the 516 patients who underwent thyroidectomy, the sensitivity and specificity of the BRAFV600E mutation test alone for PTC diagnosis were 76.71% and 100.0%, respectively, which increased to 96.62% and 88.03%, respectively, when combining the BRAFV600E mutation test with cytology. BRAFV600E mutation was significantly associated with lymph node metastasis (p < 0.001), but not with age, gender, or tumor size. Conclusions The BRAFV600E mutation test in FNA samples has potential to reduce false negatives in PTC diagnosis, and therefore plays an important role in the diagnosis of thyroid nodules, especially those with an indeterminate or nondiagnostic cytology, which should be considered for repeat FNA.
Collapse
Affiliation(s)
- Huang Chen
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Aiping Song
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Ye Wang
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Yifan He
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Jie Tong
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Jinxi Di
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Chun Li
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Zhongren Zhou
- Department of Endocrinology, The China-Japan Friendship Hospital, Beijing, China
| | - Xiaopin Cai
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Dingrong Zhong
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China
| | - Jiping Da
- Department of Pathology, The China-Japan Friendship Hospital, Beijing, China.,Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hosptial, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| |
Collapse
|
13
|
TIRADS, SRE and SWE in INDETERMINATE thyroid nodule characterization: Which has better diagnostic performance? Radiol Med 2021; 126:1189-1200. [PMID: 34129178 PMCID: PMC8370962 DOI: 10.1007/s11547-021-01349-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/20/2021] [Indexed: 12/16/2022]
Abstract
Purpose To assess Strain Ratio (SRE) and Shear Wave Elastography (SWE) accuracy alone and with TIRADS classification, for the risk stratification of indeterminate thyroid nodules. Materials and methods 128 Patients with 128 indeterminate nodules candidates for thyroidectomy underwent preoperative staging neck ultrasound and were classified according to K-TIRADS score. After TIRADS evaluation, semi-quantitative (SRE) and quantitative (SWE expressed in kPa) elastosonography were performed and relative diagnostic performances, alone and in combination, were compared through ROC curves analysis. In order to maximize the SRE and SWE sensitivity and specificity, their cut-off values were calculated using the Liu test. Bonferroni test was used to evaluate statistically significant differences with a p value < 0.05. Results Sensitivity, specificity, PPV and NPV were, respectively, 71.4%, 82.4%, 62.5%, 87.5% for K-TIRADS baseline US, 85.7%, 94.1%, 85.7%, 94.1% for SRE and 57.1%, 79.4%, 53.3%, 81.8% for SWE (kPa expressed). SRE evaluation showed the best diagnostic accuracy compared to the SWE (kPa expressed) (p < 0.05) and to the K-TIRADS (p > 0.05). The association of SRE with conventional ultrasound with K-TIRADS score increased sensitivity (92.9% vs 71.4%) but decreased the specificity than conventional US alone (76.5% vs 82.4%). Conclusion Strain Elastosonography can be associated with K-TIRADS US examination in the thyroid nodule characterization with indeterminate cytology; in fact, adding the SRE to K-TIRADS assessment significantly increases its sensitivity and negative predictive value. However, further multicenter studies on larger population are warranted.
Collapse
|
14
|
Van Den Heede K, Tolley NS, Di Marco AN, Palazzo FF. Differentiated Thyroid Cancer: A Health Economic Review. Cancers (Basel) 2021; 13:cancers13092253. [PMID: 34067214 PMCID: PMC8125846 DOI: 10.3390/cancers13092253] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary This review reflects on health economic considerations associated with the increasing diagnosis and treatment of differentiated thyroid cancer. Analysis of different relevant health economic topics, such as overdiagnosis, overtreatment, surgical costs, and costs of follow-up are being addressed. Several unanswered research questions such as optimising molecular markers for diagnosis, active surveillance of primary tumours, and improved risk stratification and survivorship care all influence future healthcare expenditures. Abstract The incidence of differentiated thyroid cancer (DTC) is rising, mainly because of an increased detection of asymptomatic thyroid nodularity revealed by the liberal use of thyroid ultrasound. This review aims to reflect on the health economic considerations associated with the increasing diagnosis and treatment of DTC. Overdiagnosis and the resulting overtreatment have led to more surgical procedures, increasing health care and patients’ costs, and a large pool of community-dwelling thyroid cancer follow-up patients. Additionally, the cost of thyroid surgery seems to increase year on year even when inflation is taken into account. The increased healthcare costs and spending have placed significant pressure to identify potential factors associated with these increased costs. Some truly ground-breaking work in health economics has been undertaken, but more cost-effectiveness studies and micro-cost analyses are required to evaluate expenses and guide future solutions.
Collapse
Affiliation(s)
- Klaas Van Den Heede
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of General and Endocrine Surgery, OLV Hospital, 9300 Aalst, Belgium
- Correspondence:
| | - Neil S. Tolley
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
| | - Aimee N. Di Marco
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
| | - Fausto F. Palazzo
- Department of Endocrine & Thyroid Surgery, Hammersmith Hospital, London W12 0HS, UK; (N.S.T.); (A.N.D.M.); (F.F.P.)
- Department of Surgery and Cancer, Imperial College, London SW7 2AZ, UK
| |
Collapse
|
15
|
Konnikova MR, Cherkasova OP, Nazarov MM, Vrazhnov DA, Kistenev YV, Titov SE, Kopeikina EV, Shevchenko SP, Shkurinov AP. Malignant and benign thyroid nodule differentiation through the analysis of blood plasma with terahertz spectroscopy. BIOMEDICAL OPTICS EXPRESS 2021; 12:1020-1035. [PMID: 33680557 PMCID: PMC7901318 DOI: 10.1364/boe.412715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 05/04/2023]
Abstract
The liquid and lyophilized blood plasma of patients with benign or malignant thyroid nodules and healthy individuals were studied by terahertz (THz) time-domain spectroscopy and machine learning. The blood plasma samples from malignant nodule patients were shown to have higher absorption. The glucose concentration and miRNA-146b level were correlated with the sample's absorption at 1 THz. A two-stage ensemble algorithm was proposed for the THz spectra analysis. The first stage was based on the Support Vector Machine with a linear kernel to separate healthy and thyroid nodule participants. The second stage included additional data preprocessing by Ornstein-Uhlenbeck kernel Principal Component Analysis to separate benign and malignant thyroid nodule participants. Thus, the distinction of malignant and benign thyroid nodule patients through their lyophilized blood plasma analysis by terahertz time-domain spectroscopy and machine learning was demonstrated.
Collapse
Affiliation(s)
- Maria R. Konnikova
- Institute for Problems of Laser and Information Technologies of the Russian Academy of Sciences, Branch of Federal Scientific Research Center, “Crystallography and Photonics” of the RAS, Shatura 140700, Russia
- Faculty of Physics, Lomonosov Moscow State University, 119991, Moscow, Russia
| | - Olga P. Cherkasova
- Institute for Problems of Laser and Information Technologies of the Russian Academy of Sciences, Branch of Federal Scientific Research Center, “Crystallography and Photonics” of the RAS, Shatura 140700, Russia
- Institute of Laser Physics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
| | - Maxim M. Nazarov
- National Research Centre Kurchatov Institute, Moscow, 123182, Russia
| | - Denis A. Vrazhnov
- Institute of Strength Physics and Materials Science of the Siberian Branch of the Russian Academy of Sciences, Tomsk, 634055, Russia
| | - Yuri V. Kistenev
- Tomsk State University, Tomsk, 634050, Russia
- Siberian State Medical University, Tomsk, 634050, Russia
| | - Sergei E. Titov
- Institute of Molecular and Cellular Biology of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, 630090, Russia
- Novosibirsk State University, Novosibirsk, 630090, Russia
| | | | | | - Alexander P. Shkurinov
- Institute for Problems of Laser and Information Technologies of the Russian Academy of Sciences, Branch of Federal Scientific Research Center, “Crystallography and Photonics” of the RAS, Shatura 140700, Russia
- Faculty of Physics, Lomonosov Moscow State University, 119991, Moscow, Russia
| |
Collapse
|
16
|
Yoon J, Lee E, Kang SW, Han K, Park VY, Kwak JY. Implications of US radiomics signature for predicting malignancy in thyroid nodules with indeterminate cytology. Eur Radiol 2021; 31:5059-5067. [PMID: 33459858 DOI: 10.1007/s00330-020-07670-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/16/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the role of the radiomics score using US images to predict malignancy in AUS/FLUS and FN/SFN nodules. METHODS One hundred fifty-five indeterminate thyroid nodules in 154 patients who received initial US-guided FNA for diagnostic purposes were included in this retrospective study. A representative US image of each tumor was acquired, and square ROIs covering the whole nodule were drawn using the Paint program of Windows 7. Texture features were extracted by in-house texture analysis algorithms implemented in MATLAB 2019b. The LASSO logistic regression model was used to choose the most useful predictive features, and ten-fold cross-validation was performed. Two prediction models were constructed using multivariable logistic regression analysis: one based on clinical variables, and the other based on clinical variables with the radiomics score. Predictability of the two models was assessed with the AUC of the ROC curves. RESULTS Clinical characteristics did not significantly differ between malignant and benign nodules, except for mean nodule size. Among 730 candidate texture features generated from a single US image, 15 features were selected. Radiomics signatures were constructed with a radiomics score, using selected features. In multivariable logistic regression analysis, higher radiomics score was associated with malignancy (OR = 10.923; p < 0.001). The AUC of the malignancy prediction model composed of clinical variables with the radiomics score was significantly higher than the model composed of clinical variables alone (0.839 vs 0.583). CONCLUSIONS Quantitative US radiomics features can help predict malignancy in thyroid nodules with indeterminate cytology.
Collapse
Affiliation(s)
- Jiyoung Yoon
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunjung Lee
- Department of Computational Science and Engineering, Yonsei University, Seoul, South Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University, College of Medicine, Seoul, South Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Vivian Youngjean Park
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Kwak
- Department of Radiology, Research Institute of Radiological Science, and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea.
| |
Collapse
|
17
|
Daniels K, Gummadi S, Zhu Z, Wang S, Patel J, Swendseid B, Lyshchik A, Curry J, Cottrill E, Eisenbrey J. Machine Learning by Ultrasonography for Genetic Risk Stratification of Thyroid Nodules. JAMA Otolaryngol Head Neck Surg 2021; 146:36-41. [PMID: 31647509 DOI: 10.1001/jamaoto.2019.3073] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Thyroid nodules are common incidental findings. Ultrasonography and molecular testing can be used to assess risk of malignant neoplasm. Objective To examine whether a model developed through automated machine learning can stratify thyroid nodules as high or low genetic risk by ultrasonography imaging alone compared with stratification by molecular testing for high- and low-risk mutations. Design, Setting, and Participants This diagnostic study was conducted at a single tertiary care urban academic institution and included patients (n = 121) who underwent ultrasonography and molecular testing for thyroid nodules from January 1, 2017, through August 1, 2018. Nodules were classified as high risk or low risk on the basis of results of an institutional molecular testing panel for thyroid risk genes. All thyroid nodules that underwent genetic sequencing for cytological results with Bethesda System categories III and IV were reviewed. Patients without diagnostic ultrasonographic images within 6 months of fine-needle aspiration or who received definitive treatment at an outside medical center were excluded. Main Outcomes and Measures Thyroid nodules were categorized by the model as high risk or low risk using ultrasonographic images. Results were compared using genetic testing. Results Among the 134 lesions identified in 121 patients (mean [SD] age, 55.7 [14.2] years; 102 women [84.3%]), 683 diagnostic ultrasonographic images were selected. Of the 683 images, 556 (81.4%) were used for training the model, 74 (10.8%) for validation, and 53 (7.8%) for testing. Most nodules had no mutation (75 [56.0%]), whereas 43 nodules (32.1%) had a high-risk mutation and 16 (11.9%) had an unknown or a low-risk mutation (χ2 = 39.060; P < .001). In total, 228 images (33.4%) were of nodules classified as genetically high risk (n = 43), and 455 (66.6%) were of low-risk nodules (n = 91). The model performed with a sensitivity of 45% (95% CI, 23.1%-68.5%), a specificity of 97% (95% CI, 84.2%-99.9%), a positive predictive value of 90% (95% CI, 55.2%-98.5%), a negative predictive value of 74.4% (95% CI, 66.1%-81.3%), and an overall accuracy of 77.4% (95% CI, 63.8%-97.7%). Conclusions and Relevance The study found that the model developed through automated machine learning could produce high specificity for identifying nodules with high-risk mutations on molecular testing. This finding shows promise for the diagnostic applications of machine learning interpretation of sonographic imaging of indeterminate thyroid nodules.
Collapse
Affiliation(s)
- Kelly Daniels
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sriharsha Gummadi
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania.,Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Ziyin Zhu
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shuo Wang
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jena Patel
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Brian Swendseid
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elizabeth Cottrill
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
18
|
Sodo A, Verri M, Palermo A, Naciu AM, Sponziello M, Durante C, Di Gioacchino M, Paolucci A, di Masi A, Longo F, Crucitti P, Taffon C, Ricci MA, Crescenzi A. Raman Spectroscopy Discloses Altered Molecular Profile in Thyroid Adenomas. Diagnostics (Basel) 2020; 11:diagnostics11010043. [PMID: 33383892 PMCID: PMC7823803 DOI: 10.3390/diagnostics11010043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/13/2022] Open
Abstract
Follicular patterned nodules are sometimes complex to be classified due to ambiguous nuclear features and/or questionable capsular or vascular invasion. In this setting, there is a poor inter-observer concordance even among expert pathologists. Raman spectroscopy was recently used to separate benign and malignant thyroid nodules based on their molecular fingerprint; anyway, some histologically proved follicular adenomas were clustered as having a characteristic profile of malignant lesions. In this study, we analyzed five follicular thyroid adenomas with a malignant spectroscopic profile compared to five follicular adenomas with a benign Raman spectrum in order to assess possible molecular differences between the two groups. Morphological, immunohistochemical, and molecular analyses evidenced expression of malignancy-associated proteins in four out of five malignant clustered adenomas. The remaining malignant clustered adenoma showed a TSHR mutation previously associated with autonomously functioning follicular carcinomas. In conclusion, thyroid follicular adenomas are a group of morphologically benign neoplasms that may have altered the mutational or expression profile; cases of adenomas with altered immunophenotype are recognized as showing a profile associated with malignancy by Raman spectroscopy. This correlation warrants a more extensive evaluation and suggests a potential predictive value of spectroscopic assessment in recognizing characteristics associated with tumor progression in follicular thyroid neoplasms.
Collapse
Affiliation(s)
- Armida Sodo
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Martina Verri
- Pathology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.V.); (C.T.)
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy; (A.P.); (A.M.N.)
| | - Anda Mihaela Naciu
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy; (A.P.); (A.M.N.)
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (M.S.); (C.D.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (M.S.); (C.D.)
| | - Michael Di Gioacchino
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Alessio Paolucci
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Alessandra di Masi
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Filippo Longo
- Unit of Thoracic Surgery, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (F.L.); (P.C.)
| | - Pierfilippo Crucitti
- Unit of Thoracic Surgery, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (F.L.); (P.C.)
| | - Chiara Taffon
- Pathology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.V.); (C.T.)
| | - Maria Antonietta Ricci
- Department of Sciences, University Roma Tre, 00146 Rome, Italy; (A.S.); (M.D.G.); (A.P.); (A.d.M.); (M.A.R.)
| | - Anna Crescenzi
- Pathology Unit, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.V.); (C.T.)
- Correspondence: ; Tel.: +39-06-225411106
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Thyroid cancer is the most common endocrine cancer in adults with rising incidence. Challenges in imaging thyroid cancer are twofold: distinguishing thyroid cancer from benign thyroid nodules, which occur in 50% of the population over 50 years; and correct staging of thyroid cancer to facilitate appropriate radical surgery in a single session. The clinical management of thyroid cancer patients has been covered in detail by the 2015 guidelines of the American Thyroid Association (ATA). The purpose of this review is to state the principles underlying optimal multimodal imaging of thyroid cancer and aid clinicians in avoiding important pitfalls. RECENT FINDINGS Recent additions to the literature include assessment of ultrasound-based scoring systems to improve selection of nodules for fine needle biopsy (FNB) and the evaluation of new radioactive tracers for imaging thyroid cancer. SUMMARY The mainstay of diagnosing thyroid cancer is thyroid ultrasound with ultrasound-guided FNB. Contrast-enhanced computed tomography and PET with [F]-fluorodeoxyglucose (FDG) and MRI are reserved for advanced and/or recurrent cases of differentiated thyroid cancer and anaplastic thyroid cancer, while [F]FDOPA and [Ga]DOTATOC are the preferred tracers for medullary thyroid cancer.
Collapse
Affiliation(s)
- Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital
- Department of Clinical Science, University of Bergen
| | - Martin Biermann
- Nuclear Medicine/PET-center, Department of Radiology, Haukeland University Hospital
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
20
|
Vielh P, Balogh Z, Suciu V, Richon C, Job B, Meurice G, Valent A, Lacroix L, Marty V, Motte N, Dessen P, Caillou B, Ghuzlan AA, Bidart JM, Lazar V, Hofman P, Scoazec JY, El-Naggar AK, Schlumberger M. DNA FISH Diagnostic Assay on Cytological Samples of Thyroid Follicular Neoplasms. Cancers (Basel) 2020; 12:cancers12092529. [PMID: 32899953 PMCID: PMC7564487 DOI: 10.3390/cancers12092529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Cytopathology cannot distinguish benign from malignant follicular lesions in 20–30% of cases. These indeterminate cases includes the so-called follicular neoplasms (FNs) according to The Bethesda System for Reporting Thyroid Cytopathology. Frozen samples from 66 classic follicular adenomas (cFAs) and carcinomas (cFTCs) studied by array-comparative genomic hybridization identified three specific alterations of cFTCs (losses of 1p36.33-35.1 and 22q13.2-13.31, and gain of whole chromosome X) confirmed by fluorescent in situ hybridization (FISH) in a second independent series of 60 touch preparations from frozen samples of cFAs and cFTCs. In a third independent set of 27 cases of already stained pre-operative fine-needle aspiration cytology samples diagnosed as FNs and histologically verified, FISH analysis using these three markers identified half of cFTCs. Specificity of our assay for identifying cFTCs is higher than 98% which might be comparable with BRAF600E testing in cases of suspicion of classic papillary thyroid carcinomas. Abstract Although fine-needle aspiration cytology (FNAC) is helpful in determining whether thyroid nodules are benign or malignant, this distinction remains a cytological challenge in follicular neoplasms. Identification of genomic alterations in cytological specimens with direct and routine techniques would therefore have great clinical value. A series of 153 cases consisting of 72 and 81 histopathologically confirmed classic follicular adenomas (cFAs) and classic follicular thyroid carcinomas (cFTCs), respectively, was studied by means of different molecular techniques in three different cohorts of patients (pts). In the first cohort (training set) of 66 pts, three specific alterations characterized by array comparative genomic hybridization (aCGH) were exclusively found in half of cFTCs. These structural abnormalities corresponded to losses of 1p36.33-35.1 and 22q13.2-13.31, and gain of whole chromosome X. The second independent cohort (validation set) of 60 pts confirmed these data on touch preparations of frozen follicular neoplasms by triple DNA fluorescent in situ hybridization using selected commercially available probes. The third cohort, consisting of 27 archived cytological samples from an equal number of pts that had been obtained for preoperative FNAC and morphologically classified as and histologically verified to be follicular neoplasms, confirmed our previous findings and showed the feasibility of the DNA FISH (DNA fluorescent in situ hybridization) assay. All together, these data suggest that our triple DNA FISH diagnostic assay may detect 50% of cFTCs with a specificity higher than 98% and be useful as a low-cost adjunct to cytomorphology to help further classify follicular neoplasms on already routinely stained cytological specimens.
Collapse
Affiliation(s)
- Philippe Vielh
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
- Correspondence: or
| | - Zsofia Balogh
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Voichita Suciu
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Catherine Richon
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Bastien Job
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Guillaume Meurice
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Alexander Valent
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Ludovic Lacroix
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Virginie Marty
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Nelly Motte
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Philippe Dessen
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Bernard Caillou
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Abir Al Ghuzlan
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Jean-Michel Bidart
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Vladimir Lazar
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology and Biobank, Pasteur Hospital, 06002 Nice, France;
| | - Jean-Yves Scoazec
- Department of Medical Biology and Pathology, Gustave Roussy, Université Paris-Saclay and Experimental and Translational Pathology Platform, CNRS UMS3655-INSERM US23 AMMICA, 94805 Villejuif, France; (Z.B.); (V.S.); (C.R.); (B.J.); (G.M.); (A.V.); (L.L.); (V.M.); (N.M.); (P.D.); (B.C.); (A.A.G.); (J.-M.B.); (V.L.); (J.-Y.S.)
| | - Adel K. El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Martin Schlumberger
- Department of Endocrinology, Gustave Roussy, Université Paris-Saclay, 94805 Villejuif, France;
| |
Collapse
|
21
|
Trovato M. A historical excursus of diagnostic methods for Hashimoto thyroiditis and Graves' disease. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020. [DOI: 10.23736/s0393-3660.19.04176-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
22
|
Lorenz J, Rothhammer-Hampl T, Zoubaa S, Bumes E, Pukrop T, Kölbl O, Corbacioglu S, Schmidt NO, Proescholdt M, Hau P, Riemenschneider MJ. A comprehensive DNA panel next generation sequencing approach supporting diagnostics and therapy prediction in neurooncology. Acta Neuropathol Commun 2020; 8:124. [PMID: 32758285 PMCID: PMC7405456 DOI: 10.1186/s40478-020-01000-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022] Open
Abstract
Recent updates in the classification of central nervous system (CNS) tumors have increased the need for molecular testing. Assessment of multiple alterations in parallel, complex combinations of gene sequence and chromosomal changes, as well as therapy prediction by identification of actionable mutations are the major challenges. We here report on a customized next generation sequencing (NGS)-based DNA panel assay that combines diagnostic and predictive testing and -as a comprehensive approach- allows for simultaneous single nucleotide variant (SNP) / small insertion/deletion (InDel), copy number variation (CNV) and loss of heterozygosity (LOH) detection. We analyzed formalin-fixed and paraffin-embedded (FFPE) DNA from a total of 104 patients with CNS tumors. After amplicon capture-based library preparation, sequencing was performed on the relatively cost-efficient Illiumina MiniSeq platform and evaluated with freely available bioinformatical tools. 57 genes for exonic SNP/InDel calling (19 of those in intronic regions for CNV analysis), 3 chromosomal arms and 4 entire chromosomes for CNV and LOH analysis were covered. Results were extensively validated. Our approach yielded high accuracy, sensitivity and specificity. It led to refined diagnoses in a relevant number of analyzed cases, reliably enabled complex subclassifications (e.g. for medulloblastomas) and identified actionable targets for clinical use. Thus, our single-platform approach is an efficient and powerful tool to comprehensively support molecular testing in neurooncology. Future functionality is guaranteed as novel upcoming biomarkers can be easily incorporated in a modular panel design.
Collapse
Affiliation(s)
- Julia Lorenz
- Department of Neuropathology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Tanja Rothhammer-Hampl
- Department of Neuropathology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Saida Zoubaa
- Department of Neuropathology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
| | - Elisabeth Bumes
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
| | - Tobias Pukrop
- Department of Internal Medicine III, Regensburg University Hospital, Regensburg, Germany
| | - Oliver Kölbl
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
- Department of Radiotherapy, Regensburg University Hospital, Regensburg, Germany
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Regensburg University Hospital, Regensburg, Germany
| | - Nils O Schmidt
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Martin Proescholdt
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
- Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Peter Hau
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany
- Department of Neurology, Regensburg University Hospital, Regensburg, Germany
| | - Markus J Riemenschneider
- Department of Neuropathology, Regensburg University Hospital, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
- Wilhelm Sander Neuro-Oncology Unit, Regensburg University Hospital, Regensburg, Germany.
| |
Collapse
|
23
|
Zhou Y, Chi Y, Bhandari A, Xia E, Thakur PC, Qu J, Wang O, Zhang X. Downregulated CDH3 decreases proliferation, migration, and invasion in thyroid cancer. Am J Transl Res 2020; 12:3057-3067. [PMID: 32655830 PMCID: PMC7344063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Placental-Cadherin (CDH3), a cell adhesion molecule, is associated with the function of cells to bind with other cells and the extracellular matrix (ECM). CDH3 is highly expressed in many malignancies, and has been proved it could be a serum marker to monitor colorectal cancer, but the CDH3 expression levels in thyroid cancer is still not clear. In this article, we will illuminate the correlation between CDHs expression and thyroid cancer. MATERIALS AND METHODS We analyzed the level of CDH3 expression in 60 pair of tissue samples (contrast thyroid cancer tissues with adjacent normal thyroid tissues) by Real-time PCR, and TCGA data portal. After that, we transfected small interfering RNA to silence CDH3 in thyroid cancer cell lines (KTC-1 and BCPAP) and confirmed the function of CDH3 by performed colony formation, migration, invasion, cell counting kit-8 and apoptosis assays. RESULTS CDH3 was upregulated in thyroid cancer tissues compared to the adjacent normal tissues (T:N=71.87±39.88:5.35±5.91, P<0.0001) and TCGA (T:N=19.43±13.82:1.22±1.33, P<0.0001). In thyroid cell lines (KTC-1 and BCPAP) experiments showed that downregulated CDH3 inhibited proliferation, migration, and invasion. Meanwhile, inhibited CDH3 expression could upregulate E-cadherin, downregulated N-cadherin, which may control invasion and migration. CONCLUSION Thyroid cancer cells CDH3 expression levels is a correlation with its ability to grow, migrate and invade.
Collapse
Affiliation(s)
- Yili Zhou
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang, PR China
| | - Yili Chi
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang, PR China
| | - Adheesh Bhandari
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang, PR China
- Nepal Cancer Hospital & Research CenterHarisiddhi, Lalitpur, Nepal
| | - Erjie Xia
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang, PR China
| | | | - Jinmiao Qu
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang, PR China
| | - Ouchen Wang
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang, PR China
| | - Xiaohua Zhang
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou, Zhejiang, PR China
| |
Collapse
|
24
|
Muzza M, Colombo C, Pogliaghi G, Karapanou O, Fugazzola L. Molecular markers for the classification of cytologically indeterminate thyroid nodules. J Endocrinol Invest 2020; 43:703-716. [PMID: 31853887 DOI: 10.1007/s40618-019-01164-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The diagnosis of indeterminate lesions of the thyroid is a challenge in cytopathology practice. Indeed, up to 30% of cases lack the morphological features needed to provide definitive classification. Molecular tests have been developed to assist in the diagnosis of these indeterminate cases. The first studies dealing with the preoperative molecular evaluation of FNA samples focused on the analysis of BRAFV600E or on the combined evaluation of two or three genetic alterations. The sensitivity of molecular testing was then improved through the introduction of gene panels, which became available for clinical use in the late 2000s. Two different categories of molecular tests have been developed, the 'rule-out' methods, which aim to reduce the avoidable treatment of benign nodules, and the 'rule-in' tests that have the purpose to optimize surgical management. The genetic evaluation of indeterminate thyroid nodules is predicted to improve patient care, particularly if molecular tests are used appropriately and with the awareness of their advantages and weaknesses. The main disadvantage of these tests is the cost, which makes them rarely used in Europe. To overcome this limitation, customized panels have been set up, which are able to detect the most frequent genetic alterations of thyroid cancer. CONCLUSIONS In the present review, the most recent available versions of commercial molecular tests and of custom, non-commercial panels are described. Their characteristics and accuracy in the differential diagnosis of indeterminate nodules, namely Bethesda classes III (Atypical follicular lesion of undetermined significance, AUS/FLUS) and IV (Suspicious for follicular neoplasm, FN/SFN) are fully analyzed and discussed.
Collapse
Affiliation(s)
- M Muzza
- Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy
| | - C Colombo
- Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy
| | - G Pogliaghi
- Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy
| | - O Karapanou
- Department of Endocrinology, 401 Military Hospital, 11525, Athens, Greece
| | - L Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS IstitutoAuxologicoItaliano, 20149, Milan, Italy.
- Department of Pathophysiology and Transplantation, University of Milan, P.le Brescia 20, 20149, Milano, Italy.
| |
Collapse
|
25
|
TSH Level and Risk of Malignancy in Patients with Bethesda Category IV Thyroid Nodules. Discov Oncol 2020; 11:200-204. [PMID: 32266672 DOI: 10.1007/s12672-020-00384-4] [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: 01/16/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022] Open
Abstract
Fine needle aspiration biopsy does not permit to distinguish between benign and malignant follicular thyroid lesions (category IV in the Bethesda Cytopathology System). Some reports have suggested an association between increased serum TSH levels and thyroid cancer, so the aim of this study was to investigate the association between TSH levels and malignancy in patients with follicular thyroid nodules. Therefore, we conducted a retrospective study of all subjects who underwent surgical treatment for Bethesda IV thyroid nodules in a single center (years 2012-2017). A total of 127 patients were analyzed, and malignancy was present in 38.6% of the patients. Using ROC analysis, the best TSH cut-off point to differentiate benign from malignant disease was 2.1 mU/l and the age cut-off with better sensitivity and specificity was 47 years. The proportion of subjects with TSH ≥ 2.1 mU/l was greater among subjects with cancer than in those with benign diseases (65.3 vs 44.9%, P = 0.029). The concurrence of both cut-off points (TSH ≥ 2.1 mU/l and age ≥ 47 years) showed a higher diagnostic accuracy than either of the two variables separately. Therefore, the present study supports an association between serum concentrations of TSH and risk of malignancy among subjects with Bethesda IV thyroid nodules. TSH levels could modify the diagnostic and therapeutic approach of patients with Bethesda IV nodules.
Collapse
|
26
|
Titov S, Demenkov PS, Lukyanov SA, Sergiyko SV, Katanyan GA, Veryaskina YA, Ivanov MK. Preoperative detection of malignancy in fine-needle aspiration cytology (FNAC) smears with indeterminate cytology (Bethesda III, IV) by a combined molecular classifier. J Clin Pathol 2020; 73:722-727. [PMID: 32213552 DOI: 10.1136/jclinpath-2020-206445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/18/2020] [Accepted: 03/01/2020] [Indexed: 01/21/2023]
Abstract
AIMS Analysis of molecular markers in addition to cytological analysis of fine-needle aspiration (FNA) samples is a promising way to improve the preoperative diagnosis of thyroid nodules. Previously, we have developed an algorithm for the differential diagnosis of thyroid nodules by means of a small set of molecular markers. Here, we aimed to validate this approach using FNA cytology samples of Bethesda categories III and IV, in which preoperative detection of malignancy by cytological analysis is impossible. METHODS A total of 122 FNA smears from patients with indeterminate cytology (Bethesda III: 13 patients, Bethesda IV: 109 patients) were analysed by real-time PCR regarding the preselected set of molecular markers (the BRAF V600E mutation, normalised concentrations of HMGA2 mRNA, 3 microRNAs, and the mitochondrial/nuclear DNA ratio). The decision tree-based classifier was used to discriminate between benign and malignant tumours. RESULTS The molecular testing detected malignancy in FNA smears of indeterminate cytology with 89.2% sensitivity, 84.6% positive predictive value, 92.9% specificity and 95.2% negative predictive value; these characteristics are comparable with those of more complicated commercial tests. Residual risk of malignancy for the thyroid nodules that were shown to be benign by this molecular method did not exceed the reported risk of malignancy for Bethesda II histological diagnosis. Analytical-accuracy assessment revealed required nucleic-acid input of ≥5 ng. CONCLUSIONS The study shows feasibility of preoperative differential diagnosis of thyroid nodules of indeterminate cytology using a small panel of molecular markers of different types by a simple PCR-based method using stained FNA smears.
Collapse
Affiliation(s)
- Sergei Titov
- Department of the Structure and Function of Chromosomes, Institute of Molecular and Cellular Biology SB RAS, Novosibirsk, Russian Federation .,AO Vector-Best, Novosibirsk, Russian Federation
| | - Pavel S Demenkov
- Department of Systems Biology, Institute of Cytology and Genetics SB RAS, Novosibirsk, Russian Federation.,Department of Mathematics and Mechanics, Novosibirsk State University, Novosibirsk, Russian Federation
| | - Sergei A Lukyanov
- Department of General and Pediatric Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation
| | - Sergei V Sergiyko
- Department of General and Pediatric Surgery, South Ural State Medical University, Chelyabinsk, Russian Federation
| | - Gevork A Katanyan
- Department of Surgery, Regional Clinical Hospital No. 2, Krasnodar, Russian Federation
| | - Yulia A Veryaskina
- Department of the Structure and Function of Chromosomes, Institute of Molecular and Cellular Biology SB RAS, Novosibirsk, Russian Federation.,Department of Systems Biology, Institute of Cytology and Genetics SB RAS, Novosibirsk, Russian Federation
| | - Mikhail K Ivanov
- Department of the Structure and Function of Chromosomes, Institute of Molecular and Cellular Biology SB RAS, Novosibirsk, Russian Federation.,AO Vector-Best, Novosibirsk, Russian Federation
| |
Collapse
|
27
|
Guan Y, Bhandari A, Xia E, Kong L, Zhang X, Wang O. Downregulating integrin subunit alpha 7 (ITGA7) promotes proliferation, invasion, and migration of papillary thyroid carcinoma cells through regulating epithelial-to-mesenchymal transition. Acta Biochim Biophys Sin (Shanghai) 2020; 52:116-124. [PMID: 31942970 DOI: 10.1093/abbs/gmz144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/19/2019] [Accepted: 11/18/2019] [Indexed: 12/14/2022] Open
Abstract
Thyroid cancer is one of the common malignancies of the endocrine system and the number of thyroid cancer cases is increasing constantly. Significant work has focused on the molecular mechanisms of thyroid cancer, but many mechanisms remain undiscovered. In this study, we employed a comprehensive analysis of whole-transcriptome resequencing derived from paired papillary thyroid cancer (PTC) and normal thyroid tissues. We performed a massive parallel whole-transcriptome resequencing of matched PTC and normal thyroid tissues in 19 patients and found that integrin subunit alpha 7 (ITGA7) was downregulated in thyroid tumor tissues, but the function of ITGA7 in this cancer is still unclear. We also discovered that ITGA7 gene in thyroid cancer tissues was downregulated compared to paired adjacent non-tumor tissues by real-time quantitative polymerase chain reaction. After transfection with small interfering RNA to knock down ITGA7, the abilities of colony formation, proliferation, migration, and invasion were enhanced in PTC cell lines (TPC1 and KTC-1). Meanwhile, ITGA7 knockdown decreased apoptotic cell death in thyroid cells but promoted the expressions of N-cadherin and vimentin and decreased E-cadherin expression by epithelial-to-mesenchymal transition, which may induce invasion and migration. In conclusion, these results indicated that ITGA7 is involved in the progress of PTC and might act as a tumor suppressor gene.
Collapse
Affiliation(s)
- Yaoyao Guan
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Adheesh Bhandari
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Erjie Xia
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Lingguo Kong
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaohua Zhang
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ouchen Wang
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| |
Collapse
|
28
|
Castellana M, Piccardo A, Virili C, Scappaticcio L, Grani G, Durante C, Giovanella L, Trimboli P. Can ultrasound systems for risk stratification of thyroid nodules identify follicular carcinoma? Cancer Cytopathol 2020; 128:250-259. [PMID: 31899594 DOI: 10.1002/cncy.22235] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/30/2019] [Accepted: 10/15/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ultrasound (US) risk stratification systems (RSSs) have been developed to reduce the number of unnecessary fine needle aspirations (FNAs) of thyroid nodules. These systems were designed primarily to identify papillary thyroid carcinomas, thus their performance on follicular thyroid carcinoma (FTC) is debatable. The present study was undertaken to investigate the accuracy of RSSs in selecting FTCs for FNA. METHODS Patients with FTC who underwent US examinations between 2012 and 2018 in 2 institutions were selected. US images were reviewed retrospectively, and FTCs were reclassified according to the American Association of Clinical Endocrinologist/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME), American College of Radiology (ACR-TIRADS), 2015 American Thyroid Association, British Thyroid Association, European Thyroid Association, Korean Society of Thyroid Radiology and Korean Society of Radiology, and Thyroid Imaging Reporting and Data System (TIRADS). Risk class and indication for FNA were assessed. RESULTS Forty-five FTCs from 45 consecutive patients were included in the study. The median tumor diameter was 32 mm (range, 11-100), and ovoid isoechoic nodule with or without lobulated margins was the most frequent presentation. When FTCs were classified according to RSSs, the most common categories were intermediate and high risk, though 1 case in 3 was not classifiable. FTCs were classified as high risk/high suspicion/malignant in 11% to 74% of cases, with a statistically significant difference among the systems. FNA was indicated in 69% to 100% of cases, with good agreement among AACE/ACE/AME, ACR-TIRADS, and TIRADS. CONCLUSION Current RSSs show high performance in selecting FTCs for FNA. This result is mainly due to the dimensional RSSs cutoffs indicating FNA. On the contrary, given the reported unsuspicious echo-structural presentation of FTC and the recognized limitation of cytological assessment to detect it, caution is advised when using US to manage cytologically indeterminate nodules.
Collapse
Affiliation(s)
- Marco Castellana
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, E.O. Ospedali Galliera, Genoa, Italy
| | - Camilla Virili
- Science and Medico-Surgical Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Lorenzo Scappaticcio
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Unit of Endocrinology and Metabolic Diseases, University of Campania L. Vanvitelli, Naples, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| |
Collapse
|
29
|
Titov SE, Ivanov MK, Demenkov PS, Katanyan GA, Kozorezova ES, Malek AV, Veryaskina YA, Zhimulev IF. Combined quantitation of HMGA2 mRNA, microRNAs, and mitochondrial-DNA content enables the identification and typing of thyroid tumors in fine-needle aspiration smears. BMC Cancer 2019; 19:1010. [PMID: 31660895 PMCID: PMC6819494 DOI: 10.1186/s12885-019-6154-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 09/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background Analysis of molecular markers in addition to cytological analysis of fine-needle aspiration (FNA) samples is a promising way to improve the preoperative diagnosis of thyroid nodules. Nonetheless, in clinical practice, applications of existing diagnostic solutions based on the detection of somatic mutations or analysis of gene expression are limited by their high cost and difficulties with clinical interpretation. The aim of our work was to develop an algorithm for the differential diagnosis of thyroid nodules on the basis of a small set of molecular markers analyzed by real-time PCR. Methods A total of 494 preoperative FNA samples of thyroid goiters and tumors from 232 patients with known histological reports were analyzed: goiter, 105 samples (50 patients); follicular adenoma, 101 (48); follicular carcinoma, 43 (28); Hürthle cell carcinoma, 25 (11); papillary carcinoma, 121 (56); follicular variant of papillary carcinoma, 80 (32); and medullary carcinoma, 19 (12). Total nucleic acids extracted from dried FNA smears were analyzed for five somatic point mutations and two translocations typical of thyroid tumors as well as for relative concentrations of HMGA2 mRNA and 13 microRNAs and the ratio of mitochondrial to nuclear DNA by real-time PCR. A decision tree–based algorithm was built to discriminate benign and malignant tumors and to type the thyroid cancer. Leave-p-out cross-validation with five partitions was performed to estimate prediction quality. A comparison of two independent samples by quantitative traits was carried out via the Mann–Whitney U test. Results A minimum set of markers was selected (levels of HMGA2 mRNA and miR-375, − 221, and -146b in combination with the mitochondrial-to-nuclear DNA ratio) and yielded highly accurate discrimination (sensitivity = 0.97; positive predictive value = 0.98) between goiters with benign tumors and malignant tumors and accurate typing of papillary, medullary, and Hürthle cell carcinomas. The results support an alternative classification of follicular tumors, which differs from the histological one. Conclusions The study shows the feasibility of the preoperative differential diagnosis of thyroid nodules using a panel of several molecular markers by a simple PCR-based method. Combining markers of different types increases the accuracy of classification.
Collapse
Affiliation(s)
- Sergei E Titov
- Institute of Molecular and Cellular Biology, Novosibirsk, 630090, Russia. .,AO Vector-Best, Koltsovo, 630559, Russia.
| | - Mikhail K Ivanov
- Institute of Molecular and Cellular Biology, Novosibirsk, 630090, Russia.,AO Vector-Best, Koltsovo, 630559, Russia
| | - Pavel S Demenkov
- Institute of Cytology and Genetics, Novosibirsk, 630090, Russia.,Novosibirsk State University, Novosibirsk, 630090, Russia
| | | | - Eugenia S Kozorezova
- Siberian District Medical Center of Federal Medical and Biological Agency, Novosibirsk, 630007, Russia
| | - Anastasia V Malek
- N.N. Petrov National Medical Research Center of Oncology, St. Petersburg, 197758, Russia
| | - Yulia A Veryaskina
- Institute of Molecular and Cellular Biology, Novosibirsk, 630090, Russia
| | - Igor F Zhimulev
- Institute of Molecular and Cellular Biology, Novosibirsk, 630090, Russia
| |
Collapse
|
30
|
Castellana M, Trimboli P, Piccardo A, Giovanella L, Treglia G. Performance of 18F-FDG PET/CT in Selecting Thyroid Nodules with Indeterminate Fine-Needle Aspiration Cytology for Surgery. A Systematic Review and a Meta-Analysis. J Clin Med 2019; 8:jcm8091333. [PMID: 31466411 PMCID: PMC6780221 DOI: 10.3390/jcm8091333] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/16/2019] [Accepted: 08/27/2019] [Indexed: 12/17/2022] Open
Abstract
Thyroid nodules with indeterminate fine-needle aspiration cytology (FNA) represent a major challenge in clinical practice. We conducted a systematic review and meta-analysis evaluating the ability of hybrid imaging using fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to appropriately select these nodules for surgery. PubMed, CENTRAL, Scopus, and Web of Science were searched until July 2019. Original articles reporting data on the performance of 18F-FDG PET/CT in thyroid nodules with indeterminate FNA were included. Summary operating points including 95% confidence interval values (95% CI) were estimated using a random-effects model. Out of 786 retrieved papers, eight studies evaluating 104 malignant and 327 benign thyroid nodules were included. The pooled positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of 18F-FDG PET/CT were 1.7 (95% CI: 1.4-2.0), 0.4 (95% CI: 0.2-0.7), and 3.5 (95% CI: 1.7-7.1), respectively. No heterogeneity was found for LR+ and DOR. In patients with thyroid nodules with indeterminate FNA, 18F-FDG PET/CT has a moderate ability to correctly discriminate malignant from benign lesions and could represent a reliable option to reduce unnecessary diagnostic surgeries. However, further studies using standardized criteria for interpretation are needed to confirm the reproducibility of these findings.
Collapse
Affiliation(s)
- Marco Castellana
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, IT-70124 Bari, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, Galliera Hospital, IT-16128 Genoa, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland
- Department of Nuclear Medicine, University Hospital of Zürich and University of Zürich, CH-8091 Zürich, Switzerland
| | - Giorgio Treglia
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland.
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, CH-6500 Bellinzona, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland.
| |
Collapse
|
31
|
The Diagnostic Performance of Afirma Gene Expression Classifier for the Indeterminate Thyroid Nodules: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7150527. [PMID: 31531363 PMCID: PMC6720051 DOI: 10.1155/2019/7150527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 06/25/2019] [Accepted: 07/07/2019] [Indexed: 01/07/2023]
Abstract
Background Approximately 15 to 30% of thyroid nodules evaluated by fine-needle aspiration (FNA) were classified as indeterminate; the accurate diagnostic molecular tests of these nodules remain a challenge. We aimed to evaluate the diagnostic performance of Afirma gene expression classifier (GEC) for the indeterminate thyroid nodules (ITNs). Methods Studies published from January 2005 to December 2018 were systematically reviewed. The gold reference standard relied on the histopathologic results diagnosis from thyroidectomy surgical specimens. MetaDisc software was used to investigate the pooled sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves. Results A total of 18 studies involving 5290 patients with 3290 cases of ITNs were included. Collected data revealed that the pooled sensitivity of GEC was 95.5% (95% CI 93.3%–97.0%, p < 0.001), the specificity was 22.1% (95% CI 19.4%-24.9%, p < 0.001), the NPV was 88.2% (95% CI 0.833–0.921, p < 0.001), the PPV was 44.3% (95% CI 0.416–0.471, p < 0.001), and the DOR was 5.25 (95% CI 3.42–8.04, p= 0.855). Conclusion The GEC has quite high sensitivity of 95.5% but low specificity of 22.1%. The high sensitivity makes it probable to rule out malignant nodules. Thus, over half of nodules with GEC-suspicious results still require further validation like molecular markers, diagnostic surgery, or long follow-up, which limits its use in future clinical practice.
Collapse
|
32
|
Sanchez A, Bocklage T. Precision cytopathology: expanding opportunities for biomarker testing in cytopathology. J Am Soc Cytopathol 2019; 8:95-115. [PMID: 31287426 DOI: 10.1016/j.jasc.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 06/09/2023]
Abstract
Precision cytopathology refers to therapeutically linked biomarker testing in cytopatology, a dynamically growing area of the discipline. This review describes basic steps to expand precision cytopathology services. Focusing exclusively on solid tumors, the review is divided into four sections: Section 1: Overview of precision pathology- opportunities and challenges; Section 2: Basic steps in establishing or expanding a precision cytopathology laboratory; Section 3: Cytopathology specimens suitable for next generation sequencing platforms; and Section 4: Summary. precision cytopathology continues to rapidly evolve in parallel with expanding targeted therapy options. Biomarker assays (companion diagnostics) comprise a multitude of test types including immunohistochemistry, in situ hybridization and molecular genetic tests such as PCR and next generation sequencing all of which are performable on cytology specimens. Best practices for precision cytopathology will incorporate traditional diagnostic approaches allied with careful specimen triage to enable successful biomarker analysis. Beyond triaging, cytopathologists knowledgeable about molecular test options and capabilities have the opportunity to refine diagnoses, prognoses and predictive information thereby assuming a lead role in precision oncology biomarker testing.
Collapse
Affiliation(s)
| | - Thèrése Bocklage
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, MS.
| |
Collapse
|
33
|
Gay S, Schiaffino S, Santamorena G, Massa B, Ansaldo G, Turtulici G, Giusti M, At The Policlinico San Martino Genoa TT. Role of Strain Elastography and Shear-Wave Elastography in a Multiparametric Clinical Approach to Indeterminate Cytology Thyroid Nodules. Med Sci Monit 2018; 24:6273-6279. [PMID: 30194820 PMCID: PMC6140375 DOI: 10.12659/msm.909870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background In thyroid nodules with indeterminate cytology, further clinical assessment aimed at ruling out malignancy is often mandatory. Ancillary imaging techniques and genetic mutation analysis can improve the risk stratification of such lesions, thereby facilitating the clinician’s decision to undertaken surgery or simple follow-up. The aim of this study was to evaluate the diagnostic performance of shear-wave elastography (SW), strain elastography (ELX 2/1), conventional ultrasound (US), contrast-enhanced ultrasound (CEUS), and BRAF V600E mutation analysis in the aforementioned lesions. Material/Methods We enrolled 81 patients, each with 1 indeterminate-cytology thyroid nodule. Thyroid function, thyroperoxidase antibodies and calcitonin were known in each case. SW, ELX 2/1, US, CEUS, and BRAF mutation analysis were subsequently performed, followed by a second FNAB. If the lesion was not downgraded to benign, surgery was recommended and histological reports collected. Results There were 28 nodules (34%) that proved benign on the second FNAB; 38 nodules (47%) underwent surgery (17 benign, 21 malignant), and 15 nodules (19%) refused surgery. The only techniques related to histological outcome were US (AUC=0,766), ELX 2/1 (AUC=0.701), and BRAF analysis (AUC=0.762). ELX 2/1 and SW reports were not correlated with each other (P=0.45). A scoring system taking into account all the variables considered performed better than the single variables alone (AUC=0.831). Conclusions In indeterminate-cytology thyroid lesions, repeating FNAB can avoid unnecessary surgery. ELX 2/1 seems to perform better than SW in distinguishing malignancy; these techniques could, however, be complementary in describing such lesions. A multiparametric approach appears the most accurate in predicting nodule histology.
Collapse
Affiliation(s)
- Stefano Gay
- Endocrine Unit, Policlinico San Martino, Genoa, Italy
| | | | | | - Barbara Massa
- Cyto-Histopathological Unit, Policlinico San Martino, Genova, Italy
| | | | - Giovanni Turtulici
- Interventional Radiology Unit, Ospedale Evangelico Internazionale, Genoa, Italy
| | | | | |
Collapse
|
34
|
Pesenti C, Muzza M, Colombo C, Proverbio MC, Farè C, Ferrero S, Miozzo M, Fugazzola L, Tabano S. MassARRAY-based simultaneous detection of hotspot somatic mutations and recurrent fusion genes in papillary thyroid carcinoma: the PTC-MA assay. Endocrine 2018; 61:36-41. [PMID: 29214440 PMCID: PMC5997117 DOI: 10.1007/s12020-017-1483-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/22/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE We exploited the MassARRAY (MA) genotyping platform to develop the "PTC-MA assay", which allows the simultaneous detection of 13 hotspot mutations, in the BRAF, KRAS, NRAS, HRAS, TERT, AKT1, PIK3CA, and EIF1AX genes, and six recurrent genetic rearrangements, involving the RET and TRK genes in papillary thyroid cancer (PTC). METHODS The assay was developed using DNA and cDNA from 12 frozen and 11 formalin-fixed paraffin embedded samples from 23 PTC cases, together with positive and negative controls. RESULTS The PTC-MA assay displays high sensitivity towards point mutations and gene rearrangements, detecting their presence at frequencies as low as 5%. Moreover, this technique allows quantification of the mutated alleles identified at each tested locus. CONCLUSIONS The PTC-MA assay is a novel MA test, which is able to detect fusion genes generated by genomic rearrangements concomitantly with the analysis of hotspot point mutations, thus allowing the evaluation of key diagnostic, prognostic, and therapeutic markers of PTC in a single experiment without any informatics analysis. As the assay is sensitive, robust, easily achievable, and affordable, it is suitable for the diagnostic practice. Finally, the PTC-MA assay can be easily implemented and updated by adding novel genetic markers, according to clinical requirements.
Collapse
Affiliation(s)
- Chiara Pesenti
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Marina Muzza
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carla Colombo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Maria Carla Proverbio
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Claudia Farè
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Monica Miozzo
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Laura Fugazzola
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milano, Italy.
| | - Silvia Tabano
- Division of Pathology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
35
|
Bartolazzi A, Sciacchitano S, D'Alessandria C. Galectin-3: The Impact on the Clinical Management of Patients with Thyroid Nodules and Future Perspectives. Int J Mol Sci 2018; 19:ijms19020445. [PMID: 29393868 PMCID: PMC5855667 DOI: 10.3390/ijms19020445] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 01/17/2018] [Accepted: 01/29/2018] [Indexed: 02/06/2023] Open
Abstract
Galectins (S-type lectins) are an evolutionarily-conserved family of lectin molecules, which can be expressed intracellularly and in the extracellular matrix, as well. Galectins bind β-galactose-containing glycoconjugates and are functionally active in converting glycan-related information into cell biological programs. Altered glycosylation notably occurring in cancer cells and expression of specific galectins provide, indeed, a fashionable mechanism of molecular interactions able to regulate several tumor relevant functions, among which are cell adhesion and migration, cell differentiation, gene transcription and RNA splicing, cell cycle and apoptosis. Furthermore, several galectin molecules also play a role in regulating the immune response. These functions are strongly dependent on the cell context, in which specific galectins and related glyco-ligands are expressed. Thyroid cancer likely represents the paradigmatic tumor model in which experimental studies on galectins' glycobiology, in particular on galectin-3 expression and function, contributed greatly to the improvement of cancer diagnosis. The discovery of a restricted expression of galectin-3 in well-differentiated thyroid carcinomas (WDTC), compared to normal and benign thyroid conditions, contributed also to promoting preclinical studies aimed at exploring new strategies for imaging thyroid cancer in vivo based on galectin-3 immuno-targeting. Results derived from these recent experimental studies promise a further improvement of both thyroid cancer diagnosis and therapy in the near future. In this review, the biological role of galectin-3 expression in thyroid cancer, the validation and translation to a clinical setting of a galectin-3 test method for the preoperative characterization of thyroid nodules and a galectin-3-based immuno-positron emission tomography (immuno-PET) imaging of thyroid cancer in vivo are presented and discussed.
Collapse
MESH Headings
- Animals
- Antibodies, Monoclonal/therapeutic use
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/immunology
- Blood Proteins
- Cell Adhesion/drug effects
- Cell Cycle/drug effects
- Cell Cycle/genetics
- Cell Cycle/immunology
- Cell Movement/drug effects
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/immunology
- Cell Transformation, Neoplastic/pathology
- Galectin 3/antagonists & inhibitors
- Galectin 3/genetics
- Galectin 3/immunology
- Galectins
- Gene Expression Regulation, Neoplastic
- Humans
- Neoplastic Cells, Circulating
- Positron-Emission Tomography/methods
- Signal Transduction
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/drug therapy
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/immunology
- Thyroid Nodule/diagnostic imaging
- Thyroid Nodule/drug therapy
- Thyroid Nodule/genetics
- Thyroid Nodule/immunology
Collapse
Affiliation(s)
- Armando Bartolazzi
- Pathology Research Laboratory, Saint Andrea University Hospital, via di Grottarossa 1035, 00189 Rome, Italy.
| | - Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I viale Regina Elena 324, 00161 Rome, Italy.
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Calogero D'Alessandria
- Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 München, Germany.
| |
Collapse
|
36
|
Sciacchitano S, Lavra L, Morgante A, Ulivieri A, Magi F, De Francesco GP, Bellotti C, Salehi LB, Ricci A. Galectin-3: One Molecule for an Alphabet of Diseases, from A to Z. Int J Mol Sci 2018; 19:ijms19020379. [PMID: 29373564 PMCID: PMC5855601 DOI: 10.3390/ijms19020379] [Citation(s) in RCA: 235] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 02/07/2023] Open
Abstract
Galectin-3 (Gal-3) regulates basic cellular functions such as cell-cell and cell-matrix interactions, growth, proliferation, differentiation, and inflammation. It is not surprising, therefore, that this protein is involved in the pathogenesis of many relevant human diseases, including cancer, fibrosis, chronic inflammation and scarring affecting many different tissues. The papers published in the literature have progressively increased in number during the last decades, testifying the great interest given to this protein by numerous researchers involved in many different clinical contexts. Considering the crucial role exerted by Gal-3 in many different clinical conditions, Gal-3 is emerging as a new diagnostic, prognostic biomarker and as a new promising therapeutic target. The current review aims to extensively examine the studies published so far on the role of Gal-3 in all the clinical conditions and diseases, listed in alphabetical order, where it was analyzed.
Collapse
Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy.
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Luca Lavra
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Alessandra Morgante
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Alessandra Ulivieri
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Fiorenza Magi
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
| | - Gian Paolo De Francesco
- Department of Oncological Science, Breast Unit, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189 Rome, Italy.
| | - Carlo Bellotti
- Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa, 1035/39, 00189 Rome, Italy.
| | - Leila B Salehi
- Laboratory of Biomedical Research, Niccolò Cusano University Foundation, Via Don Carlo Gnocchi 3, 00166 Rome, Italy.
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy.
| | - Alberto Ricci
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome, Italy.
| |
Collapse
|
37
|
Valabrega S, Santolamazza G, Romanelli F, Scapicchio G, D'Angelo F, Bellotti C, Aurello P, Izzo L, Giovagnoli MR, Trimboli P. Cancer Rate of the Indeterminate Lesions at Low or High Risk According to Italian System for Reporting of Thyroid FNA. Front Endocrinol (Lausanne) 2018; 9:371. [PMID: 30050499 PMCID: PMC6052905 DOI: 10.3389/fendo.2018.00371] [Citation(s) in RCA: 4] [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: 05/14/2018] [Accepted: 06/21/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Italian consensus for the classification and reporting of thyroid cytology (ICCRTC) has been used in almost all Italian institutions since 2014. High reliability of ICCRTC in classifying low and high risk indeterminate nodules (Tir 3A and Tir 3B, respectively) was demonstrated. Here we reviewed our casuistry of thyroid indeterminate lesions to analyze the histologic outcome. Methods: All lesions undergone FNA and final histology at S. Andrea Hospital of Rome after a cytologic assessment of Tir 3A and Tir 3B, according to ICCRTC, were included in the study. Results: A number of 157 indeterminate FNA was found after the introduction of ICCRTC. Of these, 75 undergone surgery and were finally included for the study. At histology we found a 33.3% of cancers and a 67.7% of benign lesions. Out of the overall series, 25 were classified as Tir 3A and 50 as Tir 3B. Cancer rate observed in Tir 3A (1/25, 4%) was significantly (p = 0.0002) lower than that of Tir 3B (24/50, 48%). No significant difference was found in age and size between the two subcategories. Conclusions: We confirm in our series that Italian consensus for the classification and reporting of thyroid cytology allows to discriminate indeterminate lesions at low and high risk of malignancy.
Collapse
Affiliation(s)
- Stefano Valabrega
- Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
- *Correspondence: Stefano Valabrega
| | - Giuliano Santolamazza
- Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
| | | | - Giorgia Scapicchio
- Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
| | - Francesco D'Angelo
- Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
| | - Carlo Bellotti
- Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
| | - Paolo Aurello
- Department of Medical and Surgical Sciences, Ospedale S. Andrea, Sapienza University, Rome, Italy
| | - Luciano Izzo
- Department of Surgery “P. Valdoni, Sapienza University, Rome, Italy
| | - Maria R. Giovagnoli
- Department of Clinical and Molecular Medicine, Ospedale S. Andrea, Sapienza University, Rome, Italy
| | - Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| |
Collapse
|
38
|
Galectin-3 Performance in Histologic a Cytologic Assessment of Thyroid Nodules: A Systematic Review and Meta-Analysis. Int J Mol Sci 2017; 18:ijms18081756. [PMID: 28800068 PMCID: PMC5578146 DOI: 10.3390/ijms18081756] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 02/07/2023] Open
Abstract
The literature on Galectin-3 (Gal-3) was systematically reviewed to achieve more robust information on its histologic reliability in identifying thyroid cancers and on the concordance between Gal-3 test in histologic and cytologic samples. A computer search of the PubMed and Scopus databases was conducted by combinations of the terms thyroid and Gal-3. Initially, 545 articles were found and, after their critical review, 52 original papers were finally included. They reported 8172 nodules with histologic evaluation of Gal-3, of which 358 with also preoperative FNAC Gal-3 assessment. At histology, Gal-3 sensitivity was 87% (95% confidence intervals [CI] from 86% to 88%), and specificity 87% (95% CI from 86% to 88%); in both cases, we found heterogeneity (I2 85% and 93%, respectively) and significant publication bias (p < 0.001). The pooled rate of positive Gal-3 at fine needle aspiration (FNAC) among cancers with histologically proven Gal-3 positivity was 94% (95% CI from 89% to 97%), with neither heterogeneity (I2 14.5%) nor bias (p = 0.086). These data show high reliability of Gal-3 for thyroid cancer at histology, while its sensitivity on FNAC samples is lower. The limits of cytologic preparations and interpretation of Gal-3 results have to be solved.
Collapse
|