1
|
Parsa AA, Gharib H. Thyroid Nodules: Past, Present & Future. Endocr Pract 2024:S1530-891X(24)00558-5. [PMID: 38880348 DOI: 10.1016/j.eprac.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
The ability to distinguish benign from malignant thyroid nodules has been a challenge for over a century. Historically, thyroidectomy, as the only definitive method to diagnose thyroid cancer, led to a significant number of thyroid resections for benign disease considering that approximately 90-95% of thyroid nodules are benign. Diagnostic advancements including highly sensitive ultrasonography, fine needle aspiration cytology, molecular studies and future use of artificial intelligence, help distinguish benign from malignant and has significantly reduced the number of unnecessary surgeries for benign nodules. Current and likely future diagnostic improvements have led us to a new conundrum. While decreasing the number of surgeries for benign disease, we are now overdiagnosing and overtreating low-risk subclinical malignancies. Here we describe some of the changes leading to our current state.
Collapse
Affiliation(s)
- Alan A Parsa
- Associate Professor, John A. Burns School of Medicine, Honolulu, HI.
| | - Hossein Gharib
- Professor, Mayo Clinic College of Medicine, Rochester, MN.
| |
Collapse
|
2
|
Smulever A, Pitoia F. Thirty years of active surveillance for low-risk thyroid cancer, lessons learned and future directions. Rev Endocr Metab Disord 2024; 25:65-78. [PMID: 37833520 DOI: 10.1007/s11154-023-09844-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
Active Surveillance is a non-invasive strategy designed to identify a minority of patients with low-risk papillary thyroid carcinoma who might experience clinical progression and benefit from additional definitive treatments. Global experience suggests that these tumors typically show minimal changes in size during active surveillance, often demonstrating very slow growth or even size reduction. Moreover, the rate of lymph node metastases is low and can be effectively managed through rescue surgery, without impacting cancer-related mortality. However, despite 30 years of experience demonstrating the safety and feasibility of active surveillance for appropriately selected patients, this approach seems to have limited adoption in specific contexts. This limitation can be attributed to various barriers, including disparities in access to accurate information about the indolent nature of this disease and the prevalence of a maximalist mindset among certain patients and medical settings. This review aims to revisit the experience from the last three decades, provide current insights into the clinical outcomes of active surveillance trials, and propose a systematic approach for its implementation. Furthermore, it intends to emphasize the importance of precise patient selection and provides new perspectives in the field.
Collapse
Affiliation(s)
- Anabella Smulever
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Córdoba, Buenos Aires, 2351, Argentina.
- Division of Endocrinology, Instituto de Investigaciones Médicas A. Lanari, University of Buenos Aires, Buenos Aires, Argentina.
| | - Fabian Pitoia
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Córdoba, Buenos Aires, 2351, Argentina
| |
Collapse
|
3
|
Lin Y, Wu Y. Trends in incidence and overdiagnosis of thyroid cancer in China, Japan, and South Korea. Cancer Sci 2023; 114:4052-4062. [PMID: 37488752 PMCID: PMC10551580 DOI: 10.1111/cas.15909] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
We used data from 13 cancer registries in China, Japan, and South Korea to analyze time trends in overdiagnosis of thyroid cancer between 1998 and 2012. Age-standardized and age-specific incidence and annual percentage changes were calculated. The number of thyroid cancers diagnosed and the proportion attributable to overdiagnosis were estimated, with calculations stratified by sex and age group. The Spearman method was used to analyze the correlation between thyroid cancer incidence and overdiagnosis. From 1998 to 2012, both the incidence and proportions of overdiagnoses of thyroid cancer in China, Japan, and South Korea showed an increasing trend, with higher rates in women than men. South Korea had both the highest incidence for men (10.1/105 ) and women (46.7/105 ) and the highest proportions of overdiagnosis (men, 90.3%; women, 94.9%). The fastest growth in overdiagnosis was in Chinese men and women (annual percentage changes 6.1 and 4.6, respectively). We found significant positive correlations between age-standardized incidence and proportions of overdiagnosis for both men (Spearman r = 0.98, p < 0.05) and women (Spearman r = 0.99, p < 0.05) in the three countries. Age-specific incidence curves in Chinese and South Korean individuals were of an inverted U-shape. Overdiagnosis of thyroid cancer in Japan was mainly concentrated in middle-aged and older patients, whereas in China and South Korea, it occurred primarily in the middle-aged. The incidence and overdiagnosis of thyroid cancer in China, Japan, and South Korea are increasing, necessitating the implementation of comprehensive measures to reduce these overdiagnoses.
Collapse
Affiliation(s)
- Yongtian Lin
- Department of EpidemiologyClinical Oncology School of Fujian Medical University, Fujian Cancer HospitalFuzhouChina
| | - Yu Wu
- Department of Head and Neck SurgeryClinical Oncology School of Fujian Medical University, Fujian Cancer HospitalFuzhouChina
| |
Collapse
|
4
|
Medić F, Miletić AI, Jakovčević A, Habek D. Papillary thyroid carcinoma within a mature cystic ovarian teratoma. Wien Med Wochenschr 2023; 173:245-247. [PMID: 37166564 DOI: 10.1007/s10354-023-01016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/21/2023] [Indexed: 05/12/2023]
Abstract
Mature cystic ovarian teratoma (dermoid cyst) is the most common germ cell tumor. Malignant tissue alteration in mature cystic teratoma is extremely rare, and malignant proliferation of thyroid tissue has been documented in only a few cases. This article presents a case of incidentally detected papillary microcarcinoma (PTMC) within a mature cystic ovarian teratoma. A 42-year-old patient with an ultrasound-suspected dermoid cyst was indicated for surgical treatment. Laparoscopic adnexectomy was performed, and a cystic-solid tumor 3.5 cm in diameter was removed entirely. Pathohistological analysis confirmed the diagnosis of a mature cystic teratoma with a PTMC 0.3 cm in diameter. Afterward, the patient underwent additional investigations with an oncologic radiotherapist and endocrinologist. Thyroid ultrasound, thyroglobulin serum levels, anti-thyroglobulin antibodies, thyroid scintigraphy, and abdominal positron emission tomography (PET) scan were performed to exclude disease dissemination. All results were with no findings of other disease seed/metastasis, and the patient will be followed up regularly by a gynecologist and endocrinologist.
Collapse
Affiliation(s)
- Filip Medić
- University Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Sveti Duh 64, 10 000, Zagreb, Croatia.
| | - Antonio Ivan Miletić
- University Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Sveti Duh 64, 10 000, Zagreb, Croatia
| | - Antonia Jakovčević
- Department of Pathology, University Hospital Centre Zagreb, Kišpatićeva 12, 10 000, Zagreb, Croatia
| | - Dubravko Habek
- School of Medicine, Catholic University of Croatia, Zagreb, Croatia
| |
Collapse
|
5
|
Smulever A, Pitoia F. Conservative management of low-risk papillary thyroid carcinoma: a review of the active surveillance experience. Thyroid Res 2023; 16:6. [PMID: 36907911 PMCID: PMC10009928 DOI: 10.1186/s13044-023-00148-6] [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: 10/12/2022] [Accepted: 01/22/2023] [Indexed: 03/14/2023] Open
Abstract
The detection of low-risk thyroid carcinoma has increased in recent decades, although disease-specific mortality remained without changes. The high prevalence of occult carcinomas in autopsy studies, and hence the underlying indolent course of this entity, prompted the emergence of active surveillance as an alternative approach to these tumors. This strategy aims to recognize the minority group of patients who will develop clinical progression and probably benefit from deferred surgery. Experience around the world has shown that during active surveillance these tumors are mostly unchanged in size, with very-slow growth and even a decrease in diameter. Moreover, the rates of lymph node metastases were low and easily handled by rescue surgery, and distant metastases have not been reported. Given the high prevalence of small thyroid carcinomas and the excellent outcomes for observation, active surveillance provides a safe and feasible alternative in properly selected patients with low-risk thyroid cancer.
Collapse
Affiliation(s)
- Anabella Smulever
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, Argentina
| | - Fabian Pitoia
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, Argentina.
| |
Collapse
|
6
|
Yi KH. The 2017 United States Preventive Services Task Force Recommendation for Thyroid Cancer Screening Is No Longer the Gold Standard. Endocrinol Metab (Seoul) 2023; 38:72-74. [PMID: 36891652 PMCID: PMC10008657 DOI: 10.3803/enm.2023.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Affiliation(s)
- Ka Hee Yi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
- Corresponding author: Ka Hee Yi Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea Tel: +82-2-870-3864, Fax: +82-2-870-3866, E-mail:
| |
Collapse
|
7
|
Liu C, Zhao H, Xia Y, Cao Y, Zhang L, Zhao Y, Gao L, Liu R, Liu Y, Liu H, Meng Z, Liu S, Li X. Active surveillance of highly suspicious thyroid nodules cohort in China shows a worse psychological status in younger patients. Front Oncol 2022; 12:981495. [PMID: 36091122 PMCID: PMC9458970 DOI: 10.3389/fonc.2022.981495] [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: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Active surveillance has been considered a safe alternative to surgery for low-risk papillary thyroid microcarcinoma. This study aimed to assess the oncological outcomes and psychological status of active surveillance of highly suspicious thyroid nodules ≤10 mm in China. Methods This prospective single-center cohort study enrolled 336 patients with highly suspicious thyroid nodules for active surveillance to assess oncological outcomes and psychological status. The psychological status of patients was assessed by two different questionnaires and compared among different patient groups. Results During a median follow-up period of 28.5 months, eight patients underwent delayed surgery for tumor enlargement and one for lymph node metastases. The cumulative incidence of disease progression at 5 and 10 years was 6.0% and 12.8%, respectively. Patients who underwent delayed surgery had no permanent complications, and no patient had distant metastasis or death. Patients ≤30 years old had a higher baseline anxiety score (4.9 vs. 3.8, p=0.024), a higher proportion of baseline anxiety score, i.e., ≥8 points (24.0% vs. 12.6%, p=0.033), and a worse baseline emotional function (62.7 vs. 70.7, p=0.013) than patients >30. During AS, patients ≤30 years of age had higher overall anxiety levels (p=0.005) and a worse overall emotional function (p=0.001). Conclusions Active surveillance in Chinese patients with highly suspicious subcentimetre thyroid nodules has good oncological outcomes and can be used as a safe alternative to surgery. Younger patients (≤30) show a worse psychological status; therefore, more attention should be paid to younger patients.
Collapse
Affiliation(s)
- Chunhao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liyang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruifeng Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuewu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongfeng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhilan Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuzhou Liu
- Department of Otolaryngology Head and Neck Surgery, Hainan General Hospital, Haikou, China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Xiaoyi Li,
| |
Collapse
|
8
|
Kanokwongnuwat W, Larbcharoensub N, Sriphrapradang C, Suppasilp C, Thamnirat K, Sakulpisuti C, Kositwattanarerk A, Utamakul C, Sritara C, Chamroonrat W. Risk-stratified papillary thyroid microcarcinoma: post-operative management and treatment outcome in a single center. Endocrine 2022; 77:134-142. [PMID: 35476179 PMCID: PMC9242919 DOI: 10.1007/s12020-022-03060-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This article aims to review and assess the post-operative management and treatment outcomes of papillary thyroid microcarcinoma (PTMC) in risk-stratified patients. METHODS We retrospectively analyzed the data of PTMC patients who underwent thyroid surgery with or without radioactive iodine treatment (RAI) in a single center between January 2011 and December 2017. Demographic and clinicopathologic data were collected. Risk stratification according to the 2015 American Thyroid Association guideline was applied. RESULTS Three hundred forty PTMC patients were included. Post-operative RAI was performed in 216/340 (63.53%) patients. In the non-RAI scenario, there were 122 low-risk and two intermediate-risk patients. In total, 261 (76.77%), 57 (16.76%), and 22 (6.47%) patients were classified as low, intermediate, and high risk, respectively. With a median follow-up time of 36 months (interquartile range: 23, 52), we found unfavorable outcomes (evidenced by imaging or out-of-range serum tumor marker levels: high thyroglobulin [Tg] or rising Tg antibody [TgAb] levels) in 8/340 (2.35%) patients, all of which received RAI. PTMC patients with unfavorable outcomes were stratified as low risk (4/261 [1.53%]), intermediate risk (1/57 [1.75%]), or high risk (3/22 [13.64%]). One death occurred in a patient with initial distant metastasis in the high-risk group. Initial high-risk stratification and initial stimulated Tg (of at least 10 ng/mL) were demonstrated as independent predictors for PTMC unfavorable outcomes (persistent or recurrent disease). Five patients with unfavorable outcomes (four with persistent disease and one with recurrent disease) had abnormal Tg or TgAb values despite unremarkable imaging findings. Moreover, 79/124 (63.71%) patients in the non-RAI scenario were only followed up with neck ultrasound. CONCLUSIONS In general, at least 98% of low-risk and intermediate-risk PTMC patients showed favorable outcomes without persistent or recurrent disease, defined by either imaging or serum tumor markers. Nevertheless, aggressive disease could occur in few PTMC patients. Decisions on post-operative management and follow-up may be guided by initial high-risk stratification and initial stimulated Tg levels (≥10 ng/mL) as independent predictors for PTMC unfavorable outcomes. Monitoring using both imaging and serum tumor markers is crucial and should be implemented for patients with PTMC.
Collapse
Affiliation(s)
- Wasit Kanokwongnuwat
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Division of Nuclear Medicine, Department of Radiology, Prapokklao Hospital, Chanthaburi, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutintorn Sriphrapradang
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Chaiyawat Suppasilp
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanungnij Thamnirat
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninart Sakulpisuti
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Arpakorn Kositwattanarerk
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chirawat Utamakul
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chanika Sritara
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wichana Chamroonrat
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
9
|
Mohorea I, Terzea D, Mihalache D, Socea B, Şerban D, Ceausu M. Cytomorphological study of thyroid carcinoma. Exp Ther Med 2022; 23:117. [PMID: 34970340 PMCID: PMC8713177 DOI: 10.3892/etm.2021.11040] [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: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022] Open
Abstract
The most common neoplasm of the endocrine system is found in the thyroid gland with a significant increase in recent decades largely due to modern diagnostic methods. Thyroid tumors generally have a favorable evolution, but there are also aggressive variants with a poor prognosis. In these aggressive tumors, the most reliable method of detecting and making a differential diagnosis is represented by ultrasound-guided fine-needle cytopuncture, confirmed by histopathological examination. Although fine-needle aspiration puncture and cytological examination are considered to have a high sensitivity and specificity, diagnostic certainty is established later only by histopathological examination. Fine-needle aspiration cytopuncture of the thyroid gland correlated with histopathological examination has played a crucial role in recognizing and identifying variants of papillary carcinoma known to have aggressive biological behavior, especially in cases of poorly differentiated carcinoma. Recognition of aggressive variants of papillary carcinoma is of major importance in the prognosis and clinical management of patients. The aim of this study was to present the correlations found in a series of thyroid tumors from patients treated in surgery and oncology departments, as well as tumors accidentally detected during autopsies in the department of forensics. All the cases selected in the study benefited from a complex histopathological diagnosis adapted to each case in order to ensure maximum efficiency.
Collapse
Affiliation(s)
- Iuliana Mohorea
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Pathology, Braila Emergency County Hospital, 810325 Braila, Romania
| | - Dana Terzea
- Department of Pathology, 'C.I. Parhon' Clinical Hospital for Endocrine Diseases, 011863 Bucharest, Romania
| | - Daniela Mihalache
- Department of Pathology, Braila Emergency County Hospital, 810325 Braila, Romania.,Department of Pathology, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800008 Galati, Romania
| | - Bogdan Socea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Dragoş Şerban
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Mihai Ceausu
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
10
|
Lam AK. Histopathological Assessment for Papillary Thyroid Carcinoma. Methods Mol Biol 2022; 2534:93-108. [PMID: 35670970 DOI: 10.1007/978-1-0716-2505-7_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Histologic assessments of papillary thyroid carcinoma are crucial for management of patients with the cancer as well as research on the cancer as papillary thyroid carcinoma has different histologic subtypes and many parameters which are essential in predicting the biological aggressiveness of the cancer. The histologic assessments should be guided by universally adopted protocols including World Health Organization (WHO) classification of endocrine tumors, International Collaboration on Cancer Reporting (ICCR) dataset, American Thyroid Association initial risk stratification for differentiated thyroid carcinomas and TNM stage groupings. The essential steps in histologic assessment involve the identification of characteristic features of papillary thyroid carcinoma, correct histologic subtyping, noting the number of carcinomas, measuring the size of the carcinoma, documenting the different aggressive histological parameters (mitotic activity, presence of tumor encapsulation/circumscription, lymphatic vessel invasion, blood vessel invasion, necrosis, extrathyroidal extension), resection margin status, associated pathology, presence of parathyroid gland, lymph node and distant metastases as well as synthesis of pathological stage based on the various clinical, macroscopic, and histological features.
Collapse
Affiliation(s)
- Alfred K Lam
- Cancer Molecular Pathology of School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
- Pathology Queensland, Gold Coast University Hospital, Southport, QLD, Australia.
- Faculty of Medicine, University of Queensland, Herston, QLD, Australia.
| |
Collapse
|
11
|
Wang J, Sheng X, Dai Y, Zhang J, Song L, Guo Y. The Application Value of the Central Lymph Node Metastasis Risk Assessment Model in Papillary Thyroid Microcarcinoma of Stage cN0: A Study of 828 Patients. Front Endocrinol (Lausanne) 2022; 13:843573. [PMID: 35360071 PMCID: PMC8960455 DOI: 10.3389/fendo.2022.843573] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study is to build a risk assessment system for central lymph node metastasis (CLNM) in papillary thyroid microcarcinoma (PTMC) of stage cN0 and to explore its application value in clinical practice. METHODS A total of 500 patients with PTMC who underwent thyroid operation from 2013 to 2015 in Ningbo First Hospital were selected as the model group. Independent risk factors related to CLNM in PTMC were analyzed and determined, and a risk assessment system for CLNM was preliminarily established. Furthermore, the clinicopathological data from 328 PTMC patients with the same conditions as the model group from 2016 to 2017 were further collected as the validation group to verify the diagnostic value of the risk assessment system. RESULTS The risk assessment system was based on the score rating (score ≤ 5 was classified as low risk, 6-8 was classified as medium risk, and ≥9 was classified as high-risk). The area under the receiver operating characteristic curve (ROC) was 0.687 (95% CI: 0.635-0.783). According to the risk assessment system, 328 PTMC patients in the validation group were scored. Among the low-risk group, the moderate-risk group, and the high-group, 96.8%, 58.1%, and 43.2% were the CLNM (-) patients, and 3.1%, 41.9%, and 65.8% were CLNM (+) patients, respectively. The area under ROC was 0.837 (95% CI: 0.778-0.869). CONCLUSIONS The risk assessment system in this study is of diagnostic value and can provide a theoretical foundation for intraoperative decision-making of prophylactic central neck dissection (pCND).
Collapse
Affiliation(s)
- Jinqiu Wang
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
| | - Xianneng Sheng
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
| | - Yongping Dai
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
| | - Jiabo Zhang
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
| | - Lihua Song
- School of Medicine, Ningbo University, Ningbo, China
| | - Yu Guo
- Department of Thyroid and Breast Surgery, Ningbo First Hospital, Ningbo, China
- *Correspondence: Yu Guo,
| |
Collapse
|
12
|
The Overdiagnosis of Thyroid Micropapillary Carcinoma: The Rising Incidence, Inert Biological Behavior, and Countermeasures. JOURNAL OF ONCOLOGY 2021; 2021:5544232. [PMID: 34306078 PMCID: PMC8285179 DOI: 10.1155/2021/5544232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/01/2021] [Accepted: 06/27/2021] [Indexed: 12/24/2022]
Abstract
The incidence of papillary thyroid microcarcinoma (PTMC) has exponentially increased in the past three decades. The 2014 World Cancer Report stated that, among the new cases of thyroid carcinoma, >50% are PTMC. The incidence of thyroid cancer was growing by 20.1% annually in China. Most of PTMC have low risk and excellent prognoses. It must be realized that the problem of overdiagnosis of thyroid cancer is quite serious. In this article, we summarized the phenomenon and the cause of "overdiagnosis" of PTMC, the progress of clinical management, and the countermeasures.
Collapse
|
13
|
Mohorea IS, Socea B, Şerban D, Ceausu Z, Tulin A, Melinte V, Ceausu M. Incidence of thyroid carcinomas in an extended retrospective study of 526 autopsies. Exp Ther Med 2021; 21:607. [PMID: 33936264 PMCID: PMC8082578 DOI: 10.3892/etm.2021.10039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/12/2021] [Indexed: 12/17/2022] Open
Abstract
Thyroid cancer accounts for 1% of all malignancies, and is becoming increasingly common worldwide. The literature reports a prevalence of ~50% of thyroid nodules detected during autopsies in subjects with unknown thyroid pathology. An extended retrospective study of 526 autopsy cases was performed to identify the prevalence of thyroid carcinoma, among various types of thyroid nodules identified incidentally. Tissue samples were taken from thyroid nodules, for investigation of the presence of thyroid carcinoma, along with their macroscopic and microscopic features by means of histopathology and immunohistochemistry (IHC) methods. Histopathological diagnosis of malignancy was found in 51 cases of analyzed thyroid samples. Systematic detailed studies demonstrated that a thyroid gland, apparently normal on macroscopic examination, may be the site of pathological manifestations, sometimes presenting carcinomatous findings. Among thyroid carcinomas, the highest frequency was that of papillary microcarcinomas, which have a long evolution, and are incidentally detected during autopsies. Papillary microcarcinoma is an extremely common incidental finding and the vast majority of these tumors pursue a benign course. Furthermore, it is therefore necessary to create national screening programs for the early detection of thyroid carcinoma.
Collapse
Affiliation(s)
- Iuliana Sobaru Mohorea
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Pathology, Braila Emergency County Hospital, 810325 Braila, Romania
| | - Bogdan Socea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Dragoş Şerban
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Zenaida Ceausu
- Department of Pathology, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania
| | - Adrian Tulin
- Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Prof. Dr. Agrippa Ionescu' Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Violeta Melinte
- Department of Infectious Diseases, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Infectious Diseases, 'Victor Babeş' Clinical Hospital, 030303 Bucharest, Romania
| | - Mihai Ceausu
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
14
|
Secular Trends in Ablation Therapy for Graves' Disease: An Analysis of a 15-Year Experience at a Tertiary Hospital in South Korea. J Clin Med 2021; 10:jcm10081629. [PMID: 33921321 PMCID: PMC8069724 DOI: 10.3390/jcm10081629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 01/22/2023] Open
Abstract
Ablation therapy, such as radioactive iodine (RAI) therapy or thyroidectomy, is generally used as the second-line treatment for Graves' disease (GD) in Asia. This study investigated changes in the clinical characteristics and outcomes of ablation therapies for GD over 15 years. Patients who underwent ablation therapy between 2001 and 2015 at a single tertiary hospital were included. Among the 10,991 GD patients treated over this 15-year period, 1357 (12.3%) underwent ablation therapy, and the most common reason was intractable GD. The proportion of patients who underwent any type of ablation therapy significantly decreased from 9.0% (2001-2005) to 7.7% (2011-2015). However, the proportion of patients who underwent surgery significantly increased from 1.1% (2001-2005) to 2.4% (2011-2015), and the proportion of patients who received ablation therapy due to suspected thyroid cancer increased from 5% to 13% over time. With a median follow-up duration of 6.2 years, remission was achieved in 86% and 98% of patients in the RAI and surgery groups, respectively, and these rates remained stable over time. In conclusion, although the proportion of patients who underwent ablation therapy for GD decreased during 15 years, the proportion of those who underwent surgery increased in association with the increased rate of suspected thyroid cancers.
Collapse
|
15
|
Pitoia F, Smulever A. Active surveillance in low risk papillary thyroid carcinoma. World J Clin Oncol 2020; 11:320-336. [PMID: 32874948 PMCID: PMC7450818 DOI: 10.5306/wjco.v11.i6.320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/07/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
In recent decades, while the incidence of thyroid cancer has increased exponentially around the world, mortality has remained stable. The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas, which exhibit slow growth rates with indolent courses. A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis, as the majority of these tumors would not likely result in death if left untreated. Although surgical resection was the classical standard therapy for papillary microcarcinomas, active surveillance (AS) has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery. Despite the encouraging results of AS, its implementation in clinical practice is strongly influenced by psychosocial factors. The aim of this review is to describe the epidemiology, clinical evolution, prognostic factors, and mortality of papillary thyroid microcarcinomas. We also summarize the AS strategy according to published evidence, characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics, as well as analyze the current limitations for AS implementation.
Collapse
Affiliation(s)
- Fabian Pitoia
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires 1120, Argentina
| | - Anabella Smulever
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires 1120, Argentina
| |
Collapse
|
16
|
Pérez-Soto RH, Velázquez-Fernández D, Arellano-Gutiérrez G, Chapa-Ibargüengoitia M, Trolle-Silva AM, Iñiguez-Ariza N, Pérez-Enríquez B, Sierra-Salazar M, Pantoja Millán JP, Herrera MF. Preoperative and Postoperative Risk Stratification of Thyroid Papillary Microcarcinoma: A Comparative Study Between Kuma Criteria and 2015 American Thyroid Association Guidelines Risk Stratification. Thyroid 2020; 30:857-862. [PMID: 32031061 DOI: 10.1089/thy.2019.0698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: The incidence of micropapillary thyroid carcinoma (mPTC) has increased in the last decade. Active surveillance (AS) has been proposed as an alternative management for low-risk mPTC based on preoperative Kuma criteria. Controversy still exists on how to appropriately manage this group of patients, as some low-risk mPTC may harbor some postoperative features associated with disease recurrence as described in the 2015 American Thyroid Association (ATA) guidelines. Methods: We retrospectively reviewed 108 patients with histopathologic diagnosis of mPTC after surgery at a third level hospital in Mexico City from 2000 to 2018. Demographic and clinicopathologic data were analyzed as predictors for disease recurrence and/or metastatic disease (lymph node or distant). Comparison between group stratification based on preoperative Kuma criteria and postoperative 2015 ATA guidelines risk criteria for disease recurrence was performed. Measures of diagnostic accuracy were obtained for preoperative risk features according to the Kuma criteria. Results: Of 108 patients, 79 (73%) were classified as preoperative high-risk mPTC and 29 (27%) as low risk based on the Kuma criteria. Of these 79 high-risk patients, 38 (48%) were reclassified as low risk for disease recurrence, 12 (15%) as intermediate risk, and 29 (37%) remained as high risk based on the 2015 ATA risk criteria. Of the 29 preoperative low-risk patients, 19 (65.5%) remained as postoperative low risk for disease recurrence, 2 (7%) as intermediate risk, and 8 (27.5%) as high risk. Higher accuracy of preoperative risk features was obtained for lymph node and distant metastases, 84.2% and 97.2%, respectively. After multivariate analysis, age <40 years and microscopic extrathyroidal extension (ETE) were associated with higher risk for metastatic disease (lymph node or distant) in our cohort. Conclusions: Patients with mPTC under 40 years old and microscopic ETE are more prone to develop metastatic disease (lymph node or distant). One-third of our patients stratified as low-risk mPTC according to the Kuma criteria for AS had histopathologic features associated with a more aggressive clinical behavior or structural recurrence. In addition, lymph node and distant metastases are the preoperative risk features with the highest diagnostic accuracy for preoperative risk stratification.
Collapse
Affiliation(s)
- Rafael Humberto Pérez-Soto
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - David Velázquez-Fernández
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Gregorio Arellano-Gutiérrez
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Mónica Chapa-Ibargüengoitia
- Department of Radiology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Alicia Maybí Trolle-Silva
- Department of Anatomical Pathology, and National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Nicole Iñiguez-Ariza
- Department of Endocrinology and Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Bernardo Pérez-Enríquez
- Department of Endocrinology and Metabolism, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Mauricio Sierra-Salazar
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Juan Pablo Pantoja Millán
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Miguel F Herrera
- Endocrine and Advanced Laparoscopic Surgery Service, Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| |
Collapse
|
17
|
Genomic and Transcriptomic Characteristics According to Size of Papillary Thyroid Microcarcinoma. Cancers (Basel) 2020; 12:cancers12051345. [PMID: 32466217 PMCID: PMC7281223 DOI: 10.3390/cancers12051345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/22/2022] Open
Abstract
It is controversial as to whether papillary thyroid microcarcinoma (PTMC) has some genomic and transcriptomic characteristics that differentiate between an early-stage lesion that would eventually evolve into the larger papillary thyroid cancer (PTC), and an occult indolent cancer in itself. To investigate this, we comprehensively elucidated the genomic and transcriptomic landscapes of PTMCs of different sizes, using a large-scaled database. This study included 3435 PTCs, 1985 of which were PTMCs. We performed targeted next-generation sequencing for 221 PTCs and integrated these data with the data including The Cancer Genome Atlas (TCGA) project. The frequency of v-raf murine sarcoma viral oncogene homolog B (BRAF)V600E mutation was higher in PTMCs >0.5 cm than that in very small PTMCs (≤0.5 cm) and decreased again in PTCs >2 cm. Among PTMCs, the prevalence of mutations in rat sarcoma (RAS) and telomerase reverse transcriptase (TERT) promoter was not significantly different according to their size, but lower than in large PTCs. There was no change in the tumor mutational burden, the number of driver mutations, and transcriptomic profiles with tumor size, among PTMCs and all PTCs. Although a few genes with differential expression and TERT promoter mutations were found in a few PTMCs, our findings showed that there were no useful genomic or transcriptomic characteristics for the prediction of the future progression of PTMC.
Collapse
|
18
|
Krajewska J, Kukulska A, Oczko-Wojciechowska M, Kotecka-Blicharz A, Drosik-Rutowicz K, Haras-Gil M, Jarzab B, Handkiewicz-Junak D. Early Diagnosis of Low-Risk Papillary Thyroid Cancer Results Rather in Overtreatment Than a Better Survival. Front Endocrinol (Lausanne) 2020; 11:571421. [PMID: 33123090 PMCID: PMC7573306 DOI: 10.3389/fendo.2020.571421] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022] Open
Abstract
We are witnessing a rapid worldwide increase in the incidence of papillary thyroid carcinoma (PTC) in the last thirty years. Extensive implementation of cancer screening and wide availability of neck ultrasound or other imaging studies is the main reason responsible for this phenomenon. It resulted in a detection of a growing number of clinically asymptomatic PTCs, mainly low-risk tumors, without any beneficial impact on survival. An indolent nature of low-risk PTC, particularly papillary thyroid microcarcinoma (PTMC), and the excellent outcomes raise an ongoing discussion regarding the adequacy of treatment applied. The question of whether PTMC is overtreated or not is currently completed by another, whether PTMC requires any treatment. Current ATA guidelines propose less extensive preoperative diagnostics and, if differentiated thyroid cancer is diagnosed, less aggressive surgical approach and limit indications for postoperative radioiodine therapy. However, in intrathyroidal PTMCs in the absence of lymph node or distant metastases, active surveillance may constitute alternative management with a low progression rate of 1%-5% and without any increase in the risk of poorer outcomes related to delayed surgery in patients, in whom it was necessary. This review summarizes the current knowledge and future perspectives of active surveillance in low-risk PTC.
Collapse
Affiliation(s)
- Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
- *Correspondence: Jolanta Krajewska,
| | - Aleksandra Kukulska
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
- Radiotherapy Department, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Malgorzata Oczko-Wojciechowska
- Department of Genetic and Molecular Diagnostics of Cancer, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Agnieszka Kotecka-Blicharz
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Katarzyna Drosik-Rutowicz
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
- Radiotherapy Department, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Malgorzata Haras-Gil
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| |
Collapse
|
19
|
Zou L, Gao Z, Zeng F, Xiao J, Chen J, Feng X, Chen D, Fang Y, Cui J, Liu Y, Li Z, Zhu F, Duan Q, Lin X. Sulfasalazine suppresses thyroid cancer cell proliferation and metastasis through T-cell originated protein kinase. Oncol Lett 2019; 18:3517-3526. [PMID: 31516569 PMCID: PMC6732979 DOI: 10.3892/ol.2019.10721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 06/25/2019] [Indexed: 12/13/2022] Open
Abstract
Thyroid cancer patients with radioactive iodine-refractory or rapidly progressing presentation require effective treatment. T-cell originated protein kinase (TOPK) is highly expressed in a number of different tumor types, where it promotes proliferation and metastasis. However, the expression of TOPK in thyroid cancer is poorly documented. Therefore, immunohistochemistry was used to detect the expression of TOPK in thyroid cancer tissues, and its clinical significance in this disease was investigated. Sulfasalazine, a targeted inhibitor of TOPK that directly binds the protein with a dissociation constant (Kd) of 228 µM, was also investigated using microscale thermophoresis. Sulfasalazine inhibited TOPK activity, as determined by an in vitro pull-down assay. Furthermore, sulfasalazine inhibited the proliferation and metastasis of thyroid cancer cells. The results indicated that TOPK may be a potential therapeutic target and diagnostic biomarker for thyroid cancer and may be used as an index to evaluate malignant thyroid nodules. Therefore, sulfasalazine is a potential novel compound for the targeted treatment of thyroid cancer.
Collapse
Affiliation(s)
- Ling Zou
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China.,Department of Biochemistry and Molecular Biology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zhi Gao
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China
| | - Fanfan Zeng
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Juanjuan Xiao
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Junmei Chen
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China
| | - Xiaohong Feng
- Health and Family Planning Committee of Qingshan, Wuhan, Hubei 430080, P.R. China
| | - Di Chen
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China
| | - Ying Fang
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China
| | - Jing Cui
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China
| | - Yang Liu
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China
| | - Zhi Li
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China
| | - Feng Zhu
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Qiuhong Duan
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xuan Lin
- Department of Internal Medicine, CR and WISCO General Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430080, P.R. China
| |
Collapse
|
20
|
Active surveillance for prostate and thyroid cancers: evolution in clinical paradigms and lessons learned. Nat Rev Clin Oncol 2019; 16:168-184. [PMID: 30413793 DOI: 10.1038/s41571-018-0116-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The adverse effects of overdiagnosis and overtreatment observed in men with clinically insignificant prostate cancers after the introduction of prostate-specific antigen-based screening are now being observed in those with thyroid cancer, owing to the introduction of new imaging technologies. Thus, the evolving paradigm of active surveillance in prostate and thyroid cancers might be valuable in informing the development of future active surveillance protocols. The lessons learned from active surveillance and their implications include the need to minimize the use of broad, population-based screening programmes that do not incorporate patient education and the need for individualized or shared decision-making, which can decrease the extent of overtreatment. Furthermore, from the experience in patients with prostate cancer, we have learned that consensus is required regarding the optimal selection of patients for active surveillance, using more-specific evidence-based methods for stratifying patients by risk. In this Review, we describe the epidemiology, pathology and screening guidelines for the management of patients with prostate and thyroid cancers; the evidence of overdiagnosis and overtreatment; and provide overviews of existing international active surveillance protocols.
Collapse
|
21
|
Ben Hamou A, Espiard S, Do Cao C, Ladsous M, Loyer C, Moerman A, Boury S, Kyheng M, Dhaenens CM, Tiffreau V, Pigny P, Lebuffe G, Caiazzo R, Aubert S, Vantyghem MC. Systematic thyroid screening in myotonic dystrophy: link between thyroid volume and insulin resistance. Orphanet J Rare Dis 2019; 14:42. [PMID: 30760283 PMCID: PMC6375124 DOI: 10.1186/s13023-019-1019-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/03/2019] [Indexed: 12/19/2022] Open
Abstract
Background Myotonic dystrophy (DM1), a neuromuscular disease related to DMPK gene mutations, is associated to endocrine disorders and cancer. A routine endocrine work-up, including thyroid ultrasound (US), was conducted in 115 genetically-proven DM1 patients in a neuromuscular reference center. The aim of this study was to determine the prevalence and the causes of US thyroid abnormalities in DM1. Results In the whole population (age 45.1 ± 12.2 years, 61.7% female), palpable nodules or goiters were present in 29.2%. The percentage of US goiter (thyroid volume > 18 mL) and US nodules were, respectively, 38.3 and 60.9%. Sixteen of the 115 patients had a thyroidectomy, after 22 fine-needle aspiration cytology guided by thyroid imaging reporting and data system (TIRADS) classification. Six micro- (1/6 pT3) and 3 macro-papillary thyroid carcinoma (PTCs) (2/3 intermediate risk) were diagnosed (7.9% of 115). Thyroid US led to the diagnosis of 4 multifocal and 2 unifocal (including 1 macro-PTC) non-palpable PTCs. Ultrasound thyroid volume was positively correlated to body mass index (BMI) (p = 0.015) and parity (p = 0.036), and was inversely correlated to TSH (p < 0.001) and vitamin D levels (p = 0.023). The BMI, the frequencies of glucose intolerance and PTC were significantly higher in UsGoiter versus non-UsGoiter groups. Conclusion In this systematically screened DM1 cohort, the frequency of UsGoiter, mainly associated to BMI, was about 40%, US nodules 60%, thyroidectomies 13–14%, and PTCs 8%, two-thirds of them being micro-PTCs with good prognosis. Therefore, a systematic screening remains debatable. A targeted US screening in case of clinical abnormality or high BMI seems more appropriate. Electronic supplementary material The online version of this article (10.1186/s13023-019-1019-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Adrien Ben Hamou
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000, Lille, France. .,Department of Endocrinology, Diabetology and Metabolism, CHR-U Lille, 1, Rue Polonovski, 59037, Lille, France.
| | - Stéphanie Espiard
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000, Lille, France
| | - Christine Do Cao
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000, Lille, France
| | - Miriam Ladsous
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000, Lille, France
| | - Camille Loyer
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000, Lille, France
| | | | | | - Maéva Kyheng
- CHU Lille, EA 2694 - Public Health, Epidemiology and Quality of Care, F-59000, Lille, France
| | - Claire-Marie Dhaenens
- Univ Lille, Inserm, CHU Lille, UMR 837-1, Alzheimer & Tauopathies, F-59000, Lille, France
| | - Vincent Tiffreau
- CHU Lille Neuromuscular Reference Center, F-59000, Lille, France
| | - Pascal Pigny
- CHU Lille, Institute of Biochemistry and Molecular Biology - Biology Center, F-59000, Lille, France
| | | | - Robert Caiazzo
- CHU Lille, General and Endocrine Surgery, F-59000, Lille, France.,Univ Lille, Inserm, CHU Lille, UMR 1190 Translational Research in Diabetes, F-59000, Lille, France.,EGID European Genomics Institute for Diabetes, CHU Lille, F-59000, Lille, France
| | - Sébastien Aubert
- CHU Lille, Institute of Biochemistry and Molecular Biology - Pathology Center, F-59000, Lille, France
| | - Marie Christine Vantyghem
- CHU Lille, Endocrinology, Diabetology and Metabolism, F-59000, Lille, France. .,CHU Lille Neuromuscular Reference Center, F-59000, Lille, France. .,Univ Lille, Inserm, CHU Lille, UMR 1190 Translational Research in Diabetes, F-59000, Lille, France. .,EGID European Genomics Institute for Diabetes, CHU Lille, F-59000, Lille, France. .,Department of Endocrinology, Diabetology and Metabolism, CHR-U Lille, 1, Rue Polonovski, 59037, Lille, France.
| |
Collapse
|
22
|
Symonds CJ, Seal P, Ghaznavi S, Cheung WY, Paschke R. Thyroid nodule ultrasound reports in routine clinical practice provide insufficient information to estimate risk of malignancy. Endocrine 2018; 61:303-307. [PMID: 29802606 DOI: 10.1007/s12020-018-1634-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/10/2018] [Indexed: 01/25/2023]
Abstract
PURPOSE Ultrasonographic characteristics of thyroid nodules play an important role in estimating the risk of malignancy (ROM). Guidelines mandate all thyroid nodules be characterized by six key ultrasonographic features to estimate the ROM. Our objective was to evaluate how frequently these characteristics were identified by radiologists and the ensuing utility to estimate ROM. METHODS We retrospectively reviewed 1930 consecutive diagnostic thyroid ultrasound reports from a large community radiology practice. A total of 1339 individual patients were found to have one or more thyroid nodules. Each report was analyzed for six key ultrasonographic features. A utility score (UtS) was calculated (range 0-6) with a single point given for a comment on each feature. RESULTS Of the 1339 patients, 75% of the studies reported more than one nodule (mean number of nodules = 3.4). Mean maximal diameter of the largest nodule per patient = 1.8 cm. The mean UtS was 2.57. Nodule size did not influence the UtS.: Nodule <1 cm (UtS: 2.53), 1-2 cm (UtS: 2.68) and >2 cm (UtS: 2.49). We believe a UtS of four or greater is needed to confidently estimate ROM: we found this in 13.7% of reports. CONCLUSIONS Our retrospective analysis of a large number of consecutive thyroid ultrasound reports in routine clinical practice suggests that the vast majority provide insufficient information to allow the clinician to risk stratify the nodules by estimating the ROM. This could lead to both over-diagnosis and over-treatment of benign/indolent thyroid lesions or under-diagnosis of clinically important thyroid cancers.
Collapse
Affiliation(s)
- Christopher John Symonds
- Section of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Paula Seal
- Department of Diagnostic Imaging, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sana Ghaznavi
- Section of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Winson Y Cheung
- Section of Medical Oncology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ralf Paschke
- Section of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
23
|
Domínguez JM, Nilo F, Martínez MT, Massardo JM, Muñoz S, Contreras T, Carmona R, Jerez J, González H, Droppelmann N, León A. Papillary thyroid microcarcinoma: characteristics at presentation, and evaluation of clinical and histological features associated with a worse prognosis in a Latin American cohort. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2018; 62:6-13. [PMID: 29694628 PMCID: PMC10118695 DOI: 10.20945/2359-3997000000013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
Objective We aimed to describe the presentation of papillary microcarcinoma (PTMC) and identify the clinical and histological features associated with persistence/recurrence in a Latin American cohort. Subjects and methods Retrospective study of PTMC patients who underwent total thyroidectomy, with or without radioactive iodine (RAI), and who were followed for at least 2 years. Risk of recurrence was estimated with ATA 2009 and 2015 classifications, and risk of mortality with 7th and 8th AJCC/TNM systems. Clinical data obtained during follow-up were used to detect structural and biochemical persistence/recurrence. Results We included 209 patients, predominantly female (90%), 44.5 ± 12.6 years old, 183 (88%) received RAI (90.4 ± 44.2 mCi), followed-up for a median of 4.4 years (range 2.0-7.8). The 7th and 8th AJCC/TNM system classified 89% and 95.2% of the patients as stage I, respectively. ATA 2009 and ATA 2015 classified 70.8% and 78.5% of the patients as low risk, respectively. Fifteen (7%) patients had persistence/recurrence during follow-up. In multivariate analysis, only lymph node metastasis was associated with persistence/recurrence (coefficient beta 4.0, p = 0.016; 95% CI 1.3-12.9). There were no PTMC related deaths. Conclusions Our series found no mortality and low rate of persistence/recurrence associated with PTMC. Lymph node metastasis was the only feature associated with recurrence in multivariate analysis. The updated ATA 2015 and 8th AJCC/TNM systems classified more PTMCs than previous classifications as low risk of recurrence and mortality, respectively.
Collapse
Affiliation(s)
- José M Domínguez
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Flavia Nilo
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María T Martínez
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José M Massardo
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sueli Muñoz
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tania Contreras
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rocío Carmona
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joaquín Jerez
- Department of Endocrinology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hernán González
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicolás Droppelmann
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Augusto León
- Department of Surgery, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
24
|
Raue F, Frank-Raue K. Thyroid Cancer: Risk-Stratified Management and Individualized Therapy. Clin Cancer Res 2018; 22:5012-5021. [PMID: 27742787 DOI: 10.1158/1078-0432.ccr-16-0484] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022]
Abstract
Thyroid cancer is the most common endocrine malignancy. Differentiated thyroid cancer (DTC) with the two subtypes, papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC), is the most frequent subtype of thyroid cancer; more rare subtypes are medullary thyroid cancer (MTC) and anaplastic thyroid cancer (ATC). The incidence of DTC has increased rapidly in recent years due to the more frequent use of imaging methods such as ultrasound of the neck and fine-needle aspiration (FNA) of thyroid nodules. After total thyroidectomy and radioiodine treatment, DTC remains an indolent and curable disease in most patients, whereas the cure rate in MTC is lower and depends on early diagnosis. Most ATCs are incurable. In recent years, there has been great progress in identifying genetic changes in thyroid cancer, and genetic testing of FNA samples or blood samples provides useful information for clinical decision making. Tumor staging, either postoperatively or by imaging, and measuring the tumor markers thyroglobulin for DTC and calcitonin for MTC, allow for dynamic risk-adapted stratification for follow-up procedures. In advanced metastatic thyroid cancer, molecular targeted therapy using tyrosine kinase receptor inhibitors, including sorafenib, lenvantinib, vandetanib, and cabozantinib, helps control tumor progression and prolongs progression-free survival. Using a dynamic risk-stratified approach to manage thyroid cancer, the outcomes for most thyroid cancer patients are excellent compared with those for other cancers. The major challenge in the future is to identify high-risk patients and to treat and monitor them appropriately. Clin Cancer Res; 22(20); 5012-21. ©2016 AACR SEE ALL ARTICLES IN THIS CCR FOCUS SECTION, "ENDOCRINE CANCERS REVISING PARADIGMS".
Collapse
Affiliation(s)
- Friedhelm Raue
- Molecular Laboratory, Endocrine Practice, Heidelberg, Germany.
| | | |
Collapse
|
25
|
González Bóssolo A, Garcia MM, González PJ, Garcia M, Villarmarzo G, Martinez JH. A new paradigm in low-risk papillary microcarcinoma: active surveillance. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170065. [PMID: 28924477 PMCID: PMC5592700 DOI: 10.1530/edm-17-0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 01/27/2023] Open
Abstract
Classical papillary thyroid microcarcinoma (PTMC) is a variant of papillary thyroid carcinoma (PTC) known to have excellent prognosis. It has a mortality of 0.3%, even in the presence of distance metastasis. The latest American Thyroid Association guidelines state that although lobectomy is acceptable, active surveillance can be considered in the appropriate setting. We present the case of a 37-year-old female with a history of PTMC who underwent surgical management consisting of a total thyroidectomy. Although she has remained disease-free, her quality of life has been greatly affected by the sequelae of this procedure. This case serves as an excellent example of how first-line surgical treatment may result more harmful than the disease itself.
Collapse
Affiliation(s)
| | | | - Paula Jeffs González
- Endocrinology, Diabetes and Metabolism, San Juan City Hospital, Hato Rey Pathologies, San Juan, Puerto Rico
| | | | - Guillermo Villarmarzo
- Endocrinology, Diabetes and Metabolism, San Juan City Hospital, Hato Rey Pathologies, San Juan, Puerto Rico
| | | |
Collapse
|
26
|
Hu J, Li C, Liu C, Zhao S, Wang Y, Fu Z. Expressions of miRNAs in papillary thyroid carcinoma and their associations with the clinical characteristics of PTC. Cancer Biomark 2017; 18:87-94. [PMID: 28085013 DOI: 10.3233/cbm-161723] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The sensitivity and specificity of biomarkers which have been used in clinical practice for diagnosis of papillary thyroid carcinoma (PTC) are low, it is essential to develop novel diagnostic and prognostic biomarkers for PTC. OBJECTIVE To explore the expressions of miR-940, miR-15a, miR-16 and IL-23 in PTC tissues and plasma and their associations with the clinical characteristics of PTC. METHODS We investigated the expressions of miR-940, miR-15a, miR-16 and IL-23 in plasma and thyroid tissues of PTC, nodular goiter and healthy people with qRT-PCR, and further analyzed the associations between their levels and the clinical characteristics of PTC. RESULTS Level of IL-23 expression was higher while levels of miR-940, miR-15a and miR-16 expression in the PTC tissues were lower compared with the nodular goiter tissues and perineoplastic thyroid tissues. And the levels of miR-940, miR-15a, miR-16 and IL-23 expression in the PTC tissues were associated with some clinical characteristics of PTC, including bilateral tumor, multicentricity, extrallyroidal invasion, cervical lymph node metastasis, distant metastasis and clinical advanced stages (III/IV). CONCLUSIONS Expressions of miR-940, miR-15a, miR-16 and IL-23 in PTC tissues might be useful biomarkers and promising targets in the diagnosis of papillary thyroid carcinoma.
Collapse
Affiliation(s)
- Jianxia Hu
- The Laboratory of Thyroid Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,The Laboratory of Thyroid Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chengqian Li
- Endocrinology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,The Laboratory of Thyroid Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chongkai Liu
- Department of Urology, The People's Hospital of Jimo, Qingdao, Shandong, China
| | - Shihua Zhao
- The Laboratory of Thyroid Disease, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yangang Wang
- Endocrinology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhengju Fu
- Endocrinology Department, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| |
Collapse
|
27
|
Leboulleux S, Tuttle RM, Pacini F, Schlumberger M. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol 2016; 4:933-942. [PMID: 27550849 DOI: 10.1016/s2213-8587(16)30180-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/01/2016] [Accepted: 07/05/2016] [Indexed: 02/08/2023]
Abstract
The incidence of differentiated thyroid cancer is increasing greatly in high-income countries. Roughly 50% of this increase is attributable to the identification of intrathyroidal papillary thyroid microcarcinomas. Since mortality associated with these tumours remains low and stable, the increasing diagnosis has led to concerns about overdiagnosis and overtreatment. Management of papillary thyroid microcarcinomas should take into account the reported absence of mortality when diagnosed in the absence of lymph node metastases and distant metastases, as shown even in recent studies promoting active surveillance; a low recurrence rate of 1-5%; and the risk of permanent complications from surgery that cannot be decreased to less than 1-3%, even in high-volume tertiary care centres with experienced surgeons. On the basis of these data, active surveillance with curative intent, in which active treatment is delayed until the cancer shows signs of significant progression to avoid side-effects of treatment, should be considered in properly selected patients.
Collapse
Affiliation(s)
- Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France.
| | - R Michael Tuttle
- Endocrinology Service, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY, USA
| | - Furio Pacini
- Section of Endocrinology, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France
| |
Collapse
|
28
|
Vaccarella S, Dal Maso L, Laversanne M, Bray F, Plummer M, Franceschi S. The Impact of Diagnostic Changes on the Rise in Thyroid Cancer Incidence: A Population-Based Study in Selected High-Resource Countries. Thyroid 2015; 25:1127-36. [PMID: 26133012 DOI: 10.1089/thy.2015.0116] [Citation(s) in RCA: 218] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Thyroid cancer (TC) incidence is rising in many countries, but the corresponding mortality is constant or declining. Incidence increases appear largely restricted to small papillary TC in young/middle-age individuals. We compared age-specific incidence rates across countries and time periods in order to estimate the fraction of TC possibly attributable to increased surveillance of the thyroid gland (diagnostic changes) following the introduction of neck ultrasonography in the 1980s. METHODS We focused on high-resource countries, including four Nordic countries, England and Scotland, France, Italy, the United States, Australia, Japan, and the Republic of Korea. Before the 1970s, TC incidence in Nordic countries increased proportionally to the second power of age, consistent with the multistage model of carcinogenesis. Using this historical observation for reference, we attributed the progressive departure from linearity of the age curves in each country to an increased detection of asymptomatic disease in young/middle-age individuals. The proportion of cases attributable to diagnostic changes was estimated from the difference between observed rates and those expected using the Nordic countries as reference. RESULTS Diagnostic changes may account for ≥60% of TC cases diagnosed in 2003-2007 in women aged under 80 years in France, Italy, the United States, Australia, and the Republic of Korea, and approximately 50% in other assessed countries, except Japan (30%). The proportions attributable to diagnostic changes were higher in countries with largest incidence increases and were consistent across sexes, although increases were smaller and delayed in men. CONCLUSIONS A large proportion of TC cases diagnosed in high-resource countries in the last two decades are likely to be due to diagnostic changes. This proportion has progressively increased over time, and it is likely to grow further in the future. Since there is evidence of harm but no proof of benefit from the intense scrutiny of the thyroid, the dangers of overdiagnosis and overtreatment of TC should be urgently addressed.
Collapse
Affiliation(s)
| | - Luigino Dal Maso
- 2 Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | | | - Freddie Bray
- 1 International Agency for Research on Cancer , Lyon, France
| | - Martyn Plummer
- 1 International Agency for Research on Cancer , Lyon, France
| | | |
Collapse
|
29
|
Tallini G, de Biase D, Durante C, Acquaviva G, Bisceglia M, Bruno R, Bacchi Reggiani ML, Casadei GP, Costante G, Cremonini N, Lamartina L, Meringolo D, Nardi F, Pession A, Rhoden KJ, Ronga G, Torlontano M, Verrienti A, Visani M, Filetti S. BRAF V600E and risk stratification of thyroid microcarcinoma: a multicenter pathological and clinical study. Mod Pathol 2015; 28:1343-59. [PMID: 26271724 DOI: 10.1038/modpathol.2015.92] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 02/08/2023]
Abstract
Studies from single institutions have analyzed BRAF in papillary microcarcinomas, sometimes with contradictory results. Most of them have provided limited integration of histological and clinical data. To obtain a comprehensive picture of BRAF V600E-mutated microcarcinomas and to evaluate the role of BRAF testing in risk stratification we performed a retrospective multicenter analysis integrating microscopical, pathological, and clinical information. Three hundred and sixty-five samples from 300 patients treated at six medical institutions covering different geographical regions of Italy were analyzed with central review of all cases. BRAF V600E statistical analysis was conducted on 298 microcarcinomas from 264 patients after exclusion of those that did not meet the required criteria. BRAF V600E was identified in 145/298 tumors (49%) including the following subtypes: 35/37 (95%, P<0.0001) tall cell and 72/114 (64%, P<0.0001) classic; conversely 94/129 follicular variant papillary microcarcinomas (73%, P<0.0001) were BRAF wild type. BRAF V600E-mutated microcarcinomas were characterized by markedly infiltrative contours (P<0.0001) with elongated strings of neoplastic cells departing from the tumor, and by intraglandular tumor spread (P<0.0001), typically within 5 mm of the tumor border. Multivariate analysis correlated BRAF V600E with specific microscopic features (nuclear grooves, optically clear nuclei, tall cells within the tumor, and tumor fibrosis), aggressive growth pattern (infiltrative tumor border, extension into extrathyroidal tissues, and intraglandular tumor spread), higher American Thyroid Association recurrence risk group, and non-incidental tumor discovery. The following showed the strongest link to BRAF V600E: tall cell subtype, many neoplastic cells with nuclear grooves or with optically clear nuclei, infiltrative growth, intraglandular tumor spread, and a tumor discovery that was non-incidental. BRAF V600E-mutated microcarcinomas represent a distinct biological subtype. The mutation is associated with conventional clinico-pathological features considered to be adverse prognostic factors for papillary microcarcinoma, for which it could be regarded as a surrogate marker. BRAF analysis may be useful to identify tumors (BRAF wild type) that have negligible clinical risk.
Collapse
Affiliation(s)
- Giovanni Tallini
- Department of Medicine (DIMES), Anatomic Pathology Unit, Bellaria Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Dario de Biase
- Department of Medicine (DIMES), Anatomic Pathology Unit, Bellaria Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Cosimo Durante
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| | - Giorgia Acquaviva
- Department of Medicine (DIMES), Anatomic Pathology Unit, Bellaria Hospital, University of Bologna School of Medicine, Bologna, Italy
| | - Michele Bisceglia
- Anatomic Pathology Unit, School of Biomedical Sciences, Etromapmacs Pole, Lesina, Italy
| | - Rocco Bruno
- Endocrinology Unit, Tinchi-Pisticci Hospital, Matera, Italy
| | | | | | - Giuseppe Costante
- Department of Health Science, University Magna Grecia di Catanzaro, Catanzaro, Italy
| | - Nadia Cremonini
- Endocrinology Unit, AUSL Bologna-Maggiore Hospital, Bologna, Italy
| | - Livia Lamartina
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| | | | - Francesco Nardi
- Department of Experimental Medicine, Anatomic Pathology Unit, University 'Sapienza', Rome, Italy
| | - Annalisa Pession
- Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - Kerry J Rhoden
- Department of Medicine (DIMEC), Medical Genetics Unit, University of Bologna, Bologna, Italy
| | - Giuseppe Ronga
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| | - Massimo Torlontano
- Department of Medical Science, Ospedale Casa Sollievo della Sofferenza-IRCCS, San Giovanni Rotondo, Italy
| | - Antonella Verrienti
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| | - Michela Visani
- Department of Pharmacology and Biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | - Sebastiano Filetti
- Department of Internal Medicine and Medical Specialties, University 'Sapienza', Rome, Italy
| |
Collapse
|
30
|
Durr-e-Sabih, Rahim K. Thyroid Nodule Imaging, Status and Limitations. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2015; 3:50-7. [PMID: 27408881 PMCID: PMC4937690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Durr-e-Sabih
- Multan Institute of Nuclear Medicine and Radiotherapy, Multan, Pakistan,*Corresponding author: Durr-e-Sabih, Multan Institute of Nuclear Medicine and Radiotherapy, Multan, Pakistan. E-mail:
| | - Kashif Rahim
- Multan Institute of Nuclear Medicine and Radiotherapy, Multan, Pakistan
| |
Collapse
|
31
|
Zevallos JP, Hartman CM, Kramer JR, Sturgis EM, Chiao EY. Increased thyroid cancer incidence corresponds to increased use of thyroid ultrasound and fine-needle aspiration: a study of the Veterans Affairs health care system. Cancer 2014; 121:741-6. [PMID: 25376872 DOI: 10.1002/cncr.29122] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Thyroid cancer incidence has increased in the last several decades and may represent either a true increase in the number of cases or increased screening. The objective of this study was to examine thyroid cancer incidence and the use of thyroid ultrasound and fine-needle aspiration (FNA) screening in the Veterans Affairs (VA) health care system. The authors hypothesized that the incidence of thyroid cancer would correspond to increases in the use of these diagnostic modalities. METHODS This was a multiyear, cross-sectional study using VA administrative data from 2000 to 2012. Joinpoint regression analysis was used to identify trends in thyroid cancer incidence and the use of thyroid ultrasound and FNA. RESULTS An increase in thyroid cancer incidence occurred from 10.3 per 100,000 individuals in 2000 to 21.5 per 100,000 individuals in 2012. The rate of thyroid ultrasound use increased from 125.6 per 100,000 individuals in 2001 to 572.1 per 100,000 individuals in 2012, and the rate of thyroid FNA use increased from 7.0 per 100,000 individuals in 2000 to 46.2 per 100,000 individuals in 2012. A statistically significant increase in thyroid cancer incidence between 2000 and 2008 (annual percent change [APC], 3.81; P < .05) was followed by a more pronounced increase between 2008 and 2012 (APC, 10.32; P < .05). A simultaneous increase in the use of thyroid ultrasound occurred between 2002 and 2012 (APC, 15.48; P < .05) and the use of thyroid FNA between 2000 and 2012 (APC, 18.36; P < .05). CONCLUSIONS Although the incidence of thyroid cancer doubled, a nearly 5-fold increase in the use of thyroid ultrasound and a nearly 7-fold increase in the use of thyroid FNA occurred between 2000 and 2012. These findings suggest that the increase in thyroid cancer incidence may be related to increases in the use of thyroid ultrasound and FNA.
Collapse
Affiliation(s)
- Jose P Zevallos
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | | |
Collapse
|