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Scappaticcio L, Di Martino N, Caruso P, Ferrazzano P, Marino FZ, Clery E, Cioce A, Cozzolino G, Maiorino MI, Docimo G, Trimboli P, Franco R, Esposito K, Bellastella G. The value of ACR, European, Korean, and ATA ultrasound risk stratification systems combined with RAS mutations for detecting thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules. Hormones (Athens) 2024:10.1007/s42000-024-00573-8. [PMID: 38884926 DOI: 10.1007/s42000-024-00573-8] [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: 03/02/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic value of four commonly utilized ultrasound (US) RSSs, namely, the American College of Radiology [ACR], European [EU], Korean [K] TI-RADSs and American Thyroid Association [ATA] US-based RSS criteria, in combination with activating point mutations of the RAS genes (NRAS, HRAS, and KRAS) for detection of thyroid carcinoma in cytologically indeterminate and suspicious for malignancy thyroid nodules. METHODS We retrospectively analyzed cytologically indeterminate and suspicious for malignancy thyroid nodules which underwent US, molecular testing and surgery between September 1, 2018, and December 31, 2023. Receiver operating characteristic (ROC) curves were generated, and the area under the curve (AUC, 95% confidence interval [CI]) was calculated. RESULTS A total of 100 cytologically indeterminate and 24 suspicious for malignancy thyroid nodules were analyzed. Compared to the four US-based RSSs alone, the diagnostic value of the four US-based RSSs combined with RAS mutations did not significantly improved (cytologically indeterminate, AUC [95% CI] 0.6 [0.5-0.7] and 0.6 [0.5-0.7], respectively, p = 0.70; cytologically suspicious for malignancy, AUC [95% CI] 0.7 [0.5-0.9] and 0.8 [0.6-0.9], respectively, p = 0.23). CONCLUSIONS The diagnostic value of the four main US-based RSSs (ACR, EU, K, and ATA) was not improved in conjunction with the evaluation of RAS mutations for preoperative risk stratification of cytologically indeterminate thyroid nodules. CLINICAL RELEVANCE STATEMENT In cytologically indeterminate nodules categorized according to US-based RSSs, isolated RAS positivity does not reliably distinguish between benignity and malignancy.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicole Di Martino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Caruso
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy.
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Pamela Ferrazzano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Eduardo Clery
- Pathology Unit, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Cioce
- Pathology Unit, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Cozzolino
- Unit of Thyroid Surgery, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
- Unit of Thyroid Surgery, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pierpaolo Trimboli
- Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Renato Franco
- Pathology Unit, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, 80138, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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Bryant D, Barberan-Martin S, Maeshima R, Torres IDV, Rabii M, Baird W, Sauvadet A, Demetriou C, Jones P, Knöpfel N, Michailidis F, Riachi M, Bennett DC, Zecchin D, Pittman A, Polubothu S, Hart S, Kinsler VA. RNA therapy for oncogenic NRAS-driven naevi induces apoptosis. J Invest Dermatol 2024:S0022-202X(24)00449-4. [PMID: 38897541 DOI: 10.1016/j.jid.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 06/21/2024]
Abstract
RAS proteins regulate cell division, differentiation and apoptosis via multiple downstream effector pathways. Oncogenic RAS variants are the commonest drivers in cancers, however they also drive many benign lesions predisposing to malignancy, such as melanocytic naevi, thyroid nodules, and colonic polyps. Reversal of these benign lesions could reduce cancer incidence, however the effects of oncogenic RAS have been notoriously difficult to target with downstream pathway inhibitors. Here we show effective suppression of oncogenic and currently undruggable NRASQ61K in primary cells from melanocytic naevi using siRNA targeted to the recurrent causal variant. This results in striking reduction in expression of ARL6IP1, a known inhibitor of endoplasmic reticulum stress-induced apoptosis not previously linked to NRAS. We go on to show that a single dose of siRNA in primary cells triggers an apoptotic cascade, in contrast to treatment with a MEK inhibitor. Protective packaging of the targeted siRNA into lipid nanoparticles permits successful delivery into a humanised mouse model of melanocytic naevi, and results in variant NRAS knockdown in vivo. These data show that RAS-induced protection from apoptosis is involved in persistence of NRAS-driven melanocytic naevi and anticipate that targeted siRNA could form the basis of clinical trials for RAS-driven benign tumours.
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Affiliation(s)
- Dale Bryant
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Sara Barberan-Martin
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Ruhina Maeshima
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Ignacio Del Valle Torres
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Mohammad Rabii
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - William Baird
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Aimie Sauvadet
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | | | - Phoebe Jones
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Nicole Knöpfel
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - Fanourios Michailidis
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Melissa Riachi
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | | | - Davide Zecchin
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | | | - Satyamaanasa Polubothu
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - Stephen Hart
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Veronica A Kinsler
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK.
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3
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Verma T, Marshall C, Dantey KE, Thompson DV, Banizs A, Finkelstein SD, DelTondo J. The role of the ThyGeNEXT oncogene panel used in combination with the expanded miRNA panel ThyraMIRv2 in Indeterminate thyroid nodules: A large, blinded, real-world, observational study. Cancer Cytopathol 2024. [PMID: 38814813 DOI: 10.1002/cncy.22829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Molecular analysis of fine-needle aspiration biopsies (FNAB) improves the diagnostic accuracy of cytologically indeterminate thyroid nodules (ITNs). Recently, the use of MPTXv2 has been shown to further improve the accuracy of risk stratification of ITNs. METHODS A total of 338 patient samples with atypia of undetermined significance (n = 260) or follicular neoplasm (n = 78) cytology diagnosis and corresponding surgical outcomes or clinical follow-up, collected between 2016 and 2020 were included. All samples underwent multiplatform testing (MPTXv1), which includes an oncogene panel (ThyGeNEXT®) plus a microRNA risk classifier (ThyraMIR®). A blinded, secondary analysis was performed to assess the added utility of MPTXv2 (ThyraMIR®v2). The average length of follow-up for the surveillance group (n = 248) was 30 months. RESULTS Sensitivity at moderate threshold was 96% and specificity at positive threshold was 99% for MPTXv2. At 14% disease prevalence, the negative predictive value at the moderate threshold was 99% and the positive predictive value at the positive threshold was 89% for MPTXv2. MPTXv2 had fewer patients classified into the moderate-risk group than MPTXv1, which was statistically significant (p < .001). Using surgical resection, the gold standard for outcomes, MPTXv2 showed a statistically greater area under the curve (p = .028) than MPTXv1, demonstrating greater accuracy for MPTXv2. CONCLUSION Both test versions demonstrated robust performance with low false-positive molecular results. Data suggest that incorporation of MPTXv1, and more recently MPTXv2, into clinical practice within our healthcare network resulted in improved accuracy of ITN risk stratification.
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Affiliation(s)
- Tanvi Verma
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Cody Marshall
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | | | | | - Anna Banizs
- Interpace Diagnostics, Inc, Parsipanny, New Jersey, USA
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Guo M, Sun Y, Wei Y, Xu J, Zhang C. Advances in targeted therapy and biomarker research in thyroid cancer. Front Endocrinol (Lausanne) 2024; 15:1372553. [PMID: 38501105 PMCID: PMC10944873 DOI: 10.3389/fendo.2024.1372553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Driven by the intricacy of the illness and the need for individualized treatments, targeted therapy and biomarker research in thyroid cancer represent an important frontier in oncology. The variety of genetic changes associated with thyroid cancer demand more investigation to elucidate molecular details. This research is clinically significant since it can be used to develop customized treatment plans. A more focused approach is provided by targeted therapies, which target certain molecular targets such as mutant BRAF or RET proteins. This strategy minimizes collateral harm to healthy tissues and may also reduce adverse effects. Simultaneously, patient categorization based on molecular profiles is made possible by biomarker exploration, which allows for customized therapy regimens and maximizes therapeutic results. The benefits of targeted therapy and biomarker research go beyond their immediate clinical impact to encompass the whole cancer landscape. Comprehending the genetic underpinnings of thyroid cancer facilitates the creation of novel treatments that specifically target aberrant molecules. This advances the treatment of thyroid cancer and advances precision medicine, paving the way for the treatment of other cancers. Taken simply, more study on thyroid cancer is promising for better patient care. The concepts discovered during this investigation have the potential to completely transform the way that care is provided, bringing in a new era of personalized, precision medicine. This paradigm shift could improve the prognosis and quality of life for individuals with thyroid cancer and act as an inspiration for advances in other cancer types.
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Affiliation(s)
- Mei Guo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuqi Sun
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuyao Wei
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianxin Xu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chun Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Riccio IR, LaForteza AC, Hussein MH, Linhuber JP, Issa PP, Staav J, Fawzy MS, Toraih EA, Kandil E. Diagnostic utility of RAS mutation testing for refining cytologically indeterminate thyroid nodules. EXCLI JOURNAL 2024; 23:283-299. [PMID: 38487090 PMCID: PMC10938255 DOI: 10.17179/excli2024-6975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/08/2024] [Indexed: 03/17/2024]
Abstract
RAS mutations are prevalent in indeterminate thyroid nodules, but their association with malignancy risk and utility for diagnosis remains unclear. We performed a systematic review and meta-analysis to establish the clinical value of RAS mutation testing for cytologically indeterminate thyroid nodules. PubMed and Embase were systematically searched for relevant studies. Thirty studies comprising 13,328 nodules met the inclusion criteria. Random effects meta-analysis synthesized pooled estimates of RAS mutation rates, risk of malignancy with RAS positivity, and histologic subtype outcomes. The pooled mutation rate was 31 % (95 % CI 19-44 %) among 5,307 indeterminate nodules. NRAS mutations predominated at 67 % compared to HRAS (24 %) and KRAS (12 %). The malignancy rate with RAS mutations was 58 % (95 %CI=48-68 %). RAS positivity increased malignancy risk 1.7-fold (RR 1.68, 95 %CI=1.21-2.34, p=0.002), with significant between-study heterogeneity (I2=89 %). Excluding one outlier study increased the relative risk to 1.75 (95 %CI=1.54-1.98) and I2 to 14 %. Funnel plot asymmetry and Egger's test (p=0.03) indicated potential publication bias. Among RAS-positive malignant nodules, 38.6 % were follicular variant papillary carcinoma, 34.1 % classical variant, and 23.2 % follicular carcinoma. No statistically significant difference in the odds of harboring RAS mutation was found between subtypes. In conclusion, RAS mutation testing demonstrates clinical utility for refining the diagnosis of cytologically indeterminate thyroid nodules. Positivity confers a 1.7-fold increased malignancy risk, supporting use for personalized decision-making regarding surgery vs. monitoring. Follicular variant papillary carcinoma constitutes the most common RAS-positive malignant histological subtype. See also the graphical abstract(Fig. 1).
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Affiliation(s)
- Isabel R. Riccio
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Alexandra C. LaForteza
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohammad H. Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Peter P. Issa
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Jonathan Staav
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Manal S. Fawzy
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar, Saudi Arabia
| | - Eman A. Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Zhang M, Hu X, Liu L, Wang Y, Jiang J, Li H, Fei W, Zhong T, Jiang Z. Clinical value of multi-gene testing in distinguishing benign and malignant thyroid nodules. Medicine (Baltimore) 2024; 103:e35960. [PMID: 38277563 PMCID: PMC10817136 DOI: 10.1097/md.0000000000035960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/13/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND The newly released 2022 WHO Classification of Neuroendocrine Neoplasms (version 5) and a recent update on thyroid tumor classifications have emphasized genetic testing to an unprecedented level. Fine needle aspiration (FNA) has been widely applied for the preoperative diagnosis of thyroid nodules. However, it is limited mainly to testing for a single gene-BRAFV600E, whereas multi-gene testing data are scarce, especially in the Asian population. This study aimed to explore the clinical value of multi-gene testing in the differential diagnosis of benign and malignant thyroid nodules based on the 2023 Bethesda System for Reporting Thyroid Cytopathology (BSRTC). METHODS A total of 615 thyroid nodules underwent ultrasound-guided fine-needle aspiration cytology (FNAC) were collected from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The next-generation sequencing platform was applied for multi-gene testing. A panel of well-recognized commonly mutated genes in thyroid cancer were analyzed, including BRAFV600E, KRAS, NRAS, HRAS, TERT, TP53, PAX8/PPARG, CCDC6/ RET and NCOA4/ RET. RESULTS Gene mutations were identified in 324 nodules (52.7%), with BRAFV600E being the most prevalent driver gene alteration observed in this cohort (233/324; 79.1%), followed by RAS (77/324, 23.8%). The overall malignancy rate of gene mutations was 89.7% in our cohort, of which the lymph node metastasis rate was 45.3%. The combination of multi-gene testing and cytology resulted in 89.3% sensitivity, 95.2% specificity, 98.9% positive predictive value, 64.5% negative predictive value and 90.3% accuracy, which were significantly higher than those from mere cytology (sensitivity 68.6%, specificity 87.5%, positive predictive value 95.9%, negative predictive value 39.8%, accuracy 72.2%). CONCLUSIONS Multi-gene testing could substantially enhance the detection rate of malignant thyroid nodules and protect patients with benign nodules from unnecessary surgeries. Multi-gene testing provides a valuable reference for individualized preoperative decision-making, which may serve as a crucial method for postoperative treatment and prognosis assessment.
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Affiliation(s)
- Murui Zhang
- Department of Pathology, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Xiaotong Hu
- Department of Pathology, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Lunming Liu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Yihong Wang
- Department of Pathology, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Junchang Jiang
- Department of Pathology, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Hui Li
- Department of Pathology, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Weiqiang Fei
- Department of Pathology, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Tingting Zhong
- Department of Pathology, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
| | - Zhinong Jiang
- Department of Pathology, Sir Run Run Shaw Hospital of Zhejiang University College of Medicine & Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Hangzhou, China
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Giovanella L, Campennì A, Tuncel M, Petranović Ovčariček P. Integrated Diagnostics of Thyroid Nodules. Cancers (Basel) 2024; 16:311. [PMID: 38254799 PMCID: PMC10814240 DOI: 10.3390/cancers16020311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Thyroid nodules are common findings, particularly in iodine-deficient regions. Our paper aims to revise different diagnostic tools available in clinical thyroidology and propose their rational integration. We will elaborate on the pros and cons of thyroid ultrasound (US) and its scoring systems, thyroid scintigraphy, fine-needle aspiration cytology (FNAC), molecular imaging, and artificial intelligence (AI). Ultrasonographic scoring systems can help differentiate between benign and malignant nodules. Depending on the constellation or number of suspicious ultrasound features, a FNAC is recommended. However, hyperfunctioning thyroid nodules are presumed to exclude malignancy with a very high negative predictive value (NPV). Particularly in regions where iodine supply is low, most hyperfunctioning thyroid nodules are seen in patients with normal thyroid-stimulating hormone (TSH) levels. Thyroid scintigraphy is essential for the detection of these nodules. Among non-toxic thyroid nodules, a careful application of US risk stratification systems is pivotal to exclude inappropriate FNAC and guide the procedure on suspicious ones. However, almost one-third of cytology examinations are rendered as indeterminate, requiring "diagnostic surgery" to provide a definitive diagnosis. 99mTc-methoxy-isobutyl-isonitrile ([99mTc]Tc-MIBI) and [18F]fluoro-deoxy-glucose ([18F]FDG) molecular imaging can spare those patients from unnecessary surgeries. The clinical value of AI in the evaluation of thyroid nodules needs to be determined.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco SA, Clinica Moncucco, 6900 Lugano, Switzerland
- Clinic for Nuclear Medicine, University Hospital Zürich, 8004 Zürich, Switzerland
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98100 Messina, Italy;
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, 06230 Ankara, Turkey;
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10 000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
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Neyrand S, Trecourt A, Lopez J, Just PA, Descotes F, Borson-Chazot F, Ray-Coquard I, Decaussin-Petrucci M, Devouassoux-Shisheboran M. Role of gene sequencing in classifying struma ovarii: BRAF p.G469A mutation and TERT promoter alterations favour malignant struma ovarii. Histopathology 2024; 84:291-300. [PMID: 37771077 DOI: 10.1111/his.15052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 09/30/2023]
Abstract
AIMS Struma ovarii (SO) are rare, accounting for 0.3-1% of ovarian tumours, and include benign and malignant lesions. In most cases, histology is not predictive of clinical outcome and prognosis. The prognosis of histologically malignant thyroid-type carcinomas can indeed be excellent, while SO, composed of normal thyroid tissue, can recur and are designated highly differentiated follicular carcinoma of the ovary. Clearer diagnostic criteria are therefore required. METHODS AND RESULTS We retrospectively studied 31 SO using DNA and RNA sequencing with pan-cancer gene panels, including eight biologically malignant SO (BMSO) defined based on ovarian serosal or extra-ovarian dissemination at presentation or during follow-up, 10 stage IA histologically malignant SO (HMSO) with thyroid-type carcinoma morphology and 13 biologically and histologically benign SO (BSO), with none of the above-mentioned characteristics. Molecular alterations were observed in 87.5% of BMSO, 70% of HMSO and 7.7% of BSO (P < 0.001). All patients with a peritoneal dissemination at presentation or during follow-up had at least one gene alteration. BRAF mutations (44.5%) were only observed in malignant forms (HMSO and BMSO) and TERT promoter alterations (25%) only in cases of BMSO. The BRAF p.G469A mutation, which is extremely rare in thyroid carcinomas, was the molecular alteration most frequently associated with malignant SO (28.5%). CONCLUSION Our results highlight the clinical utility of molecular sequencing in SO, based on this limited number of cases. However, as malignant SO evolve slowly, more extensive molecular studies in SO with more than 10 years' follow-up are required to draw any conclusions on the prognostic value of the associated gene alterations.
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Affiliation(s)
- Sophie Neyrand
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Alexis Trecourt
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- University Claude Bernard Lyon I, Villeurbanne, France
| | - Jonathan Lopez
- University Claude Bernard Lyon I, Villeurbanne, France
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Pierre Alexandre Just
- TMRG French Network for Rare Ovarian Malignant Tumor, Paris, France
- Department of Pathology La Timone Hospital, Marseille, France
| | - Françoise Descotes
- Department of Biochemistry and Molecular Biology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Françoise Borson-Chazot
- University Claude Bernard Lyon I, Villeurbanne, France
- Department of Endocrinology, Hospices Civils de Lyon, Groupement Hospitalier Est, University Claude Bernard Lyon I, Bron, France
| | - Isabelle Ray-Coquard
- University Claude Bernard Lyon I, Villeurbanne, France
- TMRG French Network for Rare Ovarian Malignant Tumor, Paris, France
- Department of Medical Oncology, Centre Léon Bérard, University Claude Bernard Lyon I, Lyon, France
| | - Myriam Decaussin-Petrucci
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- University Claude Bernard Lyon I, Villeurbanne, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- University Claude Bernard Lyon I, Villeurbanne, France
- TMRG French Network for Rare Ovarian Malignant Tumor, Paris, France
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Mendoza RP, Simon RC, Cipriani NA, Antic T. The Diagnostic Utility of Repeat Fine-needle Aspirations of Benign Thyroid Nodules. Eur Thyroid J 2024; 13:ETJ-23-0153. [PMID: 38198295 PMCID: PMC10959051 DOI: 10.1530/etj-23-0153] [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: 08/08/2023] [Accepted: 01/10/2024] [Indexed: 01/12/2024] Open
Abstract
Objective This study aims to analyze the diagnostic utility of multiple repeat FNA on thyroid nodules with initially benign diagnosis. Methods In a 5-year period, 1658 thyroid nodules with initially benign FNAs were retrospectively reviewed and followed for subsequent resection and repeat biopsy. Results Out of 2150 thyroid nodules, 1658 (77.1%) were diagnosed as benign on FNAs. The average age was 57.4 years (range 11-93 years), and most were females (83.8%). Repeat FNA was performed on 183 benign nodules, of which 141 (8.5%) were sampled a second time and 42 (2.5%) had 2 or more repeat samplings. For the benign nodules without repeat FNAs, 124 had benign resection. Of cases with one-time repeat FNA, most (n=101) remained benign on repeat FNAs, 13 of which were benign on resection. Eleven had atypical repeat FNAs, 5 were resected, 4 of which were benign and one was atypical follicular neoplasm with HRAS and TERT promoter mutations. Of cases with multiple repeat FNA, most (n=35) were still benign on repeat FNAs, one had benign resection. Two had atypical repeat biopsies, one was PTC on resection with CCD6::RET fusion. The positive predictive value significantly decreased from 41.1% on single FNA to 8.3% on one-time repeat (p<0.001) and 16.7% on multiple repeat (p=0.002). The total cost for workup of previously benign nodules was $285,454. Conclusions Repeat FNA biopsies did not provide an additional diagnostic value in the evaluation of benign thyroid nodules, and often led to unwarranted follow-up procedures and significantly increased health care cost.
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Affiliation(s)
- Rachelle P Mendoza
- Department of Pathology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Nicole A Cipriani
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Tatjana Antic
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
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10
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Harahap AS, Subekti I, Panigoro SS, Asmarinah, Lisnawati, Werdhani RA, Agustina H, Khoirunnisa D, Mutmainnah M, Gultom FL, Assadyk AH, Ham MF. Developing Models to Predict BRAFV600E and RAS Mutational Status in Papillary Thyroid Carcinoma Using Clinicopathological Features and pERK1/2 Immunohistochemistry Expression. Biomedicines 2023; 11:2803. [PMID: 37893176 PMCID: PMC10603905 DOI: 10.3390/biomedicines11102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
The Cancer Genome Atlas (TCGA) has classified papillary thyroid carcinoma (PTC) into indolent RAS-like and aggressive BRAF-like based on its distinct driver gene mutations. This retrospective study aimed to assess clinicopathology and pERK1/2 expression variations between BRAF-like and RAS-like PTCs and establish predictive models for BRAFV600E and RAS-mutated PTCs. A total of 222 PTCs underwent immunohistochemistry staining to assess pERK1/2 expression and Sanger sequencing to analyze the BRAF and RAS genes. Multivariate logistic regression was employed to develop prediction models. Independent predictors of the BRAFV600E mutation include a nuclear score of 3, the absence of capsules, an aggressive histology subtype, and pERK1/2 levels exceeding 10% (X2 = 0.128, p > 0.05, AUC = 0.734, p < 0.001). The RAS mutation predictive model includes follicular histology subtype and pERK1/2 expression > 10% (X2 = 0.174, p > 0.05, AUC = 0.8, p < 0.001). We propose using the prediction model concurrently with four potential combination group outcomes. PTC cases included in a combination of the low-BRAFV600E-scoring group and high-RAS-scoring group are categorized as RAS-like (adjOR = 4.857, p = 0.01, 95% CI = 1.470-16.049). PTCs included in a combination of the high-BRAFV600E-scoring group and low-RAS-scoring group are categorized as BRAF-like PTCs (adjOR = 3.091, p = 0.001, 95% CI = 1.594-5.995). The different prediction models indicate variations in biological behavior between BRAF-like and RAS-like PTCs.
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Affiliation(s)
- Agnes Stephanie Harahap
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (L.); (D.K.); (M.M.)
- Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
- Doctoral Program in Medical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Imam Subekti
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia;
| | - Sonar Soni Panigoro
- Department of Surgery, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia;
| | - Asmarinah
- Department of Medical Biology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia;
| | - Lisnawati
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (L.); (D.K.); (M.M.)
| | - Retno Asti Werdhani
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 10310, Indonesia;
| | - Hasrayati Agustina
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung 40161, Indonesia;
| | - Dina Khoirunnisa
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (L.); (D.K.); (M.M.)
| | - Mutiah Mutmainnah
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (L.); (D.K.); (M.M.)
| | - Fajar Lamhot Gultom
- Department of Anatomical Pathology, MRCCC Siloam Hospital, Jakarta 12930, Indonesia;
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Kristen Indonesia, Jakarta 13630, Indonesia
| | - Abdillah Hasbi Assadyk
- Department of Otorhinolaryngology, Head and Neck Surgery, Harapan Kita National Women and Children Health Center, Jakarta 11420, Indonesia;
| | - Maria Francisca Ham
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia; (A.S.H.); (L.); (D.K.); (M.M.)
- Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
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11
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Vignali P, Macerola E, Poma AM, Sparavelli R, Basolo F. Indeterminate Thyroid Nodules: From Cytology to Molecular Testing. Diagnostics (Basel) 2023; 13:3008. [PMID: 37761374 PMCID: PMC10528553 DOI: 10.3390/diagnostics13183008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Thyroid cancer is the most common malignancy of the endocrine system. Fine-needle aspiration (FNA) biopsy of thyroid nodules has become the gold standard procedure, in terms of cost and efficacy, for guiding clinicians towards appropriate patients' management. One challenge for cytopathologists is to accurately classify cytological specimens as benign or malignant based on cytomorphological features. In fact, with a frequency ranging from 10% to 30%, nodules are diagnosed as indeterminate. In recent years, the mutational landscape of thyroid tumors has been extensively described, and two molecular profiles have been identified: RAS-like (NRAS, HRAS, and KRAS mutations; EIF1AX mutations; BRAF K601E mutation; and PPARG and THADA fusions) and BRAFV600E-like (including BRAFV600E mutation and RET and BRAF fusions). The purpose of this review is to discuss the latest molecular findings in the context of indeterminate thyroid nodules, highlighting the role of molecular tests in patients' management.
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Affiliation(s)
| | | | | | | | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (P.V.); (A.M.P.); (R.S.)
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12
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An J, Kwon H, Kim YJ. The Role of Blood Microbiome in the Development of Thyroid Cancer in Breast Cancer Survivors. Cancers (Basel) 2023; 15:4492. [PMID: 37760462 PMCID: PMC10526815 DOI: 10.3390/cancers15184492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Patients diagnosed with breast cancer are likely to be diagnosed with thyroid cancer as a second primary cancer. Similarly, patients with thyroid cancer are likely to develop breast cancer. In this study, we found an association between these two types of cancers in the microbiomes of patients with breast cancer. Blood samples were collected from 96 patients with breast cancer, their bacterial extracellular vesicles were isolated, and their microbiomes were analyzed. After microbiome analysis, researchers performed thyroid function tests, estrogen levels, and thyroid ultrasound results of these patients, and the relationships among these parameters were analyzed. Based on the thyroid ultrasonography results, differences in the microbiome were confirmed in the normal, cyst, nodule, and thyroid lobectomy groups. We investigated the microbiome differences between normal thyroid and thyroid cancer. In particular, the abundance of the genus Bacillus is related to estrogen levels, which could affect thyroid abnormalities and increase thyroid-stimulating hormone levels. This study explains the causes of thyroid cancer in patients with breast cancer using microbiomes and serological tests for thyroid hormones and estrogen. These can be used as basic data for preventing thyroid cancer in patients with breast cancer.
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Affiliation(s)
- Jeongshin An
- Institute of Convergence Medicine Research, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
- Department of Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Hyungju Kwon
- Department of Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Young Ju Kim
- Department of Obstetrics and Gynecology, Ewha Medical Institute, College of Medicine, Ewha Womans University, Seoul 07804, Republic of Korea
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13
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Cochand-Priollet B, Maleki Z. Cytology and Histology of Thyroid Nodules: Exploring Novel Insights in the Molecular Era for Enhanced Patient Management. Curr Oncol 2023; 30:7753-7772. [PMID: 37623043 PMCID: PMC10453903 DOI: 10.3390/curroncol30080562] [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] [Received: 06/30/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023] Open
Abstract
Significant advancements have been made over the past decade in our understanding of thyroid cancers, encompassing histomorphology, cytology, and ancillary techniques, particularly molecular tests. As a result, it is now feasible to put forth a comprehensive histo/cytomolecular approach to treating these tumors, thereby offering patients treatments that are precisely tailored to their unique circumstances.
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Affiliation(s)
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins Hospital, The Johns Hopkins Medical Institution, Baltimore, MD 21287, USA;
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14
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Orlando G, Graceffa G, Mazzola S, Vassallo F, Proclamà MP, Richiusa P, Radellini S, Paladino NC, Melfa G, Scerrino G. The Role of "Critical" Ultrasound Reassessment in the Decision-Making of Bethesda III Thyroid Nodules. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1484. [PMID: 37629774 PMCID: PMC10456377 DOI: 10.3390/medicina59081484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Bethesda III (BIII) thyroid nodules have an expected malignancy rate of 5-15%. Our purpose was to assess which US criteria are most associated with cancer risk, and the value of critical ultrasound (US) reassessment. Methods: From 2018 to 2022, 298 BIII nodules were enrolled for thyroidectomy (79 malignancies). We evaluated ultrasonographic data: hechogenicity, intralesional vascularization, spiculated margins, micro-calcifications, "taller than wide" shape, extra-thyroidal growth, size increase, as well as their association with histology. We also evaluated if the ultrasound reassessment modified the strategy. Results: Spiculated margins and microcalcification were significantly correlated with malignancy risk. Spiculated margins showed a specificity of 0.95 IC95% (0.93-0.98); sensitivity 0.70 IC95% (0.59-0.80). Microcalcifications showed a sensitivity of 0.87 CI95% (0.80-0.94); specificity 0.75 CI95% (0.72-0.83). The presence of these signs readdressed the strategy in 76/79 cases Then, the indication for surgery was appropriate in 75% of cases. Conclusions: Microcalcifications and spiculated margins should be routinely sought during a final ultrasound reassessment in BIII nodules. These signs allowed for a modification of the strategy in favor of surgery in 96% of the cases that were not otherwise referred to surgery. The importance of integrating ultrasound and cytology in the evaluation of BIII thyroid nodules is confirmed. Reassessment with ultrasound of BIII nodules allowed for a redirection of the surgical choice.
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Affiliation(s)
- Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Giuseppa Graceffa
- Unit of Oncological Surgery, Department of Surgical Oncology and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone”, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
| | - Fabrizio Vassallo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Maria Pia Proclamà
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Stefano Radellini
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005 Marseille, France
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.O.); (F.V.); (M.P.P.); (G.M.)
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, University of Palermo, Via L. Giuffré, 5, 90127 Palermo, Italy;
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15
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Bikas A, Ahmadi S, Pappa T, Marqusee E, Wong K, Nehs MA, Cho NL, Haase J, Doherty GM, Sehgal K, Barletta JA, Alexander EK, Landa I. Additional Oncogenic Alterations in RAS-Driven Differentiated Thyroid Cancers Associate with Worse Clinicopathologic Outcomes. Clin Cancer Res 2023; 29:2678-2685. [PMID: 37260297 PMCID: PMC10524472 DOI: 10.1158/1078-0432.ccr-23-0278] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 05/12/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE RAS mutations occur across the spectrum of thyroid neoplasms, and more tools are needed for better prognostication. The objective of this study was to evaluate how additional genetic events affecting key genes modify prognosis in patients with RAS-mutant thyroid cancers, and specifically differentiated thyroid cancers (DTC). EXPERIMENTAL DESIGN We performed a clinical-genomic analysis of consecutive patients with DTC, poorly differentiated (PDTC), or anaplastic thyroid cancer (ATC) between January 2014 and December 2021, in whom a custom-targeted next-generation sequencing assay was performed. Patients harboring RAS mutations were included, and we compared their clinical features and outcomes based upon the presence of additional oncogenic alterations. RESULTS Seventy-eight patients were identified, with 22% (17/78) harboring a driver RAS mutation plus an additional oncogenic alteration. All six (100%) ATCs had an additional mutation. Compared with DTCs harboring a solitary RAS mutation, patients with DTC with RAS and additional mutation(s) were more likely to be classified as American Thyroid Association high-risk of recurrence (77% vs. 12%; P < 0.001) and to have larger primary tumors (4.7 vs. 2.5 cm; P = 0.002) and advanced stage (III or IV) at presentation (67% vs. 3%; P < 0.001). Importantly, over an average 65-month follow-up, DTC-specific-mortality was more than 10-fold higher (20% vs. 1.8%; P = 0.011) when additional mutations were identified. CONCLUSIONS Identification of key additional mutations in patients with RAS-mutant thyroid cancers confers a more aggressive phenotype, increases mortality risk in DTC, and can explain the diversity of RAS-mutated thyroid neoplasia. These data support genomic profiling of DTCs to inform prognosis and clinical decision-making.
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Affiliation(s)
- Athanasios Bikas
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Sara Ahmadi
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Theodora Pappa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts
| | - Ellen Marqusee
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Kristine Wong
- Harvard Medical School, Boston Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston Massachusetts
| | - Matthew A. Nehs
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Nancy L. Cho
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Jacob Haase
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Gerard M. Doherty
- Harvard Medical School, Boston Massachusetts
- Department of Surgery, Brigham and Women’s Hospital, Boston Massachusetts
| | - Kartik Sehgal
- Harvard Medical School, Boston Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston Massachusetts
| | - Justine A. Barletta
- Harvard Medical School, Boston Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston Massachusetts
| | - Erik K. Alexander
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
| | - Iñigo Landa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston Massachusetts
- Harvard Medical School, Boston Massachusetts
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16
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Choi HR, Kim K. Mouse Models to Examine Differentiated Thyroid Cancer Pathogenesis: Recent Updates. Int J Mol Sci 2023; 24:11138. [PMID: 37446316 DOI: 10.3390/ijms241311138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Although the overall prognosis of differentiated thyroid cancer (DTC), the most common endocrine malignancy, is favorable, a subset of patients exhibits aggressive features. Therefore, preclinical models that can be utilized to investigate DTC pathogenesis and novel treatments are necessary. Various mouse models have been developed based on advances in thyroid cancer genetics. This review focuses on recent progress in mouse models that have been developed to elucidate the molecular pathogenesis of DTC.
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Affiliation(s)
- Hye Ryeon Choi
- Department of Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul 01830, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, Catholic University of Korea, Seoul 06591, Republic of Korea
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17
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Harahap AS, Subekti I, Panigoro SS, Asmarinah, Lisnawati, Werdhani RA, Agustina H, Khoirunnisa D, Mutmainnah M, Salinah, Siswoyo AD, Ham MF. Profile of BRAFV600E, BRAFK601E, NRAS, HRAS, and KRAS Mutational Status, and Clinicopathological Characteristics of Papillary Thyroid Carcinoma in Indonesian National Referral Hospital. Appl Clin Genet 2023; 16:99-110. [PMID: 37255533 PMCID: PMC10226481 DOI: 10.2147/tacg.s412364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/19/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION BRAFV600E and RAS mutations are the most common gene mutations in papillary thyroid carcinoma (PTC) that may be correlated with its biological behavior. There are still limited data about BRAFV600E and RAS mutations in Indonesia. This study aims to determine the prevalence of BRAFV600E and RAS mutations, and their association with clinicopathologic characteristics. METHODS Patients who had total thyroidectomy from 2019 to 2021 and those who met our study criteria underwent PCR and DNA sequencing analysis for BRAFV600E, BRAFK601E, exon 2 and 3 of NRAS, HRAS, and KRAS. Analyses were performed to determine the associations of BRAFV600E and RAS mutations with clinicopathologic characteristics. RESULTS Of 172 PTC patients, BRAFV600E mutation was observed in 37.8% of the patients and RAS mutations were found in 21.5%. One patient harbored BRAFK601E mutation. There was a significant association of BRAFV600E with a high-stage (p = 0.033, OR: 3.279; 95% CI: 1.048-10.259), tall-cell variants (p ≤0.001, OR: 41.143; 95% CI: 11.979-141.308), non-encapsulated (p = 0.001, OR: 4.176; 95% CI: 2.008-8.685), lymphovascular invasion (p = 0.043, OR: 1.912; 95% CI: 1.018-3.592), extrathyroidal extension (p = <0.001, OR: 3.983; 95% CI: 1.970-8.054), and lymph node metastasis (p = 0.009, OR: 2.301; 95% CI: 1.224-4.326). Follicular variant (p = 0.001, OR: 7.011; 95% CI: 2.690-18.268), encapsulated (p = 0.017, OR: 2.433; 95% CI: 1.161-5.100), and absent of extrathyroidal extension (p = 0.033, OR: 2.890; 95% CI: 1.052-7.940) were associated with RAS mutations. CONCLUSION A significant association between BRAFV600E mutation and high clinical stage, tall-cell variants, non-encapsulated morphology, lymphovascular invasion, extrathyroidal extension, and lymph node metastasis in PTC was observed. RAS mutations were associated with the follicular variant, encapsulated tumor, and no extrathyroidal extension. HRAS-mutated PTC frequently exhibited tumor multifocality.
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Affiliation(s)
- Agnes Stephanie Harahap
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Doctoral Program in Medical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Imam Subekti
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sonar Soni Panigoro
- Department of Surgery, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Asmarinah
- Department of Medical Biology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Lisnawati
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Retno Asti Werdhani
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Hasrayati Agustina
- Department of Anatomical Pathology, Faculty of Medicine Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Dina Khoirunnisa
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mutiah Mutmainnah
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Salinah
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Alvita Dewi Siswoyo
- Department of Radiology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Maria Francisca Ham
- Department of Anatomical Pathology, Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Human Cancer Research Center-Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Simoncini G, Orsatti A, Malvi D, Tardio ML, Maloberti T, de Biase D, D'Errico A, Vasuri F. NRAS-mutated oncocytic benign liver lesion in an organ donor: Pitfalls and troubles in frozen section diagnosis and risk assessment. Pathol Res Pract 2023; 246:154531. [PMID: 37182314 DOI: 10.1016/j.prp.2023.154531] [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: 04/04/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND In the transplant setting, the definition of the risk of neoplastic transmission from donor to recipient often requires intraoperative pathological evaluation on frozen sections. Although most lesions can be easily classified into acceptable or unacceptable risk according to the Italian National Guidelines, there are cases in which unusual histologic features cannot be further investigated because of the lack of ancillary techniques on frozen sections. CASE PRESENTATION Here we present a case of a liver lesion in a 51-year-old male donor, subjected to histopathological on-call examination. The frozen sections showed a well-demarcated lesion consisting of epithelioid cells disposed in laminar structures and intermingled with a dense lymphocytic population: this led to organ discard with interruption of the donation process. The definitive histological analysis required an extensive immunohistochemical (IHC) investigation: the final diagnosis was "bile duct adenoma with oncocytic features", eventually confirmed by a strongly positive anti-mitochondrial IHC. Finally, an NGS panel analysis was performed, which revealed NRAS mutation. DISCUSSION To the best of our knowledge, this is the first case of oncocytic bile duct adenoma confirmed by anti-mitochondrial IHC and with NRAS mutation. The most challenging aspect of this case was represented by the transplant setting. In fact, the oncocytic features and the dense lymphocytic infiltrate represented concomitant unusual histological features that led to the halt of the organ donation procedures.
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Affiliation(s)
- Giulia Simoncini
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy
| | - Agnese Orsatti
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy
| | - Deborah Malvi
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy.
| | - Maria L Tardio
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy
| | - Thais Maloberti
- Department of Medicine, University of Bologna, Bologna, Italy
| | - Dario de Biase
- Department of Pharmacy and biotechnology (FaBiT), University of Bologna, Bologna, Italy
| | | | - Francesco Vasuri
- Pathology Unit, IRCCS Azienda-Ospedaliero Universitaria di Bologna, Italy
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19
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Kim M, Jeon S, Jung CK. Preoperative Risk Stratification of Follicular-patterned Thyroid Lesions on Core Needle Biopsy by Histologic Subtyping and RAS Variant-specific Immunohistochemistry. Endocr Pathol 2023:10.1007/s12022-023-09763-3. [PMID: 37040004 DOI: 10.1007/s12022-023-09763-3] [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] [Accepted: 03/29/2023] [Indexed: 04/12/2023]
Abstract
Follicular-patterned lesions often have indeterminate results (diagnostic category III or IV) by core needle biopsy (CNB) and fine needle aspiration (FNA). However, CNB diagnoses follicular neoplasm (category IV) more frequently than FNA. Therefore, we aimed to develop a risk stratification system for CNB samples with category III/IV using immunohistochemistry (IHC). The specificity of the RAS Q61R antibody was validated on 58 thyroid nodules with six different types of RAS genetic variants and 40 cases of RAS wild-type. We then applied IHC analysis of RAS Q61R to 207 CNB samples with category III/IV in which all patients underwent surgical resection. RAS Q61R IHC had 98% sensitivity and 98% specificity for detecting the RAS p.Q16R variant. In an independent dataset, the positive rate of RAS Q61R was significantly higher in NIFTP (48%) and malignancies (45%) than in benign tumors (19%). The risk of NIFTP/malignancy was highest in the group with nuclear atypia and RAS Q61R expression (86%) and lowest in the group without both parameters (32%). The high-risk group with either nuclear atypia or RAS Q61R had 67.3% sensitivity, 73.4% specificity, 75.2% positive predictive value, and 65.1% negative predictive value for identifying NIFTP/malignancy. We conclude that RAS Q61R IHC can be a rule-in diagnostic test for NIFTP/malignancy in CNB category III/IV results. Combining of the histologic parameter (nuclear atypia) with RAS Q61R IHC results can further stratify CNB category III/IV into a high-risk group, which is sufficient for a surgical referral, and a low-risk group sufficient for observation.
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Affiliation(s)
- Meejeong Kim
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sora Jeon
- College of Medicine, Cancer Research Institute, The Catholic University of Korea, Seoul, Korea
| | - Chan Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- College of Medicine, Cancer Research Institute, The Catholic University of Korea, Seoul, Korea.
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20
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Wang Y, Xu L, Lu W, Kong X, Shi K, Wang L, Kong D. Clinical evaluation of malignancy diagnosis of rare thyroid carcinomas by an artificial intelligent automatic diagnosis system. Endocrine 2023; 80:93-99. [PMID: 36462146 DOI: 10.1007/s12020-022-03269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To evaluate the application value of a generally trained artificial intelligence (AI) automatic diagnosis system in the malignancy diagnosis of rare thyroid carcinomas, such as follicular thyroid carcinoma, medullary thyroid carcinoma, primary thyroid lymphoma and anaplastic thyroid carcinoma and compare the diagnostic performance with radiologists of different experience levels. METHODS We retrospectively studied 342 patients with 378 thyroid nodules that included 196 rare malignant nodules by using postoperative pathology as the gold standard, and compared the diagnostic performances of three radiologists (one junior, one mid-level, one senior) and that of AI automatic diagnosis system. RESULTS The accuracy of the AI system in malignancy diagnosis was 0.825, which was significantly higher than that of all three radiologists and higher than the best radiologist in this study by a margin of 0.097 with P-value of 2.252 × 10-16. The mid-level radiologist and senior radiologist had higher sensitivity (0.857 and 0.959) than that of the AI system (0.847) at the cost of having much lower specificity (0.533, 0.478 versus 0.802). The junior radiologist showed relatively balanced sensitivity and specificity (0.816 and 0.549) but both were lower than that of the AI system. CONCLUSIONS The generally trained AI automatic diagnosis system showed high accuracy in the differential diagnosis of begin nodules and rare malignancy nodules. It may assist radiologists for screening of rare malignancy nodules that even senior radiologists are not acquainted with.
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Affiliation(s)
- Yuan Wang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Lei Xu
- Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou, China
- South and North Lake Institute for Medical Artificial Intelligence, Haiyan, China
- Zhejiang Society for Mathematical Medicine, Hangzhou, China
| | - Wenliang Lu
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Xiangkai Kong
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Kaiyuan Shi
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Liping Wang
- Zhejiang Society for Mathematical Medicine, Hangzhou, China.
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China.
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China.
- Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou, China.
- South and North Lake Institute for Medical Artificial Intelligence, Haiyan, China.
- Zhejiang Society for Mathematical Medicine, Hangzhou, China.
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21
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Hudson TJ, Pusztaszeri MP, Hier MP, Forest VI, Yang JW, Payne RJ. Does the likelihood of malignancy in thyroid nodules with RAS mutations increase in direct proportion with the allele frequency percentage? J Otolaryngol Head Neck Surg 2023; 52:12. [PMID: 36774522 PMCID: PMC9921308 DOI: 10.1186/s40463-022-00611-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/06/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Genomic testing has enhanced pre-surgical decision making for cytologically indeterminate thyroid nodules, but there remains uncertainty regarding RAS mutations. The addition of extra genetic alterations to previous driver mutation panels has been shown to improve predictive value. This study aims to evaluate the relationship between the mutant allele frequency (AF) and likelihood of malignancy in thyroid nodules with RAS mutations. METHODS A retrospective cohort review was performed evaluating patients with indeterminate cytology (Bethesda categories III, IV and V) and ThyroSeq® v3 testing demonstrating a RAS mutation, who underwent surgery. Univariate and multivariate regression analyses were used to evaluate relationships between AF, other genetic alterations, and malignancy. RESULTS Thirty-nine patients met criteria, 77% of the thyroid nodules (30/39) were found to be malignant. None demonstrated aggressive pathology. On univariate regression, there was no relationship between AF and likelihood of malignancy. There was, however, a significant correlation between AF and the rate of an additional genetic alteration. Multivariate analysis found a trend between RAS, a second genetic alteration and malignancy, but it did not reach statistical significance. CONCLUSIONS There was no direct relationship between the level of allelic frequency in thyroid nodules expressing RAS mutations and the likelihood of malignancy. There was a statistically significant relationship between increasing AF and the presence of a second genetic abnormality, suggesting a possible progression from initial driver mutation and then a second genetic alteration prior to malignant transformation.
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Affiliation(s)
- Thomas J Hudson
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la Côte-Sainte-Catherine Rd., Montreal, QC, H3T 1E2, Canada.,nt of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | | | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la Côte-Sainte-Catherine Rd., Montreal, QC, H3T 1E2, Canada
| | - Veronique-Isabelle Forest
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la Côte-Sainte-Catherine Rd., Montreal, QC, H3T 1E2, Canada
| | - Ji-Wei Yang
- Division of Endocrinology, McGill University Health Centre, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la Côte-Sainte-Catherine Rd., Montreal, QC, H3T 1E2, Canada. .,nt of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada.
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22
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Macerola E, Poma AM, Vignali P, Proietti A, Torregrossa L, Ugolini C, Basolo A, Matrone A, Elisei R, Santini F, Basolo F. MicroRNA expression profiling of RAS-mutant thyroid tumors with follicular architecture: microRNA signatures to discriminate benign from malignant lesions. J Endocrinol Invest 2023:10.1007/s40618-023-02023-5. [PMID: 36749451 DOI: 10.1007/s40618-023-02023-5] [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: 10/26/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE RAS mutations represent common driver alterations in thyroid cancer. They can be found in benign, low-risk and malignant thyroid tumors with follicular architecture, which are often diagnosed as indeterminate nodules on preoperative cytology. Therefore, the detection of RAS mutations in preoperative setting has a suboptimal predictive value for malignancy. In this study, we investigated differentially expressed microRNA (miRNA) in benign and malignant thyroid tumors with follicular architecture carrying mutations in RAS genes. METHODS Total RNA was purified from 60 RAS-mutant follicular-patterned thyroid tumors, including follicular adenoma (FA), noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), papillary and follicular thyroid carcinoma cases (PTC, FTC); 22 RAS-negative FAs were used as controls. The expression analysis of 798 miRNAs was performed by digital counting (nCounter nanoString platform). RESULTS Comparing RAS-mutant and RAS-negative FAs, 12 miRNAs showed significant deregulation, which was likely related to the oncogenic effects of RAS mutations. Twenty-two miRNAs were differentially expressed in RAS-mutant benign versus malignant tumors. Considering the tumor type, 24 miRNAs were deregulated in PTC, 19 in NIFTP, and seven in FTC and compared to FA group; among these, miR-146b-5p, miR-144-3p, and miR-451a showed consistent deregulation in all the comparisons with the highest fold change. CONCLUSIONS The miRNA expression analysis of follicular-patterned thyroid tumors demonstrated that RAS mutations influences miRNA profile in benign tumors. In addition, several miRNAs showed a histotype-specific deregulation and could discriminate between RAS-mutant benign and RAS-mutant malignant thyroid lesions, thus deserving further investigation as potential diagnostic markers.
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Affiliation(s)
- E Macerola
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - A M Poma
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - P Vignali
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - A Proietti
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - L Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - C Ugolini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - A Basolo
- Department of Clinical and Experimental Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - A Matrone
- Department of Clinical and Experimental Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - R Elisei
- Department of Clinical and Experimental Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - F Santini
- Department of Clinical and Experimental Medicine, University of Pisa, via Savi, 10, 56126, Pisa, Italy
| | - F Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, via Savi, 10, 56126, Pisa, Italy.
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23
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Bernardi S, Taccogna S, D'Angelo M, Giudici F, Mauri G, Raggiunti B, Tina D, Zanconati F, Papini E, Negro R. Immunocytochemistry Profile of Benign Thyroid Nodules Not Responding to Thermal Ablation: A Retrospective Study. Int J Endocrinol 2023; 2023:7951942. [PMID: 37082757 PMCID: PMC10113047 DOI: 10.1155/2023/7951942] [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: 12/25/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/22/2023] Open
Abstract
Purpose Thermal ablations (TA) are gaining ground as alternative options to conventional therapies for symptomatic benign thyroid nodules. Little is known about the impact of nodule biology on the outcomes of TA. The aim of our study was to evaluate the baseline immunocytochemistry profile of thyroid nodules that were poorly responsive to TA in order to identify potential predictors of the treatment response. Methods From a cohort of 406 patients with benign thyroid nodules treated with TA and followed for 5 years, we retrospectively selected two groups of patients: NONRESPONDERS (patients who did not respond to TA and were later surgically treated) and RESPONDERS (patients who responded to TA). The fine-needle aspiration cytology (FNAC) slides obtained before TA were stained for Galectin-3, HBME-1, CK-19, and Ki-67. Results Benign nodules of NONRESPONDERS (n = 19) did not express CK-19 (p = 0.03), as compared to RESPONDERS (n = 26). We combined the absence of CK-19 and the presence of Ki-67 to obtain a composite biomarker of resistance to TA, which discriminated between likelihood of retreatment and no retreatment with an AUC of 0.68 (95%CI: 0.55-0.81) and a sensitivity, specificity, PPV, and NPV of 29%, 91%, 71%, and 64%, respectively. Conclusion In benign thyroid nodules, the absence of CK-19 was associated with resistance to TA, while the presence of CK-19 was predictive of response to TA. If confirmed, this finding could provide rapid and inexpensive information about the potential outcome of TA on benign thyroid nodules. In addition, as CK-19 can be expressed in adenomatous hyperplasia, it could be speculated that these nodules, rather than follicular adenomas, might be better candidates for TA.
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Affiliation(s)
- Stella Bernardi
- Department of Medical Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste 34149, Italy
- SS Endocrinologia UCO Medicina Clinica, Cattinara Teaching Hospital, Strada di Fiume, Trieste 34149, Italy
| | - Silvia Taccogna
- Pathology Unit, Regina Apostolorum Hospital, Albano Laziale (RM) 00041, Italy
| | - Martina D'Angelo
- Pathology Unit, Regina Apostolorum Hospital, Albano Laziale (RM) 00041, Italy
| | - Fabiola Giudici
- Bureau Biostatistique et Epidémiologie, Gustave-Roussy Institute, Rue Eduard Vaillant, Villejuif 94805, France
| | - Giovanni Mauri
- IRCCS European Institute of Oncology, Milano 20141, Italy
- Department of Oncology, University of Milan, Milan 20100, Italy
| | - Bruno Raggiunti
- UOC Malattie Endocrine e Diabetologia, PO di Atri, ASL Teramo, Teramo, Italy
| | - Doris Tina
- UOC Malattie Endocrine e Diabetologia, PO di Atri, ASL Teramo, Teramo, Italy
| | - Fabrizio Zanconati
- Department of Medical Surgical and Health Sciences, University of Trieste, Cattinara Teaching Hospital, Strada di Fiume, Trieste 34149, Italy
- UCO Anatomia Patologica, Cattinara Teaching Hospital, Strada di Fiume, Trieste 34149, Italy
| | - Enrico Papini
- Endocrinology Department, Regina Apostolorum Hospital, Albano Laziale (RM) 00041, Italy
| | - Roberto Negro
- UO Endocrinologia, “V. Fazzi” Hospital, Lecce 73100, Italy
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24
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Ma T, Wang L, Zhang X, Shi Y. A clinical and molecular pathology prediction model for central lymph node metastasis in cN0 papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2023; 14:1075598. [PMID: 36817603 PMCID: PMC9932534 DOI: 10.3389/fendo.2023.1075598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The frequency of thyroid cancer has rapidly increased in recent years globally. Thus, more papillary thyroid microcarcinoma (PTMC) patients are being diagnosed, including clinical lymph node-negative (cN0) patients. Our study attempted to develop a prediction model for assessing the probability of central lymph node metastasis (CLNM) in cN0 PTMC patients. METHODS A total of 595 patients from the Affiliated Hospital of Qingdao University (training cohort: 456 patients) and the Affiliated Hospital of Jining Medical University (verification cohort: 139 patients) who underwent thyroid surgery between January 2020 and May 2022 were enrolled in this study. Their clinical and molecular pathology data were analyzed with multivariate logistic regression to identify independent factors, and then we established a prediction model to assess the risk of CLNM in cN0 PTMC patients. RESULTS Multivariate logistic regression analysis revealed that sex, Hashimoto's thyroiditis (HT), tumor size, extrathyroidal extension, TERT promoter mutations and NRAS mutation were independent factors of CLNM. The prediction model demonstrated good discrimination ability (C-index: 0.757 and 0.753 in the derivation and validation cohorts, respectively). The calibration curve of the model was near the optimum diagonal line, and decision curve analysis (DCA) showed a noticeably better benefit. CONCLUSION CLNM in cN0 PTMC patients is associated with male sex, tumor size, extrathyroidal extension, HT, TERT promoter mutations and NRAS mutation. The prediction model exhibits good discrimination, calibration and clinical usefulness. This model will help to assess CLNM risk and make clinical decisions in cN0 PTMC patients.
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Affiliation(s)
- Teng Ma
- Department of Thyroid Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Lulu Wang
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xueyan Zhang
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Yafei Shi
- Department of Thyroid Surgery, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
- *Correspondence: Yafei Shi,
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25
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Molecular Landscape of Pediatric Thyroid Cancer: A Review. Diagnostics (Basel) 2022; 12:diagnostics12123136. [PMID: 36553142 PMCID: PMC9776958 DOI: 10.3390/diagnostics12123136] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Thyroid carcinomas (TC) are rare in the pediatric population; however, they constitute the most common endocrine malignancy. Despite some similarities with adult carcinomas, they have distinct clinical behavior and responses to therapy due to their unique pathology and molecular characteristics. The age cut-off used for defining the pediatric age group has been variable across different studies, and the universally accepted recommendations influence accurate interpretation of the available data. Moreover, factors such as radiation exposure and germline mutations have greater impact in children than in adults. Papillary TC is the most common and the most evaluated pediatric TC. Others, including follicular, poorly differentiated and medullary carcinomas, are rarer and have limited available literature. Most studies are from the West. Asian studies are primarily from Japan, with few from China, India, Saudi Arabia and Republic of Korea. This review provides a comprehensive account of the well-established and novel biomarkers in the field, including point mutations, fusions, miRNA, and thyroid differentiation genes. Familial and syndromic associations are also discussed. Current management guidelines for pediatric patients are largely derived from those for adults. An awareness of the molecular landscape is essential to acknowledge the uniqueness of these tumors and establish specific diagnostic and therapeutic guidelines.
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26
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Marotta V, Cennamo M, La Civita E, Vitale M, Terracciano D. Cell-Free DNA Analysis within the Challenges of Thyroid Cancer Management. Cancers (Basel) 2022; 14:cancers14215370. [PMID: 36358788 PMCID: PMC9654679 DOI: 10.3390/cancers14215370] [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: 09/29/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Simple Summary Liquid biopsy is a minimally invasive method that emerged as a new promising tool for improving diagnosis, risk stratification, follow-up, and treatment of cancer patients. To date, the majority of the research in the area of liquid biopsy has focused on plasma-based cell-free DNA as a potential surrogate for tumor DNA obtained from a tissue biopsy. In the last decades, breakthrough advancements have been performed in the knowledge of thyroid cancer genetics, and the role of molecular characterization in clinical decision-making is continuously rising, from diagnosis completion to the personalization of treatment approach. Hence, it is expectable for cell-free DNA to be applicable in thyroid cancer management. This review aims to investigate the cell-free DNA utility for thyroid cancer patients’ care. Abstract Thyroid cancer is the most frequent endocrine malignancy with an increasing incidence trend during the past forty years and a concomitant rise in cancer-related mortality. The circulating cell-free DNA (cfDNA) analysis is a patient’s friendly and repeatable procedure allowing to obtain surrogate information about the genetics and epigenetics of the tumor. The aim of the present review was to address the suitability of cfDNA testing in different forms of thyroid cancer, and the potential clinical applications, as referred to the clinical weaknesses. Despite being limited by the absence of standardization and by reproducibility and validity issues, cfDNA assessment has great potential for the improvement of thyroid cancer management. cfDNA may support the pre-surgical definition of thyroid nodules by complementing invasive thyroid fine needle aspiration cytology. In addition, it may empower risk stratification and could be used as a biomarker for monitoring the post-surgical disease status, both during active surveillance and in the case of anti-tumor treatment.
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Affiliation(s)
- Vincenzo Marotta
- UOC Clinica Endocrinologica e Diabetologica, AOU San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy
- Correspondence: ; Tel.: +39-333-852-1005
| | - Michele Cennamo
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Mario Vitale
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, 84081 Baronissi, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
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Identification of key somatic oncogenic mutation based on a confounder-free causal inference model. PLoS Comput Biol 2022; 18:e1010529. [PMID: 36137089 PMCID: PMC9499235 DOI: 10.1371/journal.pcbi.1010529] [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: 04/10/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022] Open
Abstract
Abnormal cell proliferation and epithelial-mesenchymal transition (EMT) are the essential events that induce cancer initiation and progression. A fundamental goal in cancer research is to develop an efficient method to detect mutational genes capable of driving cancer. Although several computational methods have been proposed to identify these key mutations, many of them focus on the association between genetic mutations and functional changes in relevant biological processes, but not their real causality. Causal effect inference provides a way to estimate the real induce effect of a certain mutation on vital biological processes of cancer initiation and progression, through addressing the confounder bias due to neutral mutations and unobserved latent variables. In this study, integrating genomic and transcriptomic data, we construct a novel causal inference model based on a deep variational autoencoder to identify key oncogenic somatic mutations. Applied to 10 cancer types, our method quantifies the causal effect of genetic mutations on cell proliferation and EMT by reducing both observed and unobserved confounding biases. The experimental results indicate that genes with higher mutation frequency do not necessarily mean they are more potent in inducing cancer and promoting cancer development. Moreover, our study fills a gap in the use of machine learning for causal inference to identify oncogenic mutations. Identifying key mutations of cancers is helpful to better understand the mechanisms of cancer cell transformation and is critical for therapeutic approaches. Besides sequence and structure-based computational approaches, some functional impact-based methods which consider the association between mutation events and the activity of cancer-related biological processes have also been developed to detect key mutations. However, these methods mainly consider the correlation but ignore that the correlation is far from causality due to the existence of observed and unobserved confounding factors. We develop a confounder-free machine learning-based causal inference framework to estimate the causal effect of mutations on abnormal cell proliferation and epithelial-mesenchymal transition (EMT). It fills a gap in the use of causal mechanisms to discover potential driver mutations in cancer biological systems. Applying our method to 10 cancer types, the identified key mutations are highly consistent with public well-verified ones. Additionally, some new key mutations have also been discovered.
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28
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A Potential Four-Gene Signature and Nomogram for Predicting the Overall Survival of Papillary Thyroid Cancer. DISEASE MARKERS 2022; 2022:8735551. [PMID: 36193505 PMCID: PMC9526076 DOI: 10.1155/2022/8735551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/14/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
Background. Although the prognosis of papillary thyroid cancer (PTC) is relatively good, some patients experience recurrence or distant metastasis after thyroidectomy and progress to radioactive iodine refractory stage. Therefore, accurate prediction of clinical outlook can aid to screen out the minority of patients with poorer prognosis and avoid excessive treatment in low-risk patients. Methods. The RNA-seq and clinical data of PTC patients was downloaded from the Gene Expression Omnibus (GEO) and the Cancer Genome Atlas (TCGA) databases. Multivariate and Lasso Cox regression analyses were used to construct a prognostic nomogram to predict overall survival (OS). Thereafter, quantitative RT-PCR and Human Protein Atlas (HPA) database were employed to verify the expression of key genes. Results. A four-gene risk score comprising ABI3BP, DPT, MRO, and TENM1 was exhibited strong prognostic value. Moreover, an integrated nomogram was established based on the risk score, age, AJCC (American Joint Commission on Cancer) stage, tumor size, extrathyroidal extension, and history of neoadjuvant treatment, which exhibited significantly better predictive performance than TNM stage system (
). GSEA (Gene Set Enrichment Analysis) and GSVA (Gene Set Variation Analysis) revealed that the different tumor-associated hallmarks, biological processes, and pathways were substantially enriched in the poor-prognosis group. In addition, a ceRNA network was constructed by including the four genes (ABI3BP, DPT, MRO, and TENM1), 54 lncRNAs, and 10 miRNAs. Finally, both the relative mRNA and protein expression of ABI3BP, DPT, MRO, and TENM1 were validated. Conclusion. The present study identified a four-gene risk signature and developed a novel nomogram, which could be regarded as a reliable prognostic model for PTC patients. The findings also revealed preliminary potential mechanisms that may influence the prognosis outcome. These results can be conducive to design personalized treatment and prognosis management in affected patients.
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Rajab M, Payne RJ, Forest VI, Pusztaszeri M. Molecular Testing for Thyroid Nodules: The Experience at McGill University Teaching Hospitals in Canada. Cancers (Basel) 2022; 14:cancers14174140. [PMID: 36077677 PMCID: PMC9454567 DOI: 10.3390/cancers14174140] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
In the past few decades, molecular characterization of thyroid cancer has made significant progress and is able to identify thyroid-cancer-related molecular markers that can then be applied clinically for improved decision making. The aim of this review is to provide a general overview about the molecular markers (mutations and alterations) of thyroid cancers, present several molecular tests, and discuss the clinical applications of identifying these markers supported by the clinical experience of several high-volume thyroid cancer specialists at the McGill university hospitals in Montreal, Canada. Our group experience showed that molecular testing can reclassify more than half of the patients with indeterminate thyroid nodules (Bethesda III and IV) into benign and spare these patients from unnecessary diagnostic surgery. Furthermore, it can help optimize the initial management in thyroid cancers with no evidence of high risk of recurrence of disease preoperatively. While routine molecular testing is not firmly established for thyroid FNA specimens that are suspicious or positive for malignancy (Bethesda V and VI), knowledge of a thyroid nodule’s molecular risk group profile in such cases, together with its clinical and radiologic features, can help select the optimal surgical options (lobectomy versus upfront total thyroidectomy and central neck dissection), as demonstrated by our studies.
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Affiliation(s)
- Mohannad Rajab
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
- Departments of Otolaryngology—Head and Neck Surgery, Royal Victoria Hospital, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
- Department of Otolaryngology—Head and Neck Surgery, King Faisal Specialist Hospital & Research Center, Al Madinah Al Munawwarah 42523, Saudi Arabia
| | - Richard J. Payne
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
- Departments of Otolaryngology—Head and Neck Surgery, Royal Victoria Hospital, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
| | - Véronique-Isabelle Forest
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
- Correspondence: ; Tel.: +1-(514)-340-8222 (ext. 4197)
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Chen Z, Du Y, Cheng L, Zhang Y, Zheng S, Li R, Zhang W, Zhang W, He W. Diagnostic performance of simplified TI-RADS for malignant thyroid nodules: comparison with 2017 ACR-TI-RADS and 2020 C-TI-RADS. Cancer Imaging 2022; 22:41. [PMID: 35978376 PMCID: PMC9386958 DOI: 10.1186/s40644-022-00478-y] [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: 05/05/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study is to propose a new TI-RADS and compare it with the American College of Radiology (2017 ACR)-TI-RADS and the 2020 Chinese (2020 C)-TI-RADS. Methods A retrospective analysis of 749 thyroid nodules was performed. Based on the calculated odds ratio of ultrasonic signs between benign and malignant nodules, a new thyroid nodule score and malignancy rate were calculated. A receiver operating characteristic curve was drawn to analyze the new system’s effectiveness in the differential diagnosis of benign and malignant thyroid nodules and was compared with the 2020 C-TI-RADS and 2017 ACR-TI-RADS. Five ultrasound physicians with different qualifications graded another 123 thyroid nodules according to the 2017ACR-TI-RADS, 2020 C-TI-RADS, and the newly proposed TI-RADS. Intergroup and intragroup consistency was evaluated using the Kappa test and intraclass correlation coefficient (ICC) test. Results 1) The new thyroid nodule score was divided into 0, 1, 2, 3, 4, and 5 points, with malignancy rates of 1.52%, 7.69%, 38.24%, 76.00%, 90.75%, and 93.75%, respectively. Using 3 points as the cutoff value to diagnose benign and malignant thyroid nodules, the sensitivity and specificity were 94.03% and 67.39%, respectively, which were higher than those of the 2017 ACR-TI-RADS and 2020 C-TI-RADS. The simplified TI-RADS, namely, sTI-RADS, was established as follows: sTI-RADS 3 (0 points), malignancy rate < 2%; sTI-RADS 4a (1 point), malignancy rate 2–10%; sTI-RADS 4b (2 points), malignancy rate 10–50%; sTI-RADS 4 (3 points), malignancy rate 50–90%; and sTI-RADS 5 (4 and 5 points), malignancy rate > 90%. 2) Five ultrasound doctors graded thyroid nodules by the 2017 ACR-TI-RADS, 2020C-TI-RADS and sTI-RADS. Intragroup consistency was good among all tests; ICC were 0.86 (0.82–0.90), 0.84 (0.78–0.88), and 0.88 (0.84–0.91), respectively, while only sTI-RADS had good intergroup consistency. Conclusion In summary, we proposed a new TI-RADS, namely, sTI-RADS, which was obtained using a simple assignment method with higher specificity, accuracy, positive predictive value, and Youden index than the 2017 ACR-TI-RADS and 2020 C-TI-RADS.
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Affiliation(s)
- Zhiguang Chen
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China
| | - Yue Du
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China
| | - Linggang Cheng
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China
| | - Yukang Zhang
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China
| | - Shuai Zheng
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China
| | - Rui Li
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China
| | - Wenkai Zhang
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China
| | - Wei Zhang
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China.
| | - Wen He
- Department of Ultrasound, Fengtai District, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, BeijingBeijing, 100160, China.
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Qian XQ, Agyekum EA, Zhao LL, Yu RL, Li XY, Gu DJ, Yan N, Xu M, Yuan Y, Wang YG, Xin-ping W, Xu FJ. A comparison of DP-TOF Mass Spectroscopy (MS) and Next Generation Sequencing (NGS) methods for detecting molecular mutations in thyroid nodules fine needle aspiration biopsies. Front Endocrinol (Lausanne) 2022; 13:928788. [PMID: 35992139 PMCID: PMC9386519 DOI: 10.3389/fendo.2022.928788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Mutations in the B-Raf proto-oncogene, serine/threonine kinase (BRAF), have been linked to a variety of solid tumors such as papillary thyroid carcinoma. The purpose of this study was to compare the DP-TOF, a DNA mass spectroscopy (MS) platform, and next-generation sequencing (NGS) methods for detecting multiple-gene mutations (including BRAFV600E) in thyroid nodule fine-needle aspiration fluid. In this study, we collected samples from 93 patients who had previously undergone NGS detection and had sufficient DNA samples remaining. The MS method was used to detect multiple-gene mutations (including BRAFV600E) in DNA remaining samples. NGS detection method was used as the standard. The MS method's overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.8%, 100%, 100%, and 88%, respectively in BRAFV600E gene mutation detection. With a kappa-value of 0.92 (95%CI 0.82-0.99), the level of agreement between these methods was incredibly high. Furthermore, when compared to NGS in multiple-gene detection, the MS method demonstrated higher sensitivity and specificity, 82.9% and 100%, respectively. In addition, we collected the postoperative pathological findings of 50 patients. When the postoperative pathological findings were used as the standard, the MS method demonstrated higher sensitivity and specificity, at 80% and 80%, respectively. Our findings show that the MS method can be used as an inexpensive, accurate, and dependable initial screening method to detect genes mutations and as an adjunct to clinical diagnosis.
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Affiliation(s)
- Xiao-qin Qian
- Department of Ultrasound, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, China
| | - Enock Adjei Agyekum
- Department of Ultrasound, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, China
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Ling-ling Zhao
- Research and Development Center, Hangzhou D.A. Medical Laboratory, Hangzhou, China
| | - Run-liu Yu
- Research and Development Center, Hangzhou D.A. Medical Laboratory, Hangzhou, China
| | - Xiu-ying Li
- Nanjing D.A. Medical Laboratory, Nanjing, China
| | - De-jian Gu
- Nanjing D.A. Medical Laboratory, Nanjing, China
| | - Na Yan
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou, China
| | - Ming Xu
- Department of Medicine, Zhejiang Digena Diagnosis Technology CO., LTD, Zhejiang, China
| | - Yuan Yuan
- Department of Ultrasound, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu-guo Wang
- Department of Ultrasound, Jiangsu Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, China
- *Correspondence: Fei-ju Xu, ; Wu Xin-ping, ; Yu-guo Wang,
| | - Wu Xin-ping
- Department of Ultrasound, Jiangsu Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing, China
- *Correspondence: Fei-ju Xu, ; Wu Xin-ping, ; Yu-guo Wang,
| | - Fei-ju Xu
- Department of Ultrasound, Affiliated People’s Hospital of Jiangsu University, Zhenjiang, China
- *Correspondence: Fei-ju Xu, ; Wu Xin-ping, ; Yu-guo Wang,
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Prabhash K, Saha S, Joshi A, Noronha V, Patil V, Menon N, Singh A, Shetty O, Mittal N, Chandrani P, Chougule A. NRAS mutation in differentiated thyroid cancer. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_296_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Xu D, Wang Y, Wu H, Lu W, Chang W, Yao J, Yan M, Peng C, Yang C, Wang L, Xu L. An artificial intelligence ultrasound system's ability to distinguish benign from malignant follicular-patterned lesions. Front Endocrinol (Lausanne) 2022; 13:981403. [PMID: 36387869 PMCID: PMC9660226 DOI: 10.3389/fendo.2022.981403] [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] [Received: 07/11/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the application value of a generally trained artificial intelligence (AI) automatic diagnosis system in the malignancy diagnosis of follicular-patterned thyroid lesions (FPTL), including follicular thyroid carcinoma (FTC), adenomatoid hyperplasia nodule (AHN) and follicular thyroid adenoma (FTA) and compare the diagnostic performance with radiologists of different experience levels. METHODS We retrospectively reviewed 607 patients with 699 thyroid nodules that included 168 malignant nodules by using postoperative pathology as the gold standard, and compared the diagnostic performances of three radiologists (one junior, two senior) and that of AI automatic diagnosis system in malignancy diagnosis of FPTL in terms of sensitivity, specificity and accuracy, respectively. Pairwise t-test was used to evaluate the statistically significant difference. RESULTS The accuracy of the AI system in malignancy diagnosis was 0.71, which was higher than the best radiologist in this study by a margin of 0.09 with a p-value of 2.08×10-5. Two radiologists had higher sensitivity (0.84 and 0.78) than that of the AI system (0.69) at the cost of having much lower specificity (0.35, 0.57 versus 0.71). One senior radiologist showed balanced sensitivity and specificity (0.62 and 0.54) but both were lower than that of the AI system. CONCLUSIONS The generally trained AI automatic diagnosis system can potentially assist radiologists for distinguishing FTC from other FPTL cases that share poorly distinguishable ultrasonographical features.
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Affiliation(s)
- Dong Xu
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, China
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuan Wang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Hao Wu
- Department of Ultrasound, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenliang Lu
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Wanru Chang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Jincao Yao
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Meiying Yan
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Chanjuan Peng
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Chen Yang
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
| | - Liping Wang
- Department of Ultrasonography, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, China
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- *Correspondence: Liping Wang, ; Lei Xu,
| | - Lei Xu
- Ultrasound Branch, Zhejiang Society for Mathematical Medicine, Hangzhou, China
- Group of Computational Imaging and Digital Medicine, Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou, China
- Group of Intelligent Medical Devices, South and North Lake Institute for Medical Artificial Intelligence, Haiyan, China
- *Correspondence: Liping Wang, ; Lei Xu,
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Emerging Biomarkers in Thyroid Practice and Research. Cancers (Basel) 2021; 14:cancers14010204. [PMID: 35008368 PMCID: PMC8744846 DOI: 10.3390/cancers14010204] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Tumor biomarkers are molecules at genetic or protein level, or certain evaluable characteristics. These help in perfecting patient management. Over the past decade, advanced and more sensitive techniques have led to the identification of many new biomarkers in the field of oncology. A knowledge of the recent developments is essential for their application to clinical practice, and furthering research. This review provides a comprehensive account of such various markers identified in thyroid carcinoma, the most common endocrine malignancy. While some of these have been brought into use in routine patient management, others are novel and need more research before clinical application. Abstract Thyroid cancer is the most common endocrine malignancy. Recent developments in molecular biological techniques have led to a better understanding of the pathogenesis and clinical behavior of thyroid neoplasms. This has culminated in the updating of thyroid tumor classification, including the re-categorization of existing and introduction of new entities. In this review, we discuss various molecular biomarkers possessing diagnostic, prognostic, predictive and therapeutic roles in thyroid cancer. A comprehensive account of epigenetic dysregulation, including DNA methylation, the function of various microRNAs and long non-coding RNAs, germline mutations determining familial occurrence of medullary and non-medullary thyroid carcinoma, and single nucleotide polymorphisms predisposed to thyroid tumorigenesis has been provided. In addition to novel immunohistochemical markers, including those for neuroendocrine differentiation, and next-generation immunohistochemistry (BRAF V600E, RAS, TRK, and ALK), the relevance of well-established markers, such as Ki-67, in current clinical practice has also been discussed. A tumor microenvironment (PD-L1, CD markers) and its influence in predicting responses to immunotherapy in thyroid cancer and the expanding arena of techniques, including liquid biopsy based on circulating nucleic acids and plasma-derived exosomes as a non-invasive technique for patient management, are also summarized.
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Gilani SM, Abi-Raad R, Garritano J, Cai G, Prasad ML, Adeniran AJ. RAS mutation and associated risk of malignancy in the thyroid gland: An FNA study with cytology-histology correlation. Cancer Cytopathol 2021; 130:284-293. [PMID: 34847284 DOI: 10.1002/cncy.22537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Activating point mutations of the RAS gene (NRAS, HRAS, and KRAS) can be seen in benign and malignant thyroid tumors; among these, NRAS mutations are more commonly seen. This study was conducted to evaluate the thyroid risk of malignancy (ROM) associated with RAS mutations in thyroid fine-needle aspiration (FNA) at the authors' institution. METHODS The authors searched their electronic database system between January 2015 and May 2021 for thyroid FNA cases with any type of RAS mutation. Molecular alterations were identified with the ThyroSeq Genomic Classifier, ThyGeNEXT (thyroid oncogene panel)/ThyraMIR (miRNA classifier), or ThyroSure gene panel. RESULTS A total of 127 cases (age, 51 ± 14 years; 100 females and 27 males) were identified, and 72 had histologic follow-up. The overall ROM associated with RAS mutations (with or without any other molecular alterations) was 29%, whereas the ROM was lower (18%) with RAS mutations only. Isolated NRAS, HRAS, and KRAS mutation-associated ROMs were 15%, 27%, and 14%, respectively. Among these RAS-mutated cases, the cases with a Bethesda category IV cytologic diagnosis had a higher ROM than the cases with a category III diagnosis (38% vs 17%). Twenty-one histologically confirmed malignant cases were mostly classified on cytology as category IV lesions (14 of 34; 41%), and the remainder were either category III (6 of 35; 17%) or V lesions (1 of 1; 100%). CONCLUSIONS This study demonstrated that the overall RAS mutation-associated ROM in thyroid FNA was intermediate (29%), and isolated HRAS mutations appeared to have a higher ROM (27%) than NRAS and KRAS mutations (15% and 14%, respectively).
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Affiliation(s)
- Syed M Gilani
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Rita Abi-Raad
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - James Garritano
- Medical Scientist Training Program, Yale School of Medicine, New Haven, Connecticut.,Applied Mathematics Program, Yale University, New Haven, Connecticut
| | - Guoping Cai
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Manju L Prasad
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
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Ratajczak M, Gaweł D, Godlewska M. Novel Inhibitor-Based Therapies for Thyroid Cancer-An Update. Int J Mol Sci 2021; 22:11829. [PMID: 34769260 PMCID: PMC8584403 DOI: 10.3390/ijms222111829] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
Thyroid cancers (TCs) are the most common tumors of the endocrine system and a constant rise in the number of TC cases has been observed for the past few decades. TCs are one of the most frequent tumors in younger adults, especially in women, therefore early diagnosis and effective therapy are especially important. Ultrasonography examination followed by fine needle biopsy have become the gold standard for diagnosis of TCs, as these strategies allow for early-stage detection and aid accurate qualification for further procedures, including surgical treatment. Despite all the advancements in detection and treatment of TCs, constant mortality levels are still observed. Therefore, a novel generation line of targeted treatment strategies is being developed, including personalized therapies with kinase inhibitors. Recent molecular studies on TCs demonstrate that kinase inhibitor-based therapies might be considered as the most promising. In the past decade, new kinase inhibitors with different mechanisms of action have been reported and approved for clinical trials. This review presents an up-to-date picture of new approaches and challenges of inhibitor-based therapies in treatment of TCs, focusing on the latest findings reported over the past two years.
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Affiliation(s)
- Maciej Ratajczak
- Centre of Postgraduate Medical Education, Department of Endocrinology, Marymoncka 99/103, 01-813 Warsaw, Poland;
| | - Damian Gaweł
- Centre of Postgraduate Medical Education, Department of Immunohematology, Marymoncka 99/103, 01-813 Warsaw, Poland
- Centre of Postgraduate Medical Education, Department of Biochemistry and Molecular Biology, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Marlena Godlewska
- Centre of Postgraduate Medical Education, Department of Biochemistry and Molecular Biology, Marymoncka 99/103, 01-813 Warsaw, Poland
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Role of Advanced Glycation End-Products and Other Ligands for AGE Receptors in Thyroid Cancer Progression. J Clin Med 2021; 10:jcm10184084. [PMID: 34575195 PMCID: PMC8470575 DOI: 10.3390/jcm10184084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
To date, thyroid cancers (TCs) remain a clinical challenge owing to their heterogeneous nature. The etiopathology of TCs is associated not only with genetic mutations or chromosomal rearrangements, but also non-genetic factors, such as oxidative-, nitrosative-, and carbonyl stress-related alterations in tumor environment. These factors, through leading to the activation of intracellular signaling pathways, induce tumor tissue proliferation. Interestingly, the incidence of TCs is often coexistent with various simultaneous mutations. Advanced glycation end-products (AGEs), their precursors and receptors (RAGEs), and other ligands for RAGEs are reported to have significant influence on carcinogenesis and TCs progression, inducing gene mutations, disturbances in histone methylation, and disorders in important carcinogenesis-related pathways, such as PI3K/AKT/NF-kB, p21/MEK/MPAK, or JAK/STAT, RAS/ERK/p53, which induce synthesis of interleukins, growth factors, and cytokines, thus influencing metastasis, angiogenesis, and cancer proliferation. Precursors of AGE (such as methylglyoxal (MG)) and selected ligands for RAGEs: AS1004, AS1008, and HMGB1 may, in the future, become potential targets for TCs treatment, as low MG concentration is associated with less aggressive anaplastic thyroid cancer, whereas the administration of anti-RAGE antibodies inhibits the progression of papillary thyroid cancer and anaplastic thyroid cancer. This review is aimed at collecting the information on the role of compounds, engaged in glycation process, in the pathogenesis of TCs. Moreover, the utility of these compounds in the diagnosis and treatment of TCs is thoroughly discussed. Understanding the mechanism of action of these compounds on TCs pathogenesis and progression may potentially be the grounds for the development of new treatment strategies, aiming at quality-of-life improvements.
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