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Nielsen S, Kuchta K, Huang G, Zuber S, Holoubek S, Karcioglu A, Khokar A, Prinz R, Moo‐Young T. Predicting disease-specific survival in patients undergoing active surveillance for papillary thyroid carcinoma. World J Surg 2025; 49:1011-1021. [PMID: 39702859 PMCID: PMC11994147 DOI: 10.1002/wjs.12434] [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] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 11/23/2024] [Indexed: 12/21/2024]
Abstract
BACKGROUND American Thyroid Association guidelines support active surveillance (AS) for low-risk papillary thyroid cancer (PTC). We developed a calculator to aid patient selection. METHODS From 2004 to 2020, 148,904 PTC patients were selected from the surveillance, epidemiology, and end results (SEER) database. Univariable and multivariable analysis evaluated patient and treatment characteristics. Patients were randomly allocated into training (80%) or validation sets (20%). Coefficients generated a mathematical model to predict 5- and 10-year disease-specific survival (DSS). RESULTS The mean DSS was 15.5 years with a 5- and 10-year DSS of 99.3% and 98.6%, respectively. Age, sex, race, median household income (MHI), tumor size, and nodal status were significant on multivariable analysis (p ≤ 0.05) and included variables in our calculator. 2404 patients underwent non-operative management (NOM) and were more likely older, male, higher MHI, larger tumor size, and less nodal positivity. Area under the curve (AUC) for 5- and 10-year DSS were 0.83 and 0.81, respectively, for the training set and 0.81 and 0.79, respectively, for the validation set. EXAMPLE 65-year-old White female with a 0.8 cm PTC, cN0 with a MHI ≥ $75,000, had a 10-year predicted DSS was 95.6% with NOM and 99.3% with surgery. Alternatively, changing the patient's race to Hispanic, the 10-year predicted DSS was 94.1% with NOM and 99.0% with surgery. CONCLUSIONS As awareness of AS for PTC expands, it is important to consider objective data to guide informed decision making. This validated calculator is a useful tool to predict DSS for patients considering AS for PTC.
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Affiliation(s)
- Stanton Nielsen
- Department of SurgeryNorthShore University HealthSystemEvanstonILUSA
- The University of Chicago Medical Center ChicagoChicagoILUSA
| | - Kristine Kuchta
- Department of SurgeryNorthShore University HealthSystemEvanstonILUSA
| | - Grace Huang
- Department of SurgeryNorthShore University HealthSystemEvanstonILUSA
| | - Samuel Zuber
- Department of SurgeryNorthShore University HealthSystemEvanstonILUSA
| | - Simon Holoubek
- Department of SurgeryUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Amanda Karcioglu
- Department of SurgeryNorthShore University HealthSystemEvanstonILUSA
- The University of Chicago Medical Center ChicagoChicagoILUSA
| | - Amna Khokar
- Department of SurgeryJohn H. Stroger Jr, Hospital of Cook CountyChicagoILUSA
| | - Richard Prinz
- Department of SurgeryNorthShore University HealthSystemEvanstonILUSA
| | - Tricia Moo‐Young
- Department of SurgeryNorthShore University HealthSystemEvanstonILUSA
- The University of Chicago Medical Center ChicagoChicagoILUSA
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Kostek M, Kostek H, Unlu MT, Caliskan O, Cakir Y, Sengul Z, Ekmekcioglu O, Kafi M, Ozel A, Aygun N, Uludag M. Deciding on Fine Needle Aspiration Biopsy in Thyroid Incidentalomas in FDG-PET/CT: Should Ultrasonographic Evaluation or FDG Uptake Be in the Foreground? SISLI ETFAL HASTANESI TIP BULTENI 2025; 59:20-27. [PMID: 40226554 PMCID: PMC11983016 DOI: 10.14744/semb.2025.49140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2024] [Revised: 02/06/2025] [Accepted: 02/11/2025] [Indexed: 04/15/2025]
Abstract
Objectives 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) is a widespread imaging technique for whole-body scanning. Incidental lesions may be detected in thyroid gland and the importance and management of these lesions are still a matter of debate. The aims of this study were the evaluation of the diagnostic success of ultrasonography and FDG-PET/CT for predicting malignancy and contribution of these techniques for the decision of Fine Needle Aspiration Biopsy (FNAB) in incidental thyroid lesions detected in FDG-PET/CT. Methods Patients who underwent FDG-PET/CT in Nuclear Medicine Unit in a single institution between January 2018 and December 2022 were screened for thyroid incidentaloma with increased focal FDG uptake. Imaging studies and pathology results of the patients with Focal Thyroid Incidentalomas (FTI) were reviewed retrospectively. Results A total of 14.003 FDG-PET/CT reports of 8.259 patients were evaluated. In FDG-PET/CT imaging, 495 (6.0%) patients had increased uptake in thyroid gland, 383 (4.6%) patients had focal and 112 (1.4%) patients had diffuse FDG uptake. The rate of malignancy in FTIs was 19.2%. In the ROC curve analysis, regarding the prediction of malignancy in FTIs with FDG uptake, a SUVmax value of 5.5 and above predicts malignancy with a sensitivity of 71.4% and a specificity of 68.6% (AUC:0.718, p=0.018, 95%CI:0.564-0.872). The sensitivity of ACR-TIRADS-5 was 35.7% (95%CI:14.6-61.7) and sensitivity of the combination of SUVmax>5.5 and ACR-TIRADS-5 was 30.0% (95%CI:8.5-60.7). Conclusion FDG-PET/CT findings can be used for determining malignancy risk and cutoff values such as 5.5 can be threshold for ordering FNAB. In patients with SUVmax less than 5.5, ultrasonographic risk classification criteria should be used for decision-making.
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Affiliation(s)
- Mehmet Kostek
- Address for correspondence: Mehmet Kostek, MD. Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye Phone: +90 542 391 00 56 E-mail:
| | - Hatice Kostek
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
- Department of Endocrinology and Metabolism, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Taner Unlu
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ozan Caliskan
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Yasin Cakir
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Zerin Sengul
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ozgul Ekmekcioglu
- Department of Nuclear Medicine, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mesut Kafi
- Department of Nuclear Medicine, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Alper Ozel
- Department of Radiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Nurcihan Aygun
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Uludag
- Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Liu Y, Liu H, Zhan J, Chai Q, Zhu J, Ding S, Chen L. Contrast-Enhanced Ultrasound for Diagnosing Thyroid Nodules With Indeterminate Cytology: A Retrospective Study. Clin Endocrinol (Oxf) 2025; 102:223-231. [PMID: 39502003 DOI: 10.1111/cen.15160] [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: 04/08/2024] [Revised: 10/21/2024] [Accepted: 10/24/2024] [Indexed: 01/03/2025]
Abstract
BACKGROUND A small number of thyroid nodules cannot be clearly diagnosed using ultrasound-guided fine needle aspiration biopsy. Contrast-enhanced ultrasound (CEUS) has high diagnostic performance for thyroid nodules. We explored the value of CEUS for diagnosing thyroid nodules with indeterminate cytology. METHODS Between September 2019 and July 2022, 27,646 patients with thyroid nodule(s) underwent conventional ultrasound (CUS) in our hospital. From these patients, 597 nodules were subjected to CEUS and ultrasound-guided fine needle aspiration biopsy and 116 thyroid nodules with indeterminate cytology diagnose were enrolled in this study. The independent risk factors for predicting malignancy were determined using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were drawn for CUS, CEUS, and CEUS combined with CUS. The area under the curve (AUC) was calculated and compared. RESULTS Of the 116 thyroid nodules, 40 (34.5%) were benign and 76 (65.5%) were malignant. Univariate analysis showed that the shape, echogenicity, margin, microcalcification, enhancement intensity, enhancement homogeneity, wash in, and wash out were significantly different between benign and malignant thyroid nodules (all p < 0.05). Multivariate logistic regression analysis showed that taller-than-wide, irregular margin, microcalcification, hypo-enhancement, heterogeneity enhancement, synchronous/slower wash in, and synchronous/slower wash out were independent risk factors for malignancy (all p < 0.05). ROC curve analysis showed that the AUC of CUS and CEUS were 0.769 and 0.848, respectively. No significant difference was observed in the AUC between the two modalities (p > 0.05). However, the AUC (0.934) of the CUS combined with CEUS was significantly higher than that of CEUS or CUS alone (both p < 0.05). CONCLUSIONS CEUS is helpful in diagnosing thyroid nodules with indeterminate cytology. CUS combined with CEUS is highly valuable for predicting malignancy.
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Affiliation(s)
- Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Hui Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Department of Ultrasound, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Qiliang Chai
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Jun Zhu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Shengnan Ding
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
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Girardi FM, Wagner VP, Martins MD. Thyroid Incidentalomas: Scrutinizing the Mode of Detection and Evaluating its Contribution to Thyroid Cancer Diagnosis. Indian J Otolaryngol Head Neck Surg 2024; 76:1733-1740. [PMID: 38566651 PMCID: PMC10982254 DOI: 10.1007/s12070-023-04392-y] [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: 06/14/2023] [Accepted: 11/18/2023] [Indexed: 04/04/2024] Open
Abstract
There is an ongoing debate about the reasons behind the increasing incidence of thyroid cancer in the last two to three decades. Here, we investigate how thyroid nodules were detected in a large series of consultations for thyroid nodular pathology. METHODS In total, 576 patients were analyzed, with a total of 1014 nodules described. RESULTS In 347 (60.2%) cases, the diagnosis of a thyroid nodule was incidental, mostly during imaging tests for other reasons. Incidental diagnosis occurred among all ranges of nodule diameter and between palpable and non-palpable cases, even within a small proportion of symptomatic cases. In univariate analysis, incidental diagnosis was associated with smaller nodule diameter, non-palpable nodules, asymptomatic cases, older patient age, less advanced stages (T1-2), and conservative management. After multivariate analysis, older age, euthyroidism, and smaller diameter were statistically significant. Incidental diagnosis contributed to the diagnosis of 53.8% of the cases of cancer. Advanced T stages (T3-4) were more common in non-incidental diagnoses. CONCLUSION Our results indicate that incidental diagnosis of thyroid nodules is a significant contributor to thyroid cancer diagnosis in all ranges of nodule diameter, especially at earlier stages.
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Affiliation(s)
- Fábio Muradás Girardi
- Integrated Oncology Center of Ana Nery Hospital, Borges de Medeiros Street, 274, 503, Santa Cruz do Sul, RS 96810-034 Brazil
| | - Vivian P. Wagner
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- Department of Oral Medicine, Porto Alegre Clinics Hospital (HCPA/UFRGS), Porto Alegre, RS Brazil
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Chen C, Gao D, Luo L, Qu R, Hu X, Wang Y, Guo Y. Parathyroid preservation in total endoscopic thyroid surgeries via the mammary areolas approach: Real-world data from a single center. Asian J Surg 2023; 46:5421-5428. [PMID: 37344318 DOI: 10.1016/j.asjsur.2023.05.169] [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: 01/12/2023] [Revised: 04/22/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Preserving parathyroid glands in situ is crucial to avoid surgical hypoparathyroidism, but it is also one of the greatest challenges during thyroid surgery. Magnified endoscopic imaging has been proposed as a way to improve parathyroid preservation. METHODS 2,603 consecutive patients who underwent thyroid surgery at the First People's Hospital of Zunyi from January 2018 to July 2022 were screened. 1,355 patients were eligible, including 965 endoscopic and 390 open cases. Parathyroid hormone (PTH) loss levels and severe parathyroid injury rates were compared between endoscopic and open cases. Meanwhile, factors that contribute to parathyroid injuries were assessed, including surgical extent, tumor size, carbon nanoparticle guidance, and surgical proficiency. RESULTS PTH loss levels were similar between endoscopic and open cases (P = 0.440). The incidence of severe parathyroid injuries was also comparable (7.8% for endoscopic vs. 6.9% for open, P = 0.592). The endoscopic group had higher rates of autologous parathyroid transplantation (39.5% vs. 24.4%, P = 0.000), while accidental parathyroidectomy rates were similar (11.4% vs. 10.8%, P = 0.739). Among patients who received the same extent of thyroid surgeries, no significant difference was found in PTH loss levels and severe parathyroid injury rates, except for a higher risk of severe parathyroid injuries in endoscopic bilateral thyroidectomy (18.52% vs. 11.52%, P = 0.033). CONCLUSIONS Despite the magnified endoscopic imaging facilitating the identification of parathyroid tissues, endoscopic approaches are not superior to open ones for the in-situ preservation of parathyroid glands. For a bilateral thyroidectomy, open approaches are safer for parathyroid preservation.
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Affiliation(s)
- Chen Chen
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Fenghuang N Rd, 563000, Zunyi, Guizhou, China.
| | - Dan Gao
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Fenghuang N Rd, 563000, Zunyi, Guizhou, China.
| | - Libo Luo
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Fenghuang N Rd, 563000, Zunyi, Guizhou, China.
| | - Rui Qu
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Fenghuang N Rd, 563000, Zunyi, Guizhou, China.
| | - Xiaochi Hu
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Fenghuang N Rd, 563000, Zunyi, Guizhou, China.
| | - Yixiao Wang
- Department of Surgery, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Fenghuang N Rd, 563000, Zunyi, Guizhou, China.
| | - Youming Guo
- Breast and Thyroid Center, The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University), Fenghuang N Rd, 563000, Zunyi, Guizhou, China.
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Issa PP, Munshi R, Albuck AL, Omar M, Abu Alhuda RF, Metz T, Hussein M, Shama M, Lee GS, Toraih E, Kandil E. Recommend with caution: A meta-analysis investigating papillary thyroid carcinoma tumor progression under active surveillance. Am J Otolaryngol 2023; 44:103994. [PMID: 37607459 DOI: 10.1016/j.amjoto.2023.103994] [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: 03/19/2023] [Accepted: 07/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is an indolent disease with favorable outcomes. The non-surgical treatment approach known as active surveillance (AS) has been introduced as an alternative treatment instead of the traditional thyroidectomy. However, 10-15 % of PTC tend to progress. We sought to determine factors predicting the progression of PTC under AS. METHODS A systematic search was performed in January 2022 using PubMed, Embase, Google Scholar, Web of Science, and ScienceDirect. PRISMA guidelines were used by multiple reviewers to extract study characteristics (author name, publication date, journal name, country, institution, and study design), as well as main outcomes and measures. A combination of utilization of thyroid replacement therapy, baseline tumor size and volume, follow-up tumor size and volume, and the presence of lymph node metastasis and its distribution, as well as surveillance duration, were the main measures of this study. RESULTS Nine studies with 4166 patients were included, of which 354 showed tumor progression during AS (15 %; 95%CI = 7 % - 23 %). The average follow-up period was 41.58 months. The mean tumor maximum diameter was 8.54 mm (95%CI = 7.04-10.03). Tumor progression was most commonly secondary to an increase in volume by ≥50 % (75 %; 95%CI = 68 % - 80 %), then increase in diameter by ≥3 mm (41 %; 95%CI = 13 % - 76 %), and finally the development of lymph node metastasis (13 %; 95%CI = 9 % - 19 %). Approximately only 2 % of all patients thus developed new lymph node metastasis. Patient age, sex, and tumor size were not associated with higher risks of tumor progression. 12 % of AS patients eventually underwent surgery, though only 40 % (95%CI = 27 % - 53 %) of these patients displayed tumor progression. CONCLUSIONS Our meta-analysis determined a tumor progression rate of 15 % in patients who underwent AS management, 13 % of which (2 % of all patients) developed lymph node metastasis. We found no protective or risk factors for tumor progression, and that almost half of all patients who underwent delayed surgery did so for reasons other than tumor progression. While not biopsying small (<1 cm) or very low suspicious nodules is already recommended, AS may be an appropriate treatment option in patients appropriately counseled, considering the low risk of advanced tumor progression but also the considerable patient population who fail to adhere to treatment. Alternatively, in aim of preventing overtreatment in patients who would rather take proactive measures against their low-risk carcinoma, minimally-invasive ablation techniques may be an attractive option.
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Affiliation(s)
- Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America; School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Ruhul Munshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Aaron L Albuck
- School of Medicine, Tulane University, New Orleans, LA, United States of America
| | - Mahmoud Omar
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Ruba F Abu Alhuda
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Tyler Metz
- School of Medicine, Tulane University, New Orleans, LA, United States of America
| | - Mohammad Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Grace S Lee
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America; Genetics Unit, Department of Histology and Cell Biology, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America.
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Lin Y, Wu Y. Trends in incidence and overdiagnosis of thyroid cancer in China, Japan, and South Korea. Cancer Sci 2023; 114:4052-4062. [PMID: 37488752 PMCID: PMC10551580 DOI: 10.1111/cas.15909] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
We used data from 13 cancer registries in China, Japan, and South Korea to analyze time trends in overdiagnosis of thyroid cancer between 1998 and 2012. Age-standardized and age-specific incidence and annual percentage changes were calculated. The number of thyroid cancers diagnosed and the proportion attributable to overdiagnosis were estimated, with calculations stratified by sex and age group. The Spearman method was used to analyze the correlation between thyroid cancer incidence and overdiagnosis. From 1998 to 2012, both the incidence and proportions of overdiagnoses of thyroid cancer in China, Japan, and South Korea showed an increasing trend, with higher rates in women than men. South Korea had both the highest incidence for men (10.1/105 ) and women (46.7/105 ) and the highest proportions of overdiagnosis (men, 90.3%; women, 94.9%). The fastest growth in overdiagnosis was in Chinese men and women (annual percentage changes 6.1 and 4.6, respectively). We found significant positive correlations between age-standardized incidence and proportions of overdiagnosis for both men (Spearman r = 0.98, p < 0.05) and women (Spearman r = 0.99, p < 0.05) in the three countries. Age-specific incidence curves in Chinese and South Korean individuals were of an inverted U-shape. Overdiagnosis of thyroid cancer in Japan was mainly concentrated in middle-aged and older patients, whereas in China and South Korea, it occurred primarily in the middle-aged. The incidence and overdiagnosis of thyroid cancer in China, Japan, and South Korea are increasing, necessitating the implementation of comprehensive measures to reduce these overdiagnoses.
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Affiliation(s)
- Yongtian Lin
- Department of EpidemiologyClinical Oncology School of Fujian Medical University, Fujian Cancer HospitalFuzhouChina
| | - Yu Wu
- Department of Head and Neck SurgeryClinical Oncology School of Fujian Medical University, Fujian Cancer HospitalFuzhouChina
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Osseis M, Jammal G, Kazan D, Noun R. Comparison between Fine Needle Aspiration Cytology with Histopathology in the Diagnosis of Thyroid Nodules. J Pers Med 2023; 13:1197. [PMID: 37623448 PMCID: PMC10455374 DOI: 10.3390/jpm13081197] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Accurate diagnosis of thyroid nodules is crucial for avoiding unnecessary surgeries and enabling timely treatment. Fine needle aspiration cytology (FNAC) and ultrasound are commonly employed diagnostic techniques, but their reliability is debated. This study aimed to compare the diagnostic accuracy of FNAC and ultrasounds using histopathology as the reference standard. METHODS A retrospective review was conducted on 344 patients who underwent thyroidectomy between January 2017 and May 2022. An ultrasound and FNAC were performed before surgery, and histopathological findings were compared. Statistical analyses were conducted to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false positive rate, false negative rate, and overall accuracy for each diagnostic method. RESULTS Among the study population, 38.67% of thyroid tumors were malignant. Ultrasound showed a sensitivity of 68.18%, specificity of 76.55%, PPV of 64.74%, NPV of 79.20%, and overall accuracy of 73.31%. FNAC had a sensitivity of 89.31%, specificity of 48.44%, PPV of 78%, NPV of 68.89%, and accuracy of 75.89%. The correlation coefficient between ultrasound and FNAC was 0.512 (p < 0.0000001). Ultrasound correlated with histopathology with a coefficient of 0.408 (p < 0.0000001), while FNAC with histopathology had a coefficient of 0.304 (p < 0.00001). The correlation coefficient between these three diagnostic methods was 0.423 (p < 0.0001). CONCLUSION In the diagnosis of thyroid nodules, both FNAC and ultrasound demonstrated moderate diagnostic accuracy. Ultrasound showed a higher specificity, while FNAC exhibited a higher sensitivity. Combining these techniques may improve diagnostic accuracy. Further research and the development of more reliable diagnostic methods are warranted to optimize the management of thyroid nodules and avoid unnecessary surgeries.
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Hussein M, Mueller L, Issa PP, Haidari M, Trinh L, Toraih E, Kandil E. Sexual disparity and the risk of second primary thyroid cancer: a paradox. Gland Surg 2023; 12:432-441. [PMID: 37200932 PMCID: PMC10186173 DOI: 10.21037/gs-22-411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/19/2023] [Indexed: 07/30/2024]
Abstract
BACKGROUND Despite extensive research on sex differences in primary thyroid cancer, there is a lack of data on the role of sex in the risk of developing second primary thyroid cancer (SPTC). We aimed to investigate the risk of SPTC development according to patient sex, with an emphasis concerning previous malignancy location as well as age. METHODS Cancer survivors diagnosed with SPTC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. The SEER*Stat software package obtained standardized incidence ratios (SIR) and absolute excess risks of subsequent thyroid cancer development. RESULTS Data for 9,730 (62.3%) females and 5,890 (37.7%) males were extracted for a total of 15,620 SPTC individuals. Asian/Pacific Islanders had the highest incidence of SPTC [SIR =2.67, 95% confidence interval (CI): 2.49-2.86]. The risk of SPTC was higher in males (SIR =2.01, 95% CI: 1.94-2.08) than when compared to females (SIR =1.83, 95% CI: 1.79-1.88; P<0.001). Head and neck tumors had significantly higher SIRs for SPTC development in males when compared to females. CONCLUSIONS Survivors of primary malignancies have an increased risk SPTC, especially males. Our work suggests that oncologists and endocrinologists may consider the need for increased surveillance of both male and female patients given their increased risk of SPTC.
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Affiliation(s)
- Mohammad Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Lauren Mueller
- School of Medicine, Tulane University, New Orleans, LA, USA
| | - Peter P. Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Muhib Haidari
- School of Medicine, Tulane University, New Orleans, LA, USA
| | - Lily Trinh
- School of Medicine, Tulane University, New Orleans, LA, USA
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Eman Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
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Jansen T, Stikkelbroeck N, van de Ven A, van Engen-van Grunsven I, Janssen M, Bonenkamp H, Gotthardt M, Netea-Maier RT. Clinical Characteristics, Diagnostic Approach and Outcome of Thyroid Incidental Findings vs. Clinically Overt Thyroid Nodules: An Observational Single-Centre Study. Cancers (Basel) 2023; 15:cancers15082350. [PMID: 37190278 DOI: 10.3390/cancers15082350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Context: Thyroid nodules are common and can present as clinically overt nodules (visible, palpable or symptomatic nodules) and so-called incidentalomas (coincidental findings on imaging techniques). The majority are benign but recognizing clinically relevant nodules remains a challenge. Current Dutch guidelines recommend to refrain from additional diagnostic testing in incidentalomas other than FDG-PET-incidentalomas, unless there are suspicious clinical and/or sonographic features. However, there is no consensus on the further approach and no "real-life" data on the outcome of such an approach. Objective: To compare clinical characteristics, diagnostic approaches and clinical outcome between patients referred with thyroid incidentalomas and non-incidentalomas at one academic referral thyroid clinic. Methods: Clinical and demographical characteristics, diagnostic and therapeutic approaches and outcome were retrospectively obtained from the files of all patients newly referred because of thyroid incidentalomas or non-incidentalomas to our institution (between March 2011 and January 2017). Subsequently, the data were compared between both groups. Results: In total, 351 patients (64.3%) were referred because of non-incidentalomas and 195 (35.7%) because of incidentalomas. Incidentalomas were smaller (48.7% <2 cm) than non-incidentalomas (23.4% <2 cm). Furthermore, incidentalomas were less often symptomatic (15.9 vs. 42.7% p < 0.001). Fine-needle aspiration was performed in a similar percentage of the patients in the two groups (62.6% of incidentalomas vs. 69.8% in non-incidentaloma, p = 0.08). Significantly less malignancies were found among incidentalomas compared to non-incidentalomas (5.1% vs. 11.1%, p = 0.019). Moreover, significantly more malignancies occurred in PET-incidentalomas than non-PET-incidentalomas (11.8% vs. 2.8%, p = 0.023). In fact, the proportion of malignancies in PET-incidentalomas and non-incidentalomas was similar (11.8% vs. 11.1%, p = 0.895). Stability or decrease in size was observed in 96.5% of nodules receiving ultrasound follow-up. Conclusions: Patients with small asymptomatic thyroid incidentalomas represent an important proportion of the patients referred for additional diagnostic evaluation. The risk of malignancy in these patients is lower than in those with symptomatic palpable lesions, particularly in the patients with incidentalomas discovered on CT, MRI or US. Our findings support the current recommendations from the Dutch guidelines to not indiscriminately perform additional analysis and treatment on all incidentalomas, but prioritize this to FDG-PET-incidentalomas and clinically relevant non-PET-incidentalomas. Moreover, US features can further refine the selection of the patients who require immediate FNAC and/or surgery.
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Affiliation(s)
- Tom Jansen
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Nike Stikkelbroeck
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Annenienke van de Ven
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Ilse van Engen-van Grunsven
- Department of Pathology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Marcel Janssen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Han Bonenkamp
- Department of Surgery, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Geert Groteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Ozisik H, Ozdil B, Suner A, Sipahi M, Erdogan M, Cetinkalp S, Ozgen G, Saygili F, Oktay G, Aktug H. The expression of HDAC9 and P300 in papillary thyroid carcinoma cell line. Pathol Res Pract 2023; 243:154385. [PMID: 36857949 DOI: 10.1016/j.prp.2023.154385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer and accounts for 85-90% of all thyroid cancers. Metastatic differentiated thyroid cancer, radioiodine-refractory thyroid cancer, and anaplastic thyroid cancer still lack effective therapeutic options. Here, we aimed to assess HDAC9 and P300 expression in the papillary thyroid carcinoma cell line and compare them with normal thyroid cells. METHODS Nthy-ori-3-1, a normal thyroid cell line, and BCPAP, a PTC cell line, were cultured for 24 and 48 h and immunofluorescence staining was used to determine the levels of HDAC9 and P300 protein expression. HDAC9 paracrine release was assessed using an ELISA assay. RESULTS HDAC9 protein expression was higher in both cell groups at the 48th hour than at the 24th hour; however, P300 protein expression was lower in BCPAP cells at the 48th hour than at the 24th hour. In comparison to Nthy-ori-3-1, BCPAP expressed more HDAC9 and P300 proteins. HDAC9 secretion slightly increased in Nthy-ori-3-1 cells from 24 to 48 h. Furthermore, HDAC9 secretion in BCPAP cells dramatically decreased from 24 to 48 h. CONCLUSION Our findings revealed that the expression of HDAC9 and P300 was higher in the PTC cell line than in normal thyroid cells. This indicates that the acetylation mechanism in thyroid cancer cells is not the same as it is in healthy cells. Epigenetic studies may reveal the mechanisms underlying PTC with further analysis.
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Affiliation(s)
- Hatice Ozisik
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkey.
| | - Berrin Ozdil
- Ege University, Department of Histology and Embryology, İzmir, Turkey; Department of Histology and Embryology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Aslı Suner
- Ege University, Department of Biostatistics and Medical Informatics, İzmir, Turkey
| | - Murat Sipahi
- Dokuz Eylül University, Institue of Health Sciences, Department of Biochemistry, İzmir, Turkey
| | - Mehmet Erdogan
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkey
| | - Sevki Cetinkalp
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkey
| | - Gokhan Ozgen
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkey
| | - Fusun Saygili
- Ege University, Department of Endocrinology and Metabolism, İzmir, Turkey
| | - Gulgun Oktay
- Dokuz Eylül University, Department of Medical Biochemistry, İzmir, Turkey
| | - Huseyin Aktug
- Ege University, Department of Histology and Embryology, İzmir, Turkey
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12
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Qu MY, Tang W, Cui XY, Jin YX, Wang ZY, Guo CY, Jia XD, Shi YQ, Zang JJ. Increased Prevalence of Thyroid Nodules Across Nearly 10 Years in Shanghai, China. Curr Med Sci 2023; 43:191-197. [PMID: 36547870 DOI: 10.1007/s11596-022-2666-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/09/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to determine whether the prevalence of thyroid nodules (TNs) increased due to modern lifestyles or other factors, despite the advances in screening and diagnostic tools. METHODS This study included 3474 pairs of participants, who were matched by gender and age (±3 years) from two cross-sectional sampling surveys: (1) the program on the iodine nutritional status and related health status of residents in Shanghai in 2009; (2) the thyroid disease screening program for adults in Shanghai between 2017 and 2018. The prevalence of TNs and thyroid diseases in 2009 and 2017-2018 were compared, and the potential risk factors of TNs were detected. RESULTS The prevalence of TNs in 2009 was 28.9%: 22.5% in males and 34.5% in females. In 2017, this increased to 43.8%: 37.9% in males and 49.1% in females. The prevalence of TNs significantly increased from 2009 to 2017 (odds ratio, 1.486; 95% confidence interval, 1.238-1.786). In addition, female gender, thyroid disease history, and age were the main risk factors for TNs after adjusting for confounders in the logistic regression across the time period. CONCLUSION The prevalence of TNs significantly increased across nearly 10 years in Shanghai.
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Affiliation(s)
- Meng-Ying Qu
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Wei Tang
- Department of Endocrinology, Changzheng Hospital, Shanghai, 200003, China
| | - Xue-Ying Cui
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Yu-Xiang Jin
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zheng-Yuan Wang
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Chang-Yi Guo
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Xiao-Dong Jia
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Yong-Quan Shi
- Department of Endocrinology, Changzheng Hospital, Shanghai, 200003, China
| | - Jia-Jie Zang
- Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China.
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Lian D, Chen W, Chen G, Liu C, Du D, Zhang N. Comparison between cutting versus retraction of anterior cervical musculature during endoscopic thyroidectomy. Medicine (Baltimore) 2022; 101:e29673. [PMID: 36401391 PMCID: PMC9678569 DOI: 10.1097/md.0000000000029673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
To compare the different techniques of managing the anterior cervical muscle group during endoscopic thyroidectomy via the trans-thoraco-areolar approach. A total of 90 patients with thyroid tumors less than 3 cm were evaluated. The time for each intraoperative step, total surgery duration, intraoperative blood loss volume, pathology results, number of lymph nodes dissected and patient satisfaction with esthetics were assessed. Intraoperative blood loss volume, drainage volume on the first postoperative day, number of lymph nodes dissected in the central region, postoperative hospitalization duration, number of transient laryngeal nerve palsy cases, and number of transient hypocalcemia cases were similar between the muscle transection (MT) and muscle retraction (MR) groups. The MT group had significantly higher postoperative pain scores after 12 hours, but pain scores at 48 hours postoperatively were not significantly different between the 2 groups. In the unilateral thyroidectomy subgroup, the durations of isthmus resection, freeing the lateral thyroid, exposing the laryngeal recurrent nerve, and management of the inferior pole were similar for both muscle management methods. The muscle dissection and suture time was significantly longer for the MT group than that for the MR group; in contrast, the upper pole management time of the muscle resection group was significantly shorter. In the bilateral resection subgroup, both muscle management methods required similar durations for managing the contralateral upper pole after ipsilateral thyroidectomy. However, intraoperative blood loss was significantly higher for MR than for MT, while postoperative pain was relatively mild. In the malignant tumor subgroup, duration of inferior thyroid pole management was significantly less for MT than for MR. There are significant differences between the 2 muscle management methods in handling and suturing muscles. Both methods have satisfactory postoperative outcomes for resection of thyroid nodules with diameters ≤3 cm. For tumors located in the upper pole, transection of the anterior cervical muscles confers higher feasibility of the thyroidectomy technique; however, suturing becomes difficult in such scenarios.
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Affiliation(s)
- Dongbo Lian
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Weijian Chen
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Guanyang Chen
- Department of Gastroenterology, Liver and Gallbladder Surgery, Peking University Ninth School of Clinical Medicine, Beijing, PR China
| | - Chen Liu
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Dexiao Du
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
| | - Nengwei Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, PR China
- *Correspondence: Nengwei Zhang, Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, PR China (e-mail: )
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14
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Lavorgna TR, Hussein M, Issa PP, Toraih E, Kandil E. Ultraviolet Light Exposure Decreases Thyroid Cancer Risk: A National Perspective. Biomedicines 2022; 10:biomedicines10102452. [PMID: 36289713 PMCID: PMC9598664 DOI: 10.3390/biomedicines10102452] [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: 08/29/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Ultraviolet (UV) light has been reported to have both pro-oncogenic and anti-oncogenic effects. Since patient pigmentation can influence the role of UV light exposure, we thought to investigate the recent trends in thyroid cancer incidence and survival with an emphasis on patient race and UV exposure. Patients diagnosed with thyroid cancer from the Surveillance, Epidemiology, and End Results (SEER) database were identified. A total of 284,178 patients were enrolled. Data were stratified according to population sex, race, and state. UV exposure data in Watt-Hours Per Square Meter for the state were obtained from the National Cancer Institute Cancer Atlas. Thyroid cancer incidence rate varied by race, ranging from 14.9 cases per 100,000 in Asian or Pacific Islanders and 14.7 per 100,000 in Caucasians, to 8.7 per 100,000 in African American and 8.0 per 100,000 in Native Americans. UV exposure was negatively correlated with thyroid cancer incidence when analyzed across all populations (r = −0.299, p = 0.035). UV exposure was most steeply negatively correlated with thyroid cancer rates in Black populations (r = −0.56, p < 0.001). Despite this, Black men had the worst 5-year survival rate when compared to other ethnic populations. Overall, UV exposure does not increase the risk of thyroid cancer and may serve as a protective factor in the development of thyroid cancer.
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Affiliation(s)
| | - Mohammad Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Peter P. Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Eman Toraih
- 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
- Correspondence: ; Tel.: +1-504-988-2301; Fax: +1-504-988-4762
| | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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15
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Issa PP, Omar M, Buti Y, Issa CP, Chabot B, Carnabatu CJ, Munshi R, Hussein M, Aboueisha M, Shama M, Corsetti RL, Toraih E, Kandil E. Hashimoto’s Thyroiditis Minimizes Lymph Node Metastasis in BRAF Mutant Papillary Thyroid Carcinomas. Biomedicines 2022; 10:biomedicines10082051. [PMID: 36009596 PMCID: PMC9405831 DOI: 10.3390/biomedicines10082051] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Hashimoto’s thyroiditis (HT) (autoimmune thyroiditis) is a clinicopathological entity associated with chronic lymphocytic infiltration resulting in hypothyroidism. HT is a double-edged sword that increases the risk of papillary thyroid cancer (PTC), yet it serves as a protective factor for PTC progression. BRAF mutation in PTCs is associated with rapid cell growth, aggressive tumor characteristics, and higher mortality rates. Here, we aimed to analyze the influence of HT in patients with PTCs and its effect on lymph node metastasis (LNM) in BRAF mutant tumors. Adults diagnosed with PTC between 2008 and January 2021 were retrospectively included. A total of 427 patients, 128 of whom had underlying HT, were included. The HT group had significantly higher rates of microcarcinoma (49.2% vs. 37.5%, p = 0.025) and less lateral LNM (8.6% vs. 17.1%, p = 0.024). Interestingly, BRAF-mutated PTCs were found to have significantly less overall LNM (20.9% vs. 51%, p = 0.001), central LNM (25.6% vs. 45.1%, p = 0.040) and lateral LNM (9.3% vs. 29.4%, p = 0.010) in patients with HT when compared to those without underlying HT. HT was found to be an independent protective predictor of overall and lateral LNM. Altogether, HT was able to neutralize the effect of BRAF mutation and was determined to be an independent protective factor against LNM. Specifically, our work may influence treatment-aggressiveness decision making for endocrinologists, oncologists and surgeons alike.
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Affiliation(s)
- Peter P. Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Yusef Buti
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Chad P. Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Bert Chabot
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Ruhul Munshi
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohammad Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Aboueisha
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Shama
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Ralph L. Corsetti
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman Toraih
- 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
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Correspondence: ; Tel.: + 504-988-7407; Fax: + 504-988-4762
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16
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The Learning Curve and Importance of Collaboration in Endoscopic Thyroidectomy Via Breast Areola Approach: A Single Surgical Team's Experience of 100 Patients. J Craniofac Surg 2022; 33:e802-e806. [PMID: 35767477 DOI: 10.1097/scs.0000000000008667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Endoscopic thyroidectomy is popular among young patients because of its excellent cosmetic outcomes. But it takes a long time to become proficient and competent for surgeons. In addition, collaboration plays a critical role in endoscopic thyroidectomy. Our research aims to evaluate the learning curve of endoscopic thyroidectomy via breast areola approach, provide details of this approach, and demonstrate the importance of collaboration. METHODS The authors retrospectively analyzed 100 cases of benign and malignant thyroid disease who underwent endoscopic thyroidectomy via breast areola approach between January 2015 and December 2020, which were performed by the same group of surgeons with little experience of endoscopic thyroidectomy. The learning curve was analyzed by moving average method. The mean operation time, blood loss, tumor size, postoperative complications were used to determine learning curve progression. RESULTS The learning curve in the first 30 cases were uplifted, stable at 30 to 60 cases and declined in the following cases. The mean operation time and blood loss decreased significant after the first 30 cases and again after the first 60 cases. And there was no difference in postoperative complications. CONCLUSIONS A well-trained surgeon with experience in conventional open thyroidectomy can significantly reduce the total operation time by studying the learning curve. The key steps including establishment of working space and reaching for recurrent laryngeal nerve. A stable level can be achieved after 30 cases. More than 60 cases are required to become proficient. A successful endoscopic thyroid surgery requires a stable team.
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Иванникова ТЕ, Ширяева ТЮ, Нагаева ЕВ, Шеремета МС, Бровин ДН, Безлепкина ОБ. [Definitive treatment of Graves' disease in children]. PROBLEMY ENDOKRINOLOGII 2022; 68:104-111. [PMID: 35488761 PMCID: PMC9112851 DOI: 10.14341/probl13086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hyperthyreoidism due to Graves' disease is a rare disorder in pediatric practice. There is 2 treatment options in Graves' disease: medical treatment and definitive treatment, including surgery and radioactive iodine. Each method has its advantages and disadvantages. If medical therapy is ineffective the choice between radical treatment method is raised: radioactive iodine or total thyroidectomy. In this research we analyze treatment outcomes in pediatric Graves' disease patients after different radical treatment methods. AIM Comparative analysis of radical treatment outcomes in pediatric patients with Graves' disease. MATERIALS AND METHODS Retrospective and prospective one-center research of 122 patients with Graves' disease after radical treatment (between 2016 and 2021)RESULTS: The mean age was 13.5±3,5 year at the moment of examination. Patients were divided into 2 groups due to the radical treatments method: 1 group (n=60) were children after surgical treatment, 2 group (n=62) - after radioactive iodine. The mean dose of medical treatment in these groups did not reliably differ (p=0,06), duration of the medical treatment was reliably longer in patients after radioactive iodine (p=0,024). Graves' orbitopathy was diagnosed in 58 patients (47,5%) and met equally often in both groups, but active stage of Graves' orbitopathy was diagnosed only in patients from the 1st group. Thyroid size was reliable bigger in patients from the 1st group (p=0,004), and thyroid gland nodes were diagnosed only in patients from 1st group (p=0,0007). CONCLUSION RI can be considered an effective and safe treatment for GD. The effectiveness of RI depends on the volume of the thyroid gland; according to the results of the constructed ROC curve, the risk of repeated RI is higher with a volume of more than 55 cm3. Also radioactive iodine is undesirable if there is signs of ophatalmopathy due to its possible deterioration. According to the results of the study hypoparathyroidism after surgical treatment was diagnosed in 20%, recurrent laryngeal nerve injury was diagnosed after surgical treatment in 5% of patients. In patients with identified nodular goiter according to the results of ultrasound, surgical treatment is preferable due to the impossibility of excluding thyroid cancer.
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Affiliation(s)
| | - Т. Ю. Ширяева
- Национальный медицинский исследовательский центр эндокринологии
| | - Е. В. Нагаева
- Национальный медицинский исследовательский центр эндокринологии
| | - М. С. Шеремета
- Национальный медицинский исследовательский центр эндокринологии
| | - Д. Н. Бровин
- Национальный медицинский исследовательский центр эндокринологии
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Hurley CM, Phoenix E, Duff G, Lennon P, Shelley OP. Incidental Thyroid Tumour during Surgical Tracheostomy in a Patient with Toxic Epidermal Necrolysis. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Lee J, Lee HY, Kim WC. Trends in the incidence of thyroid cancer in Incheon Province, South Korea, from 2004 to 2013: A representative sample study from Incheon cancer registry. Asia Pac J Clin Oncol 2022; 18:e398-e403. [PMID: 35098678 DOI: 10.1111/ajco.13733] [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: 03/18/2021] [Accepted: 10/31/2021] [Indexed: 12/01/2022]
Abstract
AIM This study aimed to assess the trends in the incidence of thyroid cancer in Incheon Province, South Korea, from 2004 to 2013 and to identify its association with thyroid cancer screening. METHODS We evaluated randomly sampled data of 10% of thyroid cancer patients collected between 2004 and 2013 from the Incheon Cancer Registry, Incheon, South Korea. The expected annual incidence rates of thyroid cancer from 2004 to 2013 were calculated, and the trends in annual incidence change were assessed using a Poisson regression model. In addition, the annual proportion change in the thyroid cancer population according to the detection method and tumor size was also calculated by evaluating the linear-by-linear association. RESULTS The average expected prevalence of thyroid cancer was 30 per 100,000 individuals from 2004 to 2013. The expected annual incidence of thyroid cancer per 100,000 individuals increased from 7 in 2004 to 49 in 2013, with an annual 1.25-fold difference (p < 0.001). Screening helped improve the detection of thyroid cancer annually, with the proportion increasing by screening detection (p < 0.001). Majority (54%) of the tumors were small (< 10 mm) and their detection rate increased from 2004 to 2013 (p < 0.001). CONCLUSIONS The incidence of thyroid cancer has increased from 2004 to 2013 in Incheon Province, South Korea, with the increase being most significant for small tumors. These findings indicate that the increased incidence is primarily due to the widespread use of screening and not an actual increase in clinically significant thyroid cancer.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | | | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.,Incheon Cancer Registry, Incheon, South Korea
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20
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Yang N, Yang H, Guo JJ, Hu M, Li S. Cost-Effectiveness Analysis of Ultrasound Screening for Thyroid Cancer in Asymptomatic Adults. Front Public Health 2021; 9:729684. [PMID: 34631648 PMCID: PMC8494179 DOI: 10.3389/fpubh.2021.729684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: This study evaluated the long-term cost-effectiveness of ultrasound screening for thyroid cancer compared with non-screening in asymptomatic adults. Methods: Applying a Markov decision-tree model with effectiveness and cost data from literature, we compared the long-term cost-effectiveness of the two strategies: ultrasound screening and non-screening for thyroid cancer. A one-way sensitivity analysis and a probabilistic sensitivity analysis were performed to verify the stability of model results. Results: The cumulative cost of screening for thyroid cancer was $18,819.24, with 18.74 quality-adjusted life years (QALYs), whereas the cumulative cost of non-screening was $15,864.28, with 18.71 QALYs. The incremental cost-effectiveness ratio of $106,947.50/QALY greatly exceeded the threshold of $50,000. The result of the one-way sensitivity analysis showed that the utility values of benign nodules and utility of health after thyroid cancer surgery would affect the results. Conclusions: Ultrasound screening for thyroid cancer has no obvious advantage in terms of cost-effectiveness compared with non-screening. The optimized thyroid screening strategy for a specific population is essential.
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Affiliation(s)
- Nan Yang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Han Yang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Jeff Jianfei Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, United States
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Chinese Evidence-Based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
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21
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Issing PR, Köhler T, Tebben H, Wenger M, Issing C. [The Therapy of Malignant Thyroid Disease from ENT-Perspective]. Laryngorhinootologie 2021; 100:889-895. [PMID: 33906243 DOI: 10.1055/a-1475-4939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Malignant tumours of the thyroid gland show a rising incidence. As in the ENT-department Bad Hersfeld the management of thyroid disorders has been in focus for a longer period, we want to share our experiences in this field. MATERIAL AND METHODS The investigation started in the year of 2014 till July 2020. All patients who underwent thyroid surgery were evaluated concerning important demographic and medical parameters such as age, sex, histology, calcium, recurrent nerve palsy, etc. RESULTS: So far 63 patients with a malignant thyroid disease were enrolled in this study. The sex ratio showed a preponderance of the female patients with 42 and 21 males. Age had a wide range from 11 to 95 years. Patients with a differentiated cancer were in average younger than those with anaplastic disease. Histologically the papillary variant dominated with 65 % (n = 41) the other tumours as the follicular (n = 6), the medullary (n = 5) and the anaplastic carcinoma (n = 6). In two female patients with primary hyperparathyroidism a carcinoma of the parathyroid was found surprisingly. All patients underwent surgery; those with an advanced differentiated carcinoma were treated with radioiodine additionally. To our knowledge there was just one tumour related death in case of a differentiated carcinoma, whereas all patients with an anaplastic disease died of their malignancy. CONCLUSIONS The otorhinolaryngologist is involved in the management of thyroid malignancies. As well as in the benign diseases of the endocrine neck organs the interdisciplinary collaboration is mandatory for a high medical standard.
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Affiliation(s)
- Peter Rolf Issing
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Germany
| | - Torsten Köhler
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Germany
| | - Hendrik Tebben
- Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Germany
| | - Martin Wenger
- Nuklearmedizin, Klinikum Bad Hersfeld GmbH, Bad Hersfeld, Germany
| | - Christian Issing
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
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22
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Margulis I, Naroditsky I, Gross-Cohen M, Ilan N, Vlodavsky I, Doweck I. A Pro-Tumorigenic Effect of Heparanase 2 (Hpa2) in Thyroid Carcinoma Involves Its Localization to the Nuclear Membrane. Front Oncol 2021; 11:645524. [PMID: 33959505 PMCID: PMC8093622 DOI: 10.3389/fonc.2021.645524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/30/2021] [Indexed: 11/13/2022] Open
Abstract
Activity of the endo-beta-glucuronidase heparanase, capable of cleaving heparan sulfate (HS), is most often elevated in many types of tumors, associating with increased tumor metastasis and decreased patients' survival. Heparanase is therefore considered to be a valid drug target, and heparanase inhibitors are being evaluated clinically in cancer patients. Heparanase 2 (Hpa2) is a close homolog of heparanase that gained very little attention, likely because it lacks HS-degrading activity typical of heparanase. The role of Hpa2 in cancer was not examined in detail. In head and neck cancer, high levels of Hpa2 are associated with decreased tumor cell dissemination to regional lymph nodes and prolonged patients' survival, suggesting that Hpa2 functions to attenuate tumor growth. Here, we examined the role of Hpa2 in normal thyroid tissue and in benign thyroid tumor, non-metastatic, and metastatic papillary thyroid carcinoma (PTC) utilizing immunostaining in correlation with clinicopathological parameters. Interestingly, we found that Hpa2 staining intensity does not significantly change in the transition from normal thyroid gland to benign, non-metastatic, or metastatic thyroid carcinoma. Remarkably, we observed that in some biopsies, Hpa2 is accumulating on the membrane (envelop) of the nucleus and termed this cellular localization NM (nuclear membrane). Notably, NM localization of Hpa2 occurred primarily in metastatic PTC and was associated with an increased number of positive (metastatic) lymph nodes collected at surgery. These results describe for the first time unrecognized localization of Hpa2 to the nuclear membrane, implying that in PTC, Hpa2 functions to promote tumor metastasis.
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Affiliation(s)
- Itai Margulis
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa, Israel
| | - Inna Naroditsky
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Miriam Gross-Cohen
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Neta Ilan
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Israel Vlodavsky
- Technion Integrated Cancer Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilana Doweck
- Department of Otolaryngology, Head and Neck Surgery, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
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23
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Zhou J, Song Y, Zhan W, Wei X, Zhang S, Zhang R, Gu Y, Chen X, Shi L, Luo X, Yang L, Li Q, Bai B, Ye X, Zhai H, Zhang H, Jia X, Dong Y, Zhang J, Yang Z, Zhang H, Zheng Y, Xu W, Lai L, Yin L. Thyroid imaging reporting and data system (TIRADS) for ultrasound features of nodules: multicentric retrospective study in China. Endocrine 2021; 72:157-170. [PMID: 32852733 DOI: 10.1007/s12020-020-02442-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/28/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE To establish a practical and simplified Chinese thyroid imaging reporting and data system (C-TIRADS) based on the Chinese patient database. METHODS A total of 2141 thyroid nodules that were neither cystic nor spongy were used in the current study. These specimens were derived from 2141 patients in 131 alliance hospitals of the Chinese Artificial Intelligence Alliance for Thyroid and Breast Ultrasound. The ultrasound features, including location, orientation, margin, halo, composition, echogenicity, echotexture, echogenic foci and posterior features were assessed. Univariate and multivariate analyses were performed to investigate the association between ultrasound features and malignancy. The regression equation, the weighting, and the counting methods were used to determine the malignant risk of the thyroid nodules. The areas under the receiver operating characteristic curve (Az values) were calculated. RESULTS Of the 2141 thyroid nodules, 1572 were benign, 565 were malignant, and 4 were borderline. Vertical orientation, ill-defined, or irregular margin (including extrathyroidal extension), microcalcifications, solid, and markedly hypoechoic were positively associated with malignancy, while comet-tail artifacts were negatively associated with malignancy. The logistic regression equation yielded the highest Az value of 0.913, which was significantly higher than that obtained using the weighting method (0.893) and the counting method (0.890); however, no significant difference was found between the latter two. The C-TIRADS, based on the counting method, was designed following the principle of balancing the diagnostic performance and sensitivity of the risk stratification with the ease of use. CONCLUSIONS A relatively simple C-TIRADS was established using the counting value of positive and negative ultrasound features.
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Affiliation(s)
- JianQiao Zhou
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
| | - YanYan Song
- Department of Biostatistics, Institute of Medical Sciences, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
| | - WeiWei Zhan
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China.
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - Sheng Zhang
- Department of Diagnostic and Therapeutic Ultrasound, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China
| | - RuiFang Zhang
- Department of Ultrasound, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Ying Gu
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, China
| | - Xia Chen
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, China
| | - Liying Shi
- Department of Ultrasound, Affiliated Hospital of Guizhou Medical University, Guiyang, 550001, China
| | - XiaoMao Luo
- Department of Ultrasound, The Third Affiliated Hospital Of Kunming Medical University, Yunnan Cancer Hospital, Kunming, 650031, China
| | - LiChun Yang
- Department of Ultrasound, The Third Affiliated Hospital Of Kunming Medical University, Yunnan Cancer Hospital, Kunming, 650031, China
| | - QiaoYing Li
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, China
| | - BaoYan Bai
- Department of Ultrasound, Affiliated Hospital of Yan'an University, School of Medicine, Yan'an University, Shanxi, 716000, China
| | - XinHua Ye
- Department of Ultrasound, the first affiliated Hospital of Nanjing Medical University, NanJing, 210029, China
| | - Hong Zhai
- Department of Abdominal Ultrasound, The fourth Clinical Medical Collegen, Xinjiang Medical University, Urumqi, 830000, China
| | - Hua Zhang
- Department of ultrasound, Anyang tumor hospital, The Fourth Affiliated Hospital of Henan University of Science and Technology, Anyang, 455000, China
| | - XiaoHong Jia
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - YiJie Dong
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - JingWen Zhang
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - ZhiFang Yang
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - HuiTing Zhang
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Yi Zheng
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - WenWen Xu
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - LiMei Lai
- Department of Ultrasound, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - LiXue Yin
- Institute of Ultrasound in Medicine, The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China, Chengdu, 610071, China
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Zhang M, Deng YL, Liu C, Chen PP, Luo Q, Miao Y, Cui FP, Wang LQ, Jiang M, Zeng Q. Urinary phthalate metabolite concentrations, oxidative stress and thyroid function biomarkers among patients with thyroid nodules. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 272:116416. [PMID: 33433341 DOI: 10.1016/j.envpol.2020.116416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/04/2020] [Accepted: 12/29/2020] [Indexed: 06/12/2023]
Abstract
Prior human studies have explored effects of phthalate exposures on thyroid function, but the underlying biological mechanisms remain poorly unclear. We aimed to explore the associations between phthalate exposures and thyroid function among a potentially susceptible population such as patients with thyroid nodules, and further to assess the mediating role of oxidative stress. We measured eight phthalate metabolites, three oxidative stress biomarkers [8-hydroxy-2-deoxyguanosine (8-OHdG), 8-iso-prostaglandin F2α (8-isoPGF2α) and 4-hydroxy-2-nonenal-mercapturic acid (HNE-MA)] in urine and three thyroid function biomarkers [thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4)] in serum among 214 patients with thyroid nodules. Multivariate regression models were applied to assess the associations among urinary phthalate metabolites, oxidative stress and thyroid function biomarkers. The potential mediating role of oxidative stress was explored by mediation analysis. We observed that multiple urinary phthalate metabolites were associated with altered FT4 and increased oxidative stress biomarkers (all FDR-adjusted P ≤ 0.05). Meanwhile, we found that 8-isoPGF2α was negatively associated with FT3/FT4 among patients with benign thyroid nodules (FDR-adjusted P = 0.08). The mediation analysis indicated that 8-isoPGF2α mediated the associations of urinary MEHHP and %MEHP with FT3/FT4, with 55.6% and 32.6% proportion of the mediating effects, respectively. Our data suggest that lipid peroxidation may be an intermediate mechanism involved in the effects of certain phthalate exposures on altered thyroid function among patients with benign thyroid nodules.
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Affiliation(s)
- Min Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yan-Ling Deng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Chong Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Pan-Pan Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Qiong Luo
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yu Miao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Fei-Peng Cui
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Long-Qiang Wang
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Ming Jiang
- Department of Thyroid and Breast Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Qiang Zeng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, And State Key Laboratory of Environmental Health (incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
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25
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Koo E, Henderson MA, Dwyer M, Skandarajah AR. Radiation-Associated Thyroid Cancer Surveillance and Management in a Cohort of Late Effects Patients. World J Surg 2021; 44:3028-3035. [PMID: 32372144 DOI: 10.1007/s00268-020-05547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Compared to the general population, the incidence of thyroid cancer in childhood and adolescent and young adult malignancy survivors is increased 14.0-18.0 times (CI 11.7-23.8). The cumulative incidence is variably reported as 0.5% by age 45 with 30-year incidence of 1.3% in women and 0.6% in men. This study aims to evaluate the incidence of radiation-associated thyroid cancer amongst patients treated with prior radiation to the thyroid followed up in a late effects service. A secondary aim was to assess screening compliance in this cohort. METHODS The medical records of all patients attending the late effects service from 1 January 2000 to 20 February 2013 were interrogated to identify patients exposed to thyroid irradiation. The screening compliance and incidence of thyroid cancer were assessed for the duration whilst under the guidance of the late effect service. Mode of diagnosis, all imaging and cytology were retrieved from the institutional electronic record. Cytology was categorized according to Bethesda. RESULTS Four hundred and sixty-five patients were exposed to direct or scatter neck irradiation. Compliance with thyroid surveillance was observed in 76.9%. Ultrasound features of microcalcification and increased internal vascularity had a low sensitivity (62.5%) for predicting a malignant nodule, which improved when used in conjunction with a Bethesda IV-VI result (91.7%). However, cytological assessment was not performed in 45.6% of operative cases. Thirty-three patients had thyroid carcinoma of which 45.4% (n = 15) were incidental. The majority were papillary thyroid cancers (88.9%); of which 12.5% were node positive and 34.4% were multifocal. The incidence of thyroid cancer was elevated 57.6 times compared to the Australian general population (p < 0.001). CONCLUSION Due to the high incidence of thyroid cancer, this study supports screening in this cohort. However, due to the risk of overtreatment, we endorse further investigation of thyroid nodules with ultrasound-guided fine-needle aspiration cytology based on sonographic criteria as for the general population and American Thyroid Association guidelines.
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Affiliation(s)
- Eva Koo
- University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, The Royal Melbourne Hospital, The Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Michael A Henderson
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
- Department of Surgery, The Royal Melbourne Hospital, The Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Mary Dwyer
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
- Department of Surgery, The Royal Melbourne Hospital, The Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - Anita R Skandarajah
- University of Melbourne, Parkville, VIC, Australia.
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia.
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
- Department of Surgery, The Royal Melbourne Hospital, The Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia.
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26
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Zhang Y, Wang K, Qin W, Jin C, Song Y, Jia P, Wang S, Song Y, Ning Y, Li L. Six Air Pollutants Associated With Increased Risk of Thyroid Nodules: A Study of 4.9 Million Chinese Adults. Front Endocrinol (Lausanne) 2021; 12:753607. [PMID: 34966357 PMCID: PMC8710776 DOI: 10.3389/fendo.2021.753607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Thyroid nodules has become a significant public health issue worldwide with a rapidly increasing prevalence. However, its association with outdoor air pollution remains poorly understood. We aim to investigate the relationship between six outdoor air pollutants (PM2.5, PM10, NO2, SO2, CO, and O3) and the risk of thyroid nodules. METHODS We utilized a database including 4,920,536 participants who attended the annual physical examinations in the Meinian HealthCare Screening Center in 157 Chinese cities in 2017. City-specific concentrations of six pollutants (PM2.5, PM10, NO2, SO2, CO, and O3) from 2015 to 2017 were estimated based on the China's National Urban Air Quality Real Time Publishing Platform. Thyroid nodule was measured with ultrasound. Multivariable Logistic regression was used to examine the associations between air pollutants and thyroid nodules with adjustment for age, sex, education, smoking, body mass index, fasting blood glucose, triglyceride, low density lipoprotein cholesterol, high density lipoprotein cholesterol, urine iodine, gross domestic product, and thyroid stimulating hormone. We conducted stratified analyses to investigate potential effect modification by sex, age, and urine iodine groups. RESULTS Approximately 38% of the participants (1,869,742) were diagnosed with thyroid nodules. Each of the six air pollutants was significantly and linearly associated with the risk for thyroid nodules. The adjusted odds ratios [95% CI] for every increase of 10 μg/m3 for PM2.5, PM10, NO2, SO2, and O3 were 1.062 [1.061, 1.064], 1.04 [1.03, 1.04], 1.10 [1.09, 1.10], 1.11 [1.11, 1.12], and 1.151 [1.149, 1.154], respectively; The odds ratio for each increase of 1 mg/m3 for CO was 1.50 [1.49 to 1.52]. Furthermore, these associations were significantly higher in the participants who were men, younger, or having lower urine iodine level (p <0.001). CONCLUSION The six air pollutants may contribute to the high prevalence of thyroid nodules in China.
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Affiliation(s)
- Yunjing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center (PKUHSC), Beijing, China
| | - Kai Wang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, China
| | - Wei Qin
- Department of Social Medicine and Health Education, School of Public Health, PKUHSC, Beijing, China
| | - Cheng Jin
- Meinian Institute of Health, Beijing, China
- PKUHSC Meinian Public Health Research Institute, Beijing, China
| | - Yiqing Song
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Peng Jia
- School of Resources and Environmental Science, Wuhan University, Wuhan, China
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China
| | - Shengfeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center (PKUHSC), Beijing, China
- *Correspondence: Shengfeng Wang, ; Yongfeng Song, ; Yi Ning, ; Liming Li,
| | - Yongfeng Song
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Clinical Medical Center of Endocrinology and Metabolism, Jinan, China
- Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, China
- *Correspondence: Shengfeng Wang, ; Yongfeng Song, ; Yi Ning, ; Liming Li,
| | - Yi Ning
- Meinian Institute of Health, Beijing, China
- PKUHSC Meinian Public Health Research Institute, Beijing, China
- *Correspondence: Shengfeng Wang, ; Yongfeng Song, ; Yi Ning, ; Liming Li,
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center (PKUHSC), Beijing, China
- *Correspondence: Shengfeng Wang, ; Yongfeng Song, ; Yi Ning, ; Liming Li,
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Wilson M, Patel A, Goldner W, Baker J, Sayed Z, Fingeret AL. Postoperative thyroid hormone supplementation rates following thyroid lobectomy. Am J Surg 2020; 221:804-808. [PMID: 32682499 DOI: 10.1016/j.amjsurg.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 03/30/2019] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thyroid lobectomy is performed for symptomatic benign nodules, indeterminate nodules, or low-risk well differentiated thyroid cancer. We aimed to determine factors associated with thyroid stimulating hormone over goal (TH) following lobectomy. METHODS We performed a retrospective single-institution cohort study of patients undergoing thyroid lobectomy from January 2016 to December 2017. TH was defined as need for thyroid hormone in accordance with guidelines. Univariate and multivariate logistic regression analysis was performed. RESULTS One hundred patients were included and 47% developed. TH: 73% of those with cancer, 38% with benign pathology (p = 0.002). Patients with TH were more likely to have thyroiditis 26% versus 3.8% (p = 0.002); higher preoperative TSH: mean 1.88mIU/L (SD 1.17) versus 1.16mIU/L (SD 0.77) (p = 0.0002), and smaller remnant thyroid lobe adjusted for body surface area 2.99ml/m2 versus 3.72ml/m2 (p = 0.003). CONCLUSIONS After thyroid lobectomy, TH is associated with preoperative TSH level, thyroiditis, remnant thyroid volume, and malignancy. The majority of patients with final pathology of carcinoma will require thyroid hormone supplementation to achieve TSH goal.
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Affiliation(s)
| | - Anery Patel
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center, USA
| | - Whitney Goldner
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, University of Nebraska Medical Center, USA
| | - John Baker
- Department of Pathology and Microbiology, University of Nebraska Medical Center, USA
| | - Zafar Sayed
- Department of Otolaryngology, Division of Head and Neck Oncology, University of Nebraska Medical Center, USA
| | - Abbey L Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, USA.
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28
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Wilson M, Patel A, Goldner W, Baker J, Sayed Z, Fingeret AL. Postoperative thyroid hormone supplementation rates following thyroid lobectomy. Am J Surg 2020; 220:1169-1173. [PMID: 32684294 DOI: 10.1016/j.amjsurg.2020.06.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/24/2020] [Accepted: 06/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Thyroid lobectomy is performed for symptomatic benign nodules, indeterminate nodules, or low-risk well-differentiated thyroid cancer. We aimed to determine factors associated with need for thyroid hormone supplementation following thyroid lobectomy. METHODS We performed a retrospective single-institution cohort study of patients undergoing thyroid lobectomy from January 2016 to December 2017. Thyroid hormone supplementation was assessed postoperatively based on guidelines for thyroid stimulating hormone (TSH) level goal for benign (0.5-4.5mIU/L) or malignant (<2mIU/L) final pathology. Univariate and multivariate logistic regression analysis was performed. RESULTS One hundred patients were included and overall 47% required thyroid hormone supplementation after thyroid lobectomy: 73% of those with cancer, 38% with benign pathology (p = 0.002). Patients requiring thyroid hormone supplementation were more likely to have thyroiditis 26% versus 3.8% of those who remained euthyroid (p = 0.002); have a higher preoperative TSH: mean 1.88mIU/L (SD 1.17) versus 1.16mIU/L (SD 0.77) (p = 0.0002), and have a smaller remnant thyroid lobe adjusted for body surface area 2.99ml/m2 versus 3.72ml/m2 (p = 0.003). CONCLUSIONS After thyroid lobectomy, the need for thyroid hormone supplementation is associated with higher preoperative TSH level, thyroiditis, remnant thyroid volume, and malignancy on final pathology. The majority of patients with final pathology of carcinoma will require thyroid hormone supplementation to achieve TSH goal. For patients with benign pathology after thyroid lobectomy the majority will not require thyroid hormone supplementation to achieve TSH goal.
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Affiliation(s)
| | - Anery Patel
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, USA
| | - Whitney Goldner
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, USA
| | - John Baker
- Department of Pathology and Microbiology, University of Nebraska Medical Center, USA
| | - Zafar Sayed
- Department of Otolaryngology, Division of Head and Neck Oncology, University of Nebraska Medical Center, USA
| | - Abbey L Fingeret
- Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, USA.
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Pitoia F, Smulever A. Active surveillance in low risk papillary thyroid carcinoma. World J Clin Oncol 2020; 11:320-336. [PMID: 32874948 PMCID: PMC7450818 DOI: 10.5306/wjco.v11.i6.320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/07/2020] [Accepted: 05/05/2020] [Indexed: 02/06/2023] Open
Abstract
In recent decades, while the incidence of thyroid cancer has increased exponentially around the world, mortality has remained stable. The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas, which exhibit slow growth rates with indolent courses. A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis, as the majority of these tumors would not likely result in death if left untreated. Although surgical resection was the classical standard therapy for papillary microcarcinomas, active surveillance (AS) has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery. Despite the encouraging results of AS, its implementation in clinical practice is strongly influenced by psychosocial factors. The aim of this review is to describe the epidemiology, clinical evolution, prognostic factors, and mortality of papillary thyroid microcarcinomas. We also summarize the AS strategy according to published evidence, characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics, as well as analyze the current limitations for AS implementation.
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Affiliation(s)
- Fabian Pitoia
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires 1120, Argentina
| | - Anabella Smulever
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires 1120, Argentina
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30
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Su A, Zhao W, Wu W, Wei T, Ruan M, Li Z, Zhu J. The association of preoperative thyroid-stimulating hormone level and the risk of differentiated thyroid cancer in patients with thyroid nodules: A systematic review and meta-analysis. Am J Surg 2020; 220:634-641. [PMID: 31955813 DOI: 10.1016/j.amjsurg.2020.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND This systematic review and meta-analysis was conducted to determine the value of preoperative thyroid-stimulating hormone (TSH) levels in assessing the risk of differentiated thyroid cancer (DTC) in patients with thyroid nodules. METHODS This meta-analysis included 23,799 subjects (15,406 non-Chinese and 8,393 Chinese) with thyroid nodules. Multivariate and individual adjusted odds ratios (OR) were calculated for a 1 mU/L increase in preoperative TSH levels to determine the risk of malignant DTC. RESULTS The OR for DTC in relation to preoperative TSH levels was significant in Chinese (1.25 [1.11, 1.40], Z = 3.67, p = 0.0002) and non-Chinese subjects (1.12 [1.03, 1.22], Z = 2.72, p = 0.006). The overall random-effects model indicated that there was a significantly increased risk for DTC in patients with thyroid nodules (OR 1.16 [1.06, 1.27], Z = 3.29, p = 0.007). CONCLUSIONS A significant association between higher TSH levels and risk of DTC was observed in both population groups investigated, with higher ORs for Chinese subjects.
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Affiliation(s)
- Anping Su
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Wanjun Zhao
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Wenshuang Wu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Tao Wei
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Meifang Ruan
- Department of Medical Affairs, Merck Serono Co., Ltd, Beijing, China.
| | - Zhihui Li
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Jingqiang Zhu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Singh Ospina N, Iñiguez-Ariza NM, Castro MR. Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment. BMJ 2020; 368:l6670. [PMID: 31911452 DOI: 10.1136/bmj.l6670] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - M Regina Castro
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Kong D, Li A, Liu Y, Cui Q, Wang K, Zhang D, Tang J, Du Y, Liu Z, Wu G, Wu K. SIX1 Activates STAT3 Signaling to Promote the Proliferation of Thyroid Carcinoma via EYA1. Front Oncol 2019; 9:1450. [PMID: 31921695 PMCID: PMC6933607 DOI: 10.3389/fonc.2019.01450] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 12/04/2019] [Indexed: 11/17/2022] Open
Abstract
As a critical member of the Retinal Determination Gene Network (RDGN), SIX1 has been regarded as a tumor promoter in various types of cancer. However, its role in papillary thyroid carcinoma (PTC) has never been investigated. In this study, thyroid carcinoma tissue microarray staining was employed to identify the expression patterns of SIX1 and its co-activator EYA1. Papillary thyroid cancer cell lines, BCPAP, and TPC-1 cells were used to investigate the potential mechanism of SIX1 in vitro and in vivo. Flow cytometry analysis, MTT assay, the growth curve assay, colony formation assay, EdU incorporation and xenograft assay were performed to demonstrate the role of SIX1 in the malignant change of PTC cells. Western blot and Real-time PCR were used to detect the interaction among the SIX1, EYA1, and STAT3 signaling. In comparison with normal tissue, high expressions of SIX1 and EYA1 were associated with a malignant tumor. Importantly, SIX1 strongly correlated with EYA1 in thyroid carcinoma tissue microarray. Functional assays indicated SIX1 increased EYA1 expression by stabilizing EYA1 at the post-transcriptional level. Besides, SIX1 promoted the proliferation and invasion of thyroid carcinoma via activation of STAT3 signaling and its downstream targets in an EYA1-dependent manner. SIX1 can integrate with EYA1 to contribute to PTC development via activation of the classical STAT3 signaling. These data suggested targeting the abnormal activation of the SIX1/EYA1 complex may represent a novel therapeutic strategy for advanced PTC patients.
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Affiliation(s)
- Deguang Kong
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Anping Li
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Yu Liu
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuxia Cui
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kun Wang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yaying Du
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhisu Liu
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kongming Wu
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
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Lin JK, Sakoda LC, Darbinian J, Socarras M, Chiao W, Calixto N, Quesenberry C, Gurushanthaiah D, Wang KH, Durr M. Risk of Mortality between Untreated and Treated Papillary Thyroid Cancer: A Matched Cohort Analysis. Ann Otol Rhinol Laryngol 2019; 129:265-272. [PMID: 31658833 DOI: 10.1177/0003489419885403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the association between treatment status and mortality risk among patients with papillary thyroid cancer (PTC). METHODS We identified 3,679 adults with PTC. Thirty-one untreated patients were matched to 155 treated patients. Hazards ratios (HR) and 95% confidence intervals (CIs) were calculated to estimate all-cause and disease-specific mortality. A low-risk subgroup was analyzed for differences in all-cause mortality. RESULTS The adjusted HRs (95% CIs) for all-cause mortality at 5 and 10 years were 4.2 (1.7-10.3) and 4.1 (1.9-9.4) and for disease- specific mortality were 14.1 (3.4-59.3) and 10.2 (2.9-36.4), respectively, for untreated versus treated patients. The adjusted HRs (95% CIs) for all- cause mortality was 0.7 (0.1-6.4) for low-risk untreated versus matched treated patients. CONCLUSIONS Compared to treated patients, untreated PTC patients were at higher risk of death while low-risk untreated PTC patients had comparable rate of metastasis and no increased risk of all-cause mortality. Level of evidence: 3.
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Affiliation(s)
- Jonathan K Lin
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Lori C Sakoda
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Jeanne Darbinian
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Melissa Socarras
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Whitney Chiao
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Nathaniel Calixto
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Charles Quesenberry
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | | | - Kevin H Wang
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Megan Durr
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
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Fugazzola L, Elisei R, Fuhrer D, Jarzab B, Leboulleux S, Newbold K, Smit J. 2019 European Thyroid Association Guidelines for the Treatment and Follow-Up of Advanced Radioiodine-Refractory Thyroid Cancer. Eur Thyroid J 2019; 8:227-245. [PMID: 31768334 PMCID: PMC6873012 DOI: 10.1159/000502229] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/19/2019] [Indexed: 01/03/2023] Open
Abstract
The vast majority of thyroid cancers of follicular origin (TC) have a very favourable outcome, but 5-10% of cases will develop metastatic disease. Around 60-70% of this subset, hence less than 5% of all patients with TC, will become radioiodine refractory (RAI-R), with a significant negative impact on prognosis and a mean life expectancy of 3-5 years. Since no European expert consensus or guidance for this challenging condition is currently available, a task force of TC experts was nominated by the European Thyroid Association (ETA) to prepare this document based on the principles of clinical evidence. The task force started to work in September 2018 and after several revision rounds, prepared a list of recommendations to support the treatment and follow-up of patients with advanced TC. Criteria for advanced RAI-R TC were proposed, and the most appropriate diagnostic tools and the local, systemic and palliative treatments are described. Systemic therapy with multikinase inhibitors is fully discussed, including recommendations on how to start it and at which dosage, on the duration of treatment, and on the management of side effects. The appropriate relationship between the specialist and the patient/family as well as ethical issues are covered. Based on the available studies and on personal experience, the experts provided 39 recommendations aimed to improve the management of advanced RAI-R TCs. Above all of them is the indication to treat and follow these patients in a specialized setting which allows the interaction between several specialists in a multidisciplinary team.
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Affiliation(s)
- Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Rossella Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dagmar Fuhrer
- Department of Endocrinology, Diabetes and Metabolism, Endocrine Tumour Center at West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Sophie Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France
| | - Kate Newbold
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom
| | - Jan Smit
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Guan Y, Bhandari A, Zhang X, Wang O. Uridine phosphorylase 1 associates to biological and clinical significance in thyroid carcinoma cell lines. J Cell Mol Med 2019; 23:7438-7448. [PMID: 31496029 PMCID: PMC6815846 DOI: 10.1111/jcmm.14612] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 07/18/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022] Open
Abstract
Thyroid cancer incidence has been continuity increasing worldwide. Uridine phosphorylase 1 (UPP1) is a protein-coding gene and has been detected that UPP1 was the higher expression in many solid malignancies, just as head and neck cancers, breast cancer, compared with paired normal tissue. But the act of UPP1 in thyroid cancer is not explicit. In this article, we investigate the function of UPP1 expression in thyroid cancer. The Cancer Genome Atlas (TCGA) unpaired thyroid cancer and normal RNA-seq data were downloaded, and our paired thyroid cancer and normal samples were analysed by a polymerase chain reaction. The expression of UPP1 was regulated by transfected small interfering RNA, and the function of UPP1 was determined via migration, invasion and cell proliferation assays. Western blot assay was achieved to determine the UPP1 expression correlates with the function of 5-FU regulate epithelial-mesenchymal transition. The significant upregulation of UPP1 in thyroid cancer tissues compared with normal thyroid tissues was revealed by our data and TCGA data. UPP1 overexpression was significantly correlated with lymph node metastasis, tumour stage and tumour size. In the cell, experiments showed that UPP1 low expression significantly suppressed the migration, invasion and proliferation. Western blot assay proves the effect of UPP1 expression on 5-FU regulates epithelial-mesenchymal transition pathway. UPP1 plays a crucial oncogene in thyroid cancer. Our findings indicate that UPP1 might be a biomarker of thyroid cancer and may act by regulating epithelial-mesenchymal transition (EMT).
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Affiliation(s)
- Yaoyao Guan
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Adheesh Bhandari
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Xiaohua Zhang
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Ouchen Wang
- Department of Thyroid and Breast SurgeryThe First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
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36
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Seifert P, Winkens T, Kühnel C, Gühne F, Freesmeyer M. I-124-PET/US Fusion Imaging in Comparison to Conventional Diagnostics and Tc-99m Pertechnetate SPECT/US Fusion Imaging for the Function Assessment of Thyroid Nodules. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2298-2308. [PMID: 31196748 DOI: 10.1016/j.ultrasmedbio.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
The purpose of this study is to investigate I-124 positron emission tomography (PET)/ultrasound (US) fusion imaging for function assessment of thyroid nodules. In 70 patients, 201 lesions were examined with conventional diagnostics (CD) (thyroid US, laboratory findings and Tc-99m pertechnetate scintigraphy), Tc-99m pertechnetate single photon emission computed tomography (SPECT) and I-124 PET/computed tomography (CT). Subsequently, US fusion imaging (SPECT/US and PET/US) was performed by three experienced investigators. Patients referred for thyroid diagnostics in a clinical routine setting were included in this study if CD produced equivocal results. PET/US was superior to CD and SPECT/US in 96% and 86%, respectively, and ambiguous findings in CD were clarified by PET/US in 96% of the 70 patients. Regarding nodule-based function assessment, 10% (66%), 39% (14%) and 71% (4%) of the 201 lesions were rated with absolute certainty (equivocal or uncertain) using CD, SPECT/US and PET/US, respectively (p < 0.001). PET/US has the potential to improve the function assessment of thyroid nodules in comparison to CD.
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Affiliation(s)
- Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Thomas Winkens
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Christian Kühnel
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany.
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Alvarez AL, Mulder M, Handelsman RS, Lew JI, Farra JC. High Rates of Underlying Thyroid Cancer in Patients Undergoing Thyroidectomy for Hyperthyroidism. J Surg Res 2019; 245:523-528. [PMID: 31450040 DOI: 10.1016/j.jss.2019.07.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/21/2019] [Accepted: 07/17/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The rate of thyroid cancer in patients with hyperthyroidism is reported to be rare, and patients with toxic thyroid nodules do not routinely undergo fine-needle aspiration (FNA) to evaluate for malignancy. However, higher rates of malignancy in hyperthyroid patients may exist than previously reported. This study examines the rate of malignancy in patients with hyperthyroidism who have undergone thyroidectomy. METHODS A retrospective review of prospectively collected data of 138 patients with hyperthyroidism who underwent thyroidectomy at a single institution was performed. Patients were divided into three groups: Graves' disease (n = 80), toxic multinodular goiter (n = 46), and toxic solitary nodule (n = 12). Patients with previous thyroid surgery were excluded from the study. All patients had biochemical confirmation of hyperthyroidism with thyroid-stimulating hormone <0.1 mIU/L and clinical diagnosis by a referring physician. RESULTS Of 138 patients, 22% (31/138) were found to have malignancy on final pathology. The breakdown of malignancy by hyperthyroid condition was as follows: 16% in Graves' disease, 24% in toxic multinodular goiter patients, and 50% in toxic solitary nodule patients. CONCLUSIONS There is a clinically significant rate of malignancy seen in patients who undergo thyroidectomy for hyperthyroidism. Patients with distinct thyroid nodules in the presence of hyperthyroidism may have the highest rates of malignancy and should undergo appropriate workup with ultrasound and FNA to exclude underlying malignancy. In cases with suspicious ultrasound features and/or FNA cytopathology, surgical treatment should be considered as initial management.
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Affiliation(s)
- Alexandra L Alvarez
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
| | - Michelle Mulder
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Rachel S Handelsman
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Josefina C Farra
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
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Su X, Chen S, He K, Mao Z, Ruan J, Zhou J, Teng X, Jin J, Fahey TJ, Wang W, Teng L. Clonal analysis of early-stage bilateral papillary thyroid cancer identifies field cancerization. Endocrine 2019; 64:614-621. [PMID: 30806961 DOI: 10.1007/s12020-019-01877-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 02/18/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Bilaterality is a newly identified indicator for aggressive tumor behavior and poor outcome in papillary thyroid cancer. However, the clonal origin of these bilateral tumors remains unclear. METHODS Here we analyzed 28 pairs of early-stage papillary thyroid cancers (stage I-II without extra-thyroidal extension, lymph node metastasis or distant metastasis) that underwent surgery at First Affiliated Hospital of Zhejiang University School of Medicine (Hangzhou, China). Genomic DNA was extracted from paraffin-embedded tissues after microdissection and analyzed for BRAF mutation and X-chromosome inactivation. RESULTS A total of 16 patients (16/28, 57.1%) harbored different BRAF status in bilateral tumors. Fourteen patients were available for X-chromosome inactivation assay and 10 of them achieved informative results. Bilateral tumors from four cases had distinct patterns of X-chromosome inactivation. Combining the results of X-chromosome inactivation and BRAF analysis, we demonstrated that at least 64.3% (18/28) cases harbored discordant X-chromosome inactivation or BRAF status, indicating their independent clonal origin in bilateral tumors. CONCLUSIONS The present study confirms "field cancerization" in early-stage bilateral thyroid cancers, suggesting that these subtype papillary thyroid cancers should be treated as independent and localized tumors.
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Affiliation(s)
- Xingyun Su
- Cancer Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shitu Chen
- Cancer Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kuifeng He
- Cancer Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zhuochao Mao
- Cancer Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiaying Ruan
- Cancer Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jie Zhou
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaodong Teng
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Judy Jin
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas J Fahey
- Department of Surgery, New York Presbyterian Hospital and Weill Medical College of Cornell University, New York, NY, USA
| | - Weibin Wang
- Cancer Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Lisong Teng
- Cancer Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Teshima M, Tokita K, Ryo E, Matsumoto F, Kondo M, Ikegami Y, Shinomiya H, Otsuki N, Hiraoka N, Nibu KI, Yoshimoto S, Mori T. Clinical impact of a cytological screening system using cyclin D1 immunostaining and genomic analysis for the diagnosis of thyroid nodules. BMC Cancer 2019; 19:245. [PMID: 30885146 PMCID: PMC6423761 DOI: 10.1186/s12885-019-5452-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Fine-needle aspiration (FNA) is the most reliable method for diagnosing thyroid nodules; however, some features such as atypia of undetermined significance or follicular lesion of undetermined significance can confound efforts to identify malignancies. Similar to BRAF, cyclin D1 may be a strong marker of cell proliferation. Methods One hundred two patients with thyroidal nodule were enrolled in this prospective study. Expression of cyclin D1 in thyroid nodules was determined by immunohistochemistry using both surgical specimens and their cytological specimens. The identification of the optimal cut off points for the diagnosis of malignancy were evaluated using the receiver operating characteristic (ROC) curves and the assessment of the area under the ROC curve (AUC). The specificity, sensitivity, positive predictive value (PPV) of markers were evaluated from crosstabs based on cut off points and significance were calculated. We also analyzed genetic variants by target NGS for thyroid nodule samples. Results The positive predictive value (PPV) and median stain ratio (MSR) of cyclin D1 nuclear staining was determined in papillary thyroid carcinoma (PPV = 91.5%, MSR = 48.5%), follicular adenoma (PPV = 66.7%, MSR = 13.1%), and adenomatous goiter and inflammation controls (MSR = 3.4%). In FNA samples, a threshold of 46% of immunolabelled cells allows to discriminate malignant lesions from benign ones (P < 0.0001), with 81% sensitivity and 100% specificity. A 46% cutoff value for positive cyclin D1 immunostaining in thyroid cells demonstrated 81% sensitivity and 100% specificity. In surgical specimens, ROC curve analysis showed a 5.8% cyclin D1 immunostaining score predicted thyroid neoplasms at 94.4% sensitivity and 92.3% specificity (P = 0.003), while a 15.7% score predicted malignancy at 86.4% sensitivity and 80.5% specificity (P < 0.0001). Finally, three tested clinico-pathological variables (extra thyroidal extension, intraglandular metastasis, and lymph node metastasis) were significant predictors of cyclin D1 immunostaining (P < 0.001). Conclusion Our cytological cyclin D1 screening system provides a simple, accurate, and convenient diagnostic method in precision medicine enabling ready determination of personalized treatment strategies for patients by next generation sequencing using cytological sample. Electronic supplementary material The online version of this article (10.1186/s12885-019-5452-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masanori Teshima
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan.,Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan.,Department of Otolaryngology - Head and Neck Surgery, Kobe University, School of Medicine, Kobe, Japan
| | - Kazuya Tokita
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Eijitsu Ryo
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Madoka Kondo
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yota Ikegami
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology - Head and Neck Surgery, Kobe University, School of Medicine, Kobe, Japan
| | - Naoki Otsuki
- Department of Otolaryngology - Head and Neck Surgery, Kobe University, School of Medicine, Kobe, Japan
| | - Nobuyoshi Hiraoka
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan.,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology - Head and Neck Surgery, Kobe University, School of Medicine, Kobe, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan. .,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan.
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Li Y, Zhou X, Zhang Q, Chen E, Sun Y, Ye D, Wang O, Zhang X, Lyu J. Lipase member H is a downstream molecular target of hypoxia inducible factor-1α and promotes papillary thyroid carcinoma cell migration in BCPAP and KTC-1 cell lines. Cancer Manag Res 2019; 11:931-941. [PMID: 30774423 PMCID: PMC6349079 DOI: 10.2147/cmar.s183355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Papillary thyroid carcinoma (PTC) is the most common type of thyroid carcinoma, which is associated with a high incidence of lymph-node metastasis. Multiple biomarkers have been identified for the precise diagnosis of PTC at an early stage. However, their role in PTC remains poorly elucidated. Previously, we reported that lipase H (LIPH), a membrane-bound protein, was highly expressed in PTC. This study aimed to fully elucidate the causal role of LIPH in the development of PTC and investigated its relationship with lymph-node metastasis in PTC. Materials and methods Quantitative reverse transcription PCR and immunohistochemistry were used to measure the mRNA and protein expression levels of LIPH in 45 and 6 pairs of PTC tissues and adjacent normal tissues, respectively. Clinical tissue data of 504 PTC tissues and 60 normal thyroid tissues from The Cancer Genome Atlas database were used to analyze the correlation between LIPH expression level and clinical features in PTC. siRNAs were used to knock down genes, while plasmids were used to overexpress genes. Two PTC cell lines (KTC-1 and BCPAP) were used in subsequent cytological function studies. In addition, a hypoxia stress model was constructed using cobaltous chloride hexahydrate reagent, and the protein expression level of the corresponding biomarkers was measured by Western blotting. Results This study revealed that high expression of LIPH in PTC was closely associated with lymph-node metastasis. Our cellular function experiments indicated that LIPH positively correlated with the malignant behavior of PTC cell lines. We further confirmed the role of LIPH in hypoxia and its relationship with the epithelial–mesenchymal transition pathway in PTC. Conclusion LIPH plays an important role in PTC oncogenesis and development, especially in lymph-node metastasis. It can be regarded as a biomarker for the diagnosis and treatment of PTC in the near future.
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Affiliation(s)
- Yuefeng Li
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, College of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China, .,Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Xiaofen Zhou
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Qiongying Zhang
- Pathology Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Endong Chen
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Yihan Sun
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Danrong Ye
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Ouchen Wang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Xiaohua Zhang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Jianxin Lyu
- Key Laboratory of Laboratory Medicine, Ministry of Education, Zhejiang Provincial Key Laboratory of Medical Genetics, College of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang, China,
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Iwata AJ, Bhan A, Lahiri S, Williams AM, Burmeister C, Chang SS, Singer MC. INCIDENTAL THYROID NODULES: RACE/ETHNICITY DISPARITIES AND OUTCOMES. Endocr Pract 2018; 24:941-947. [PMID: 30084685 DOI: 10.4158/ep-2018-0173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Black patients have a significantly lower incidence of well-differentiated thyroid cancer (WDTC) compared to all other race/ethnic groups, while white patients appear to be at greater risk. This study examines incidental thyroid nodules (ITNs) to assess whether racial disparities in WDTC arise from a differential discovery of ITNs-perhaps due to socioeconomic disparities-or reflect true differences in thyroid cancer rates. METHODS A retrospective review was performed of all patients who underwent fine-needle aspiration (FNA) of thyroid nodules by our academic medical center's endocrinology division between January 2006 and December 2010. Medical records were reviewed to identify whether the biopsied thyroid nodule was discovered incidentally through nonthyroid-related imaging or identified by palpation. RESULTS FNAs were performed on 1,369 total thyroid nodules in 1,141 study patients; 547 (48%) were classified as white, and 593 (52%) were classified as nonwhite. Among this cohort, 36.6% of patients underwent biopsy for an ITN. White patients were 1.6 times more likely to have undergone a biopsy for a nodule that was incidentally identified compared to nonwhites ( P<.0001). Indicators of socioeconomic status (SES) did not have a significant association with ITNs. Within the ITN cohort, 4.9% of nonwhite patients were found to have a thyroid malignancy compared to 12.9% of white patients ( P<.01). CONCLUSION The higher incidence of thyroid cancer in white patients appears to be not only due to diagnostic bias, but also to a true difference in cancer prevalence. ABBREVIATIONS FNA = fine-needle aspiration; ITN = incidental thyroid nodule; SEER = Surveillance Epidemiology and End Results; SES = socioeconomic status; WDTC = well-differentiated thyroid cancer.
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Reoperative central lymph node dissection for incidental papillary thyroid cancer can be performed safely: A retrospective review. Int J Surg 2018; 56:102-107. [DOI: 10.1016/j.ijsu.2018.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/10/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022]
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Bode-Lesniewska B, Cochand-Priollet B, Straccia P, Fadda G, Bongiovanni M. Management of thyroid cytological material, preanalytical procedures and bio-banking. Cytopathology 2018; 30:7-16. [DOI: 10.1111/cyt.12586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/29/2022]
Affiliation(s)
- B. Bode-Lesniewska
- Institute of Pathology and Molecular Pathology; University Hospital Zurich; Zurich Switzerland
| | - B. Cochand-Priollet
- Department of Pathology; Faculté Paris Descartes; Cochin Hospital; APHP; Paris France
| | - P. Straccia
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Foundation “Agostino Gemelli” University Hospital; Rome Italy
| | - G. Fadda
- Division of Anatomic Pathology and Histology; Catholic University of Sacred Heart; Foundation “Agostino Gemelli” University Hospital; Rome Italy
| | - M. Bongiovanni
- Service of Clinical Pathology; Institute of Pathology; Lausanne University Hospital; Lausanne Switzerland
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Vaiman M, Halevy A, Cohenpour M, Peer M, Bekerman I, Gavriel H. Evaluation and management of thyroid incidentalomas detected prior to the parathyroid surgery. Surg Oncol 2018; 27:508-512. [PMID: 30217310 DOI: 10.1016/j.suronc.2018.06.004] [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: 01/22/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND We investigated the management of thyroid incidentalomas associated with cases of parathyroid lesions in order to suggest a practical approach to their management from a surgical point of view. METHODS 639 patients underwent radiological and ultrasound investigation of the thyroid area because of parathyroid disorders and parathyroidectomy and had at least three years of follow-up. All follow-up data for these cases were investigated from the moment the lesion was detected and up to the last report. RESULTS Out of 639 cases, incidental or asymptomatic thyroid nodules were found in 179 patients (28%), of which, 22 patients were operated (parathyroidectomy + thyroidectomy) and 157 remained with the nodules. For these patients, the average period of follow-up was 7 years 5 mo. Following the results of the follow-up, 52 patients (33%) were suggested to have surgery of the thyroid gland and 49 were operated (16 total thyroidectomies and 33 hemithyroidectomies). The complications after the second surgery included recurrent laryngeal nerve palsy (n = 3), superior laryngeal nerve palsy (n = 1), permanent hypocalcaemia (n = 8), and surgical damage to the internal jugular vein (n = 1). All complications occurred at the previously operated side of the neck. CONCLUSION While surgery remains the management of choice for malignant thyroid incidentalomas, for benign cases, if an asymptomatic thyroid nodule was detected inside the thyroid lobe on the side of planned parathyroidectomy and if the size of the nodule is ˃1.5 cm we suggest combined parathyroidectomy + hemithyroidectomy.
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Affiliation(s)
- Michael Vaiman
- Department of Otorhinolaryngology Head and Neck Surgery, Assaf HaRofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Ariel Halevy
- Division of Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Mehrzad Cohenpour
- Department of Nuclear Medicine, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Michael Peer
- Department of Thoracic Surgery, Assaf HaRofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Inessa Bekerman
- Department of Radiology, Assaf HaRofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
| | - Haim Gavriel
- Department of Otorhinolaryngology Head and Neck Surgery, Assaf HaRofeh Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
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45
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Sugianto I, Yanagi Y, Konouchi H, Hisatomi M, Okada S, Bamgbose BO, Asaumi J. Incidental finding of papillary thyroid carcinoma on CT examination of mandibular lesion: Case report. Mol Clin Oncol 2018; 8:183-187. [PMID: 29387413 DOI: 10.3892/mco.2017.1478] [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: 06/13/2017] [Accepted: 09/28/2017] [Indexed: 11/05/2022] Open
Abstract
The number of significant incidental findings identified on radiographic examinations has increased. In total, 169 patients, 87 males and 82 females, with a mean age of 67.3 years (range, 17-92 years), as well as 65 patients (38.5%), 43 (66.2%) female and 22 (33.8%) male had abnormal findings in the thyroid for one year in our institution. Thyroid nodules are the most common incidental findings on oral and maxillofacial evaluations. Computed tomography (CT) and magnetic resonance imaging (MRI) examination are frequently used to detect thyroid abnormality. The present study reported a case of papillary thyroid carcinoma (PTC) detected following CT and MRI examination of a mandibular lesion. The CT examination of the oral and maxillofacial region included the thyroid, which must be examined carefully to detect various diseases, including PTC. Collaboration between radiologists and clinicians is important to manage these incidental findings.
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Affiliation(s)
- Irfan Sugianto
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.,Department of Oral Radiology Faculty of Dentistry, Hasanuddin University, Makassar 90245, Indonesia
| | - Yoshinobu Yanagi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8530, Japan
| | - Hidenobu Konouchi
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Miki Hisatomi
- Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8530, Japan
| | - Shunsuke Okada
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Babatunde O Bamgbose
- Department of Oral and Maxillofacial Radiology, Okayama University, Okayama 700-8530, Japan
| | - Junichi Asaumi
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.,Department of Oral Diagnosis and Dentomaxillofacial Radiology, Okayama University Hospital, Okayama 700-8530, Japan
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46
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Dhillon VK, Russell JO, Al Khadem MG, Tufano RP. Preoperative information for thyroid surgery. Gland Surg 2017; 6:482-487. [PMID: 29142838 DOI: 10.21037/gs.2017.05.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The preoperative information necessary to communicate to the patient to obtain informed consent in thyroid surgery is not detailed in length in the current medical literature. Advances in technology and the advent of remote access approaches in thyroid surgery have increased the need for a detailed communication of risks, benefits and alternatives to achieve an informed consent. In this review article, we outline the indications for thyroid surgery, risks of thyroid surgery, different approaches to thyroidectomy, and possible consequences of using advanced technology using intraoperative nerve monitoring (IONM) as an example. A truly detailed informed consent in the modern age of thyroid surgery is crucial. This article not only details the risks, benefits and alternatives of thyroid surgery, but also incorporates new practices, guidelines and technologies to allow patients to achieve a comprehensive preoperative understanding of treatment recommendations.
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Affiliation(s)
- Vaninder K Dhillon
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mai G Al Khadem
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Liu FC, Lin HT, Lin SF, Kuo CF, Chung TT, Yu HP. Nationwide cohort study on the epidemiology and survival outcomes of thyroid cancer. Oncotarget 2017; 8:78429-78451. [PMID: 29108240 PMCID: PMC5667973 DOI: 10.18632/oncotarget.19488] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 05/31/2017] [Indexed: 12/14/2022] Open
Abstract
In the past three decades, the thyroid cancer incidence has surged globally. Herein, the Taiwan National Health Insurance database was used to identify thyroid cancer patients and to estimate the prevalence and incidence of thyroid cancer during 1997-2012. The Taiwan Cancer Registry and the National Death Registry databases were crosslinked to obtain information on the histological subtypes and survival rates. Joinpoint regression analysis was used for estimating the average annual percentage changes (APCs) in prevalence, incidence, and survival. The age-standardized incidence of thyroid cancer increased from 5.66 per 100,000 person-years in 1997 to 12.30 per 100,000 person-years in 2012, with an average APC of 5.1 (6.9 in males, 4.6 in females). Thyroid cancer was more prevalent in patients with high socioeconomic status and in urban areas. Papillary carcinoma was the most abundant subtype, with a 2.9-fold increase of incident cases noted during 1998-2012 (from 80.6% to 89.8% of all cases). Among the different treatments, partial thyroidectomy increased the most (average APC, 17.3). The overall survival rates by sex and subtype remained stable over time, with 5-year survival rates of 90.2% in 1997 and 92.4% in 2010. In conclusion, 2.2- and 4.2-fold increases in the incidence and prevalence of thyroid cancer, respectively, were observed during 1997-2012 in Taiwan. The surging incidence of thyroid cancer but stable survival rates, and mainly increased in the papillary subtype, altogether imply enhanced detection of subclinical lesions. A true increase due to environmental carcinogens might also be responsible, but warrant further investigations.
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Affiliation(s)
- Fu-Chao Liu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Tang Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Fu Lin
- Department of Endocrinology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - Ting-Ting Chung
- Office for Big Data Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Huang-Ping Yu
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Jegerlehner S, Bulliard JL, Aujesky D, Rodondi N, Germann S, Konzelmann I, Chiolero A, NICER Working Group. Overdiagnosis and overtreatment of thyroid cancer: A population-based temporal trend study. PLoS One 2017; 12:e0179387. [PMID: 28614405 PMCID: PMC5470703 DOI: 10.1371/journal.pone.0179387] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/28/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The increase in incidence of thyroid cancer during the last decades without concomitant rise in mortality may reflect the growing detection of indolent forms of thyroid cancer, and may have fueled unnecessary thyroidectomies. Our aim was therefore, to compare recent secular trends in surgical intervention rate for thyroid cancer with the incidence and mortality of thyroid cancer to assess overdiagnosis and resulting overtreatment. METHODS We conducted a population-based temporal trend study in Switzerland from 1998 to 2012. All cases of invasive thyroid cancer, deaths from thyroid cancer, and cancer-related thyroidectomies were analyzed. We calculated changes in age-standardized thyroid cancer incidence rates, stratified by histologic subtype and tumor stage, thyroid cancer-specific mortality, and thyroidectomy rates. RESULTS Between 1998 and 2012, the age-standardized annual incidence of thyroid cancer increased from 5.9 to 11.7 cases/100,000 among women (annual mean absolute increase: +0.43/100,000/year) and from 2.7 to 3.9 cases/100,000 among men (+0.11/100,000/year). The increase was limited to the papillary subtype, the most indolent form of thyroid cancer. The incidence of early stages increased sharply, the incidence of advanced stages increased marginally, and the mortality from thyroid cancer decreased slightly. There was a three- to four-fold increase in the age-standardized annual thyroidectomy rate in both sexes. CONCLUSIONS We observed a large increase in the incidence of thyroid cancer, limited to papillary and early stage tumors, with a three- to four-fold parallel increase in thyroidectomy. The mortality slightly decreased. These findings suggest that a substantial and growing part of the detected thyroid cancers are overdiagnosed and overtreated. IMPACT Targeted screening and diagnostic strategies are warranted to avoid overdetection and unnecessary treatment of thyroid cancers.
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Affiliation(s)
- Sabrina Jegerlehner
- Division of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Luc Bulliard
- Division of Chronic Diseases, IUMSP, Lausanne University Hospital, Lausanne, Switzerland
| | - Drahomir Aujesky
- Division of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Rodondi
- Division of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Simon Germann
- Division of Chronic Diseases, IUMSP, Lausanne University Hospital, Lausanne, Switzerland
- Observatoire valaisan de la santé (OVS), Sion, Switzerland
| | | | - Arnaud Chiolero
- Division of Chronic Diseases, IUMSP, Lausanne University Hospital, Lausanne, Switzerland
- Observatoire valaisan de la santé (OVS), Sion, Switzerland
- Department of Epidemiology, McGill University, Montreal, Canada
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Baxi SS, Kurtzman R, Eaton A, Dewey E, Bickford C, Fish S, Wartofsky L, Michael Tuttle R. Pilot Study of a Web-based Decision Tool on Post-operative Use of Radioactive Iodine. EUROPEAN ENDOCRINOLOGY 2017; 13:26-29. [PMID: 29632603 PMCID: PMC5813442 DOI: 10.17925/ee.2017.13.01.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
Abstract
Background: The Thyroid Cancer Care Collaborative developed a web-based clinical decision-making module (CDMM) to inform risk-adjusted decisions on post-thyroidectomy radioactive iodine (RAI) use in papillary thyroid cancer (PTC). Methods: In a pilot study, we evaluated the CDMM in 19 PTC cases representing low- (five), intermediate- (seven) and high-risk (seven) disease. Two PTC experts and 10 PTC physicians reviewed cases and assigned risk level and RAI recommendation. The experts used a standard approach while the others used the CDMM. We assessed agreement between responses using a weighted Kappa. Results: Between experts, risk-assignment was concordant in 100%, 57% and 86% of low-, intermediate- and high-risk cases, respectively. Between CDMM users, risk-assignment was concordant in 100%, 29% and 14% in low-, intermediate- and high-risk cases, respectively (p=0.01). CDMM-assigned risk agreed with the expert-assigned risk in 100%, 25% and 0% of low-, intermediate- and high-risk cases, respectively (Kappa=0.69). For RAI use, the experts agreed in 15 cases while CDMM users agreed in eight. On further analysis, interpretation of extrathyroidal extension and lymph node staging led to discrepancies with the CDMM. Conclusions: For a web-based CDMM to accurately inform appropriate use of RAI in PTC, standard pathological and surgical reports are necessary.
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Affiliation(s)
- Shrujal S Baxi
- Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, US.,Department of Medicine, Weill Medical College of Cornell University, New York, New York, US
| | - Rachel Kurtzman
- Head and Neck Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, US
| | - Anne Eaton
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, US
| | - Eliza Dewey
- The THANC Foundation, PO Box 1021, New York, New York, US
| | - Craig Bickford
- The THANC Foundation, PO Box 1021, New York, New York, US
| | - Stephanie Fish
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, US
| | - Leonard Wartofsky
- Division of Endocrinology, Department of Medicine, MedStar Washington Hospital Center, Washington, DC, US
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, US
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50
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Schneider DF, Cherney Stafford LM, Brys N, Greenberg CC, Balentine CJ, Elfenbein DM, Pitt SC. GAUGING THE EXTENT OF THYROIDECTOMY FOR INDETERMINATE THYROID NODULES: AN ONCOLOGIC PERSPECTIVE. Endocr Pract 2017; 23:442-450. [PMID: 28095042 PMCID: PMC5403583 DOI: 10.4158/ep161540.or] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Increasing emphasis is being placed on appropriateness of care and avoidance of over- and under-treatment. Indeterminate thyroid nodules (ITNs) present a particular risk for this problem because cancer found via diagnostic lobectomy (DL) often requires a completion thyroidectomy (CT). However, initial total thyroidectomy (TT) for benign ITN results in lifelong thyroid hormone replacement. We sought to measure the accuracy and factors associated with the extent of initial thyroidectomy for ITN. METHODS We queried a single institution thyroid surgery database for all adult patients undergoing an initial operation for ITN. Multivariate logistic regression identified factors associated with either oncologic under- or overtreatment at initial operation. RESULTS There were 639 patients with ITN. The median age was 52 (range, 18 to 93) years, 78.4% were female, and final pathology revealed a cancer >1 cm in 24.7%. The most common cytology was follicular neoplasm (45.1%) followed by Hürthle cell neoplasm (20.2%). CT or initial oncologic undertreatment was required in 58 patients (9.3%). Excluding those with goiters, 19.0% were treated with TT for benign final pathology. Multivariate analysis failed to identify any factor that independently predicted the need for CT. Female gender was associated with TT in benign disease (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.0 to 4.5; P = .05). Age >45 years predicted correct initial use of DL (OR, 2.6; 95% CI, 1.2 to 5.7; P = .02). Suspicious for papillary thyroid carcinoma (OR, 5.7; 95% CI, 2.1 to 15.3; P<.01) and frozen section (OR, 9.7; 95% CI, 2.5 to 38.6; P<.01) were associated with oncologically appropriate initial TT. The highest frequency of CT occurred in patients with follicular lesion of undetermined significance (11.6%). TT for benign final pathology occurred most frequently in patients with a Hürthle cell neoplasm (24.8%). CONCLUSION In patients with ITN, nearly 30% received an inappropriate extent of initial thyroidectomy from an oncologic standpoint. Tools to pre-operatively identify both benign and malignant disease can assist in the complex decision making to gauge the proper extent of initial surgery for ITN. ABBREVIATIONS ATA = American Thyroid Association AUS = atypia of undetermined significance CI = confidence interval CT = completion thyroidectomy FLUS = follicular lesion of undetermined significance ITN = indeterminate thyroid nodule OR = odds ratio PTC = papillary thyroid carcinoma TT = total thyroidectomy.
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Affiliation(s)
- David F. Schneider
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
| | - Linda M. Cherney Stafford
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
| | | | - Caprice C. Greenberg
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
| | - Courtney J. Balentine
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
| | - Dawn M. Elfenbein
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Susan C. Pitt
- Department of Surgery and the Wisconsin Surgical Outcomes Research Program, Unversity of Wisconsin, Madison, WI
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