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Aydemirli MD, Morreau H. Multi-UniFocality (MUF), in contrast to multifocality, in thyroid lesions: Relation to lymphocytic thyroiditis. Pathol Int 2024; 74:274-284. [PMID: 38558427 DOI: 10.1111/pin.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/09/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
Whereas multifocality typically concerns papillary thyroid carcinoma (PTC) without specification of intrathyroidal metastatic or independent nature of tumor foci, the designation of the latter as Multi-UniFocal (MUF) may be relevant for select cases. A case series involving multifocal thyroid lesions with divergent histopathological morphology and/or molecular profile, with molecular evaluation of multiple individual tumor foci per patient based on a next-generation sequencing approach, was retrospectively reviewed. Twenty-five patient cases with multifocal thyroid lesions suggestive of MUF, with 2-6 (median 3) tumor foci per patient, were described. Tumor lesions comprised diverse histopathology, including PTC, (E)FVPTC, NIFTP, FA, FTC, and oncocytic. Morphologically similar and/or diverse tumor foci harbored different molecular alterations (suggestive of non-shared clonality); with(out) coexistent similar foci harboring identical molecular alterations; or (partly) shared molecular alterations. MUF was associated with chronic lymphocytic thyroiditis in almost half of the cases. The recognition of MUF may justify the independent clinical consideration per individual tumor focus; as separate lesions albeit within a multifocal context. The potential clinical relevance and prognostic value of MUF remain to be further established.
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Affiliation(s)
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
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2
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Sudarikov A. COVID-19 and Cancer Detection in Russia. Cancers (Basel) 2024; 16:1673. [PMID: 38730625 PMCID: PMC11083030 DOI: 10.3390/cancers16091673] [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: 04/06/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Overdiagnosis, associated with mass testing in healthy populations, is a significant issue for breast, prostate, renal, and thyroid cancers. During the lockdowns caused by the COVID-19 pandemic, the intensity of cancer screening was expected to go down. In this study, we analyzed the impact of the expected reduction in screening intensity on morbidity and mortality from certain malignancies. Cumulative data from the Russian National Cancer Registry available from 2000 to 2022 were analyzed. It was noted that there has been no noticeable effect of the COVID-19 lockdowns on mortality rates from breast, prostate, renal, or thyroid cancers. At the same time, the detectable incidence decreased markedly in 2020 at the time of the lockdowns and then returned to pre-pandemic levels in 2022. At the moment, there is no sufficient reason to believe that skipping screening tests in 2020 could have any impact on breast, prostate, renal, or thyroid cancer mortality two years later (2022). The data presented further confirm that the overdiagnosis of these types of malignancies is caused by widespread screening among a generally healthy population.
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Affiliation(s)
- Andrey Sudarikov
- National Medical Research Center for Hematology, Novy Zykovski Lane, 4a, 125167 Moscow, Russia
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3
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Wang R, Disharoon M, Song Z, Gillis A, Fazendin J, Lindeman B, Chen H, McMullin JL. Incidental but Not Insignificant: Thyroid Cancer in Patients with Graves Disease. J Am Coll Surg 2024; 238:751-758. [PMID: 38230856 DOI: 10.1097/xcs.0000000000000973] [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: 01/18/2024]
Abstract
BACKGROUND Graves disease is the most common cause of hyperthyroidism in the US. Treatment with antithyroid drugs and radioactive iodine is more commonly used than surgical management with total thyroidectomy (TTx). However, incidentally discovered thyroid cancer (TC) has been described on surgical pathology from patients who underwent surgical treatment of Graves disease, which would be missed with these other treatment strategies. We sought to determine the incidence rate of TC among patients with surgically treated Graves disease. STUDY DESIGN We retrospectively reviewed patients with Graves disease who underwent TTx at a single institution from 2011 to 2023. Pathology reports were reviewed for TC. Patient demographics, preoperative laboratory and radiological evaluations, preoperative medical management, and surgical outcomes were compared between patients with and without incidental TC. RESULTS There were 934 patients, of whom 60 (6.4%) patients had incidentally discovered TC on pathology. The majority (58.3%) of patients had papillary thyroid carcinoma, followed by 33.3% with papillary microcarcinoma. Preoperative ultrasound (US) was obtained in 564 (60.4%) of patients, with 44.3% with nodules, but only 34 (13.7%) of those with nodules had TC on final pathology. Preoperative fine needle aspiration was obtained in 15 patients with TC, and 8 patients (53.3%) were reported as benign lesions, which ultimately had TC on final pathology. There was no difference in sex, race or ethnicity, preoperative medical management, and postoperative outcomes between the 2 groups. CONCLUSIONS Incidental TC was found on surgical pathology in 6.4% of patients undergoing TTx for Graves disease. Preoperative imaging with US and fine needle aspiration were often unreliable at predicting TC. The incidence of TC should not be underestimated when counseling patients on definitive management for Graves disease.
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Affiliation(s)
- Rongzhi Wang
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Mitchell Disharoon
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Zhixing Song
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Andrea Gillis
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Jessica Fazendin
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Brenessa Lindeman
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Herbert Chen
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Jessica Liu McMullin
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
- Department of Surgery, University of Utah, Salt Lake City, UT (McMullin)
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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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O'Brien O, Hilmi O, Wright S, McArthur C. Value of surveillance ultrasound following hemithyroidectomy. J Laryngol Otol 2024; 138:232-236. [PMID: 37309205 DOI: 10.1017/s0022215123001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is limited evidence or agreement on the benefit, duration and frequency of post-operative surveillance neck ultrasound in patients with differentiated thyroid cancer treated with hemithyroidectomy alone. This study's primary aim was to assess the benefit of neck ultrasound in this situation, with a secondary aim to assess the detection of malignancy in the contralateral lobe in patients undergoing completion surgery. METHODS A retrospective observational study was conducted involving patients who had differentiated thyroid cancer found at diagnostic hemithyroidectomy between 1 December 2013 and 31 December 2016. RESULTS Of 105 patients, 74 underwent completion thyroidectomy. Thirty-five per cent of these patients had malignancy identified in the contralateral lobe, the majority were unsuspected sonographically. Of 31 hemithyroidectomy patients, 1 had a nodule classified as 'U3' (indeterminate) at the first ultrasound surveillance, ultimately identified as incidental papillary microcarcinomas on completion thyroidectomy. There was no other disease recurrence or malignancy at a median of 3.8 years' follow up. CONCLUSION The findings indicate a limited role for ultrasound follow up of patients with differentiated thyroid cancer treated with hemithyroidectomy alone.
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Affiliation(s)
- Owen O'Brien
- Radiology, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Omar Hilmi
- ENT Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Sylvia Wright
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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Kim MJ, Moon JH, Lee EK, Song YS, Jung KY, Lee JY, Kim JH, Kim K, Park SK, Park YJ. Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines. Endocrinol Metab (Seoul) 2024; 39:47-60. [PMID: 38356210 PMCID: PMC10901665 DOI: 10.3803/enm.2024.1937] [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: 01/14/2024] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.
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Affiliation(s)
- Min Joo Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Young Shin Song
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Deparment of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Deparment of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyungsik Kim
- Deparment of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sue K. Park
- Deparment of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Wang C, Wu Z, Lei L, Dong X, Cao W, Luo Z, Zheng Y, Wang F, Xu Y, Zhao L, Shi J, Ren J, Li J, Zhang Y, Chen W, Li N. Geographic disparities in trends of thyroid cancer incidence and mortality from 1990 to 2019 and a projection to 2030 across income-classified countries and territories. J Glob Health 2023; 13:04108. [PMID: 37766638 PMCID: PMC10540248 DOI: 10.7189/jogh.13.04108] [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: 09/29/2023] Open
Abstract
Background The rising incidence of thyroid cancer (TC) has generated growing concern globally; yet there are no studies examining whether this incidence was followed by a rise in related mortality. We aimed to comprehensively quantify current trends and future projections of TC incidence and mortality, and to explore the association between the TC burden and socioeconomic inequality in different income strata. Methods We obtained incidence and mortality data on TC and population from the 2019 Global Burden of Disease (GBD) study and the United Nations' World Population Prospects 2022. We applied an age-period-cohort (APC) model to estimate the overall annual percentage change (net drift) and age, period, and cohort effects from 1990 to 2019, and also constructed a Bayesian APC model to predict the TC burden through 2030. Results Over a third of global TC cases belonged to the high-income group. From 1990 to 2019, net drifts of TC incidence were >0 in all income groups, while a modest reduction (net drift <0) in mortality was observed in most income groups, except for the lower-middle-income group. Unfavourable age, period, and cohort effects were most notable in Vietnam, China, and Korea. The age-standardised incidence rate (ASIR) is predicted to increase whereas the age-standardized mortality rate (ASMR) is expected to decrease globally between 2020 and 2030, with geographic heterogeneity being detected across income groups. We observed a positive correlation between ASIR and universal health coverage index and health worker density, but a negative one between ASMR and the two indicators, primarily in upper-middle-income and high-income countries. Conclusions Opposite patterns in incidence and mortality of TC raise concerns about overdiagnosis, particularly in upper-middle-income and high-income countries. Discrepancies in the distribution of health service accessibility, including diagnostic techniques and therapeutic care, should be addressed by narrowing health inequalities in the TC burden across countries.
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Affiliation(s)
- Chenran Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Wu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Lei
- Department of Cancer Prevention and Control, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Xuesi Dong
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Cao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zilin Luo
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yadi Zheng
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Wang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongjie Xu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhao
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jufang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Ren
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jibin Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yawei Zhang
- Department of Cancer Prevention and Control, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wanqing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
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8
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Chen Y, Gutierrez V, Morris L, Marti JL. Diagnostic Scrutiny and Patterns of Elevated Cancer Risk: Uncovering Overdiagnosis Through Standardized Incidence Ratios. Cureus 2023; 15:e42439. [PMID: 37637595 PMCID: PMC10447997 DOI: 10.7759/cureus.42439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Certain medical diagnoses and environmental or occupational exposures may be associated with elevated risk of cancer diagnosis, either through causal mechanisms or via increased detection of a subclinical reservoir through increased diagnostic scrutiny (overdiagnosis). The present study aimed to investigate the distribution of elevated cancer risks associated with different diagnoses and exposures. A systematic literature search was conducted to identify studies published in the last 30 years that examined the standardized incidence ratio (SIR) associated with exposures and risk factors. Meta-SIRs for each cancer type were calculated. The distribution of elevated cancer risks was then compared between cancer types previously reported to be susceptible to overdiagnosis and those that have not been associated with overdiagnosis. The review of 108 studies identified four patterns: SIR generally elevated for 1) only overdiagnosis-susceptible cancer types, 2) both overdiagnosed and non-overdiagnosed cancer types, 3) select cancers in accordance with risk factor or exposure, and 4) SIRs that did not exhibit a distinct increase in any cancer type. The distribution of elevated cancer risks may serve as a signature of whether the underlying risk factor or exposure is a carcinogenic process or a mechanism of increased diagnostic scrutiny uncovering clinically occult diseases. The identification of increased cancer risk should be viewed with caution, and analyzing the pattern of elevated cancer risk distribution can potentially reveal conditions that appear to be cancer risk factors but are in fact the result of exposure to medical surveillance or other healthcare activities that lead to the detection of indolent tumors.
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Affiliation(s)
- Yunchan Chen
- Department of Surgery, Weill Cornell Medicine, New York, USA
| | | | - Luc Morris
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jennifer L Marti
- Division of Breast Surgical Oncology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, USA
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9
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Rovira A, Brunet A, Jeannon JP, Carroll PV, Touska P, Hassan F, Sandison A, Simo R. Thyroglossal duct cyst carcinoma case series-Management strategy and outcomes. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:203-210. [PMID: 37479461 DOI: 10.1016/j.otoeng.2023.03.007] [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: 01/31/2022] [Accepted: 05/04/2022] [Indexed: 07/23/2023]
Abstract
OBJECTIVE To review the clinical presentation, diagnosis, pathology and management strategies in a modern cohort of patients with thyroglossal duct cyst carcinoma. STUDY DESIGN Retrospective case series following PROCESS Guidelines. SETTING Comprehensive cancer centre. METHODS Data recorded included: gender, age at diagnosis, clinical presentation, thyroid function, diagnostic investigations, cytological results, final histology, staging and follow up status. The risk of malignancy in cytological analysis was stratified according to the Royal College of Pathologists classification in United Kingdom. RESULTS Twelve patients were included. The majority of patients (66.7%) presented with an isolated thyroglossal duct cyst. Only 4 patients had preoperative cytological suspicion of carcinoma (sensitivity: 33.3%). At the time of presentation all patients were euthyroid. Following diagnosis of malignancy, a total thyroidectomy was performed in all patients, with the exception of 2, who had a thyroglossal duct cyst carcinoma of less than 10mm. Among the 10 patients who underwent total thyroidectomy, 7 (70%) patients had proven carcinoma in the thyroid gland, 3 with deposits of less than 10mm. The average size of the thyroid cancer deposits was 7.2mm (1-20mm). With a mean follow-up of is 44 months (5-120), all patients were alive and free of recurrence at the end of the study period. CONCLUSION Thyroglossal duct cyst carcinoma is a rare condition and its management should be discussed in a multidisciplinary meeting. As with differentiated thyroid cancer originating in the thyroid gland, it bears extraordinary survival rates. Accordingly, the management of these cancers has shifted towards a more conservative approach although its peculiarities must be taken into account: ease of extracystic invasion and possible different lymph node invasion.
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Affiliation(s)
- Aleix Rovira
- Department of Otorhinolaryngology Head & Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
| | - Aina Brunet
- Department of Otorhinolaryngology Head & Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Jean Pierre Jeannon
- Department of Otorhinolaryngology Head & Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Paul V Carroll
- Department of Endocrinology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Phil Touska
- Department of Radiology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Fahim Hassan
- Department of Nuclear Medicine, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Ann Sandison
- Department of Histopathology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Ricard Simo
- Department of Otorhinolaryngology Head & Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
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10
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Farias T, Kowalski LP, Dias F, Barreira CSR, Vartanian JG, Tavares MR, Vaisman F, Momesso D, Oliveira AF, Pinheiro RN, de Castro Ribeiro HS. Guidelines from the Brazilian society of surgical oncology regarding indications and technical aspects of neck dissection in papillary, follicular, and medullary thyroid cancers. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e000607. [PMID: 37252696 PMCID: PMC10665072 DOI: 10.20945/2359-3997000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/12/2022] [Indexed: 05/31/2023]
Abstract
Objective The purpose of these guidelines is to provide specific recommendations for the surgical treatment of neck metastases in patients with papillary, follicular, and medullary thyroid carcinomas. Materials and methods Recommendations were developed based on research of scientific articles (preferentially meta-analyses) and guidelines issued by international medical specialty societies. The American College of Physicians' Guideline Grading System was used to determine the levels of evidence and grades of recommendations. The following questions were answered: A) Is elective neck dissection indicated in the treatment of papillary, follicular, and medullary thyroid carcinoma? B) When should central, lateral, and modified radical neck dissection be performed? C) Could molecular tests guide the extent of the neck dissection? Results and conclusion Recommendation 1: Elective central neck dissection is not indicated in patients with cN0 well-differentiated thyroid carcinoma or in those with noninvasive T1 and T2 tumors but may be considered in T3-T4 tumors or in the presence of metastases in the lateral neck compartments. Recommendation 2: Elective central neck dissection is recommended in medullary thyroid carcinoma. Recommendation 3: Selective neck dissection of levels II-V should be indicated to treat neck metastases in papillary thyroid cancer, an approach that decreases the risk of recurrence and mortality. Recommendation 4: Compartmental neck dissection is indicated in the treatment of lymph node recurrence after elective or therapeutic neck dissection; "berry node picking" is not recommended. Recommendation 5: There are currently no recommendations regarding the use of molecular tests in guiding the extent of neck dissection in thyroid cancer.
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Affiliation(s)
- Terence Farias
- Instituto Nacional de Câncer, Ringgold Standard Institution, Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil
- Pontifícia Universidade Católica do Rio de Janeiro, Ringgold Standard Institution, Pós-graduação em Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
| | - Luiz Paulo Kowalski
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- A.C.Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brasil
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Ringgold Standard Institution, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brasil
| | - Fernando Dias
- Instituto Nacional de Câncer, Ringgold Standard Institution, Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil
- Pontifícia Universidade Católica do Rio de Janeiro, Ringgold Standard Institution, Pós-graduação em Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brasil
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
| | - Carlos S Ritta Barreira
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- Hospital Dasa Brasília, Cirurgia de Cabeça e Pescoço, Brasília, DF, Brasil,
| | - José Guilherme Vartanian
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- A.C.Camargo Cancer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brasil
| | - Marcos Roberto Tavares
- Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Ringgold Standard Institution, São Paulo, SP, Brasil
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), Ringgold Standard Institution, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brasil
| | - Fernanda Vaisman
- Instituto Nacional de Câncer, Ringgold Standard Institution, Seção de Cirurgia de Cabeça e Pescoço/Endocrinologia, Rio de Janeiro, RJ, Brasil
| | - Denise Momesso
- Universidade Federal do Rio de Janeiro, Endocrinologia, Rio de Janeiro, RJ, Brasil
| | - Alexandre Ferreira Oliveira
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- Universidade Federal de Juiz de Fora, Ringgold Standard Institution, Departamento de Oncologia, Juiz de Fora, MG, Brasil
| | - Rodrigo Nascimento Pinheiro
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- Hospital de Base do Distrito Federal, Ringgold Standard Institution, Cirurgia Oncológica, Brasília, DF, Brasil
| | - Heber Salvador de Castro Ribeiro
- Sociedade Brasileira de Cirurgia Oncológica, Ringgold Standard Institution, Rio de Janeiro, RJ, Brasil
- A.C.Camargo Cancer Center, Ringgold Standard Institution, Departamento de Cirurgia Abdominal, São Paulo, SP, Brasil
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Wadsley J, Balasubramanian SP, Madani G, Munday J, Roques T, Rowe CW, Touska P, Boelaert K. Consensus statement on the management of incidentally discovered FDG avid thyroid nodules in patients being investigated for other cancers. Clin Endocrinol (Oxf) 2023. [PMID: 36878888 DOI: 10.1111/cen.14905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
With the widespread use of 18F-fluorodeoxyglucose positron emission tomography (FDG PET/CT) in the investigation and staging of cancers, incidental discovery of FDG-avid thyroid nodules is becoming increasingly common, with a reported incidence in the range 1%-4% of FDG PET/CT scans. The risk of malignancy in an incidentally discovered FDG avid thyroid nodule is not clear due to selection bias in reported retrospective series but is likely to be less than 15%. Even in cases where the nodule is found to be malignant, the majority will be differentiated thyroid cancers with an excellent prognosis even without treatment. If, due to index cancer diagnosis, age and co-morbidities, it is unlikely that the patient will survive 5 years, further investigation of an incidental FDG avid thyroid nodule is unlikely to be warranted. We provide a consensus statement on the circumstances in which further investigation of FDG avid thyroid nodules with ultrasound and fine needle aspiration might be appropriate.
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Affiliation(s)
| | | | - Gitta Madani
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Tom Roques
- Norfolk and Norwich Hospital, Norwich, UK
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Perioperative escape from dormancy of spontaneous micro-metastases: A role for malignant secretion of IL-6, IL-8, and VEGF, through adrenergic and prostaglandin signaling. Brain Behav Immun 2023; 109:175-187. [PMID: 36646396 DOI: 10.1016/j.bbi.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
We recently showed that a minimally-invasive removal of MDA-MB-231HM primary tumors (PTs) and elimination of their secreted factors (including IL-6, IL-8, VEGF, EGF, PDGF-aa, MIF, SerpinE1, and M-CSF), caused regression of spontaneous micro-metastases into a non-growing dormant state. To explore the underlying mechanisms and potential clinical ramifications of this phenomenon, we herein used the MDA-MB-231HM human breast cancer cell-line, in-vitro, and in vivo following orthotopic implantation in immune-deficient BALB/C nu/nu mice. Employing bioluminescence imaging, we found that adding laparotomy to minimally-invasive removal of the PT caused an outbreak of micro-metastases. However, perioperative β-adrenergic and COX-2 inhibition, using propranolol + etodolac, maintained metastatic dormancy following laparotomy. In-vitro, β-adrenergic agonists (epinephrine or metaproterenol) and prostaglandin-E2 markedly increased MDA-MB-231HM secretion of the pro-metastatic factors IL-6, IL-8, and VEGF, whereas cortisol reduced their secretion, effects that were maintained even 12 h after the washout of these agonists. In-vivo, laparotomy elevated IL-6 and IL-8 levels in both plasma and ex-vivo PT spontaneous secretion, whereas perioperative propranolol + etodolac administration blocked these effects. Similar trends were evident for EGF and MIF. Promoter-based bioinformatics analyses of excised PT transcriptomes implicated elevated NF-kB activity and reduced IRF1 activity in the gene regulatory effects of laparotomy, and these effects were inhibited by pre-surgical propranolol + etodolac. Taken together, our findings suggest a novel mechanism of post-operative metastatic outbreak, where surgery-induced adrenergic and prostanoid signaling increase the secretion of pro-metastatic factors, including IL-6, IL-8, and VEGF, from PT and possibly residual malignant tissue, and thereby prevent residual disease from entering dormancy.
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Lisco G, De Tullio A, Triggiani D, Zupo R, Giagulli VA, De Pergola G, Piazzolla G, Guastamacchia E, Sabbà C, Triggiani V. Iodine Deficiency and Iodine Prophylaxis: An Overview and Update. Nutrients 2023; 15:nu15041004. [PMID: 36839362 PMCID: PMC9967346 DOI: 10.3390/nu15041004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
The thyroid gland requires iodine to synthesize thyroid hormones, and iodine deficiency results in the inadequate production of thyroxine and related thyroid, metabolic, developmental, and reproductive disorders. Iodine requirements are higher in infants, children, and during pregnancy and lactation than in adult men and non-pregnant women. Iodine is available in a wide range of foods and water and is susceptible to almost complete gastric and duodenal absorption as an iodide ion. A healthy diet usually provides a daily iodine consumption not exceeding 50% of the recommended intake. Iodine supplementation is usually necessary to prevent iodine deficiency disorders (IDDs), especially in endemic areas. The community-based strategy of iodine fortification in salt has eradicated IDDs, such as endemic goiter and cretinism, in countries providing adequate measures of iodine prophylaxis over several decades in the 20th century. Iodized salt is the cornerstone of iodine prophylaxis in endemic areas, and the continuous monitoring of community iodine intake and its related clinical outcomes is essential. Despite the relevant improvement in clinical outcomes, subclinical iodine deficiency persists even in Western Europe, especially among girls and women, being an issue in certain physiological conditions, such as pregnancy and lactation, and in people consuming unbalanced vegetable-based or salt-restricted diets. Detailed strategies to implement iodine intake (supplementation) could be considered for specific population groups when iodized salt alone is insufficient to provide adequate requirements.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, 70013 Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, 70013 Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence:
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Lee E, Jeong SH, Nam CM, Jun JK, Park EC. Role of breast cancer screening in the overdiagnosis of thyroid cancer: results from a cross-sectional nationwide survey. BMC Womens Health 2023; 23:64. [PMID: 36782225 PMCID: PMC9926730 DOI: 10.1186/s12905-023-02205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND South Korea has the highest incidence of thyroid cancer worldwide, raising questions regarding the possibility of overdiagnosis. Examining the factors affecting thyroid cancer screening is crucial in elucidating the reasons for this unusually high incidence of thyroid cancer. Therefore, in the present study, we investigated the association between breast cancer screening and thyroid cancer screening to determine the potential role of breast cancer screening in the overdiagnosis of thyroid cancer in South Korea. METHODS We analyzed the data of women aged > 30 years who were enrolled in the 2014 Korean National Cancer Screening Survey. Self-reported breast cancer screening behavior was categorized as follows: no screening, mammography only, ultrasonography only, and both ultrasonography and mammography. Thyroid cancer screening behavior was categorized as follows: those who had or had not undergone ultrasonography screening. Logistic regression analysis was used to examine the associations between breast and thyroid cancer screening behaviors. RESULTS Of the 2270 participants, a total of 569 (25.1%) were screened for thyroid cancer. Those who underwent only mammography, only ultrasonography, or both mammography and ultrasonography were more likely to be screened for thyroid cancer than those who did not undergo breast cancer screening (odds ratio [OR]: 1.47, 95% confidence interval [CI] 1.06-2.04; OR 2.71, 95% CI 1.83-4.02; OR 2.75, 95% CI 1.99-3.80, respectively). CONCLUSIONS Our findings indicate that thyroid cancer screening in Korea is likely to be performed on an opportunistic basis. Therefore, a nationwide public health and medical initiative is needed to curb the unnecessary use of thyroid screening in the asymptomatic general population.
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Affiliation(s)
- Eunhye Lee
- grid.412674.20000 0004 1773 6524Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-Ro, Bucheon, 14584 Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Public Health, Graduate School, Yonsei University, Seoul, 03722 Republic of Korea
| | - Sung Hoon Jeong
- grid.15444.300000 0004 0470 5454Department of Public Health, Graduate School, Yonsei University, Seoul, 03722 Republic of Korea ,grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, 03722 Republic of Korea
| | - Chung Mo Nam
- grid.15444.300000 0004 0470 5454Institute of Health Services Research, Yonsei University, Seoul, 03722 Republic of Korea ,grid.15444.300000 0004 0470 5454Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722 Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, 10408, Republic of Korea. .,Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, 10408, Republic of Korea.
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, 03722, Republic of Korea. .,Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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McQueen A, Al-Zuhir N, Ali T. Incidentalomas in the head & neck. Br J Radiol 2023; 96:20220164. [PMID: 36317814 PMCID: PMC9975523 DOI: 10.1259/bjr.20220164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Incidental findings (IFs) in the head & neck are a frequent challenge to the reporting radiologist. A combination of complex anatomy, widely varied imaging techniques and the high prevalence of benign pathology, makes safe and appropriate management of head & neck IFs problematic. The non-head & neck radiologist is unlikely to have prior personal experience of the relevant specialties or current involvement with the pertinent multidisciplinary teams, creating unfamiliarity with both the clinical aspects of head & neck disease and the value of examination techniques. This triumvirate of complex anatomy, pathology and imaging creates the perfect environment for excessive investigation and overdiagnosis. In this article, the most frequently encountered and clinically relevant head & neck IFs are summarised. To reflect daily clinical practice, we will firstly consider anatomic abnormalities identified on cross-sectional imaging and ultrasound, followed by a review of PET-CT incidental findings.
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Affiliation(s)
- Andrew McQueen
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Naail Al-Zuhir
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Tamir Ali
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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16
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Ullmann TM, Papaleontiou M, Sosa JA. Current Controversies in Low-Risk Differentiated Thyroid Cancer: Reducing Overtreatment in an Era of Overdiagnosis. J Clin Endocrinol Metab 2023; 108:271-280. [PMID: 36327392 PMCID: PMC10091361 DOI: 10.1210/clinem/dgac646] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Low-risk differentiated thyroid cancer (DTC) is overdiagnosed, but true incidence has increased as well. Owing to its excellent prognosis with low morbidity and mortality, balancing treatment risks with risks of disease progression can be challenging, leading to several areas of controversy. EVIDENCE ACQUISITION This mini-review is an overview of controversies and difficult decisions around the management of all stages of low-risk DTC, from diagnosis through treatment and follow-up. In particular, overdiagnosis, active surveillance vs surgery, extent of surgery, radioactive iodine (RAI) treatment, thyrotropin suppression, and postoperative surveillance are discussed. EVIDENCE SYNTHESIS Recommendations regarding the diagnosis of DTC, the extent of treatment for low-risk DTC patients, and the intensity of posttreatment follow-up have all changed substantially in the past decade. While overdiagnosis remains a problem, there has been a true increase in incidence as well. Treatment options range from active surveillance of small tumors to total thyroidectomy followed by RAI in select cases. Recommendations for long-term surveillance frequency and duration are similarly broad. CONCLUSION Clinicians and patients must approach each case in a personalized and nuanced fashion to select the appropriate extent of treatment on an individual basis. In areas of evidential equipoise, data regarding patient-centered outcomes may help guide decision-making.
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Affiliation(s)
- Timothy M Ullmann
- Division of General Surgery, Department of Surgery, Albany Medical College, 50 New Scotland Ave., MC-193, Albany, NY 12208, USA
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 453S, Ann Arbor, MI 48109, USA
| | - Julie Ann Sosa
- Section of Endocrine Surgery, Department of Surgery, University of California, San Francisco, 513 Parnassus Ave. Ste. S320, Box 0104, San Francisco, CA 94143, USA
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Dralle H, Weber F, Machens A, Brandenburg T, Schmid KW, Führer-Sakel D. [Hemithyroidectomy or total thyroidectomy for low-risk papillary thyroid cancer? : Surgical criteria for primary and secondary choice of treatment in an interdisciplinary treatment concept]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:79-92. [PMID: 36121448 DOI: 10.1007/s00104-022-01726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/21/2023]
Abstract
The increase in small intrathyroid papillary thyroid cancer (PTC) observed worldwide over the past two decades, with no increase in cancer-specific mortality, has challenged the previous concept of total thyroidectomy as a one-size-fits-all panacea. After exclusion of papillary microcarcinomas, a systematic review of 20 clinical studies published since 2002, which compared hemithyroidectomy (HT) to total thyroidectomy (TT), found comparable long-term oncological outcomes for low-risk papillary thyroid cancer (LRPTC) 1-4 cm in diameter, whereas postoperative complication rates were markedly lower for HT. To refine individual treatment plans, HT should be combined with ipsilateral central lymph node dissection and intraoperative frozen section analysis for staging. Based on recent evidence from studies and in consideration of individual risk factors, patients with LRPTC can be offered the concept of HT as an alternative to the standard TT. A prerequisite for the treatment selection and decision is a comprehensive patient clarification of the possible advantages and disadvantages of both approaches.
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Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - F Weber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Machens
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - T Brandenburg
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - K W Schmid
- Institut für Pathologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Führer-Sakel
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Xia M, Wang S, Ye Y, Tu Y, Huang T, Gao L. Effect of the m6ARNA gene on the prognosis of thyroid cancer, immune infiltration, and promising immunotherapy. Front Immunol 2022; 13:995645. [PMID: 36389678 PMCID: PMC9664221 DOI: 10.3389/fimmu.2022.995645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 10/17/2022] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Accumulating evidence suggests that N6-methyladenosine (m6A) RNA methylation plays an important role in tumor proliferation and growth. However, its effect on the clinical prognosis, immune infiltration, and immunotherapy response of thyroid cancer patients has not been investigated in detail. METHODS Clinical data and RNA expression profiles of thyroid cancer were extracted from the Cancer Genome Atlas-thyroid carcinoma (TCGA-THCA) and preprocessed for consensus clustering. The risk model was constructed based on differentially expressed genes (DEGs) using Least Absolute Shrinkage and Selection Operator (LASSO) and Cox regression analyses. The associations between risk score and clinical traits, immune infiltration, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Set Enrichment Analysis (GSEA), immune infiltration, and immunotherapy were assessed. Immunohistochemistry was used to substantiate the clinical traits of our samples. RESULTS Gene expression analysis showed that 17 genes, except YHTDF2, had significant differences (vs healthy control, P<0.001). Consensus clustering yielded 2 clusters according to their clinical features and estimated a poorer prognosis for Cluster 1 (P=0.03). The heatmap between the 2 clusters showed differences in T (P<0.01), N (P<0.001) and stage (P<0.01). Based on univariate Cox and LASSO regression, a risk model consisting of three high-risk genes (KIAA1429, RBM15, FTO) was established, and the expression difference between normal and tumor tissues of three genes was confirmed by immunohistochemical results of our clinical tissues. KEGG and GSEA analyses showed that the risk DEGs were related mainly to proteolysis, immune response, and cancer pathways. The levels of immune infiltration in the high- and low-risk groups were different mainly in iDCs (P<0.05), NK cells (P<0.05), and type-INF-II (P<0.001). Immunotherapy analysis yielded 30 drugs associated with the expression of each gene and 20 drugs associated with the risk score. CONCLUSIONS Our risk model can act as an independent marker for thyroid cancer and provides promising immunotherapy targets for its treatment.
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Affiliation(s)
- Minqi Xia
- Department of Endocrinology and Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuo Wang
- Department of Endocrinology and Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yingchun Ye
- Department of Endocrinology and Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yi Tu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tiantian Huang
- Department of Endocrinology and Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Gao
- Department of Endocrinology and Metabolism, Renmin Hospital of Wuhan University, Wuhan, China
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Perkins JM, Papaleontiou M. Towards De-Implementation of low-value thyroid care in older adults. Curr Opin Endocrinol Diabetes Obes 2022; 29:483-491. [PMID: 35869743 PMCID: PMC9458619 DOI: 10.1097/med.0000000000000758] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review discusses the current literature regarding low-value thyroid care in older adults, summarizing recent findings pertaining to screening for thyroid dysfunction and management of hypothyroidism, thyroid nodules and low-risk differentiated thyroid cancer. RECENT FINDINGS Despite a shift to a "less is more" paradigm for clinical thyroid care in older adults in recent years, current studies demonstrate that low-value care practices are still prevalent. Ineffective and potentially harmful services, such as routine treatment of subclinical hypothyroidism which can lead to overtreatment with thyroid hormone, inappropriate use of thyroid ultrasound, blanket fine needle aspiration biopsies of thyroid nodules, and more aggressive approaches to low-risk differentiated thyroid cancers, have been shown to contribute to adverse effects, particularly in comorbid older adults. SUMMARY Low-value thyroid care is common in older adults and can trigger a cascade of overdiagnosis and overtreatment leading to patient harm and increased healthcare costs, highlighting the urgent need for de-implementation efforts.
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Affiliation(s)
- Jennifer M. Perkins
- Division of Endocrinology, Departments of Medicine and Surgery, University of California San Francisco, San Francisco, CA
| | - Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- Institute of Gerontology, University of Michigan, Ann Arbor, MI
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Arroyo N, Bell KJL, Hsiao V, Fernandes-Taylor S, Alagoz O, Zhang Y, Davies L, Francis DO. Prevalence of Subclinical Papillary Thyroid Cancer by Age: Meta-analysis of Autopsy Studies. J Clin Endocrinol Metab 2022; 107:2945-2952. [PMID: 35947867 PMCID: PMC9516102 DOI: 10.1210/clinem/dgac468] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT It is not known how underlying subclinical papillary thyroid cancer (PTC) differs by age. This meta-analysis of autopsy studies investigates how subclinical PTC prevalence changes over the lifetime. METHODS We searched PubMed, Embase, and Web of Science databases from inception to May 2021 for studies that reported the prevalence of PTC found at autopsy. Two investigators extracted the number of subclinical PTCs detected in selected age groups and extent of examination. A quality assessment tool was used to assess bias. Logistic regression models with random intercepts were used to pool the age-specific subclinical PTC prevalence estimates. RESULTS Of 1773 studies screened, 16 studies with age-specific data met the inclusion criteria (n = 6286 autopsies). The pooled subclinical PTC prevalence was 12.9% (95% CI 7.8-16.8) in whole gland and 4.6% (2.5- 6.6) in partial gland examination. Age-specific prevalence estimates were ≤40 years, 11.5% (6.8-16.1); 41-60 years, 12.1% (7.6-16.5); 61-80 years, 12.7% (8-17.5); and 81+ years, 13.4% (7.9-18.9). Sex did not affect age-specific prevalence and there was no difference in prevalence between men and women in any age group. In the regression model, the OR of prevalence increasing by age group was 1.06 (0.92-1.2, P = .37). CONCLUSION This meta-analysis shows the prevalence of subclinical PTC is stable across the lifespan. There is not a higher subclinical PTC prevalence in middle age, in contrast to higher observed incidence rates in this age group. These findings offer unique insights into the prevalence of subclinical PTC and its relationship to age.
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Affiliation(s)
- Natalia Arroyo
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Katy J L Bell
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown NSW 2050, Sydney, New South Wales, Australia
| | - Vivian Hsiao
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Sara Fernandes-Taylor
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Oguzhan Alagoz
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Yichi Zhang
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Louise Davies
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA
- Section of Otolaryngology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - David O Francis
- Wisconsin Surgical Outcomes Research Program (WiSOR), Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
- Division of Otolaryngology, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
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Zhang L, Zhou W, Zhou JQ, Shi Q, Rago T, Gambelunghe G, Zou DZ, Gu J, Lu M, Chen F, Ren J, Cheng W, Zhou P, Spiezia S, Papini E, Zhan WW. 2022 Expert consensus on the use of laser ablation for papillary thyroid microcarcinoma. Int J Hyperthermia 2022; 39:1254-1263. [PMID: 36123039 DOI: 10.1080/02656736.2022.2122596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE With the aim of standardizing and improving the use of ultrasound-guided PLA on PTMC, a panel of experts from China and Italy, jointly issued this expert consensus on the clinical use of PLA for low-risk PTMC. METHODS This expert consensus was developed by Chinese and Italian experts who have specific competence and expertise in this area. An evidence-based approach combining the knowledge and practical experience of the panelists was utilized. RESULTS Twenty-six expert consensus recommendations were developed, spanning topics including the indications and contraindications of PLA for PTMC, physician training, preoperative preparation of patients, intraoperative technical procedures, possible complications, efficacy assessment, follow-up strategy, the approach to new PTMC and metastatic lymph nodes after treatment, thyroid-stimulating hormone inhibition therapy, and quality control of the entire procedure. CONCLUSION We summarized practical recommendations about standardized and improved PLA treatment for PTMC.
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Affiliation(s)
- Lu Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Qiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Shi
- Department of Ultrasound, The Seventh People's Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Teresa Rago
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Da Zhong Zou
- Department of Ultrasound, The Affiliated Jiangyin Hospital of South-East University Medical College, Jiangsu, China
| | - Jun Gu
- Department of Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Jiangsu, China
| | - Man Lu
- Department of Ultrasound, Sichuan Provincial People's Hospital, Sichuan, China
| | - Fen Chen
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Jie Ren
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Heilongjiang, China
| | - Ping Zhou
- Department of Ultrasound, The Third Xiangya Hospital of Central South University, Hunan, China
| | - Stefano Spiezia
- Department of Endocrine and Ultrasound-Guided Surgery, Ospedale del Mare, Naples, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Wei Wei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Avagliano A, Fiume G, Bellevicine C, Troncone G, Venuta A, Acampora V, De Lella S, Ruocco MR, Masone S, Velotti N, Carotenuto P, Mallardo M, Caiazza C, Montagnani S, Arcucci A. Thyroid Cancer and Fibroblasts. Cancers (Basel) 2022; 14:cancers14174172. [PMID: 36077709 PMCID: PMC9455043 DOI: 10.3390/cancers14174172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Thyroid cancer is the most common type of endocrine cancer, and its prevalence continue to rise. Non-metastatic thyroid cancer patients are successfully treated. However, looking for new therapeutic strategies is of great importance for metastatic thyroid cancers that still lead to death. With respect to this, the tumor microenvironment (TME), which plays a key role in tumor progression, should be considered as a new promising therapeutic target to hamper thyroid cancer progression. Indeed, thyroid tumors consist of cancer cells and a heterogeneous and ever-changing niche, represented by the TME, which contributes to establishing most of the features of cancer cells. The TME consists of extracellular matrix (ECM) molecules, soluble factors, metabolites, blood and lymphatic tumor vessels and several stromal cell types that, by interacting with each other and with tumor cells, affect TME remodeling, cancer growth and progression. Among the thyroid TME components, cancer-associated fibroblasts (CAFs) have gained more attention in the last years. Indeed, recent important evidence showed that thyroid CAFs strongly sustain thyroid cancer growth and progression by producing soluble factors and ECM proteins, which, in turn, deeply affect thyroid cancer cell behavior and aggressiveness. Hence, in this article, we describe the thyroid TME, focusing on the desmoplastic stromal reaction, which is a powerful indicator of thyroid cancer progression and an invasive growth pattern. In addition, we discuss the origins and features of the thyroid CAFs, their influence on thyroid cancer growth and progression, their role in remodeling the ECM and their immune-modulating functions. We finally debate therapeutic perspectives targeting CAFs.
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Affiliation(s)
- Angelica Avagliano
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
- Correspondence: (A.A.); (A.A.); Tel.: +39-081-7463422 (A.A. & A.A.)
| | - Giuseppe Fiume
- Department of Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Alessandro Venuta
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Vittoria Acampora
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Sabrina De Lella
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Maria Rosaria Ruocco
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - Stefania Masone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Pietro Carotenuto
- TIGEM, Telethon Institute of Genetics and Medicine, 80078 Naples, Italy
- Medical Genetics, Department of Translational Medical Science, University of Naples Federico II, 80131 Naples, Italy
| | - Massimo Mallardo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - Carmen Caiazza
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, 80131 Naples, Italy
| | - Stefania Montagnani
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
| | - Alessandro Arcucci
- Department of Public Health, University of Napoli Federico II, 80131 Naples, Italy
- Correspondence: (A.A.); (A.A.); Tel.: +39-081-7463422 (A.A. & A.A.)
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23
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Rovira A, Brunet A, Jeannon JP, Carroll PV, Touska P, Hassan F, Sandison A, Simo R. Thyroglossal duct cyst carcinoma case series—Management strategy and outcomes. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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24
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Ochoa J, Pitt SC. Less-Intensive Management Options for Low-Risk Thyroid Cancer. Endocrinol Metab Clin North Am 2022; 51:351-366. [PMID: 35662445 DOI: 10.1016/j.ecl.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The incidence of thyroid cancer is increasing, whereas mortality remains relatively stable. An increasing body of research supports the use of less-intensive treatment for low-risk thyroid cancer, as the overall prognosis is excellent. Although total thyroidectomy was the gold standard for many years, the options of lobectomy alone, active surveillance, and other ablative modalities are increasingly being used. The clinicohistologic features of any thyroid cancer are important to help determine the optimal management for a given tumor. However, the patient's own desires and goals in their cancer treatment must be evaluated.
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Affiliation(s)
- Joana Ochoa
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Faculty Clinic 3rd Floor, Jacksonville, FL 33209, USA
| | - Susan C Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Taubman 2920F, Ann Arbor, MI 48109, USA.
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25
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Chaturvedi P, Singh A, Bhattacharjee A, Tuljapurkar V, Nair D, Chaukar D, Dikshit R. Population-level Outcomes of Early Thyroid Cancers: A Need to Revisit Current Practice. Rambam Maimonides Med J 2022; 13:RMMJ.10467. [PMID: 35482460 PMCID: PMC9049149 DOI: 10.5041/rmmj.10467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early thyroid cancers have excellent long-term outcomes, yet the word "cancer" draws unnecessary apprehension. This study aimed to define when the recommendations for observation and surveillance may be extended to early thyroid cancers at the population level. METHODS Non-metastasized thyroid cancers ≤40 mm diameter were identified from the 1975-2016 Surveillance, Epidemiology and End Results (SEER) database. Causes of death were compared across demographic data. Disease-specific outcomes were compared to the age-adjusted healthy United States (US) population. Survival estimates were computed using Kaplan-Meier and compared using the Cox proportional hazard model. Dynamic benchmarks impacting disease-specific overall survival were determined by decision tree modeling and tested by the Cox model. RESULTS Of the 28,728 thyroid cancers included in this study, 98.4% underwent some form of thyroid-specific treatment and were followed for a maximum of 10.9 years. This group had a 4.3% mortality rate at the end of follow-up (10.9 years maximum), with 13 times more deaths attributed to competing risks rather than thyroid cancer (stage T1a versus stage T1b, P=1.000; T1 versus T2, P<0.001). Among the untreated T1a or T1b tumors, the risk of disease-specific death was 21 times lower than death due to other causes. There was no significant difference between T1a and T1b tumors nor across sex. The age-adjusted risk of death for the healthy US population was higher than for the population with thyroid cancer. Dynamic categorization demonstrated worsening outcomes up to 73 years, uninfluenced by sex or tumor size. For patients over 73 years of age, only tumors >26 mm impacted outcomes. CONCLUSION Based on the current data, T1a and T1b nodules have similar survival outcomes and are not significantly impacted even when left untreated. Multi-institutional prospective studies are needed to confirm these findings so that current observation and surveillance recommendations can be extended to certain T1 thyroid nodules.
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Affiliation(s)
- Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Arjun Singh
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre and HBNI, Mumbai, India
- To whom correspondence should be addressed. E-mail:
| | - Vidisha Tuljapurkar
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Rajesh Dikshit
- Centre for Cancer Epidemiology, Tata Memorial Centre and HBNI, Mumbai, India
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26
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Chooi JE, Ravindiran A, Balasubramanian SP. The influence of incidental detection of thyroid nodule on thyroid cancer risk and prognosis-A systematic review. Clin Endocrinol (Oxf) 2022; 96:246-254. [PMID: 34378225 DOI: 10.1111/cen.14575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Clinically inapparent thyroid nodules discovered serendipitously on imaging for nonthyroid indications are termed as thyroid incidentalomas. It is unclear whether these incidentalomas have a lower prevalence of malignancy or slower tumour progression compared to symptomatic nodules. The aims of this systematic review were to determine the impact of incidental detection of thyroid nodules on both the risk of malignancy and on prognosis in patients with thyroid cancer. METHOD PubMed and MEDLINE® on Web of Science databases were searched from inception to March 2020 for English language articles reporting on human studies of thyroid cancer risk and/or prognosis in incidental and nonincidental nodules. RESULTS Eighteen observational studies published between 1998 and 2020 were eligible for analysis; four studies reported on risk, nine on prognosis and five studies reported on both risk and prognosis. When comparing the incidental and nonincidental groups in the risk study, the odds of incidental detection in the cancer and benign groups ranged from 0.16 to 0.5 and 0.06 to 0.38, respectively (odds ratio [OR] = 0.64-2.86) in case-control studies (n = 6); the risk of malignancy for thyroid nodules ranged from 4% to 23.5% in the incidental and 3.8% to 28.7% in the nonincidental groups (relative risk = 0.13-6.27) in the cohort studies (n = 3). A meta-analysis of the eligible case-control studies (n = 3) showed a nonsignificant summated OR of 1.04 (95% confidence interval = 0.63-1.70; p = .88). In the prognosis study, five direct and thirteen indirect markers of prognosis were compared between the incidental and nonincidental groups. A meta-analysis was not possible but incidentally detected thyroid cancer had better progression-free and overall survival. CONCLUSION Current evidence suggests that investigation and management of thyroid nodules should not be influenced by the mode of detection.
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Affiliation(s)
- Je Ern Chooi
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Abiramie Ravindiran
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, South Yorkshire, UK
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27
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Schoultz E, Johansson E, Moccia C, Jakubikova I, Ravi N, Liang S, Carlsson T, Montelius M, Patyra K, Kero J, Paulsson K, Fagman H, Bergo MO, Nilsson M. Tissue architecture delineates field cancerization in BRAFV600E-induced tumor development. Dis Model Mech 2022; 15:dmm048887. [PMID: 34379110 PMCID: PMC8380047 DOI: 10.1242/dmm.048887] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/24/2021] [Indexed: 12/29/2022] Open
Abstract
Cancer cells hijack developmental growth mechanisms but whether tissue morphogenesis and architecture modify tumorigenesis is unknown. Here, we characterized a new mouse model of sporadic thyroid carcinogenesis based on inducible expression of BRAF carrying a Val600 Glu (V600E) point mutation (BRAFV600E) from the thyroglobulin promoter (TgCreERT2). Spontaneous activation of this Braf-mutant allele due to leaky activity of the Cre recombinase revealed that intrinsic properties of thyroid follicles determined BRAF-mutant cell fate. Papillary thyroid carcinomas developed multicentrically within a normal microenvironment. Each tumor originated from a single follicle that provided a confined space for growth of a distinct tumor phenotype. Lineage tracing revealed oligoclonal tumor development in infancy and early selection of BRAFV600E kinase inhibitor-resistant clones. Somatic mutations were few, non-recurrent and limited to advanced tumors. Female mice developed larger tumors than males, reproducing the gender difference of human thyroid cancer. These data indicate that BRAFV600E-induced tumorigenesis is spatiotemporally regulated depending on the maturity and heterogeneity of follicles. Moreover, thyroid tissue organization seems to determine whether a BRAF-mutant lineage becomes a cancerized lineage. The TgCreERT2;BrafCA/+ sporadic thyroid cancer mouse model provides a new tool to evaluate drug therapy at different stages of tumor evolution.
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Affiliation(s)
- Elin Schoultz
- Sahlgrenska Center for Cancer Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, SE-40530 Göteborg, Sweden
| | - Ellen Johansson
- Sahlgrenska Center for Cancer Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, SE-40530 Göteborg, Sweden
| | - Carmen Moccia
- Sahlgrenska Center for Cancer Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, SE-40530 Göteborg, Sweden
| | - Iva Jakubikova
- Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Naveen Ravi
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund SE-22184, Sweden
| | - Shawn Liang
- Sahlgrenska Center for Cancer Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, SE-40530 Göteborg, Sweden
| | - Therese Carlsson
- Sahlgrenska Center for Cancer Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, SE-40530 Göteborg, Sweden
| | - Mikael Montelius
- Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, SE-41345 Göteborg, Sweden
| | - Konrad Patyra
- Department of Endocrinology, University of Turku, Åbo FI-20521, Finland
| | - Jukka Kero
- Department of Endocrinology, University of Turku, Åbo FI-20521, Finland
| | - Kajsa Paulsson
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund SE-22184, Sweden
| | - Henrik Fagman
- Sahlgrenska Center for Cancer Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, SE-40530 Göteborg, Sweden
- Department of Clinical Pathology, Sahlgrenska University Hospital, Göteborg SE-41345, Sweden
| | - Martin O. Bergo
- Department of Biosciences and Nutrition, Karolinska Institute, Huddinge SE-14183, Sweden
| | - Mikael Nilsson
- Sahlgrenska Center for Cancer Research, Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, University of Gothenburg, SE-40530 Göteborg, Sweden
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28
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Rodrigues MG, da Silva LFF, Araujo-Filho VJFD, Mosca LDM, Araujo-Neto VJFD, Kowalski LP, Carneiro PC. Incidental thyroid carcinoma: Correlation between FNAB cytology and pathological examination in 1093 cases. Clinics (Sao Paulo) 2022; 77:100022. [PMID: 35306374 PMCID: PMC8941178 DOI: 10.1016/j.clinsp.2022.100022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate Incidental Thyroid Carcinoma (ITC) by comparing the results of Fine Needle Aspiration Biopsy (FNAB) cytology and the postoperative pathological findings. METHODS Data of 1479 patients who underwent total thyroidectomy were retrieved. Three hundred eighty-six patients were excluded due to insufficient data. Each surgical specimen studied received two histopathological diagnoses: the local diagnosis ‒ for the same area in which the FNAB was performed; and the final diagnosis, which includes a study of the entire surgical specimen. RESULTS A thousand and ninety-three patients were investigated. FNAB result was malignant in 187 patients, benign in 204, suspicious or indeterminate in 668 cases, and inconclusive in 34 cases. The prevalence of ITC was 15.1%. Most of the ITC in this series was less than 0.5 cm. The incidence of ITC was higher in Bethesda III (17.5% ITC) and IV (19% ITC) than in Bethesda II cases (1.5% false negatives and 9% ITC). CONCLUSION Although the incidence of false-negative results in Bethesda II nodules is only 1.5%, 9% of these patients had ITC in the thyroid parenchyma outside the nodule that underwent preoperative FNAB. The incidence of ITC in the same scenario was even higher in Bethesda III (17.5%) and Bethesda IV cases (19%). Ultrasonography-guided FNAB is an excellent method for the assessment of thyroid nodules. However, biopsy sites should be carefully selected. Despite the high incidence of incidentalomas, total thyroidectomy should not always be the treatment of choice due to its rare but potentially serious complications. The findings of the present study can assist future clinical decisions towards active surveillance strategies for the management of papillary thyroid carcinoma.
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Affiliation(s)
- Mariana Gonçalves Rodrigues
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | | | - Letícia de Moraes Mosca
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Luiz Paulo Kowalski
- Departamento de Cirurgia, Cirurgia de Cabeça e Pescoço, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo Campos Carneiro
- Departamento de Patologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
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29
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Aldahmani K, Malik A, Aziz F, Beshyah S. Characteristics and management of papillary thyroid microcarcinoma in the United Arab Emirates: Experience from a large tertiary hospital. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:42-48. [PMID: 35283703 PMCID: PMC8869268 DOI: 10.4103/sjmms.sjmms_393_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/26/2021] [Accepted: 12/27/2021] [Indexed: 11/04/2022] Open
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30
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Robenshtok E, Neeman B, Reches L, Ritter A, Bachar G, Kaminer K, Shimon I, Mizrachi A. Adverse Histological Features of Differentiated Thyroid Cancer Are Commonly Found in Autopsy Studies: Implications for Treatment Guidelines. Thyroid 2022; 32:37-45. [PMID: 34779278 DOI: 10.1089/thy.2021.0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: While the popularity of lobectomy for differentiated thyroid cancer (DTC) has increased since the 2015 ATA (American Thyroid Association) guidelines, recent studies reported that adverse histological features (minimal extrathyroidal extension [mETE], multifocality, vascular invasion, and lymph node [LN] metastases) may be found in 30-60% of lobectomy specimens, questioning the validity of this approach. Aim: To assess the prevalence adverse histological features in occult DTC detected in autopsy studies. Methods: Meta-analysis of autopsy studies of the thyroid in subjects without known history of thyroid cancer. Results: Twenty-nine studies including 8750 subjects fulfilled the inclusion criteria, with incidentally discovered DTC in 740 autopsies (8.5%). Age was reported in 17 studies, with a median age of 61 years (range 41-68 years). Multifocality was reported in 27 studies with a calculated event rate of 28.2% ([CI 23.1-33.8], I2 = 46.3%), with bilateral involvement in 18% [CI 12.6-25.1]. mETE was reported in 5 studies, with an event rate of 24.5% ([CI 9.3-50.7], I2 = 88.5%), and the presence of LN metastases were reported in 13 studies with an event rate of 11% ([CI 6.1-19.1], I2 = 69.5%). Vascular invasion was reported in seven studies with an event rate of 16% ([CI 4-47], I2 = 86.8%). Of 25 studies with whole body autopsies (722 subjects), 3 cases of distant metastases were reported, of which 2 had fatal metastatic disease (where thyroid origin was not diagnosed before death), and 1 had occult disease. Conclusions: Adverse histological features including mETE, LN metastases, multifocality, and vascular invasion are common in occult DTC. When minimal in size, these adverse histological features do not seem to be markers of aggressive disease and may not be an indication for completion thyroidectomy or radioiodine therapy.
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Affiliation(s)
- Eyal Robenshtok
- Endocrinology & Metabolism Institute; Head and Neck Surgery; Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bar Neeman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Amit Ritter
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology, Head and Neck Surgery; Rabin Medical Center, Petach Tikva, Israel
| | - Gideon Bachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology, Head and Neck Surgery; Rabin Medical Center, Petach Tikva, Israel
| | - Keren Kaminer
- Endocrinology & Metabolism Institute; Head and Neck Surgery; Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Shimon
- Endocrinology & Metabolism Institute; Head and Neck Surgery; Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Otolaryngology, Head and Neck Surgery; Rabin Medical Center, Petach Tikva, Israel
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31
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Qian B, Hu L, Zhang S, Zhu J, Mei L, Huang T, Qu X. Comparison of clinicopathological features and prognosis of papillary thyroid carcinoma and microcarcinoma: A population-based propensity score matching analysis. Front Endocrinol (Lausanne) 2022; 13:944758. [PMID: 35992148 PMCID: PMC9389084 DOI: 10.3389/fendo.2022.944758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Overtreatment of papillary thyroid microcarcinoma (PTMC) has become a common concern. This study aimed to compare clinicopathological features between PTMC and papillary thyroid carcinoma (PTC) and to explore whether surgery can confer significant survival benefits in all patients with PTC or PTMC. METHODS Data of 145,951 patients with PTC registered in Surveillance, Epidemiology, and End Results (SEER) database and 8,751 patients with PTC in our institution were retrospectively collected. Patients with tumors less than 10 mm in diameter were classified as PTMC cohort and the rest as PTC cohort. Clinicopathological features between PTMC and PTC were compared on the basis of SEER cohort and validated with institutional data. Survival analysis was conducted to explore the effect of surgery on the prognosis of patients. To minimize potential confounders and selection bias, we performed propensity score matching (PSM) analysis to match more comparable cohorts. RESULTS Compared with PTC, PTMC exhibited the following characteristics: more common in women and whites, older age at diagnosis, lower proportion of follicular variants, intraglandular dissemination, extraglandular and capsular invasion, higher proportion of multifocality, fewer lymph node and distant metastases, and higher cancer-specific survival (CSS) and overall survival (OS) (all p-value < 0.05). Regarding treatment, patients with PTMC received a lower proportion of radiotherapy, chemotherapy, and total thyroidectomy but a higher proportion of lobectomy and/or isthmectomy. There was no significant difference in CSS for patients with PTMC at stage T1N0M0 with or without surgery (P = 0.36). CONCLUSION Generally, PTMC showed higher biological indolence than PTC, which meant a higher survival rate for patients in both OS and CSS. For patients with PTMC at staged T1N0M0, active surveillance (AS) may be a potentially feasible management strategy. However, the maintenance of good medical compliance and the management of psychological burden cannot be ignored for patients included in AS.
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Affiliation(s)
| | | | | | | | - Li Mei
- *Correspondence: Li Mei, ; Xincai Qu,
| | | | - Xincai Qu
- *Correspondence: Li Mei, ; Xincai Qu,
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32
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Sutherland R, Tsang V, Clifton-Bligh RJ, Gild ML. Papillary thyroid microcarcinoma: Is active surveillance always enough? Clin Endocrinol (Oxf) 2021; 95:811-817. [PMID: 34021503 DOI: 10.1111/cen.14529] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
The incidence of papillary thyroid carcinoma (PTC) has increased over recent decades. This apparent epidemic has been attributed to the overdiagnosis of small PTC ≤10 mm in diameter (papillary thyroid microcarcinoma [PTMC]) incidentally detected on imaging for unrelated presentations. Although most PTMCs follow an indolent disease course, there is a small but significant proportion of cases that display more biologically aggressive features such as early metastasis and lymph node involvement. Management of PTMC diagnosed preoperatively should be distinguished from managing those PTMCs incidentally discovered after thyroidectomy. Here, we will focus on the challenge of managing the preoperative patient. Current guidelines recommend against routine biopsy of nodules ≤10 mm, even if they display highly suspicious features on ultrasound; however, it is not known how to identify those PTMCs at higher risk of disease progression. In view of their good prognosis even without surgical resection, active surveillance has emerged as an alternative to operative management for low-risk PTMC without lymph node involvement or distant metastasis. This review aims to summarise active surveillance data for PTMC and identify clinical features that may differentiate the indolent majority from those PTMCs that exhibit early disease progression and metastasis.
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Affiliation(s)
- Rosie Sutherland
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
| | - Venessa Tsang
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Roderick J Clifton-Bligh
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Cancer Genetics Unit, Kolling Institute of Medical Research, Sydney, Australia
| | - Matti L Gild
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Cancer Genetics Unit, Kolling Institute of Medical Research, Sydney, Australia
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Sex Bias in Differentiated Thyroid Cancer. Int J Mol Sci 2021; 22:ijms222312992. [PMID: 34884794 PMCID: PMC8657786 DOI: 10.3390/ijms222312992] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 01/03/2023] Open
Abstract
Differentiated thyroid cancers are more frequent in women than in men. These different frequencies may depend on differences in patient's behavior and in thyroid investigations. However, an impact on sexual hormones is likely, although this has been insufficiently elucidated. Estrogens may increase the production of mutagenic molecules in the thyroid cell and favor the proliferation and invasion of tumoral cells by regulating both the thyrocyte enzymatic machinery and the inflammatory process associated with tumor growth. On the other hand, the worse prognosis of thyroid cancer associated with the male gender is poorly explained.
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Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients. Int Arch Otorhinolaryngol 2021; 25:e585-e593. [PMID: 34737832 PMCID: PMC8558954 DOI: 10.1055/s-0040-1722253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction
The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial.
Objective
To identify the clinical and pathological factors predictive of tumor recurrence.
Methods
We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the American Thyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence.
Results
After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (
p
= 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (
p
= 0.032; HR: 1.76; 95%CI: 1.05 to 2.96), and the presence of lymph-node metastasis (
p
< 0.001; HR: 3.69; 95%CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients.
Conclusions
The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age < 55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.
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Ha EJ, Chung SR, Na DG, Ahn HS, Chung J, Lee JY, Park JS, Yoo RE, Baek JH, Baek SM, Cho SW, Choi YJ, Hahn SY, Jung SL, Kim JH, Kim SK, Kim SJ, Lee CY, Lee HK, Lee JH, Lee YH, Lim HK, Shin JH, Sim JS, Sung JY, Yoon JH, Choi M. 2021 Korean Thyroid Imaging Reporting and Data System and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations. Korean J Radiol 2021; 22:2094-2123. [PMID: 34719893 PMCID: PMC8628155 DOI: 10.3348/kjr.2021.0713] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Incidental thyroid nodules are commonly detected on ultrasonography (US). This has contributed to the rapidly rising incidence of low-risk papillary thyroid carcinoma over the last 20 years. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors in small (1-2 cm) thyroid nodules. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Hye Shin Ahn
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Chung
- Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University College of Medicine, Hanyang University Hospital, Seoul, Korea
| | - Roh-Eul Yoo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Mi Baek
- Department of Radiology, Haeundae Sharing and Happiness Hospital, Busan, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Kee Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Soo Jin Kim
- Department of Radiology, New Korea Hospital, Gimpo, Korea
| | - Chang Yoon Lee
- Department of Radiology, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyu Lee
- Department of Radiology, Jeju National University, Jeju, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam, Korea
| | - Jin Young Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Araz M, Özkan E, Gunduz P, Soydal C, Küçük NÖ, Kır KM. Negative Histopathological Prognostic Factors Affecting Morbidity in T1 Differentiated Thyroid Carcinoma. Cancer Biother Radiopharm 2021; 37:56-62. [PMID: 34524012 DOI: 10.1089/cbr.2020.4679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The aim was to evaluate (i) if multifocality is a negative prognostic factor, (ii) the association of diameter of the largest tumor, total tumor diameter, and the ratio of the largest tumor diameter to total tumor diameter (DR) with histopathological and clinical outcome parameters in T1 differentiated thyroid carcinoma (DTC). Methods: In 1014 T1N0/1Mx patients, correlation between multifocality, contralateral lobe involvement, capsular-vascular invasion, diameter of the largest tumor, total tumor diameter, DR, and follow-up results were investigated. Results: Persistent/recurrent disease and necessity for additional radioiodine treatment (RAIT) were more frequent in cases with multifocality and contralateral lobe involvement (p = 0.035, p = 0.015, p = 0.021, and p = 0.04). Persistence/recurrence, reoperation in the neck, and additional RAIT were more frequent in patients with the size of the largest tumor focus >1 cm (p = 0.024, p < 0.001, and p = 0.002) and N1 status (p < 0.001, p < 0.001, and p < 0.001). Mean total tumor diameter was higher in patients with capsular invasion, contralateral lobe, and lymph node involvement (p = 0.001, p = 0.003, and p = 0.013). Conclusion: Multifocality, contralateral lobe involvement, diameter of the largest tumor >1 cm, and N1 status are related with increased risk of disease persistence, recurrence, reoperation, and additional RAIT. Sum of diameter of all tumor foci are associated with capsular invasion.
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Affiliation(s)
- Mine Araz
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey
| | - Elgin Özkan
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey
| | - Pınar Gunduz
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey
| | - Cigdem Soydal
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey
| | - N Özlem Küçük
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey
| | - K Metin Kır
- Nuclear Medicine Department, Ankara University Medical School, Ankara, Turkey
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Dahlberg J, Adok C, Bümming P, Demir A, Hedbäck G, Nilsson B, Nilsson M, Jansson S. Incidence, detection and outcome of differentiated thyroid cancer in Western Sweden. BJS Open 2021; 5:6408929. [PMID: 34686878 PMCID: PMC8536871 DOI: 10.1093/bjsopen/zrab099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background It is unclear whether the increasing incidence of thyroid cancer (TC) due to increased diagnosis of small and indolent tumours might mask a real increase of clinically significant cancers. The aim of this study was to correlate surgery, pathology and outcome data of individual patients to the mode of primary detection (palpation, by imaging or incidental) to assess if TC incidence has increased. Methods The Swedish Cancer Registry identified all patients with TC in Västra Götaland County representing approximately 1.6 million inhabitants. Clinical information was retrieved from medical records of patient cohorts from three study intervals (2001–2002, 2006–2007 and 2011–2014) comprising 60 per cent of all TC patients. Data were also obtained from the NORDCAN registry to compare of TC incidence with other Nordic countries. Results Between 2001 and 2014, the annualized standard incidence rate/100 000 population (ASR) of TC increased from 3.14 to 10.71 in women and from 1.12 to 3.77 in men. This was higher than the mean incidence for Sweden but similar to that in Norway and Finland. Differentiated TC (DTC) increased more than threefold. The majority of tumours (64 per cent) were detected by palpation. Larger tumours (10–20, 21–40 and greater than 40 mm) increased as much as microcarcinomas (less than 10 mm). Only 5 per cent of the tumours were detected by imaging. All disease-specific deaths (8.5 per cent of DTC in the first two cohorts) and most patients with recurrent or persistent disease (6.6 per cent of DTC cases) were diagnosed due to tumour-related symptoms. Conclusion DTC in Western Sweden gradually increased between 2001 and 2014. The majority of tumours were detected by palpation suggesting a real increase in the incidence of clinically significant thyroid malignancies.
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Affiliation(s)
- J Dahlberg
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - C Adok
- Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Bümming
- Department of Surgery Skaraborg Hospital, Skaraborgs Sjukhus, Skövde, Sweden
| | - A Demir
- Department of Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Hedbäck
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - B Nilsson
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - M Nilsson
- Sahlgrenska Centre for Cancer Research, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - S Jansson
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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38
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Ywata de Carvalho A, Kohler HF, Gomes CC, Vartanian JG, Kowalski LP. Predictive factors for recurrence of papillary thyroid carcinoma: analysis of 4,085 patients. ACTA ACUST UNITED AC 2021; 41:236-242. [PMID: 34264917 PMCID: PMC8283398 DOI: 10.14639/0392-100x-n1412] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
Objective The incidence of papillary thyroid carcinoma (PTC) has increased in recent years and its treatment remains controversial. The objective of this study is to identify clinicopathological predictive factors of tumour recurrence. Methods We retrospectively analysed 4,085 patients who underwent thyroidectomy for PTC from 1996 to 2015. Patients were stratified according to American Thyroid Association (ATA) risk categories and clinicopathological features were evaluated to identify independent factors for recurrence. Results After a mean follow-up of 58.7 (range 3-256.5) months, tumour recurrence was diagnosed in 176 (4.3%) patients, mostly in lymph nodes. Distant metastasis occurred in 18 patients (0.4%). There were 3 (0.1%) cancer-related deaths. Multivariate analysis showed that tumour size >10 mm, multifocality, extrathyroidal extension and lymph node metastasis (all, P < 0.001) were independent risk factors for recurrence. Further, recurrence was identified in 1.6% of the ATA low-risk, 7.4% of the intermediate-risk and 22.7% of the high-risk patients (P < 0.001). Conclusions In PTC patients, tumour size >10 mm, multifocality, extrathyroidal extension and presence of lymph node metastasis as well as the ATA recurrence staging system effectively predict recurrence.
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Affiliation(s)
- Andre Ywata de Carvalho
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Camila Couto Gomes
- Surgical Oncology Division, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Jose Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil.,Head and Neck Surgery Department, University of Sao Paulo, Sao Paulo, Brazil
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Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature. J Clin Med 2021; 10:jcm10163569. [PMID: 34441866 PMCID: PMC8397017 DOI: 10.3390/jcm10163569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States. It has an excellent prognosis, with a five-year relative survival rate of 98.3%.Differentiated Thyroid Carcinomas (DTCs) are the most diagnosed thyroid tumors and are characterized by a slow growth rate and indolent course. For years, the only approach to treatment was thyroidectomy. Active surveillance (AS) has recently emerged as an alternative approach; it involves regular observation aimed at recognizing the minority of patients who will clinically progress and would likely benefit from rescue surgery. To better clarify the indications for active surveillance for low-risk thyroid cancers, we reviewed the current management of low-risk DTCs with a systematic search performed according to a PRISMA flowchart in electronic databases (PubMed, Web of Science, Scopus, and EMBASE) for studies published before May 2021. Fourteen publications were included for final analysis, with a total number of 4830 patients under AS. A total of 451/4830 (9.4%) patients experienced an increase in maximum diameter by >3 mm; 609/4830 (12.6%) patients underwent delayed surgery after AS; metastatic spread to cervical lymph nodes was present in 88/4213 (2.1%) patients; 4/3589 (0.1%) patients had metastatic disease outside of cervical lymph nodes. Finally, no subject had a documented mortality due to thyroid cancer during AS. Currently, the American Thyroid Association guidelines do not support AS as the first-line treatment in patients with PMC; however, they consider AS to be an effective alternative, particularly in patients with high surgical risk or poor life expectancy due to comorbid conditions. Thus, AS could be an alternative to immediate surgery for patients with very-low-risk tumors showing no cytologic evidence of aggressive disease, for high-risk surgical candidates, for those with concurrent comorbidities requiring urgent intervention, and for patients with a relatively short life expectancy.
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Winfrey P, Robertson C, Maley C, Aktipis A. ENDLESS FORMS MOST BEAUTIFUL: A GARDEN SHOWS THAT CANCER IS A PART OF LIFE. LEONARDO (OXFORD, ENGLAND) 2021; 54:398-401. [PMID: 34565895 PMCID: PMC8460130 DOI: 10.1162/leon_a_01915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Endless Forms Most Beautiful is a crested cactus garden that embodies both an aesthetic and medically transformative approach to cancer. The cacti in this garden have mutations in their meristem cells causing uncontrolled growths-which are, by some definitions, cancer. The garden was installed near the new Biodesign Institute C building on the Arizona State University campus in Tempe. Crested cacti, and other fasciated plants, are examples of organisms that live with cancer, but do not die from it. These plants help to widen the framework for thinking about what cancer is, how to live with it, and ultimately inspired a new center, the Arizona Cancer Evolution (ACE) Center, which investigates cancer across life.
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Affiliation(s)
| | | | - Carlo Maley
- Biodesign Institute, Arizona State University
- School of Life Sciences, Arizona State University
- Arizona Cancer Evolution Center
| | - Athena Aktipis
- Biodesign Institute, Arizona State University
- Arizona Cancer Evolution Center
- Department of Psychology, Arizona State University
- Interdisciplinary Cooperation Initiative 1001 S McAllister Ave Tempe, AZ 85281
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Nakamura N. Reexamining the role of tissue inflammation in radiation carcinogenesis: a hypothesis to explain an earlier onset of cancer. Int J Radiat Biol 2021; 97:1341-1351. [PMID: 34270352 DOI: 10.1080/09553002.2021.1955998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Ionizing radiation is a well-known carcinogen, and epidemiologic efforts have been made to evaluate cancer risks following a radiation exposure. The basic approach has been to estimate increased levels of cancer mortality resulting from exposures to radiation, which is consistent with the somatic mutation theory of cancer. However, the possibility that an irradiation might cause an earlier onset of cancer has also been raised since the earliest days of animal studies. Recently, the mutation induction model has been challenged because it is unable to explain the observed dose-related parallel shift of entire mouse survival curves toward younger ages following an irradiation. This is because if it is assumed that only a fraction of the irradiated individuals are affected, the irradiated population would consist of two subpopulations with different mean lifespans, which makes the overall distribution of individual lifespans broader, and hence the slope of the survival curves shallower. To explain this parallel shift, it is necessary to assume that all individuals of a population are affected. As a result of these observations, possible mechanisms which could account for the parallel shift of mouse survival curves were sought by examining the radiation induction of various types of tissue damage which could facilitate an earlier onset of spontaneously arising cancers. CONCLUSION A proposed mechanism postulates that a radiation exposure leads to tissue inflammation which subsequently stimulates spontaneously arising cancers and allows them to appear earlier than usual. This notion is not unprecedented, and because the background incidence of cancer increases exponentially with an increase in age, a slight shift of the onset age toward younger ages may make it appear as if the risk is increased. In this scenario, a radiation exposure induces DNA damage, cell death, chromosome aberrations etc., which leads to the multi-pathway responses including activation of stromal fibroblasts, macrophages and various inflammatory factors. Such an inflamed microenvironment favors the growth of spontaneously arising tumor cells although currently, the sequential order or relative importance of the individual factors remains to be known.
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Affiliation(s)
- Nori Nakamura
- Department, of Molecular Biosciences, Radiation Effects Research Foundation, Hiroshima, Japan
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42
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Seyrek NC, Baser H, Topaloglu O, Ozdemir D, Kilicarslan A, Ersoy R, Cakir B. Ultrasonographical, clinical and histopathological features of 1264 nodules with papillary thyroid carcinoma and microcarcinoma based on tumor size. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:533-541. [PMID: 34033293 PMCID: PMC10118958 DOI: 10.20945/2359-3997000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective We aimed to evaluate the patients diagnosed with papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) in terms of clinical, ultrasonographical (US) and histopathological features and their relationships with tumor size. Methods We retrospectively evaluated 881 patients who underwent thyroid surgery in our clinic and diagnosed with PTC histopathologically were enrolled the study. Demographic characteristics, US findings and histopathological features were evaluated. Results In total, 1264 nodules were identified in the 881 patients. The incidentality rates were higher in the PTMC group and also in the ≤ 5 mm group. In total multifocality rate was 32.9%, and was significantly higher in PTMC group than the PTC group. PTC and > 5 mm PTMC groups compared to PTMC and ≤ 5 mm groups respectively, were more aggresive histopathological features. Conclusion Since the incidentality rates were found significantly more common in our patients with PTMC and those with ≤ 5 mm, ultrasonographic features of the nodules should be evaluated carefully and for cases which are suspicious with US, US-guided fine needle aspiration biopsy (FNAB) should be considered in order to make the correct treatment strategy. Also our study revealed that PTC and > 5 mm PTMC groups compared to PTMC and ≤ 5 mm groups respectively, have more aggresive histopathological features.
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Affiliation(s)
- Neslihan Cuhaci Seyrek
- Ankara Yildirim Beyazit University, Faculty of Medicine, Ataturk Education and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey,
| | - Husniye Baser
- Ankara Yildirim Beyazit University, Faculty of Medicine, Ataturk Education and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Oya Topaloglu
- Ankara Yildirim Beyazit University, Faculty of Medicine, Ataturk Education and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Didem Ozdemir
- Ankara Yildirim Beyazit University, Faculty of Medicine, Ataturk Education and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Aydan Kilicarslan
- Ankara Yildirim Beyazit University, Faculty of Medicine, Ataturk Education and Research Hospital, Department of Pathology, Ankara, Turkey
| | - Reyhan Ersoy
- Ankara Yildirim Beyazit University, Faculty of Medicine, Ataturk Education and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
| | - Bekir Cakir
- Ankara Yildirim Beyazit University, Faculty of Medicine, Ataturk Education and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkey
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Joseph FG, Rubtsov D, Davoren P. Appropriateness of ultrasound imaging for thyroid pathology, the standard of radiology reporting on thyroid nodules and the detection rates of thyroid malignancy: a tertiary centre retrospective audit. Intern Med J 2021; 50:732-740. [PMID: 31180168 DOI: 10.1111/imj.14401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/24/2019] [Accepted: 06/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence of thyroid cancer is increasing worldwide without a simultaneous rise in mortality. It is thought that the incidence of non-clinically significant thyroid cancers are on the rise as a result of more sensitive diagnostic imaging. AIM To determine the number of inappropriate requests for thyroid ultrasound (US), the quality of radiology reporting for thyroid nodules based on accepted guidelines and the resultant number of thyroid cancers identified because of these investigations. METHODS Electronic medical records of patients who underwent thyroid US imaging and thereafter referred to the Endocrine Department at Gold Coast University Hospital, Queensland, between July 2014 and July 2017 were reviewed. Data for 251 patients who had thyroid US were analysed and the final 201 patients who were found to have thyroid nodules were evaluated using descriptive statistics. Indications for thyroid US imaging among referring clinicians were assessed and we compared both clinical management and radiology reporting practices of thyroid nodules to the published 2009 and 2015 American Thyroid Association (ATA) guidelines. RESULTS There were 50.2% of patients with initial thyroid US imaging deemed outside of expert recommendations where 42% of these patients required further surveillance imaging and 25.4% required fine needle aspiration of their thyroid nodules. A definite recommendation whether to evaluate thyroid nodules further was provided in 44.8% of radiology reports. There were no radiology reports that described thyroid nodules findings based on patterns as recommended by the 2015 ATA guidelines. Two cases of thyroid cancer were detected including one patient with prior history of thyroid cancer and a second patient with hypothyroidism. CONCLUSION Routine use of US thyroid imaging outside expert recommendation is common. There is lack of standardised reporting when assessing thyroid nodules on US. Limiting the initial use of US in cases of palpable neck lumps and the use of systematic reporting according to the 2017 guidelines published by the American College of Radiology Thyroid Imaging Reporting and Data System may reduce unnecessary investigations for thyroid nodules in the future.
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Affiliation(s)
- Flavian G Joseph
- Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Denis Rubtsov
- Department of General Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Peter Davoren
- Department of Endocrinology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Lancini D, Lombardi D, Piazza C. Evidence and controversies in management of thyroglossal duct cyst carcinoma. Curr Opin Otolaryngol Head Neck Surg 2021; 29:113-119. [PMID: 33664197 PMCID: PMC9928562 DOI: 10.1097/moo.0000000000000699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to analyse the rational of the possible therapeutic approaches to thyroglossal duct cyst carcinomas (TGDCCa), especially in consideration of their potential airway involvement, discussing the most debated issues concerning employment of thyroidectomy, neck dissection and adjuvant treatments. RECENT FINDINGS The literature is unanimous in defining the Sistrunk procedure as the baseline of surgical treatment of TGDCCa, and in equating the vast majority of thyroid-like TGDCCas to classic thyroid cancers from a biological point of view, while the rarer squamous cell carcinomas seem to behave more aggressively. Thyroidectomy, neck dissection and radioactive iodine treatment are considered for high-risk lesions, with the addition of customized partial resection of laryngeal cartilages when airway involvement is encountered. Furthermore, the analysis of thyroid mutational markers has promise for accurate prevision of more aggressive clinical behaviours. SUMMARY Even if rare, clinicians should be aware of TGDCCa due to the possibility of incidental diagnosis and, in the case of more advanced clinical scenarios, for its potential airway involvement. Sistrunk procedure combined with thyroidectomy, neck dissection and adjuvant therapy provide excellent results in high-risk patients. Additional study of pathological thyroid markers in TGDCCa is desirable to allow more individualized treatments.
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Affiliation(s)
- Davide Lancini
- Department of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia
| | - Davide Lombardi
- Department of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia
| | - Cesare Piazza
- Department of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Fishbein A, Hammock BD, Serhan CN, Panigrahy D. Carcinogenesis: Failure of resolution of inflammation? Pharmacol Ther 2021; 218:107670. [PMID: 32891711 PMCID: PMC7470770 DOI: 10.1016/j.pharmthera.2020.107670] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
Inflammation in the tumor microenvironment is a hallmark of cancer and is recognized as a key characteristic of carcinogens. However, the failure of resolution of inflammation in cancer is only recently being understood. Products of arachidonic acid and related fatty acid metabolism called eicosanoids, including prostaglandins, leukotrienes, lipoxins, and epoxyeicosanoids, critically regulate inflammation, as well as its resolution. The resolution of inflammation is now appreciated to be an active biochemical process regulated by endogenous specialized pro-resolving lipid autacoid mediators which combat infections and stimulate tissue repair/regeneration. Environmental and chemical human carcinogens, including aflatoxins, asbestos, nitrosamines, alcohol, and tobacco, induce tumor-promoting inflammation and can disrupt the resolution of inflammation contributing to a devastating global cancer burden. While mechanisms of carcinogenesis have focused on genotoxic activity to induce mutations, nongenotoxic mechanisms such as inflammation and oxidative stress promote genotoxicity, proliferation, and mutations. Moreover, carcinogens initiate oxidative stress to synergize with inflammation and DNA damage to fuel a vicious feedback loop of cell death, tissue damage, and carcinogenesis. In contrast, stimulation of resolution of inflammation may prevent carcinogenesis by clearance of cellular debris via macrophage phagocytosis and inhibition of an eicosanoid/cytokine storm of pro-inflammatory mediators. Controlling the host inflammatory response and its resolution in carcinogen-induced cancers will be critical to reducing carcinogen-induced morbidity and mortality. Here we review the recent evidence that stimulation of resolution of inflammation, including pro-resolution lipid mediators and soluble epoxide hydrolase inhibitors, may be a new chemopreventive approach to prevent carcinogen-induced cancer that should be evaluated in humans.
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Affiliation(s)
- Anna Fishbein
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Bruce D. Hammock
- Department of Entomology and Nematology, and UCD Comprehensive Cancer Center, University of California, Davis, CA 95616, USA
| | - Charles N. Serhan
- Center for Experimental Therapeutics and Reperfusion Injury, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dipak Panigrahy
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA,Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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46
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Klotz L. Overdiagnosis in urologic cancer : For World Journal of Urology Symposium on active surveillance in prostate and renal cancer. World J Urol 2021; 40:1-8. [PMID: 33492425 DOI: 10.1007/s00345-020-03523-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cancer, which historically was diagnosed at late and incurable stages, has expanded to a heterogeneous group of conditions that vary from clinically insignificant to rapidly aggressive and lethal. This evolution is due to the widespread use of screening tests for early detection of cancer, both directed (i.e., PSA, mammography, colonoscopy) and undirected (abdominal imaging). The use of these tests has resulted in both benefits and harms. The benefits are a reduction in survival and mortality, due to significant cancers being diagnosed at a more curable stage. The harms are an increase, in some cases dramatic, in the diagnosis of clinically insignificant disease. These are called 'cancer' but not destined to affect the patient's life, even in the absence of treatment. METHODS Non-explicit summary of the literature on overdiagnosis of cancer. RESULTS The phenomenon of overdiagnosis requires two factors: the presence of a common reservoir of microfocal disease and a screening test to find it. These factors exist for breast, prostate, skin, renal, and thyroid cancers, and to a lesser degree for lung cancer. The problem of cancer overdiagnosis and overtreatment is complex, with numerous etiologies and many tradeoffs. It is a particular problem in prostate cancer but is a major issue in many other cancer sites. Screening for prostate cancer based on the best data from prospective randomized trials significantly reduces cancer mortality. However, reducing overtreatment in patients diagnosed with indolent disease is critical to the success of screening. CONCLUSION Active surveillance, the focus of this series of articles, is an important strategy to reduce overtreatment. This article reviews the pathological, clinical, social, and psychological aspects of overdiagnosis in cancer.
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Affiliation(s)
- Laurence Klotz
- Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave. #MG408, Toronto, ON, M4N 3M5, Canada.
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Masaki C, Sugino K, Ito K. Clinical management of low-risk papillary thyroid microcarcinoma. Minerva Endocrinol (Torino) 2021; 46:413-427. [PMID: 33435642 DOI: 10.23736/s2724-6507.20.03283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Papillary thyroid microcarcinoma (PTMC) is well known to have an indolent nature with an excellent prognosis. Surgery has been the standard treatment during the past several decades, with metastasis or recurrence being exceedingly rare. Active surveillance (AS) is a new risk-adapted approach alternative to surgery that involves just watching, but not giving any treatment unless needed, not addressing the tumor itself. The patients for whom AS is adopted spend their time "with tumors." In follow-up, it is possible that alarming factors such as tumor progression appear, causing anxiety about progression. Furthermore, endless follow-up is needed. However, considering the indolent nature and unfavorable events such as surgical complications caused by surgery, AS is a good management plan for selected PTMC patients. Decision making balancing between the prognosis and unfavorable events is needed for the treatment plan. Consideration of the factors and timing of surgical conversion is also needed. In this review article, how AS should be adopted as a new management option that is an alternative to surgery, which has been the absolute choice of treatment up to recently, is discussed. Concurrently, the characteristics of the two treatment strategies are reviewed, while introducing the background that explains how AS came to attention.
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Affiliation(s)
- Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan -
| | | | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo, Japan
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48
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Lv E, Sheng J, Yu C, Rao D, Huang W. LncRNA influence sequential steps of hepatocellular carcinoma metastasis. Biomed Pharmacother 2021; 136:111224. [PMID: 33450489 DOI: 10.1016/j.biopha.2021.111224] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/20/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023] Open
Abstract
As a class of new and crucial molecules involved in the regulation of biological function, long noncoding RNA (lncRNA) have obtained widespread attention in recent days. While it was thought that lncRNA would be redundant in the past, it is proved that lncRNA identify a class of molecular that regulate the homeostasis including hepatocellular carcinoma in the present. All kinds of lncRNA have been implicated in a various of diseases, particularly in tumorigenesis and metastasis. But the mechanisms how they act is still not entirely clear. Metastasis is a major factor affecting long-term survival in hepatocellular carcinoma (HCC) patients. Recently, growing numbers of experiments demonstrate that there is close connection between lncRNA and HCC metastasis. Here, we will briefly introduce a series of steps (primary tumor growth, angiogenesis, epithelial-to-mesenchymal transition, invasion, intravasation, survival in circulatory system, extravasation, dormancy and subsequent secondary tumor growth) of tumor metastasis, its classical but promising theories, the role of lncRNA in metastasis and the possible mechanisms involved. LncRNA, as potentially new and important tumor diagnostic and therapeutic molecules, has attracted much attention in recent years.
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Affiliation(s)
- Enjun Lv
- Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Clinical Medicine Research Center for Hepatic Surgery of Hubei Province, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, Hubei, 430030, PR China
| | - Jiaqi Sheng
- Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Clinical Medicine Research Center for Hepatic Surgery of Hubei Province, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, Hubei, 430030, PR China
| | - Chengpeng Yu
- Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Clinical Medicine Research Center for Hepatic Surgery of Hubei Province, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, Hubei, 430030, PR China
| | - Dean Rao
- Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Clinical Medicine Research Center for Hepatic Surgery of Hubei Province, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, Hubei, 430030, PR China
| | - Wenjie Huang
- Hubei Key Laboratory of Hepato-Pancreato-Biliary Diseases, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Clinical Medicine Research Center for Hepatic Surgery of Hubei Province, Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health, Wuhan, Hubei, 430030, PR China.
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Trivedi LU, Femnou Mbuntum L, Halm EA, Mansi I. Is Statin Use Associated With Risk of Thyroid Diseases? Results of a Retrospective Cohort Study. Ann Pharmacother 2021; 55:1110-1119. [PMID: 33412925 DOI: 10.1177/1060028020986552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Given the ubiquity of statin use and prevalence of thyroid diseases, such as thyroid cancer, hyperthyroidism, and thyroiditis, understanding their association deserves further attention. OBJECTIVE To examine the association between statin use and thyroid cancer, thyrotoxicosis, goiter, and thyroiditis. METHODS Using Tricare data, 2 propensity score (PS)-matched cohorts of statin users and nonusers were formed: (1) a PS-matched general cohort (all patients aged 30-85 years) and (2) a PS-matched healthy cohort (excluded patients with cardiovascular diseases or severe comorbidities). Outcomes were thyroid cancer, thyrotoxicosis, goiter, and thyroiditis. Odds ratios (ORs) and 95% CIs of outcomes were estimated using conditional regression analysis. RESULTS Of 43 438 patients, the PS-matched general cohort matched 6342 statin users to 6342 nonusers. The OR of thyroid cancer was 0.62 (95% CI = 0.39-0.996). There was no significant difference between statin users and nonusers in risk of thyrotoxicosis (OR = 0.88; 95% CI = 0.71-1.09), goiter (OR = 0.9; 95% CI = 0.77-1.03), or thyroiditis (OR = 0.78; 95% CI = 0.53-1.15). In the PS-matched healthy cohort (3351 statin users to 3351 nonusers), there was no difference between statin users and nonusers in any outcome. Limitations of the study include its retrospective observational design and use of administrative codes in outcomes ascertainment. CONCLUSION AND RELEVANCE This study did not demonstrate any association of statins with harmful effects on thyroid diseases, which offers assurance to clinicians and patients. Furthermore, statin use appears to be associated with a decreased risk of thyroid cancer, but more studies are needed.
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Affiliation(s)
| | | | - Ethan A Halm
- University of Texas Southwestern, Dallas, TX, USA
| | - Ishak Mansi
- University of Texas Southwestern, Dallas, TX, USA.,VA North Texas Health System, Dallas, TX, USA
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50
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Cléro E, Ostroumova E, Demoury C, Grosche B, Kesminiene A, Liutsko L, Motreff Y, Oughton D, Pirard P, Rogel A, Van Nieuwenhuyse A, Laurier D, Cardis E. Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in case of a future nuclear accident. ENVIRONMENT INTERNATIONAL 2021; 146:106230. [PMID: 33171378 DOI: 10.1016/j.envint.2020.106230] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 05/06/2023]
Abstract
Exposure of the thyroid gland to ionizing radiation at a young age is the main recognized risk factor for differentiated thyroid cancer. After the Chernobyl and Fukushima nuclear accidents, thyroid cancer screening was implemented mainly for children, leading to case over-diagnosis as seen in South Korea after the implementation of opportunistic screening (where subjects are recruited at healthcare sites). The aim of cancer screening is to reduce morbidity and mortality, but screening can also cause negative effects on health (with unnecessary treatment if over-diagnosis) and on quality of life. This paper from the SHAMISEN special issue (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) presents the principles of cancer screening, the lessons learned from thyroid cancer screening, as well as the knowledge on thyroid cancer incidence after exposure to iodine-131. The SHAMISEN Consortium recommends to envisage systematic health screening after a nuclear accident, only when appropriately justified, i.e. ensuring that screening will do more good than harm. Based on the experience of the Fukushima screening, the consortium does not recommend mass or population-based thyroid cancer screening, as the negative psychological and physical effects are likely to outweigh any possible benefit in affected populations; thyroid health monitoring should however be made available to persons who request it (regardless of whether they are at increased risk or not), accompanied with appropriate information and support.
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Affiliation(s)
- Enora Cléro
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France.
| | - Evgenia Ostroumova
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Claire Demoury
- Risk and Health Impact Assessment Unit, Sciensano, Brussels, Belgium
| | - Bernd Grosche
- Federal Office for Radiation Protection (BfS), Munich, Germany
| | - Ausrele Kesminiene
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Liudmila Liutsko
- Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Deborah Oughton
- Norwegian University of Life Sciences (NMBU), Center for Environmental Radioactivity (CERAD), Aas, Norway
| | | | - Agnès Rogel
- Santé publique France, Saint-Maurice, France
| | - An Van Nieuwenhuyse
- Risk and Health Impact Assessment Unit, Sciensano, Brussels, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium
| | - Dominique Laurier
- Health and Environment Division, Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Elisabeth Cardis
- Institute for Global Health (ISGlobal), Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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