Follicular adenoma and carcinoma of the thyroid gland

Proteomic analysis reveals modulation of key proteins in follicular thyroid cancer progression

BACKGROUND

Cytopathology cannot be used to reliably distinguish follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC), the second most common form of thyroid cancer, because they exhibit nearly identical cellular morphology. Given the challenges in diagnosis and treatment, this study aims to identify the mechanisms underlying FTC is essential.

METHODS

Using parallel reaction monitoring-mass spectrometry (PRM-MS) assays, we identified and quantified 94 differentially expressed protein candidates from a retrospective cohort of 1085 FTC and FTA tissue samples from 18 clinical centers. Of these targeted proteins, those with the potential for distinguishing FTC from FTA were prioritized using machine learning. Co-immunoprecipitation (co-IP) and immunofluorescence co-localization assays, as well as gene interference, overexpression, and immunohistochemistry (IHC) experiments, were used to investigate the interactions and cellular functions of selected proteins.

RESULTS

Using machine learning models and feature selection methods, 30 of the 94 candidates were prioritized as key proteins. Co-IP and immunofluorescence co-localization assays using FTC cell lines revealed interactions among insulin-like growth factor 2 receptor (IGF2R), major vault protei (MVP), histone deacetylase 1 (HDAC1), and histone H1.5 (H1-5). Gene interference and overexpression experiments in FTC-133 cells confirmed the promotional role of these proteins in cell proliferation. IHC assays of patient samples further confirmed elevated expression of these four proteins in FTC compared with that in FTA.

CONCLUSIONS

Our findings underscore the utility of advanced proteomic techniques in elucidating the molecular underpinnings of FTC, highlighting the potential significance of IGF2R, MVP, HDAC1, and H1-5 in FTC progression, and providing a foundation for the exploration of targeted therapies.

Diagnostic accuracy of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in differentiating thyroid tumors: A systematic review and meta-analysis

BACKGROUND

Thyroid neoplasms include a range of lesions, most of which are benign, though some may progress to or present as malignant. Diagnostic tools like FNAB, ultrasound, and hormone analysis are commonly used, though they have limitations. Recently, peripheral blood markers have been explored for their potential in differentiating thyroid lesions, despite controversy evidence. This review evaluates the diagnostic utility of NLR and PLR in thyroid lesions.

METHODS

We systematically searched all relevant articles on PubMed, Science Direct, Cochrane Library, and gray literature, including Google Scholar, for studies on the diagnostic utility of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in thyroid lesions. Two researchers independently screened articles, and study quality was assessed using the QUADAS 2 tool. A random-effects model calculated pooled sensitivity and specificity, while the area under the HSROC curve summarized diagnostic accuracy. Heterogeneity was evaluated with Higgins' I² statistic, and publication bias was assessed using the MIDAS command. Subgroup analyses by sample size, gender distribution, cutoff values, and carcinoma types explored sources of heterogeneity.

RESULTS

A total of 12 studies were included in the final meta-analysis, with 9 focusing on NLR and 6 on PLR. Most of these studies were retrospective in design. The pooled sensitivity and specificity of NLR were 75% (95% CI: 65-82%) and 62% (95% CI: 42-75%), respectively. For PLR, the overall sensitivity and specificity were 70% (95% CI: 61-78%) and 57% (95% CI: 46-66%), respectively. The diagnostic accuracy, based on the area under the HSROC curve (AUC), was 0.75 (95% CI: 0.71-0.79) for NLR and 0.69 (95% CI: 0.65-0.73) for PLR. These results indicate that NLR has better diagnostic accuracy than PLR in distinguishing between benign and malignant thyroid lesions.

CONCLUSION

While the NLR demonstrates better diagnostic utility than the PLR in distinguishing between benign and malignant thyroid lesions, its standalone diagnostic accuracy remains moderate. Therefore, we recommend using these markers as complementary tools alongside other standard diagnostic modalities until further studies provide more definitive evidence. Thyroid neoplasm is a type of cancer which arises from the thyroid parenchymal cell and affects the thyroid gland. The disease encompasses a variety of lesion, including benign adenomas to malignant carcinomas [1]. The majority of thyroid glands are noncancerous and are mostly benign. In some contexts, thyroid adenomas may transform into carcinomas as the nonfunctional adenomas possess oncogene mutations [2]. Overall, 5% of thyroid nodules are malignant. Notably, approximately 20% of follicular adenomas have the potential to progress into follicular carcinomas [3]. The common thyroid malignancies include, papillary, follicular, medullary and anaplastic types, which varies based on the aggressiveness of the cancer, which are highly variable clinical features; some may be indolent and slow progressing while others may be highly aggressive tumors with a high mortality rate [4,5]. Globally, thyroid cancer cases are increasing over time. Approximately 18.3 million thyroid cases were reported with a high prevalence rate in China and United States [6]. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used and performed for this systematic review and meta-analysis. This review was registered on PROSPERO with registration number of CRD42024559798.

Multimodal ultrasound radiomics model combined with clinical model for differentiating follicular thyroid adenoma from carcinoma

OBJECTIVE

This study aimed to develop a nomogram integrating radiomics features derived from contrast-enhanced ultrasound (CEUS) and B-mode ultrasound (B-US) with clinical features to improve preoperative differentiation between follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA). Accurate preoperative diagnosis is critical for guiding appropriate treatment strategies and reducing unnecessary interventions.

METHODS

We retrospectively included 201 patients with histopathologically confirmed FTC (n = 133) or FTA (n = 68). Radiomics features were extracted from B-US and CEUS images, followed by feature selection and machine-learning model development. Five models were evaluated, and the one with the highest area under the curve (AUC) was used to construct a radiomics signature. A Clinical Risk model was developed using statistically significant clinical features, which outperformed the conventional Chinese Thyroid Imaging Reporting and Data System (C-TIRADS) in both training and test groups. The radiomics signature and Clinical Risk model were integrated into a nomogram, whose diagnostic performance, calibration and clinical utility were assessed.

RESULTS

The Clinical Risk model achieved superior diagnostic performance compared to the C-TIRADS model, with AUCs of 0.802 vs. 0.719 in the training group and 0.745 vs. 0.703 in the test group. The nomogram further improved diagnostic efficacy, with AUCs of 0.867 (95% CI, 0.800-0.933) in the training group and 0.833 (95% CI, 0.729-0.937) in the test group. It also demonstrated excellent calibration. Decision curve analysis (DCA) also indicated that the nomogram showed good clinical utility.

CONCLUSION

By combining CEUS and B-US radiomics features with clinical data, we developed a robust nomogram for distinguishing FTC from FTA. The model demonstrated superior diagnostic performance compared to existing methods and holds promise for enhancing clinical decision-making in thyroid nodule management.

CLINICAL TRIAL NUMBER

Not applicable.

Brain-thyroid crosstalk: 18F-FDG-PET/MRI evidence in patients with follicular thyroid adenomas

OBJECTIVE

The hypothalamic-pituitary-thyroid axis has been well-known. However, whether follicular thyroid adenoma (FTA) could affect brain glucose metabolism is still unknown. Therefore, we explored the brain glucose metabolic characteristics of FTA with Fluorodeoxyglucose F18 positron emission tomography/magnetic resonance imaging.

METHODS

Totally 30 FTA patients without clinical symptoms (FTA group), and 60 age- and sex-matched healthy controls (HC group) were included and randomly divided into cohort A and B in 2:1 ratio. Cohort A was analyzed with scaled sub-profile model/principal component analysis (SSM/PCA) for pattern identification. Cohort B was calculated the individual scores to validate expression of the pattern. Then we calculated the metabolic connectivity based on characteristics of the pattern to investigate the underlying mechanism. Finally, we constructed metabolic brain networks and analyzed the topological properties to further explore the brain metabolic model.

RESULTS

In SSM/PCA, FTA group showed an almost global, left-right symmetrical pattern. In metabolic connectivity, FTA group showed increased metabolic connectivity in brain regions of the sensorimotor network, ventral default mode network (DMN), posterior salient network, right executive control network (ECN), visuospatial network and language network when compared to HC group, and showed decreased connectivity in dorsal DMN and left ECN. In topological properties of brain network, FTA group showed an increased betweenness centrality (BC) in left rolandic operculum, a decreased BC in superior temporal gyrus, increased BC and Degree in right precentral gyrus, increased D in right parahippocampal gyrus and left hippocampus, and decreased D and efficiency in right orbital part of middle frontal gyrus (FDR correction for multiple comparisons, P < 0.05).

CONCLUSION

Although FTA patients are not yet symptomatic, their brain metabolic characteristics include extensive brain alterations, disrupted internal connectivity, not only involving brain regions associated with endocrine activity, but also brain networks and regions associated with motor, emotion and cognition.

Rare but Complex: Outcomes and Challenges in Managing Composite Follicular-Anaplastic Thyroid Cancer

BACKGROUND

A subset of follicular thyroid cancers (FTC) can dedifferentiate into anaplastic thyroid cancer (ATC), forming composite FTC/ATC tumors. The effect of this dedifferentiation on survival outcomes remains unclear. This study aimed to characterize the clinicopathologic features of composite FTC/ATC tumors and assess their disease-specific survival (DSS).

PATIENTS AND METHODS

The Surveillance, Epidemiology, and End Results (SEER) database (2000-2020) was used to identify patients with FTC, composite FTC/ATC, and ATC. Propensity score matching (PSM) was performed on the basis of age, sex, race, and histologic subtype. Clinicopathologic characteristics, DSS, and treatment outcomes were compared.

RESULTS

A total of 60 patients with composite FTC/ATC were matched to 180 patients with FTC and 180 patients with ATC. Compared with FTC, composite tumors were associated with larger size (p < 0.001), extra-thyroidal extension (ETE) (p < 0.001), lymph node (p < 0.001) and distant metastases (p = 0.002), more external beam radiation (p < 0.001), and chemotherapy (p < 0.001), but less radioactive iodine (RAI) (p < 0.001). Compared with ATC, composite tumors showed less ETE (p = 0.01), fewer lymph node metastases (p = 0.01), less chemotherapy (p = 0.002), and more RAI (p = 0.002). The median survival of patients with co-FTC/ATC was 7 months (p < 0.001). Advanced age (hazard ratio, HR 1.05; 95% confidence intervals, CI 1.02-1.08) and incomplete thyroidectomy (HR 2.58, 95% CI 1.20-5.56) predicted worse DSS.

CONCLUSIONS

Composite FTC/ATC tumors have survival outcomes that fall between those of FTC and ATC. Total thyroidectomy is a key component of treatment, as incomplete thyroidectomy is linked to poorer survival. Further research is needed to explore how the proportion of ATC within composite tumors influences survival outcomes.

Clinical characteristics, surgical approaches, and prognosis of follicular and papillary thyroid cancer in children and adolescents: a retrospective cohort study

PURPOSE

Follicular and papillary thyroid cancers are prevalent endocrine tumors in children and adolescents. This study seeks to highlight distinctions between papillary thyroid cancer  (PTC) and follicular thyroid cancer  (FTC) to inform subtype-specific guidelines.

PATIENTS AND METHODS

Utilizing data from the SEER database, this study contrasts the clinical features, survival rates, causes of death, TNM staging, and surgical interventions for pediatric and adolescent patients diagnosed with PTC and FTC from 2000 to 2020.

RESULTS

We analyzed 3068 pediatric and adolescent patients with differentiated thyroid cancer (DTC). Since 2005, PTC incidence has increased, while FTC remains stable. Both subtypes exhibit excellent survival rates; FTC shows near-perfect outcomes, and PTC's overall survival (OS) at 2, 5, and 10 years is 99.6, 99.2, and 98.5%, respectively. Thyroid cancer accounted for only 20.9% of deaths among PTC patients. Significant differences in T and N staging were observed. Regarding surgery, 70% of FTC patients underwent total or near-total thyroidectomy compared to 90% of PTC patients. Lymph node dissection was performed in 41.7% of FTC and 77.5% of PTC patients, indicating distinct surgical approaches.

CONCLUSION

Pediatric and adolescent patients with FTC and PTC have excellent prognoses. The extent of thyroidectomy and criteria for prophylactic central lymph node dissection should be tailored specifically for FTC and PTC, rather than generalizing under DTC.

CLINICAL TRIAL INFORMATION

NCT06592118.

Interpretable Machine Learning to Predict the Malignancy Risk of Follicular Thyroid Neoplasms in Extremely Unbalanced Data: Retrospective Cohort Study and Literature Review

Background

Diagnosing and managing follicular thyroid neoplasms (FTNs) remains a significant challenge, as the malignancy risk cannot be determined until after diagnostic surgery.

Objective

We aimed to use interpretable machine learning to predict the malignancy risk of FTNs preoperatively in a real-world setting.

Methods

We conducted a retrospective cohort study at the Peking University Third Hospital in Beijing, China. Patients with postoperative pathological diagnoses of follicular thyroid adenoma (FTA) or follicular thyroid carcinoma (FTC) were included, excluding those without preoperative thyroid ultrasonography. We used 22 predictors involving demographic characteristics, thyroid sonography, and hormones to train 5 machine learning models: logistic regression, least absolute shrinkage and selection operator regression, random forest, extreme gradient boosting, and support vector machine. The optimal model was selected based on discrimination, calibration, interpretability, and parsimony. To address the highly imbalanced data (FTA:FTC ratio>5:1), model discrimination was assessed using both the area under the receiver operating characteristic curve and the area under the precision-recall curve (AUPRC). To interpret the model, we used Shapley Additive Explanations values and partial dependence and individual conditional expectation plots. Additionally, a systematic review was performed to synthesize existing evidence and validate the discrimination ability of the previously developed Thyroid Imaging Reporting and Data System for Follicular Neoplasm scoring criteria to differentiate between benign and malignant FTNs using our data.

Results

The cohort included 1539 patients (mean age 47.98, SD 14.15 years; female: n=1126, 73.16%) with 1672 FTN tumors (FTA: n=1414; FTC: n=258; FTA:FTC ratio=5.5). The random forest model emerged as optimal, identifying mean thyroid-stimulating hormone (TSH) score, mean tumor diameter, mean TSH, TSH instability, and TSH measurement levels as the top 5 predictors in discriminating FTA from FTC, with the area under the receiver operating characteristic curve of 0.79 (95% CI 0.77-0.81) and AUPRC of 0.40 (95% CI 0.37-0.44). Malignancy risk increased nonlinearly with larger tumor diameters and higher TSH instability but decreased nonlinearly with higher mean TSH scores or mean TSH levels. FTCs with small sizes (mean diameter 2.88, SD 1.38 cm) were more likely to be misclassified as FTAs compared to larger ones (mean diameter 3.71, SD 1.36 cm). The systematic review of the 7 included studies revealed that (1) the FTA:FTC ratio varied from 0.6 to 4.0, lower than the natural distribution of 5.0; (2) no studies assessed prediction performance using AUPRC in unbalanced datasets; and (3) external validations of Thyroid Imaging Reporting and Data System for Follicular Neoplasm scoring criteria underperformed relative to the original study.

Conclusions

Tumor size and TSH measurements were important in screening FTN malignancy risk preoperatively, but accurately predicting the risk of small-sized FTNs remains challenging. Future research should address the limitations posed by the extreme imbalance in FTA and FTC distributions in real-world data.

Oncocytes in Thyroid Aspirates-Implications of Clinical Parameters and Cytologic Diagnosis

ImportanceThe clinical significance of oncocytes in thyroid aspirate is uncertain, leading to inconsistent and possible over-treatment.ObjectiveTo determine the predictive significance of clinico-radiological parameters and cytologic diagnosis on the risks of malignancy (ROM) and neoplasia.DesignData of thyroid aspirates with the presence of oncocytes were reviewed for outcomes and clinical-radiological-pathological parameters.SettingThree regional institutes performing thyroid surgery and investigations.ParticipantsFrom a population base of 1.3 million across a 9-year period, totaling 371 aspirates with oncocytes with an 85.0-month average follow-up.InterventionFine-needle aspiration of thyroid.ResultsOn clinical follow-up, the ROM for Bethesda categories C1-C6 was 15.4%/2.7%/9.2%/6.9%/37.5%/100%, while the risk of neoplasm (considering thyroidectomy follow-up) was 45.5%/23.8%/56.3%/61.9%/50%/100%, including 52 oncocytic follicular lesions (4 carcinomas and 48 adenomas) and 26 other carcinomas/malignancies. C5+ diagnoses were associated with malignancy (P = .003), and C3+ was associated with neoplasm on thyroidectomy (P = .006). Malignant/neoplastic outcomes did not correlate with sex or age (P > .05). High free triiodothyronine/free thyroxine levels were associated with a benign clinical outcome (P = .001). Cystic change on ultrasound was associated with a lower malignancy (P = .012) and neoplasm risk (P = .041). Lesion size, echogenicity, vascularity, multinodularity, lymphadenopathy, and solid areas on ultrasound were not significant in predicting malignancy or neoplasm (P > .05).ConclusionThe presence of oncocytes in thyroid aspirates does not increase malignancy risk. Most malignant oncocytic thyroid aspirates are not attributable to oncocytic carcinomas but papillary thyroid carcinomas. Ultrasound and thyroid function tests are helpful in the risk assessment of these cases.RelevanceFor treatment or follow-up decisions in patients with oncocytes in thyroid aspirates.

Sacral Metastasis in Follicular Thyroid Carcinoma: Cytology Pitfalls and Serum Thyroglobulin Utility

Sacral bone metastasis from primary follicular thyroid carcinoma (FTC) is rare. Most reported cases include factors indicative of thyroid origin, such as a history of treated thyroid cancer or newly identified thyroid nodules with malignant cytology. We herein report a 57-year-old woman with a metastatic sacral lesion of thyroid origin, initially misdiagnosed due to a false-negative fine-needle aspiration (FNA) cytology result of a thyroid nodule. The diagnosis was suspected based on an abnormally elevated serum thyroglobulin (sTg) level and confirmed through repeat core biopsy with thyroid-specific immunohistochemistry. This case highlights the limitations of FNA cytology in large thyroid nodules and underscores the potential role of sTg in diagnosing metastatic FTC in certain clinical scenarios. Thyroid carcinoma should be considered in the differential diagnosis of sacral metastases when the primary tumor is unknown.

Histopathological domain adaptation with generative adversarial networks: Bridging the domain gap between thyroid cancer histopathology datasets

Deep learning techniques are increasingly being used to classify medical imaging data with high accuracy. Despite this, due to often limited training data, these models can lack sufficient generalizability to predict unseen test data, produced in different domains, with comparable performance. This study focuses on thyroid histopathology image classification and investigates whether a Generative Adversarial Network [GAN], trained with just 156 patient samples, can produce high quality synthetic images to sufficiently augment training data and improve overall model generalizability. Utilizing a StyleGAN2 approach, the generative network produced images with an Fréchet Inception Distance (FID) score of 5.05, matching state-of-the-art GAN results in non-medical domains with comparable dataset sizes. Augmenting the training data with these GAN-generated images increased model generalizability when tested on external data sourced from three separate domains, improving overall precision and AUC by 7.45% and 7.20% respectively compared with a baseline model. Most importantly, this performance improvement was observed on minority class images, tumour subtypes which are known to suffer from high levels of inter-observer variability when classified by trained pathologists.

Description of a New miRNA Signature for the Surgical Management of Thyroid Nodules

BACKGROUND

The diagnosis of malignant thyroid nodules is mainly based on the fine-needle aspiration biopsy (FNAB). To improve the detection of malignant nodules, different molecular tests have been developed. We present a new molecular signature based on altered miRNA expressions and specific mutations.

METHODS

This is a prospective non-interventional study, including all Bethesda categories, carried out on an FNAB sampled in suspicious nodule(s) during thyroidectomy. miRNA quantification and mutations detection were performed. The reference diagnosis was the pathological assessment of the surgical specimen. Different classification algorithms were trained with molecular data to correctly classify the samples.

RESULTS

A total of 294 samples were recorded and randomly divided in two equal groups. The random forest algorithm showed the highest accuracy and used mostly miRNAs to classify the nodules. The sensitivity and the specificity of our signature were, respectively, 76% and 96%, and the positive and negative predictive values were both 90% (disease prevalence of 30%).

CONCLUSIONS

We have identified a molecular classifier that combines miRNA expressions with mutations detection. This signature could potentially help clinicians, as complementary to the Bethesda classification, to discriminate indeterminate FNABs.

Prognostic Factors for Cancer-Specific Survival and Disease-Free Interval in 130 Patients with Follicular Thyroid Carcinoma: Single Institution Experience

BACKGROUND

Follicular thyroid carcinoma (FTC) is categorized into three groups: minimally invasive FTC (MIFTC), encapsulated angioinvasive FTC (EAIFTC), and widely invasive FTC (WIFTC). FTC is the second most common type of thyroid tumor, though it remains relatively rare in the general population. This study aimed to examine the prognosis and prognostic factors in patients with follicular thyroid carcinoma.

METHODS

Data were obtained from a tertiary referral center for 130 FTC patients, covering the period from 1995 to 2020. Clinical data included demographic characteristics, tumor features, type of surgery, tumor recurrence, and vital status. Descriptive statistical methods, Kaplan-Meier survival curves, and Cox proportional hazard regression were used for statistical analysis to identify independent predictors.

RESULTS

Distant metastases occurred in 12 patients during the follow-up period. The 5-year, 10-year, 15-year, and 20-year cancer-specific survival (CSS) rates were 98.1%, 92.3%, 83.5%, and 79.8%, respectively. Independent unfavorable prognostic factors for CSS included widely invasive tumor type (hazard ratio [HR] 3.63, 95% CI 1.29-10.18), multifocality (HR 6.7, 95% CI 1.37-32.72), and presence of distant metastases (HR 2.29, 95% CI 1.08-4.84). When disease-free interval (DFI) was considered, the 5-year, 10-year, 15-year, and 20-year rates were 92.3%, 85.3%, 82.0%, and 76.6%, respectively. Independent unfavorable prognostic factors for DFI were widely invasive tumor type (HR 2.53, 95% CI 1.02-6.28) and tumor multifocality (HR 7.69, 95% CI 1.07-55.17).

CONCLUSIONS

The 10-year survival rate for patients with FTC is relatively favorable. Factors associated with poorer prognosis include the presence of distant metastases, WIFTC, and multifocality. Factors linked to disease recurrence are WIFTC and multifocality.

Molecular Markers in Follicular and Oncocytic Thyroid Carcinomas: Clinical Application of Molecular Genetic Testing

BACKGROUND

Oncocytic thyroid carcinoma (OTC) was previously considered a variant of follicular thyroid carcinoma (FTC) but has recently been reclassified as a separate form of thyroid cancer. This study aimed to demonstrate that FTC and OTC are fundamentally distinct entities that can potentially be differentiated preoperatively through cytology and/or molecular testing.

METHODS

A retrospective chart review of patients diagnosed with FTC and OTC operated upon at two university health centers from January 2016 to September 2023 (n = 3219) was conducted. Molecular testing results were correlated with histopathologic diagnosis.

RESULTS

Fifty patients met the inclusion criteria. FTC was identified in 27 (54.0%) patients, and OTC in 23 (46.0%) patients. Patients with OTC were older (61.8 years) than FTC patients (51.2 years) (p = 0.013). Moreover, aggressive tumors were found in 39.1% (9/23) of OTCs compared to 11.1% (3/27) of FTCs (p = 0.021). Amongst Bethesda category III and IV nodules, 17 out of 20 (85.0%) OTC cytology reports demonstrated an oncocytic subtype compared to only 5 out of 24 FTC cytology reports (20.8%) (p = 0.002). On molecular testing, the EIF1AX alteration was exclusively present in OTCs while the PAX8/PPARy and PTEN alterations were exclusively found in FTCs. Copy number alterations (CNAs) were found to be more prevalent in OTC (66.7%) compared to FTC (33.3%), and they were not indicative of tumor aggressiveness. Within the OTC group, all three patients who had a TP53 alteration were diagnosed with aggressive cancer. Lastly, the OTCs exhibited a higher frequency of multiple alterations on molecular testing (66.7%) compared to FTCs (33.3%).

CONCLUSION

To our knowledge, this is the largest study to date comparing the clinical application of abnormalities found on molecular testing for FTC and OTC. It further demonstrates the distinct clinicopathological and molecular characteristics of OTC.

Role of Ultrasound and Ultrasound-Based Prediction Model in Differentiating Follicular Thyroid Carcinoma From Follicular Thyroid Adenoma

OBJECTIVES

This study aims to identify distinct ultrasound (US) characteristics for distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA), and construct a user-friendly preoperative risk stratification model for thyroid follicular neoplasms.

METHODS

In this retrospective study, patients diagnosed with pathologically confirmed FTA or FTC and undergoing US examinations between July 2017 and June 2021 were designated as the training cohort, and those from July 2021 to June 2023 were enrolled as the external validation set. We systematically assessed and compared the sonographic and clinical characteristics of FTC and FTA. Univariable and multivariable logistic regression analyses were used to assess the association of US features with FTC in the training set. A prediction nomogram model, incorporating US features independently associated with FTC, was developed and validated externally to assess its performance.

RESULTS

A total of 645 patients (FTA/FTC = 530/115) were included in the training set, while 197 patients (FTA/FTC = 165/32) constituted the validation set. In the training set, solid composition, hypo-echogenicity, irregular margin, calcification, protrusion sign, trabecular formation, absent or thick halo, and mainly central hypervascularity were identified as independent factors associated with FTC. The prediction nomogram model constructed using these variables showed good performance in differentiating FTC from FTA with an area under the curve of 0.948 in the training set and 0.915 in the validation set.

CONCLUSIONS

The preoperative nomogram model constructed based on US features serves as an effective tool for the risk stratification of thyroid follicular neoplasms.

Multi-element analysis of metals in human pathological and unchanged thyroid glands - pilot study

Disturbances in the homeostasis of the elemental composition of thyroid tissue may have serious metabolic and health consequences. It is believed that the accumulation of some metals or the deficiency of others may even cause lethal tumours. Due to the fact that metallomics most often uses human serum to analyse macro and microelements as well as trace elements, it was decided to use material that is more difficult to obtain, but also adds credibility to the research - thyroid tissue samples biopsy. The experiments were conducted on 17 patients diagnosed with: nodular (10) and colloidal goitre (2), chronic thyroiditis (2), follicular adenoma (2) and papillary carcinoma (1). They were recruited by collecting a tumour fragment, control fragment and serum from each of them. The content of Ca, Cd, Co, Cr, Cu, Fe, Mg, Mn, Ni, Pb, Zn was examined using ICP-OES (Inductively Coupled Plasma - Optical Emission Spectrometers). Simultaneously, biochemical methods were used to determine the markers of inflammation, glycation and peroxidation: malondialdehyde, pentosidine, reactive free amine content, compounds with thiol groups and galectin 3 in the sera of the examined patients. Three statistically significant correlations were identified: Ca-Mg and Cu-Zn in control tissues (p < 0.05) and Cr-Mn in pathological tissues (p < 0.05). A comparison of individual groups of patients shows that there are some potentail tendencies to increase or decrease in the concentration of certain elements or markers of inflammation and glycation, therefore we discuss potential relationships between a given parameter and a thyroid disorder. The pilot study is an introduction to a deeper analysis aimed at tracing the pathomechanism of the development of thyroid diseases, so that the risk of developing these diseases can be effectively minimized.

Possible Markers for Distinguishing benign and Malignant Thyroid Tumors and Predicting Malignancy in Patients with Genetic Predisposition to Cancer

BACKGROUND

We hypothesized that mutations in several genes disrupt oxidative metabolism, increasing the risk of developing tumors and their malignancy in patients with a family predisposition to cancer. The purpose of our study was to assess the characteristics of oxidative metabolism in patients with malignant and benign tumor with and without a family history of cancer and identify the marker predicting the likelihood of malignancy.

METHODS

We conducted a study on patients with thyroid pathology (thyrotoxicosis, benign tumor pathology of the thyroid gland, and thyroid cancer) who underwent treatment at LLC "Oncology Scientific Research Center" in Tbilisi, Georgia between 2020-2021.  In patients' blood the thyroid hormones content, the oxidative metabolism parameters (activity of nonenzymatic antioxidant system (TAA), malondialdehyde (MDA) content),  geometrical and rheological (deformability index (EDI), membrane proteins content) characteristics of erythrocytes were determined.

RESULTS

in the patient's blood serum with benign tumor (47 patients) MDA exceeded (p<0.005) and TAA decreased (p<0.005) in comparison to the control level; in patients with thyroid cancer (35 patients), MDA also exceeded (p<0.005), while TAA increased (p<0.005) up to the control level. In patients with benign and malignant tumors, the size of erythrocytes increased compared to the control indicators (p<0.005); in patients with thyroid cancer and benign tumors with a family history of cancer (29 patients) EDI increased (p<0.005), content of GLUT1 in erythrocyte membranes decreased (p<0.005) compared to the control level.

CONCLUSIONS

Alterations in redox metabolism play a crucial role in tumor formation; an imbalance between anti-/pro-oxidant systems may contribute to tumor formation and support its progression into a more malignant state. Thyroid cancer is characterized by a reduction in erythrocyte deformability, related to TSH levels. These alterations are less detectable in patients with benign thyroid tumors with a family history of cancer.

Metastatic thyroid follicular carcinoma presenting as pathological left clavicle fracture: An unusual skeletal metastasis at the time of diagnosis

INTRODUCTION

Thyroid carcinoma is the most common endocrine malignancy, accounting for 3 % of recent malignancies in world wide. Differentiated thyroid carcinoma constitutes 90 % thyroid malignancies, within that follicular type constitutes 10-15 %.

CLINICAL PRESENTATION

A 55-year-old female presented with left-sided neck pain and swelling over medial end of clavicle, following normal manual work. Physical examination revealed swelling on medial end of left clavicle and palpable nodule in left thyroid lobe. Imaging studies showed two nodules in both thyroid lobes with left level IV lymphadenopathy and osteolytic lesion with pathological fracture in medial end of clavicle. Histopathological evaluation confirmed well-differentiated follicular thyroid carcinoma with clavicular metastasis. The patient underwent total thyroidectomy, followed by radioiodine therapy for medial end of left clavicle.

DISCUSSION

Follicular thyroid carcinoma (FTC) is metastasis through the bloodstream, predominantly to flat bones and upper end of long bones, but clavicular deposits are very rarely reported. FNAC only diagnosed the follicular neoplasm. Further tissue evaluation needed to confirm the malignancy. Therefore, hemithyroidectomy of the lesion side is usually carried out for histopathological diagnosis. But in this case, follicular thyroid carcinoma was confirmed through core biopsy from medial end of clavicle, leading to total thyroidectomy and left cervical block dissection, followed by radioiodine therapy for metastatic clavicular involvement.

CONCLUSION

Clavicular metastasis of follicular thyroid carcinoma is very rare. Early detection and proper management of suspicious thyroid carcinoma in uncommon skeletal sites, like the clavicle, is crucial for enhancing patient outcomes, despite the rarity of follicular carcinoma metastasis to this area.

Complexity of diagnosis and management of a giant thyroid nodule: A case report and a concise literature

It is crucial for doctors to decide whether a thyroid nodule is benign or malignant when a patient presents with one, as it will significantly impact how the patient is managed in the future. However, it is not as straightforward to determine between the two; even a physical examination, thyroid function test, ultrasonography, and biopsy have been well performed. It can be more stressful if a patient has an increased risk of malignancy, such as age (below 20- and above 60-year-old), solid nodule, rapid growth, hoarseness, lymphadenopathy, and microcalcifications on the ultrasonography. The aim of this case was to present the management of a giant thyroid nodule with malignancy presentation and a benign biopsy finding. A 41-year-old male complained of a palpable neck mass, hoarseness, and dysphagia. The thyroid function test was normal. Ultrasonography revealed suspicion of malignancy with category 4 of American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS). The biopsy revealed follicular neoplasm, and was classified as Bethesda IV. The patient underwent a total thyroidectomy due to the large tumor size and symptoms. Histopathological findings post-surgery revealed a follicular thyroid adenoma. This case highlights a complex diagnosis and management of follicular thyroid neoplasm due to their potential for both benign and malignant. Comprehensive pre- and post-operative care is essential to determine the nature of nodules. Post-operative follow-up care might improve the patient's outcome and prevent complications.

Applications of machine and deep learning to thyroid cytology and histopathology: a review

This review synthesises past research into how machine and deep learning can improve the cyto- and histopathology processing pipelines for thyroid cancer diagnosis. The current gold-standard preoperative technique of fine-needle aspiration cytology has high interobserver variability, often returns indeterminate samples and cannot reliably identify some pathologies; histopathology analysis addresses these issues to an extent, but it requires surgical resection of the suspicious lesions so cannot influence preoperative decisions. Motivated by these issues, as well as by the chronic shortage of trained pathologists, much research has been conducted into how artificial intelligence could improve current pipelines and reduce the pressure on clinicians. Many past studies have indicated the significant potential of automated image analysis in classifying thyroid lesions, particularly for those of papillary thyroid carcinoma, but these have generally been retrospective, so questions remain about both the practical efficacy of these automated tools and the realities of integrating them into clinical workflows. Furthermore, the nature of thyroid lesion classification is significantly more nuanced in practice than many current studies have addressed, and this, along with the heterogeneous nature of processing pipelines in different laboratories, means that no solution has proven itself robust enough for clinical adoption. There are, therefore, multiple avenues for future research: examine the practical implementation of these algorithms as pathologist decision-support systems; improve interpretability, which is necessary for developing trust with clinicians and regulators; and investigate multiclassification on diverse multicentre datasets, aiming for methods that demonstrate high performance in a process- and equipment-agnostic manner.

Mechanisms and Treatment Options for Hyperthyroid-Induced Osteoporosis: A Narrative Review

Normal thyroid hormone levels are crucial for the homeostasis of many metabolic cycles and processes throughout the human body. Thyroid dysfunction, such as thyrotoxicosis, can result from many different etiologies, including Graves' disease (GD), toxic multinodular goiter (MNG), and toxic adenoma. These hyperthyroid disease states can cause devastating complications and disease, including the disruption of the bone remodeling cycle and skeletal development, which can result in osteoporosis. Osteoporosis is characterized by a decrease in bone mineral density and a propensity for fragility fractures. In addition to patients with overt hyperthyroidism, studies have provided evidence of other high-risk patient demographics, such as individuals with subclinical hyperthyroidism and postmenopausal women, who may be at an increased risk for the development of secondary osteoporosis. The treatment of patients with hyperthyroid-induced osteoporosis often requires a multifaceted management plan that may be unique to each patient's situation. Antithyroid therapy is often the first step in treating this disease and may include thioamide medications. Radioactive iodine-131 therapy (RAI) and the surgical removal of the thyroid gland may also be reasonable approaches for restoring normal thyroid function. Following thyrotoxicosis mitigation, antiresorptive drugs such as bisphosphonates, calcitonin, and selective estrogen receptor modulators (SERMs) may be used to counteract decreased bone mineral density (BMD). Additionally, the implementation of vitamin D, calcium supplements, and weight-bearing exercise may also reduce bone loss. While the effects of thyroid stimulating hormone (TSH) and triiodothyronine (T3) on bone remodeling have been studied in the past, more research is needed to identify unknown mechanisms and develop future improved treatments for this condition.

Bilateral follicular thyroid carcinoma with large sternal metastasis: Case report and review of the literature

INTRODUCTION AND IMPORTANCE

Follicular thyroid cancer (FTC) typically spreads hematogenously, with bone metastasis being worrisome, often appearing to be resistant to radioactive iodine (RAI) therapy. Metastasis to sternum is exceedingly rare.

CASE PRESENTATION

A 43-year-old Egyptian male presented with chest tightness, cough, and shortness of breath. He was initially treated as bronchial asthma. Later, he was referred to our thyroid surgery clinic as a case of goitre and palpable sternal mass. He looked clinically well, with enlarged anterior neck mass and visible sternal mass, no lymphadenopathy. Laboratory tests showed thyroid-stimulating hormone levels within normal (2.13 mIU/L), and mildly decreased FT4 (10.3 pmol/L). Neck/chest CT demonstrated multinodular goitre with retrosternal extension, expansile lytic lesion in the sternum, and bilateral lung metastases. Thyroid fine needle aspiration and cytology showed FLUS, and true cut biopsy from the sternal lesion showed invasive FTC.

DISCUSSION

Rare bilateral FTC presenting as slow-growing sternal metastasis. The patient underwent total thyroidectomy, followed by high dose RAI therapy, and concluded with sternectomy and reconstruction surgery repair using polymethyl methacrylate wrapped in proline mesh. On follow-up, he received further RAI ablation therapy and became RAI refractory. He then received systemic therapy (Lenvatinib). Most recent follow up showed that the disease was controlled (low volume cancer) and he was tolerating treatment well with no reported symptoms.

CONCLUSION

Bilateral FTC with sternal metastasis is rare, and can be treated with total thyroidectomy, sternectomy and reconstruction, followed by RAI therapy and systemic therapy where required, hence inferring real survival benefit.

Follicular adenoma with bizarre nuclei and wild-type P53 expression: A case report and literature review

Introduction

Thyroid cancer is the most common endocrine tumor in humans. Follicular adenoma/carcinoma is the second most common subtype. Multiple histological patterns have been identified. Follicular adenoma with bizarre nuclei is one of the patterns associated with p53 mutation and has an unclear clinical prognosis.

Case report

A 74-year-old female presented with incidental findings of elevated TSH levels and normal thyroid markers. Ultrasound was performed and revealed multiple bilateral thyroid nodules measuring up to 1.9 cm. Fine needle aspiration was performed, and cytology showed one Bethesda category 5 nodule. Total thyroidectomy with neck dissection was performed, and the pathology showed follicular adenoma with bizarre nuclei. Based on the results of immunohistochemistry, the neoplastic cells exhibited staining for wild-type p53 and low levels of the proliferation index Ki-67.

Conclusions

We report a rare case of thyroid follicular adenoma with bizarre nuclei. In contrast to previous reports of this tumor, our patient showed a p53 wild-type pattern using immunohistochemistry. More studies are needed to better understand the etiology and clinical prognosis of this tumor.

Mandibular metastasis of follicular thyroid carcinoma

ABSTRACT

The orofacial region may be the first site for the dissemination of malignancies from the remote regions in the jawbones. The most common location of metastatic lesions in the jawbones is the mandible, with the molar region the most frequently involved site. Radiotherapy, chemotherapy, and surgical resection can be an approach in the treatment protocol depending upon patient age and growth of tumor mass. This case report presents a case of follicular variant thyroid carcinoma, infiltrative type, pT1bN0Mx with mandibular metastasis affecting both hard and soft tissue in a 55-year-old female.

Metastatic Follicular Thyroid Carcinoma of the Mandible: A Case Report at Tertiary Care Rural Centre

The most common endocrine cancer is thyroid carcinoma, however it seldom spreads to the oral cavity. Follicular thyroid carcinoma is the second most common type of thyroid cancer after papillary thyroid carcinoma. Thyroid carcinoma-related mandibular metastases is not very common, and there aren't many cases reported in the literature. We are describing a case in which the underlying cancer was diagnosed before the metastatic mandibular lesion was found. Total thyroidectomy and excision of the affected structures, with or without adjuvant therapy, appear to be the most effective treatments.

The possibilities of ultrasound imaging in the diagnosis of follicular neoplasia of the thyroid gland

Thyroid cancer is the most common cancer of the endocrine system. The diagnosis of thyroid cancer has taken a step forward due to the introduction of fine-needle biopsy of the thyroid gland with subsequent evaluation of cytological material using the Bethesda system. One category of this classification traditionally remains a gray area of diagnosis. The detection of a follicular tumor in the cytological material (category IV according to Bethesda) does not allow one to reliably classify the neoplasia as benign or malignant and requires surgical intervention. The traditional informative and widely used method for diagnosing thyroid tumors is ultrasound. However, the sensitivity and specificity of the method varies over a wide range. This review analyzes the literature on the possibilities of ultrasound diagnostics in assessing the malignant potential of follicular tumors of the thyroid gland.

Molecular profile of follicular tumors of the thyroid gland

More than 90 % of newly diagnosed cases of endocrine cancer occur in the thyroid gland. Introduction of fine needle puncture of the thyroid gland, with the classification of cytological material according to the Bethesda system, has become the cornerstone of the diagnosis of malignant neoplasms of the thyroid gland. However, traditionally in this classification there remains a weak link called a follicular tumor (category IV). The detection of a follicular tumor in the cytological material does not allow one to reliably classify the mass as benign or malignant and requires surgical intervention with morphological verification. In recent years, the possibilities of molecular genetic testing have improved markedly. Follicular tumors tend to accumulate mutations, which over time can lead to malignant transformation, but can also be used as a method of timely diagnosis. This review analyzes the literature on the possibilities of molecular genetic testing in assessing the malignant potential of follicular formations of the thyroid gland.

Case Report: A tortuous diagnosis and successful multimodal treatment of thyroid follicular carcinoma with pelvic metastasis

Purpose

To provide reference method for the treatment of thyroid follicular carcinoma by studing the clinical imaging, pathological features and multimodal treatment of a case of thyroid follicular carcinoma with bone metastasis.

Methods

By identifying the case's clinical, imaging, pathological features of a case of thyroid follicular carcinoma with bone metastasis, reflecting on the case's diagnosis and treatment process, and referring to literature about the characteristics of thyroid follicular carcinoma, the study aims to provide reference for the treatment of this kind of disease.

Result

A 67-year-old male patient was admitted to the hospital with clinical symptoms of left pelvic pain. The biopsy pathology showed well-differentiated thyroid tissue. Considering his medical history, conclusion of thyroid follicular carcinoma metastasis could be made.The patient was stable and no tumor progression was observed after a combination of therapies including ¹³¹I and topical and targeted agents.

Conclusions

Thyroid follicular carcinoma are prone to bone metastasis, and bone metastasis is the first symptom in some cases. Clinical imaging and pathology are needed for correct diagnosis, and a successful treatment requires a combination of multiple approaches including ¹³¹I, which is a Radioactive Iodine Therapy(RAI), local therapy and targeted drug therapy.

To Freeze or Not to Freeze? Recommendations for Intraoperative Examination and Gross Prosection of Thyroid Glands

The use of intraoperative consultation for indeterminate thyroid lesions is not advocated but is still requested by some surgeons. Obscured cytomorphology and nonrepresentative sampling limit the specificity of intraoperative assessment. Formalin fixation of thyroid glands before sectioning also minimizes artifacts introduced by fresh sectioning. Inking of thyroid may vary based on institutional preferences and information desired by clinical teams. Sectioning may occur in the conventional transverse method or the modified transverse vertical method to more thoroughly evaluate the lesion's periphery. Gross examination of thyroid lesions should always consider possible high-grade features, such as necrosis or extrathyroidal extension.

Malignant human thyroid neoplasms associated with blood parasitic (haemosporidian) infection

Investigation of archival cytological material obtained by cytologists during fine-needle aspiration biopsy in follicular, papillary, and medullary human thyroid cancers revealed haemosporidian (blood parasitic) infection. Haemosporidian infection was detected as exo- and intraerythrocytic stages of development in thyrocytes schizogony. The exoerythrocytic stage of development is represented as microschizonts in a thyroid needle biopsy specimen. Probably, blood parasitic infection is the common etiology for these pathologies. All biopsy material in medical laboratories was stained with RomanowskyGiemsa stain. To clarify the localization of nuclei (DNA) of thyrocytes and nuclei (DNA) of haemosporidian infection in cytological material following investigation of the entire set of smears, a selective series of original archival smears was stained (restained) with a Feulgen/Schiff reagent. Staining of smears with RomanowskyGiemsa stain is an adsorption method that enables re-use of the same smears for staining with a Feulgen/Schiff reagent where the fuchsin dye, after DNA hydrolysis by hydrochloric acid, is incorporated into DNA and stains it in redviolet (crimsonlilac) color. An intentionally unstained protoplasm of blood parasitic infection was present as a light band around erythrocyte nuclei. In follicular thyroid cancer, Feulgen staining of thyrocytes revealed nuclear DNA and parasitic DNA (haemosporidium nuclei) as point inclusions and rings and diffusely distributed in the thyrocyte cytoplasm. The thyrocyte cytoplasm and nuclei were vacuolated, with thyrocyte nuclei being deformed, flattened, and displaced to the cell periphery. The erythrocytes, which were initially stained with eosin (orange color), contained haemosporidian nuclei (DNA). In some cases, endoglobular inclusions in thyrocytes and erythrocytes were of the same size. In papillary thyroid cancer, we were able to localize the nuclear DNA of thyrocytes and the parasitic DNA as point inclusions and diffusely distributed in the thyrocyte cytoplasm. Two or more polymorphic nuclei may eccentrically occur in the hyperplastic cytoplasm. Haemosporidian microschizonts occurred circumnuclearly in thyrocytes and as an exoerythrocytic stage in the blood. The erythrocyte cytoplasm contained redviolet polymorphic haemosporidian nuclei (DNA). In medullary thyroid cancer, the hyperplastic cytoplasm of thyrocytes contained eccentrically located nuclei (DNA) of thyrocytes and small haemosporidian nuclei (DNA), which may occupy the whole thyrocyte. There were thyrocytes with vacuolated cytoplasm and pronounced nuclear polymorphism. The size of hyperplastic nuclei was several times larger than that of normal thyrocyte nuclei. The color of stained cytoplasmic and nuclear vacuoles of thyrocytes was less redviolet compared with that of surrounding tissues, which probably indicates the presence of parasitic DNA in them. The haemosporidian nuclear material in erythrocytes is represented by polymorphic nuclei, which may indicate the simultaneous presence of different pathogen species and/or generations in the blood. Intracellular parasitism of haemosporidian infection in thyrocytes (schizogony) associated with three thyroid cancers leads to pronounced cytoplasmic hyperplasia, cytoplasmic vacuolization, and nuclear vacuolization of the thyrocyte, followed by impaired secretory function. Multinucleated thyrocytes with incomplete cytokinesis appear. The absence of lytic death of the affected thyrocytes indicates that the contagium is able to control apoptosis and influence physiological functions of the cell. There is deformation of the nuclei, which leads to a decrease in their size, their flattening and displacement to the cell periphery, with high risk of DNA mutations and deletions in affected cells, reaching a neoplastic level.

Follicular Thyroid Adenoma and Follicular Thyroid Carcinoma-A Common or Distinct Background? Loss of Heterozygosity in Comprehensive Microarray Study

Pre- and postsurgical differentiation between follicular thyroid adenoma (FTA) and follicular thyroid cancer (FTC) represents a significant diagnostic challenge. Furthermore, it remains unclear whether they share a common or distinct background and what the mechanisms underlying follicular thyroid lesions malignancy are. The study aimed to compare FTA and FTC by the comprehensive microarray and to identify recurrent regions of loss of heterozygosity (LOH). We analyzed formalin-fixed paraffin-embedded (FFPE) samples acquired from 32 Caucasian patients diagnosed with FTA (16) and FTC (16). We used the OncoScan™ microarray assay (Affymetrix, USA), using highly multiplexed molecular inversion probes for single nucleotide polymorphism (SNP). The total number of LOH was higher in FTC compared with FTA (18 vs. 15). The most common LOH present in 21 cases, in both FTA (10 cases) and FTC (11 cases), was 16p12.1, which encompasses many cancer-related genes, such as TP53, and was followed by 3p21.31. The only LOH present exclusively in FTA patients (56% vs. 0%) was 11p11.2-p11.12. The alteration which tended to be detected more often in FTC (6 vs. 1 in FTA) was 12q24.11-q24.13 overlapping FOXN4, MYL2, PTPN11 genes. FTA and FTC may share a common genetic background, even though differentiating rearrangements may also be detected.

Adult-type rhabdomyoma of the thyroid: A case report

Adult-type rhabdomyoma (AR) is a benign myogenous neoplasm. It is rarely located in the thyroid. We present a case of a 61-year-old man, presenting with complaints of a mass found in his left neck for three years. Ultrasonography and computed tomography showed a mass in the left lobe of the thyroid. Subsequently, a fine-needle aspiration biopsy showed that the lesion was suspected to be an oncocytic neoplasm, and the patient underwent surgery. Finally, the lesion was confirmed to be an AR of the thyroid by postoperative pathological diagnosis. In conclusion, AR that occurs in the thyroid is remarkably rare. No case reports to date have described in detail the imaging findings of AR in the thyroid. This study demonstrates the imaging characteristics of a patient with AR of the thyroid, in order to provide more extensive insights to consider the differential diagnosis of thyroid lesions.

The Role of Claudin-1 Expression in Follicular and Papillary Thyroid Neoplasm

OBJECTIVE

This study evaluated differences in Claudin-1 expression between follicular adenoma (FA), follicular thyroid carcinoma (FTC), follicular variant papillary thyroid carcinoma (FV-PTC), and papillary thyroid carcinoma (PTC).

MATERIAL AND METHODS

This study used a cross-sectional approach. Immunostaining using the polyclonal antibody Claudin-1 was performed on 75 samples divided into 20 samples for follicular adenoma, follicular thyroid carcinoma, papillary carcinoma, and 15 samples of follicular variant thyroid carcinoma, respectively.

RESULTS

Claudin-1 expression is detected on the cytoplasmic membrane of tumor cells and appears to be varied among thyroid neoplasms. The claudin-1 expression score revealed a statistically significant difference between FA against FV-PTC, FA versus (vs) PTC, and FTC vs PTC, with median values of 4 vs 6 (p = 0.016), 4 vs 8 (p = 0.001), and 5 vs 8 (p = 0.002), respectively. However, there was no statistically significant difference in scores between the FA and the FTC (4 vs 5), or between the FTC and the FV-PTC groups (5 vs 6 (p=1,000).

CONCLUSION

These results suggest that Claudin-1 may be capable of discriminating follicular adenoma from classic and follicular variant of papillary thyroid carcinoma. It can also differentiate follicular thyroid carcinoma and papillary thyroid carcinoma, especially for cases challenging to assess by hematoxylin and eosin staining. It still holds promise in providing targeted cancer therapy.

Diagnostic performance of six ultrasound-based risk stratification systems in thyroid follicular neoplasm: A retrospective multi-center study

This study aimed to compare the diagnostic performances of six commonly used ultrasound-based risk stratification systems for distinguishing follicular thyroid adenoma (FTA) from follicular thyroid carcinoma (FTC), including the American Thyroid Association Sonographic Pattern System (ATASPS), ultrasound classification systems proposed by American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinology (AACE/ACE/AME), Korean thyroid imaging reporting and data system (K-TIRADS), European Thyroid Association for the imaging reporting and data system (EU-TIRADS), American College of Radiology for the imaging reporting and data system (ACR-TIRADS), and 2020 Chinese Guidelines for Ultrasound Malignancy Risk Stratification of Thyroid Nodules (C-TIRADS). A total of 225 FTA or FTC patients were retrospectively analyzed, involving 251 thyroid nodules diagnosed by postoperative pathological examinations in three centers from January 2013 to October 2021. The diagnostic performances of six ultrasound-based risk stratification systems for distinguishing FTA from FTC were assessed by plotting the receiver operating characteristic (ROC) curves and compared at different cut-off values. A total of 205 (81.67%) cases of FTA and 46 (18.33%) cases of FTC were involved in the present study. Compared with those of FTA, FTC presented more typical ultrasound features of solid component, hypoechoic, irregular margin and sonographic halo (all P<0.001). There were no significant differences in ultrasound features of calcification, shape and comet-tail artifacts between cases of FTA and FTC. There was a significant difference in the category of thyroid nodules assessed by the six ultrasound-based risk stratification systems (P<0.001). The areas under the curve (AUCs) of ATASPS, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS in distinguishing FTA from FTC were 0.645, 0.729, 0.766, 0.635, 0.783 and 0.798, respectively. Our study demonstrated that all the six ultrasound-based risk stratification systems present potential in the differential diagnosis of FTA and FTC. Specifically, C-TIRADS exerts the best diagnostic performance among the Chinese patients. ATASPS possesses a high sensitivity, while K-TIRADS possesses a high specificity in distinguishing FTA from FTC.

Differentiate Thyroid Follicular Adenoma from Carcinoma with Combined Ultrasound Radiomics Features and Clinical Ultrasound Features

Noninvasive differentiating thyroid follicular adenoma from carcinoma preoperatively is of great clinical value to decrease the risks resulted from excessive surgery for patients with follicular neoplasm. The purpose of this study is to investigate the accuracy of ultrasound radiomics features integrating with ultrasound features in the differentiation between thyroid follicular carcinoma and adenoma. A total of 129 patients diagnosed as thyroid follicular neoplasm with pathologically confirmed follicular adenoma and carcinoma were enrolled and analyzed retrospectively. Radiomics features were extracted from preoperative ultrasound images with manually contoured targets. Ultrasound features and clinical parameters were also obtained from electronic medical records. Radiomics signature, combined model integrating radiomics features, ultrasound features, and clinical parameters were constructed and validated to differentiate the follicular carcinoma from adenoma. A total of 23 optimal features were selected from 449 extracted radiomics features. Clinical and ultrasound parameters of sex (p = 0.003), interior structure (p = 0.035), edge (p = 0.02), platelets (p = 0.007), and creatinine (p = 0.001) were associated with the differentiation between benign and malignant follicular neoplasm. The values of area under curves (AUCs) of the radiomics signature, clinical model, and combined model were 0.772 (95% CI: 0.707-0.838), 0.792 (95% CI: 0.715-0.869), and 0.861 (95% CI: 0.775-0.909), respectively. A final corrected AUC of 0.844 was achieved for the combined model after internal validation. Radiomics features from ultrasound images combined with ultrasound features and clinical factors are feasible to differentiate thyroid follicular carcinoma from adenoma noninvasive before operation to decrease the unnecessary of diagnostic thyroidectomy for patients with benign follicular adenoma.

Recent Application of Artificial Intelligence in Non-Gynecological Cancer Cytopathology: A Systematic Review

State-of-the-art artificial intelligence (AI) has recently gained considerable interest in the healthcare sector and has provided solutions to problems through automated diagnosis. Cytological examination is a crucial step in the initial diagnosis of cancer, although it shows limited diagnostic efficacy. Recently, AI applications in the processing of cytopathological images have shown promising results despite the elementary level of the technology. Here, we performed a systematic review with a quantitative analysis of recent AI applications in non-gynecological (non-GYN) cancer cytology to understand the current technical status. We searched the major online databases, including MEDLINE, Cochrane Library, and EMBASE, for relevant English articles published from January 2010 to January 2021. The searched query terms were: "artificial intelligence", "image processing", "deep learning", "cytopathology", and "fine-needle aspiration cytology." Out of 17,000 studies, only 26 studies (26 models) were included in the full-text review, whereas 13 studies were included for quantitative analysis. There were eight classes of AI models treated of according to target organs: thyroid (n = 11, 39%), urinary bladder (n = 6, 21%), lung (n = 4, 14%), breast (n = 2, 7%), pleural effusion (n = 2, 7%), ovary (n = 1, 4%), pancreas (n = 1, 4%), and prostate (n = 1, 4). Most of the studies focused on classification and segmentation tasks. Although most of the studies showed impressive results, the sizes of the training and validation datasets were limited. Overall, AI is also promising for non-GYN cancer cytopathology analysis, such as pathology or gynecological cytology. However, the lack of well-annotated, large-scale datasets with Z-stacking and external cross-validation was the major limitation found across all studies. Future studies with larger datasets with high-quality annotations and external validation are required.

IgG4-positive Hashimoto thyroiditis and its association with IgG4-related sclerosing disease

A woman in her 50s was referred with suspected thyroid malignancy and underwent total thyroidectomy. Immunohistochemical analysis revealed IgG4-positive Hashimoto's thyroiditis. IgG4-related thyroid disease is poorly understood, and thought to encompass various entities including IgG4-positive Hashimoto's thyroiditis, Fibrosing Variant of Hashimoto's thyroiditis, Reidel's thyroiditis and Graves' disease with elevated IgG4 levels. Furthermore, it may be associated with a systemic fibrosing condition called 'IgG4-related sclerosing disease'. The clinical significance of IgG4-positive thyroid disease, however, remains unclear.

PSHG-TISS: A collection of polarization-resolved second harmonic generation microscopy images of fixed tissues

Second harmonic generation (SHG) microscopy is acknowledged as an established imaging technique capable to provide information on the collagen architecture in tissues that is highly valuable for the diagnostics of various pathologies. The polarization-resolved extension of SHG (PSHG) microscopy, together with associated image processing methods, retrieves extensive image sets under different input polarization settings, which are not fully exploited in clinical settings. To facilitate this, we introduce PSHG-TISS, a collection of PSHG images, accompanied by additional computationally generated images which can be used to complement the subjective qualitative analysis of SHG images. These latter have been calculated using the single-axis molecule model for collagen and provide 2D representations of different specific PSHG parameters known to account for the collagen structure and distribution. PSHG-TISS can aid refining existing PSHG image analysis methods, while also supporting the development of novel image processing and analysis methods capable to extract meaningful quantitative data from the raw PSHG image sets. PSHG-TISS can facilitate the breadth and widespread of PSHG applications in tissue analysis and diagnostics.

Measurement(s)	Type I Collagen
Technology Type(s)	multi-photon laser scanning microscopy
Factor Type(s)	second order susceptibility tensor elements
Sample Characteristic - Organism	Homo sapiens
Sample Characteristic - Environment	laboratory environment
Sample Characteristic - Location	Romania

Features and diagnostic accuracy of fine needle aspiration cytology of thyroid nodules: retrospective study from Oman

BACKGROUND

Fine needle aspiration cytology (FNAC) of the thyroid has been a reliable and cost-effective method for diagnosing thyroid disorders. Since FNAC results are usually operator dependent, there is a compelling need to explore FNAC accuracy among Omanis.

OBJECTIVE

Describe cytological features of FNAC and assess FNAC accuracy compared to the postsurgical histopathology report.

DESIGN

Retrospective diagnostic accuracy study SETTING: Tertiary care center.

PATIENTS AND METHODS

Our study included adult Omani adult patients with thyroid nodules who underwent FNAC from 2014 to 2017 and had final pathology results for patients who underwent thyroid surgery. The results were classified according to the UK Royal college of Pathologists 'Thy' categories. Accuracy of FNAC was calculated by determining false and true positive and negative results based on histopathology findings.

MAIN OUTCOME MEASURES

FNAC accuracy (sensitivity and specificity) compared to the postsurgical histopathology.

SAMPLE SIZE

867 patients with 1359 ultrasound guided FNACs of thyroid nodule; 137 underwent surgery.

RESULTS

The mean age of the 867 patients was 43.7 (13.3) years, with a median of 42 years, and 87.8% were females. Out of 1359 FNACs, 1001 (73.7%) were benign (Thy2), 119 (8.8%) were atypia of undetermined significance or follicular lesion of undetermined significance (Thy3a), 31 (2.3%) were follicular neoplasm or suspicious for a follicular neoplasm (Thy3f), 52 (3.8%) were suspicious for malignancy (Thy4), 55 (4%) were malignant (Thy5), 101 (7.4%) as Unsatisfactory (Thy1). Only 137 patients underwent thyroid surgery, and the FNAC reports were compared with their final histopathology reports. The sensitivity, specificity and total accuracy of FNAC were 80.2%, 98.9% and 89.9%, respectively. The positive and negative predictive values of FNAC were 98.6% and 84.3%, respectively.

CONCLUSION

Our study findings confirmed that FNAC of the thyroid is a sensitive, specific, and accurate initial tool for the diagnosis of thyroid lesions. Most of the FNACs were benign with a very low malignancy rate. Due to the minimal chance of false negative results and the slow-growing nature of thyroid malignancy, it is important that patients with benign FNAC should have periodic clinical and radiological follow-up.

LIMITATIONS

Retrospective design and single-center study, and thyroid nodule size unavailable.

CONFLICT OF INTEREST

None.

Performance of current ultrasound-based malignancy risk stratification systems for thyroid nodules in patients with follicular neoplasms

OBJECTIVES

To investigate the ability of the currently used ultrasound-based malignancy risk stratification systems for thyroid neoplasms (ATA, AACE/ACE/AME, K-TIRADS, EU-TIRADS, ACR-TIRADS and C-TIRADS) in distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA). Additionally, we evaluated the ability of these systems in correctly determining the indication for biopsy.

METHODS

Three hundred twenty-nine follicular neoplasms with definitive postoperative histopathology were included. The nodules were categorized according to each of six stratification systems, based on ultrasound findings. We dichotomized nodules into the positive predictive group of FTC (high and intermediate risk) and negative group of FTC based on the classification results. Missed biopsy was defined as neoplasms that were diagnosed as FTCs but for which biopsy was not indicated based on lesion classification. Unnecessary biopsy was defined as neoplasms that were diagnosed as FTAs but for whom biopsy was considered indicated based on classification. The diagnostic performance and missed and unnecessary biopsy rates were evaluated for each stratification system.

RESULTS

The area under the curve of each system for distinguishing follicular neoplasms was < 0.700 (range, 0.511-0.611). The missed biopsy rates were 9.0-22.4%. The missed biopsy rates for lesions ≤ 4 cm and lesions sized 2-4 cm were 16.2-35.1% and 0-20.0%, respectively. Unnecessary biopsy rates were 65.3-93.1%. In ≤ 4 cm group, the unnecessary biopsy rates were 62.2-89.7%.

CONCLUSION

The malignancy risk stratification systems can select appropriate nodules for biopsy in follicular neoplasms, while they have limitations in distinguishing follicular neoplasms and reducing unnecessary biopsy. Specific stratification systems and recommendations should be established for follicular neoplasms.

KEY POINTS

• Current ultrasound-based malignancy risk stratification systems of thyroid nodules had low efficiency in the characterization of follicular neoplasms. • The adopted stratification systems showed acceptable performance for selecting FTC for biopsy but unsatisfactory performance for reducing unnecessary biopsy.

Farm and Companion Animal Organoid Models in Translational Research: A Powerful Tool to Bridge the Gap Between Mice and Humans

Animal organoid models derived from farm and companion animals have great potential to contribute to human health as a One Health initiative, which recognize a close inter-relationship among humans, animals and their shared environment and adopt multi-and trans-disciplinary approaches to optimize health outcomes. With recent advances in organoid technology, studies on farm and companion animal organoids have gained more attention in various fields including veterinary medicine, translational medicine and biomedical research. Not only is this because three-dimensional organoids possess unique characteristics from traditional two-dimensional cell cultures including their self-organizing and self-renewing properties and high structural and functional similarities to the originating tissue, but also because relative to conventional genetically modified or artificially induced murine models, companion animal organoids can provide an excellent model for spontaneously occurring diseases which resemble human diseases. These features of companion animal organoids offer a paradigm-shifting approach in biomedical research and improve translatability of in vitro studies to subsequent in vivo studies with spontaneously diseased animals while reducing the use of conventional animal models prior to human clinical trials. Farm animal organoids also could play an important role in investigations of the pathophysiology of zoonotic and reproductive diseases by contributing to public health and improving agricultural production. Here, we discuss a brief history of organoids and the most recent updates on farm and companion animal organoids, followed by discussion on their potential in public health, food security, and comparative medicine as One Health initiatives. We highlight recent evolution in the culturing of organoids and their integration with organ-on-a-chip systems to overcome current limitations in in vitro studies. We envision multidisciplinary work integrating organoid culture and organ-on-a-chip technology can contribute to improving both human and animal health.

The utility of serum anti-thyroglobulin antibody and thyroglobulin in the preoperative differential diagnosis of thyroid follicular neoplasms

PURPOSE

Distinguishing follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) before surgery is inherently challenging owing to the lack of malignant features on ultrasound, poor sensitivity of fine-needle biopsy, and the absence of definitive markers. We investigated whether thyroglobulin (Tg), anti-thyroglobulin antibody (TgAb), thyroid peroxidase antibodies (TPOAb), and thyroid stimulating hormone (TSH) can help differentiate FTC from FTA.

METHODS

Data pertaining to 319 patients with follicular neoplasms were retrospectively analyzed. We compared the serum markers between patients with confirmed FTC and FTA. We also analyzed the prevalence of FTC in different subgroups of patients based on serum marker levels.

RESULTS

TgAb was a risk factor for FTC. Compared to TgAb ≤11.68 IU/mL group, the odds ratio (OR) for FTC in TgAb 11.69-30.50 IU/mL group and TgAb >30.50 IU/mL group were 2.206 (1.114-4.369, P = 0.023) and 3.247 (1.684-6.260, P < 0.001), respectively. The prevalence of malignancy in TgAb >30.50 IU/mL group was significantly higher than in the TgAb ≤11.68 IU/mL group (32.9 vs. 13.1%, P = 0.001). In patients with TgAb (-) status, Tg was another risk factor for FTC. Compared to Tg ≤38.51 ng/mL group, OR of Tg >434.60 ng/mL group was 3.836 (1.625-9.058, P = 0.002); the prevalence of malignancy in the Tg >434.60 ng/mL group was 47.2% and higher than other groups.

CONCLUSIONS

TgAb and Tg levels may be useful markers for preoperative differential diagnosis of follicular neoplasms. Higher TgAb and Tg levels were associated with greater malignant risk. Thus, we should be cautious of preoperative TgAb and Tg in follicular neoplasms.

Ultrasound findings of the thyroid gland in children and adolescents

Ultrasonography (US) is an important diagnostic tool in evaluating thyroid diseases in pediatric patients. This pictorial essay reviews the application of various ultrasound techniques such as B-Mode ultrasound and color Doppler, elastography and contrast enhanced ultrasound (CEUS) in children and adolescents in various thyroid pathologies including congenital thyroid abnormalities, diffuse thyroid diseases (DTD), focal thyroid lesions and thyroid malignancy.

Thyroid cancer under the scope of emerging technologies

The vast majority of thyroid cancers originate from follicular cells. We outline outstanding issues at each step along the path of cancer patient care, from prevention to post-treatment follow-up and highlight how emerging technologies will help address them in the coming years. Three directions will dominate the coming technological landscape. Genomics will reveal tumoral evolutionary history and shed light on how these cancers arise from the normal epithelium and the genomics alteration driving their progression. Transcriptomics will gain cellular and spatial resolution providing a full account of intra-tumor heterogeneity and opening a window on the microenvironment supporting thyroid tumor growth. Artificial intelligence will set morphological analysis on an objective quantitative ground laying the foundations of a systematic thyroid tumor classification system. It will also integrate into unified representations the molecular and morphological perspectives on thyroid cancer.

Using Deep Convolutional Neural Networks for Enhanced Ultrasonographic Image Diagnosis of Differentiated Thyroid Cancer

Differentiated thyroid cancer (DTC) from follicular epithelial cells is the most common form of thyroid cancer. Beyond the common papillary thyroid carcinoma (PTC), there are a number of rare but difficult-to-diagnose pathological classifications, such as follicular thyroid carcinoma (FTC). We employed deep convolutional neural networks (CNNs) to facilitate the clinical diagnosis of differentiated thyroid cancers. An image dataset with thyroid ultrasound images of 421 DTCs and 391 benign patients was collected. Three CNNs (InceptionV3, ResNet101, and VGG19) were retrained and tested after undergoing transfer learning to classify malignant and benign thyroid tumors. The enrolled cases were classified as PTC, FTC, follicular variant of PTC (FVPTC), Hürthle cell carcinoma (HCC), or benign. The accuracy of the CNNs was as follows: InceptionV3 (76.5%), ResNet101 (77.6%), and VGG19 (76.1%). The sensitivity was as follows: InceptionV3 (83.7%), ResNet101 (72.5%), and VGG19 (66.2%). The specificity was as follows: InceptionV3 (83.7%), ResNet101 (81.4%), and VGG19 (76.9%). The area under the curve was as follows: Incep-tionV3 (0.82), ResNet101 (0.83), and VGG19 (0.83). A comparison between performance of physicians and CNNs was assessed and showed significantly better outcomes in the latter. Our results demonstrate that retrained deep CNNs can enhance diagnostic accuracy in most DTCs, including follicular cancers.

Poorly differentiated thyroid carcinoma arising from a lithium-induced goiter in a patient with schizophrenia: a case report

BACKGROUND

Lithium use causes goiter by increasing serum thyroid-stimulating hormone levels through the inhibition of thyroid hormone release. However, there are no reports of poorly differentiated thyroid carcinoma resulting from lithium-induced goiter. Herein, we report the case of a patient with schizophrenia who developed poorly differentiated thyroid carcinoma arising from a lithium-induced goiter.

CASE PRESENTATION

A 61-year-old woman who was taking lithium for schizophrenia, visited the thyroid-endocrine center with a 10 × 12 cm anterior neck mass. She had a slowly growing goiter approximately 30 years ago; however, when she came to the hospital for diabetes diagnosis 2 years ago, she had no accompanying symptoms and refused evaluation. Three months before her visit, her dysphagia and dyspnea worsened as the size of her goiter increased rapidly. A neck ultrasound and enhanced thyroid computed tomography (CT) examination revealed a 10.9 × 9.2 × 12.8 cm size multi-lobulated mass on the right thyroid gland, leading to a leftward deviation of the trachea. Diagnostic total thyroidectomy was performed, and microscopic findings and immunohistochemical staining results indicated poorly differentiated thyroid carcinoma (PDTC) in the right thyroid mass. Mutation analyses for BRAF and the telomerase reverse transcriptase (TERT) promoter was performed. No BRAF gene mutations were detected; however, TERT promoter C228T point mutation was present in the PDTC. The patient underwent radioactive iodine therapy two months after the surgery. At a recent follow-up 4 months postoperatively, she was taking thyroid hormone replacement and remained in a relatively good health with a serum thyroglobulin level of 0.55 ng/ml.

CONCLUSIONS

Thyroid examination of psychiatric patients who develop goiter due to long-term lithium treatment should be monitored regularly, and appropriate investigations and surgery should be performed in a timely manner if the goiter is growing rapidly.

Differentiated Thyroid Cancer Presenting With Solitary Bony Metastases to the Frontal Bone of the Skull

A 75-year-old lady was referred to the oral and maxillofacial surgery (OMFS) team with a painless swelling in the midline of her forehead. Investigations diagnosed it as a solitary metastasis of thyroid cancer. Follicular thyroid cancers are known to metastasise to bone; however, bony metastasis to the frontal bone of the skull is very rare. This case highlights how the effective use of a multidisciplinary team can lead to better patient outcomes. The patient went on to have a total thyroidectomy and received both radioactive iodine therapy and radiotherapy to the bony metastasis.

Alteration of Trace Elements in Multinodular Goiter, Thyroid Adenoma, and Thyroid Cancer

Modest progress has been made in understanding the role of trace elements as endocrine disruptors. The aim of this study was to examine whether there is a change in the content of trace elements in thyroid disease, as well as whether the ratio of elements could be considered a blood marker for thyroid disease. In addition, this study examined the influence of biological and clinical/pathological parameters on the elemental profile. Blood samples from patients diagnosed with multinodular goiter (MNG), thyroid adenoma (TA), and thyroid cancer (TC) were examined and compared with control samples using chemometric analysis. The concentrations of essential (Mn, Co, Cu, Zn, Se) and toxic elements (Ni, As, Cd, Pb, U) were determined by ICP-MS. This study showed for the first time that the content of Mn, Co, Ni, Cu, Zn, Se, and Pb in pathological blood samples was significantly lower compared to the control, while opposite results were obtained for As, Cd, and U. Based on the classification model, the most important trace metals for discrimination of MNG and TC from the control group (CG) were Co and Zn, while Co, Zn, and Mn influenced the distinction of CG from TA. Moreover, it was found that Cu/Zn and U/Se ratios had significantly increased values in pathological blood samples leading to the possibility of establishing new circulating screening markers. These findings can represent significant translational information since these diseases are widespread and the diagnostic procedure is still difficult in many cases.

A beneficial role of computer-aided diagnosis system for less experienced physicians in the diagnosis of thyroid nodule on ultrasound

Ultrasonography (US) is the primary diagnostic tool for thyroid nodules, while the accuracy is operator-dependent. It is widely used not only by radiologists but also by physicians with different levels of experience. The aim of this study was to investigate whether US with computer-aided diagnosis (CAD) has assisting roles to physicians in the diagnosis of thyroid nodules. 451 thyroid nodules evaluated by fine-needle aspiration cytology following surgery were included. 300 (66.5%) of them were diagnosed as malignancy. Physicians with US experience less than 1 year (inexperienced, n = 10), or more than 5 years (experienced, n = 3) reviewed the US images of thyroid nodules with or without CAD assistance. The diagnostic performance of CAD was comparable to that of the experienced group, and better than those of the inexperienced group. The AUC of the CAD for conventional PTC was higher than that for FTC and follicular variant PTC (0.925 vs. 0.499), independent of tumor size. CAD assistance significantly improved diagnostic performance in the inexperienced group, but not in the experienced groups. In conclusion, the CAD system showed good performance in the diagnosis of conventional PTC. CAD assistance improved the diagnostic performance of less experienced physicians in US, especially in diagnosis of conventional PTC.