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Scorziello C, Borcea MC, Biffoni M, Pernazza A, Arienzo F, Melcarne R, Ventrone L, Laca A, Grani G, Durante C, Consorti F, Giacomelli L. Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report. Clin Case Rep 2023; 11:e7417. [PMID: 37484755 PMCID: PMC10362120 DOI: 10.1002/ccr3.7417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 07/25/2023] Open
Abstract
Incidental sonographic discovery of thyroid nodules is an increasingly common event in clinical practice. Less frequently, patients with cytological benign thyroid nodules have suspicious cervical lymph nodes detected by ultrasound examination or by cytological exam. Here, we discuss an intriguing case of cervical lymph node metastasis with a probable thyroid origin in a 65-year-old asymptomatic male smoker. He underwent thyroidectomy and unilateral cervical lymphadenectomy. Despite a negative chest X-ray, the postoperative histological examination revealed that the lymph node metastasis was actually from a lung carcinoma. Metastatic lesions in cervical lymph nodes from non-thyroidal origins must be excluded when evaluating lesions in the region, especially when thyroid nodules subjected to fine needle aspiration biopsy yield negative results, or lymph node cytological evaluations are inconsistent with thyroid cytological findings and sonographic features. Thyroid and lung adenocarcinomas share some epithelial and mesenchymal markers. Thyroglobulin helps differentiate primary thyroid tumors from lung ones, but in cases of poor differentiation, distinguishing metastatic lesions in the thyroid gland can be challenging. Lung cancer (LC) is the leading cause of cancer mortality worldwide, and survival rates have only marginally improved over the last several decades. The ongoing clinical challenge is detecting LC at earlier stages of the disease.
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Affiliation(s)
| | | | - Marco Biffoni
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Angelina Pernazza
- Department of Medico‐Surgical Sciences and BiotechnologySapienza University of RomeRomeItaly
| | - Francesca Arienzo
- Department of Radiological, Oncological and Pathological SciencesSapienza University of RomeRomeItaly
| | | | - Luca Ventrone
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Angelo Laca
- Department of Surgical SciencesSapienza University of RomeRomeItaly
| | - Giorgio Grani
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Cosimo Durante
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | | | - Laura Giacomelli
- Department of Surgical SciencesSapienza University of RomeRomeItaly
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Scorziello C, Durante C, Biffoni M, Borcea MC, Consorti F, Laca A, Melcarne R, Ventrone L, Giacomelli L. The Size of a Thyroid Nodule with ACR TI-RADS Does Not Provide a Better Prediction of the Nature of the Nodule: A Single-Center Retrospective Real-Life Observational Study. Healthcare (Basel) 2023; 11:1673. [PMID: 37372791 DOI: 10.3390/healthcare11121673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
We investigated if thyroid nodule size has a predictive value of malignancy on a par with composition, echogenicity, shape, margin, and echogenic foci, and what would be the consequence of observing the rule of the American College of Radiology (ACR) to perform a fine-needle aspiration biopsy (FNAB). We conducted a retrospective real-life observational study on 86 patients who underwent surgery after a standardized diagnostic protocol. We divided the TR3, TR4, and TR5 classes into sub-classes according to the size threshold indicating FNAB (a: up to the threshold for no FNAB; b: over the threshold for FNAB suggested). We computed sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for the different sub-classes and Youden's index (Y) for the different possible cutoffs. Each sub-class showed the following PPV (0.67, 0.68, 0.70, 0.78, 0.72), NPV (0.56, 0.54, 0.51, 0.52, 0.59), and Y (0.20, 0.20, 0.22, 0.31, 0.30). In this real-life series, we did not find a significant difference in prediction of malignancy between the sub-categories according to the size threshold. All nodules have a pre-evaluation likelihood of being malignant, and the impact and utility of size thresholds may be less clear than suggested by the ACR TIRADS guidelines in patients undergoing standardized thyroid work up.
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Affiliation(s)
- Chiara Scorziello
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Maria Carola Borcea
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Fabrizio Consorti
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Angelo Laca
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Rossella Melcarne
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Luca Ventrone
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
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Zaami S, Melcarne R, Patrone R, Gullo G, Negro F, Napoletano G, Monti M, Aceti V, Panarese A, Borcea MC, Scorziello C, Ventrone L, Mamedov SN, Meggiorini ML, Vergine M, Giacomelli L. Oncofertility and Reproductive Counseling in Patients with Breast Cancer: A Retrospective Study. J Clin Med 2022; 11:jcm11051311. [PMID: 35268402 PMCID: PMC8911138 DOI: 10.3390/jcm11051311] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction. Improving the prognosis of breast cancer patients is of utmost importance in terms of increasing survival rates. Modern medicine has therefore prioritized better quality of life for patients, even after the disease, through a better management of the potential long-term side effects induced by anticancer treatments. Fertility preservation and family planning are therefore crucial issues to be addressed in all cancer patients of reproductive age. Along those lines, a new branch of medicine with distinct multidisciplinary characteristics has developed over the years: oncofertility. Although both national and international guidelines value reproductive counseling as an essential aspect of the diagnostic-therapeutic pathway, part and parcel of the informed consent process, it is not included within the protocols adopted by the operating units for the care and management of neoplastic diseases. Objective. This study aimed to evaluate the activity of the Breast Unit of the Policlinico Umberto I Hospital, Rome, Italy, and the degree of compliance with guidelines. By knowing the strengths and weaknesses of such approaches, the standards of care offered to breast cancer patients can be improved. Materials and methods. A retrospective study based on a review of medical records was conducted between 2014 and 2021. Patients under 40 years of age diagnosed with non-metastatic malignancies were included who received chemotherapy treatment, namely neoadjuvant, adjuvant or adjuvant hormone therapy. Results. The data were extracted from the medical records of 51 patients who met the inclusion criteria, 41% of whom received reproductive counseling, and of these, 43% decided to undertake a path of fertility preservation. Factors such as the absence of children and young age reportedly favored both the interest in counseling proposals by the medical staff and the decision to undertake a path of fertility preservation. Conclusions. The study shows that there has been growing interest in the topic of oncofertility, especially in light of law 219/2017. Therefore, since 2018, multiple proposals for reproductive counseling have been set forth, but there was not an equally growing demand for fertility preservation practices, which can be explained by the invasive nature of such practices, the patients’ concern about their own state of health, and poor or inadequate information. Such impediments highlight the importance of standardized counseling and the need for a multidisciplinary medical team to support the patient in the decision-making process. The study also revealed a drop in the number of patients receiving counseling due to the COVID-19 pandemic, contrary to the positive trend that was recorded prior to the pandemic.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
- Correspondence:
| | - Rossella Melcarne
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Renato Patrone
- ICTUS, University of Naples Federico II, 80131 Naples, Italy;
| | - Giuseppe Gullo
- In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy;
| | - Francesca Negro
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
| | - Gabriele Napoletano
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (F.N.); (G.N.)
| | - Marco Monti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (M.M.); (M.L.M.)
| | - Valerio Aceti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Alessandra Panarese
- General and Transplant Surgery Department, Dipartimento di Scienze Cliniche Applicate e Biotecnologiche (DISCAB), University of L’Aquila, 67100 L’Aquila, Italy;
| | - Maria Carola Borcea
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Chiara Scorziello
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Luca Ventrone
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Samira Nicole Mamedov
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Maria Letizia Meggiorini
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, “Sapienza” University of Rome, 00161 Rome, Italy; (M.M.); (M.L.M.)
| | - Massimo Vergine
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
| | - Laura Giacomelli
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.M.); (M.C.B.); (C.S.); (L.V.); (S.N.M.); (M.V.); (L.G.)
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Grani G, Cera G, Conzo G, Del Gatto V, di Gioia CRT, Maranghi M, Lucia P, Cantisani V, Metere A, Melcarne R, Borcea MC, Scorziello C, Menditto R, Summa M, Biffoni M, Durante C, Giacomelli L. Preoperative Ultrasonography in the Evaluation of Suspected Familial Non-Medullary Thyroid Cancer: Are We Able to Predict Multifocality and Extrathyroidal Extension? J Clin Med 2021; 10:jcm10225277. [PMID: 34830559 PMCID: PMC8624166 DOI: 10.3390/jcm10225277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
Family history of thyroid cancer increases the risk of harboring thyroid malignancies that end up having extrathyroidal extension (ETE) and multifocality on histology; some authors suggest a more aggressive surgical approach. Their pre-operative identification could allow more conservative surgical procedures if none of these features are suspected. Our aim was to assess if neck ultrasonography could identify or exclude multifocality or ETE in these patients to tailor the extent of surgery. This retrospective study included patients with previous thyroid surgery, ≥1 first-grade relative with thyroid cancer, and who had undergone pre-surgical ultrasound. ETE was suspected in the case of thyroid border interruption or gross invasion of perithyroidal tissues. Multiple suspicious nodules were defined as suspicion of multifocal cancer. The cohort consisted of 45 patients (median age 49 years, 40 with thyroid cancer, 30 females). The positive predictive value of ultrasonography in predicting multifocality and ETE was 57.14% (25.25–84.03) and 41.67% (21.5–65.1%), respectively, while the negative predictive values were 63.2% (56.4–69.4%) and 72.7% (63.3–80.5%). Pre-operative ultrasound examination is unable to reliably identify or exclude multifocal disease or extrathyroidal extension. In patients scheduled for surgery and with a first-degree relative affected by DTC, a “negative” pre-operative US report does not exclude the potential finding of multifocality and ETE at final histopathology.
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Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Gianluca Cera
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Giovanni Conzo
- Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, I-80131 Naples, Italy;
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Cira Rosaria Tiziana di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (C.R.T.d.G.); (V.C.)
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Piernatale Lucia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Vito Cantisani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (C.R.T.d.G.); (V.C.)
| | - Alessio Metere
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Rossella Melcarne
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Maria Carola Borcea
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Chiara Scorziello
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Rosa Menditto
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Marco Summa
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
- Correspondence: ; Tel.: +39-0-649-975-130
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
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5
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Bellini MI, Biffoni M, Patrone R, Borcea MC, Costanzo ML, Garritano T, Melcarne R, Menditto R, Metere A, Scorziello C, Summa M, Ventrone L, D’Andrea V, Giacomelli L. Poorly Differentiated Thyroid Carcinoma: Single Centre Experience and Review of the Literature. J Clin Med 2021; 10:jcm10225258. [PMID: 34830540 PMCID: PMC8623499 DOI: 10.3390/jcm10225258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/21/2022] Open
Abstract
There is controversy in the literature regarding a distinct subset of thyroid carcinoma whose histologically classification falls between well-differentiated and anaplastic carcinomas, previously identified as ‘poorly differentiated thyroid carcinoma’ (PDTC), or ‘insular carcinoma’, in view of the peculiar morphological characteristics of the cell groupings. The correct diagnosis and treatment of this entity have important prognostic and therapeutic significance. In this review, we describe the epidemiology, diagnosis, and management of PDTC and report our single centre experience to add to the limited evidence existing in the literature.
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Affiliation(s)
- Maria Irene Bellini
- Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
- Correspondence:
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Renato Patrone
- ICTUS, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy;
| | - Maria Carola Borcea
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Maria Ludovica Costanzo
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Tiziana Garritano
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Rossella Melcarne
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Rosa Menditto
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Alessio Metere
- General Surgery Department, Ospedale dei Castelli (O.D.C.), Via Nettunense Km 11,5, 00040 Rome, Italy;
| | - Chiara Scorziello
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Marco Summa
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Luca Ventrone
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.B.); (M.C.B.); (M.L.C.); (T.G.); (R.M.); (R.M.); (C.S.); (M.S.); (L.V.); (V.D.); (L.G.)
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