1
|
Biffoni M, Grani G, Melcarne R, Geronzi V, Consorti F, Ruggieri GD, Galvano A, Razlighi MH, Iannuzzi E, Engel TD, Pace D, Di Gioia CRT, Boniardi M, Durante C, Giacomelli L. Drawing as a Way of Knowing: How a Mapping Model Assists Preoperative Evaluation of Patients with Thyroid Carcinoma. J Clin Med 2024; 13:1389. [PMID: 38592234 PMCID: PMC10931768 DOI: 10.3390/jcm13051389] [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: 01/07/2024] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Effective pre-surgical planning is crucial for achieving successful outcomes in endocrine surgery: it is essential to provide patients with a personalized plan to minimize operative and postoperative risks. Methods: Preoperative lymph node (LN) mapping is a structured high-resolution ultrasonography examination performed in the presence of two endocrinologists and the operating surgeon before intervention to produce a reliable "anatomical guide". Our aim was to propose a preoperative complete model that is non-invasive, avoids overdiagnosis of thyroid microcarcinomas, and reduces medical expenses. Results: The use of 'preoperative echography mapping' has been shown to be successful, particularly in patients with suspected or confirmed neoplastic malignancy. Regarding prognosis, positive outcomes have been observed both post-surgery and in terms of recurrence rates. We collected data on parameters such as biological sex, age, BMI, and results from cytologic tests performed with needle aspiration, and examined whether these parameters predict tumor malignancy or aggressiveness, calculated using a multivariate analysis (MVA). Conclusions: A standard multidisciplinary approach for evaluating neck lymph nodes pre-operation has proven to be an improved diagnostic and preoperative tool.
Collapse
Affiliation(s)
- Marco Biffoni
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Rossella Melcarne
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Valerio Geronzi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Fabrizio Consorti
- Department of General Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Giuseppe De Ruggieri
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Alessia Galvano
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Maryam Hosseinpour Razlighi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Eva Iannuzzi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Tal Deborah Engel
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Daniela Pace
- Department of Endocrinology, Valmontone Hospital, 00038 Valmontone, Italy;
| | - Cira Rosaria Tiziana Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy;
| | - Marco Boniardi
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy;
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Laura Giacomelli
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| |
Collapse
|
2
|
De Leo S, D'Elia S, Grani G, Dondi F, Bertagna F, Puxeddu E, Morelli S, Piovesan A, Nervo A, Zatelli MC, Gagliardi I, Samà MT, Aimaretti G, Crocetti U, Massa M, Deandrea M, Retta F, Pagano L, Rossi M, Solaroli E, Pezzullo L, Chiofalo MG, Pontecorvi A, Lombardi CP, Antonelli A, Patrizio A, Messuti I, Magri F, Spiazzi G, Ceresini G, Bruno R, Sparano C, Centanni M, Crescenzi A, Tallini G, Marotta V, Madeo B, Mian C, Filetti S, Durante C, Fugazzola L. A Prospective Multicenter Study Examining the Relationship Between Thyroid Cancer Treatment Outcomes and the Presence of Autoimmune Thyroiditis. Thyroid 2023; 33:1318-1326. [PMID: 37725571 DOI: 10.1089/thy.2023.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Background: There is some controversy on the potential relationship between autoimmune processes and clinicopathologic features as well as prognosis of differentiated thyroid cancer (DTC), and the evidence is limited by its largely retrospective nature. We examined the relationship between the presence of autoimmune thyroiditis (AT) and 1-year thyroid cancer treatment outcomes in a large multicenter study using prospectively collected data. Methods: We included data from consecutive DTC patients enrolled in the Italian Thyroid Cancer Observatory (ITCO) database (NCT04031339). We divided the groups according to the presence (AT) or absence (no autoimmune thyroiditis [noAT]) of associated AT. We used propensity score matching to compare the clinical features and outcomes between the two groups at 1-year follow-up. Results: We included data from 4233 DTC patients, including 3172 (75%) females. The American Thyroid Association (ATA) risk levels were as follows: 51% (2160/4233) low risk, 41.3% (1750/4233) intermediate risk, and 7.6% (323/4233) high risk. There were 1552 patients (36.7%) who had AT. Before propensity score matching, AT patients were significantly younger and had a smaller and bilateral tumor (p < 0.0001). Patients with AT more frequently fell into the low- and intermediate-risk categories, while the ATA high risk was more frequent among noAT patients (p = 0.004). After propensity score matching, patients with AT more frequently showed evidence of disease (structural/biochemical incomplete response) versus excellent/indeterminate response, compared with patients without AT (7.3% vs. 4.5%, p = 0.001), with an odds ratio of 1.86 ([confidence interval: 1.3-2.6], p = 0.0001). However, when considering only structural persistence as the outcome, no statistically significant differences were observed between patients with or without AT (3.4% vs. 2.7%, p = 0.35). The elevated risk associated with the ATA intermediate and high risk at diagnosis remained consistently statistically significant. Conclusions: In this large prospective series, biochemical persistence was more frequent, at 1-year follow-up, in AT patients. However, there was no significant association between the presence of AT and structural persistence of disease. These findings may be explained by the presence of a residual thyroid tissue.
Collapse
Affiliation(s)
- Simone De Leo
- Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia D'Elia
- Department of Statistical Sciences and Sapienza University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Dondi
- Nuclear Medicine Department, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and ASST-Spedali Civili, Brescia, Italy
| | - Efisio Puxeddu
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Silvia Morelli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alice Nervo
- Oncological Endocrinology Unit, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Teresa Samà
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Maggiore della Carità University Hospital, Novara, Italy
| | - Gianluca Aimaretti
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Maggiore della Carità University Hospital, Novara, Italy
| | - Umberto Crocetti
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michela Massa
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maurilio Deandrea
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Francesca Retta
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Loredana Pagano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Mattia Rossi
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Erica Solaroli
- Unit of Endocrinology, Department of Medicine, AUSL Bologna, Bologna, Italy
| | - Luciano Pezzullo
- Thyroid Oncological Surgery Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Maria Grazia Chiofalo
- Thyroid Oncological Surgery Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Alfredo Pontecorvi
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Celestino Pio Lombardi
- Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Division of Endocrine Surgery, Unicamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Armando Patrizio
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Ilaria Messuti
- Department of Endocrinology and Andrology, Humanitas Gradenigo, Turin, Italy
| | - Flavia Magri
- Unit of Internal Medicine and Endocrinology, Department of Internal Medicine and Therapeutics, University of Pavia and Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Giovanna Spiazzi
- Endocrinology and Diabetology Unit, Department of Medicine, Azienda Ospedaliera-Universitaria di Verona, Verona, Italy
| | - Graziano Ceresini
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Rocco Bruno
- Endocrine Unit, Tinchi Hospital-ASM, Matera, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- UOC Endocrinologia, AUSL Latina, Latina, Italy
| | - Anna Crescenzi
- Unit of Endocrine Organs and Neuromuscolar Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giovanni Tallini
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna Medical Center, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Marotta
- UOC Clinica Endocrinologica e Diabetologica, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria Policlinico di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Caterina Mian
- Unit of Endocrinology, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | | | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Fugazzola
- Endocrine Oncology Unit, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
3
|
Grani G, Lamartina L, Montesano T, Maranghi M, Filetti S, Durante C, Lopatriello S. Ultrasound screening for thyroid nodules and cancer in individuals with family history of thyroid cancer: a micro-costing approach. J Endocrinol Invest 2023; 46:2327-2330. [PMID: 37052872 DOI: 10.1007/s40618-023-02087-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/02/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Screening programs that target healthy populations are an important tool for identifying unrecognized, asymptomatic disease. However, ultrasound screening for thyroid cancer has no obvious advantage in terms of cost-effectiveness in asymptomatic adults. There is far less consensus (and data) on the indications for screening in high-risk individuals. The aim of the study was to estimate the costs of ultrasound screening for individuals with first-degree family history of thyroid cancer. METHODS We conducted a prospective cross-sectional study from January 1, 2009 through December 31, 2018 in the Thyroid Cancer Outpatient Clinic of a large teaching hospital in Rome, Italy. We estimated the costs of an ultrasound screening protocol using the micro-costing bottom-up method. RESULTS For individuals without thyroid nodules, the screening examination had an estimated cost of €66.21 per screenee. For those found to have unsuspicious nodules, the estimated cost rose to €119.52 per screenee, owing to the addition of thyroid function tests. The estimated cost of screening for a subject with newly diagnosed nodules that were submitted to cytology was €259.89. The total cost of screening for the entire population of 1176 individuals was € 118,133.85. The total expenditure to confirm a single thyroid cancer diagnosis was €10,598.71. CONCLUSION A sonographic screening implies a significant direct expenditure and is likely to detect a very large number of individuals with benign nodules (more than 45 asymptomatic individuals are diagnosed with a thyroid nodule for each newly detected cancer case), whose long-term follow-up will further increase healthcare costs.
Collapse
Affiliation(s)
- G Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161, Rome, Italy
| | - L Lamartina
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161, Rome, Italy
- Service de Médecine Nucléaire et Cancérologie Endocrinienne, Gustave Roussy, Département d'Imagerie Médicale112 Rue Edouard Vaillant, 94805, Villejuif, France
| | - T Montesano
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161, Rome, Italy
| | - M Maranghi
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161, Rome, Italy
| | - S Filetti
- School of Health, UNITELMA Sapienza University of Rome, Viale Regina Elena 295, 00161, Rome, Italy.
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161, Rome, Italy
| | | |
Collapse
|
4
|
Pecce V, Sponziello M, Verrienti A, Grani G, Abballe L, Bini S, Annunziata S, Perotti G, Salvatori M, Zagaria L, Maggisano V, Russo D, Filetti S, Durante C. The role of miR-139-5p in radioiodine-resistant thyroid cancer. J Endocrinol Invest 2023; 46:2079-2093. [PMID: 36933170 PMCID: PMC10514163 DOI: 10.1007/s40618-023-02059-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
PURPOSE Radioiodine I-131 (RAI) is the therapy of choice for differentiated thyroid cancer (DTC). Between 5% and 15% of DTC patients become RAI refractory, due to the loss of expression/function of iodide metabolism components, especially the Na/I symporter (NIS). We searched for a miRNA profile associated with RAI-refractory DTC to identify novel biomarkers that could be potential targets for redifferentiation therapy. METHODS We analyzed the expression of 754 miRNAs in 26 DTC tissues: 12 responsive (R) and 14 non-responsive (NR) to RAI therapy. We identified 15 dysregulated miRNAs: 14 were upregulated, while only one (miR-139-5p) was downregulated in NR vs. R tumors. We investigated the role of miR-139-5p in iodine uptake metabolism. We overexpressed miR-139-5p in two primary and five immortalized thyroid cancer cell lines, and we analyzed the transcript and protein levels of NIS and its activation through iodine uptake assay and subcellular protein localization. RESULTS The finding of higher intracellular iodine levels and increased cell membrane protein localization in miR-139-5p overexpressing cells supports the role of this miRNA in the regulation of NIS function. CONCLUSIONS Our study provides evidence of miR-139-5p involvement in iodine uptake metabolism and suggests its possible role as a therapeutic target in restoring iodine uptake in RAI-refractory DTC.
Collapse
Affiliation(s)
- V Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - M Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - A Verrienti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - G Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - L Abballe
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - S Bini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - S Annunziata
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - G Perotti
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - M Salvatori
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - L Zagaria
- Unità di Medicina Nucleare, TracerGLab, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - V Maggisano
- Department of Health Sciences, Università Di Catanzaro "Magna Graecia", Catanzaro, Italy
| | - D Russo
- Department of Health Sciences, Università Di Catanzaro "Magna Graecia", Catanzaro, Italy
| | - S Filetti
- Unitelma, Sapienza University of Rome, Rome, Italy
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
5
|
Durante C, Hegedüs L, Na DG, Papini E, Sipos JA, Baek JH, Frasoldati A, Grani G, Grant E, Horvath E, Hoang JK, Mandel SJ, Middleton WD, Ngu R, Orloff LA, Shin JH, Trimboli P, Yoon JH, Tessler FN. International Expert Consensus on US Lexicon for Thyroid Nodules. Radiology 2023; 309:e231481. [PMID: 37906014 DOI: 10.1148/radiol.231481] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Multiple US-based systems for risk stratification of thyroid nodules are in use worldwide. Unfortunately, the malignancy probability assigned to a nodule varies, and terms and definitions are not consistent, leading to confusion and making it challenging to compare study results and craft revisions. Consistent application of these systems is further hampered by interobserver variability in identifying the sonographic features on which they are founded. In 2018, an international multidisciplinary group of 19 physicians with expertise in thyroid sonography (termed the International Thyroid Nodule Ultrasound Working Group) was convened with the goal of developing an international system, tentatively called the International Thyroid Imaging Reporting and Data System, or I-TIRADS, in two phases: (phase I) creation of a lexicon and atlas of US descriptors of thyroid nodules and (phase II) development of a system that estimates the malignancy risk of a thyroid nodule. This article presents the methods and results of phase I. The purpose herein is to show what has been accomplished thus far, as well as generate interest in and support for this effort in the global thyroid community.
Collapse
Affiliation(s)
- Cosimo Durante
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Laszlo Hegedüs
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Dong Gyu Na
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Enrico Papini
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jennifer A Sipos
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jung Hwan Baek
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Andrea Frasoldati
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Giorgio Grani
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Edward Grant
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Eleonora Horvath
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jenny K Hoang
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Susan J Mandel
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - William D Middleton
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Rose Ngu
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Lisa Ann Orloff
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jung Hee Shin
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Pierpaolo Trimboli
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Jung Hyun Yoon
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| | - Franklin N Tessler
- From the Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy (C.D., G.G.); Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark (L.H.); Department of Radiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea (D.G.N.); Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy (E.P.); Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio (J.A.S.); Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, Korea (J.H.B.); Endocrinology Unit, Arcispedale S. Maria Nuova IRCCS, Reggio Emilia, Italy (A.F.); Department of Radiology, Keck Hospital of USC, University of Southern California, Los Angeles, Calif (E.G.); Department of Imaging, Universidad del Desarrollo, Clínica Alemana de Santiago, Santiago, Chile (E.H.); Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Md (J.K.H.); Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pa (S.J.M.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.); Department of Dental Radiological Imaging, Guy's and St Thomas NHS Foundation Trust & King's College London Dental Institute, London, United Kingdom (R.N.); Department of Otolaryngology - Head and Neck Surgery, Stanford Cancer Center, Stanford University School of Medicine, Stanford, Calif (L.A.O.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (J.H.S.); Clinic for Endocrinology and Diabetology, Ente Ospedaliero Cantonale, Lugano, Switzerland (P.T.); Department of Radiology, Severance Hospital Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea (J.H.Y.); and Department of Radiology, The University of Alabama at Birmingham Heersink School of Medicine, 619 19th St S, Birmingham, AL 35249 (F.N.T.)
| |
Collapse
|
6
|
Grani G, Del Gatto V, Cantisani V, Mandel SJ, Durante C. A Reappraisal of Suspicious Sonographic Features of Thyroid Nodules: Shape Is Not an Independent Predictor of Malignancy. J Clin Endocrinol Metab 2023; 108:e816-e822. [PMID: 36810804 DOI: 10.1210/clinem/dgad092] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/02/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT For the correct clinical application of the sonographic risk-stratification systems, the definition of independent risk features that are foundational to each system is crucial. OBJECTIVE The aim of this study was to identify the gray-scale sonographic features independently associated with malignancy, and to compare different definitions. METHODS This prospective, diagnostic accuracy study took place in a single thyroid nodule referral center. All patients consecutively referred to our center for fine-needle aspiration cytology of a thyroid nodule between November 1, 2015 and March 30, 2020, were enrolled before cytology. Each nodule was examined by 2 experienced clinicians to record the sonographic features on a rating form. Histologic (when available) or cytologic diagnosis was used as the reference standard. For each single sonographic feature and definition, the sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratios (DOR) were calculated. The significant predictors were then included in a multivariable regression model. RESULTS The final study cohort consisted of 903 nodules in 852 patients. A total of 76 nodules (8.4%) were malignant. Six features were independent predictors of malignancy: suspicious lymph node (DOR 16.23), extrathyroidal extension (DOR 6.60), irregular or infiltrative margins (DOR 7.13), marked hypoechogenicity (DOR 3.16), solid composition (DOR 3.61), and punctate hyperechoic foci (including microcalcifications and indeterminate foci; DOI 2.69). Taller-than-wide shape was not confirmed as an independent predictor. CONCLUSION We identified the key suspicious features of thyroid nodules and provided a simplified definition of some debated ones. Malignancy rate increases with number of features.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| | - Vito Cantisani
- Department of Radiological, Anatomo-Pathological, and Oncological Sciences, "Sapienza" University of Rome, Rome 00161, Italy
| | - Susan J Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00161, Italy
| |
Collapse
|
7
|
Grani G, Gentili M, Siciliano F, Albano D, Zilioli V, Morelli S, Puxeddu E, Zatelli MC, Gagliardi I, Piovesan A, Nervo A, Crocetti U, Massa M, Samà MT, Mele C, Deandrea M, Fugazzola L, Puligheddu B, Antonelli A, Rossetto R, D'Amore A, Ceresini G, Castello R, Solaroli E, Centanni M, Monti S, Magri F, Bruno R, Sparano C, Pezzullo L, Crescenzi A, Mian C, Tumino D, Repaci A, Castagna MG, Triggiani V, Porcelli T, Meringolo D, Locati L, Spiazzi G, Di Dalmazi G, Anagnostopoulos A, Leonardi S, Filetti S, Durante C. A Data-Driven Approach to Refine Predictions of Differentiated Thyroid Cancer Outcomes: A Prospective Multicenter Study. J Clin Endocrinol Metab 2023; 108:1921-1928. [PMID: 36795619 DOI: 10.1210/clinem/dgad075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
CONTEXT The risk stratification of patients with differentiated thyroid cancer (DTC) is crucial in clinical decision making. The most widely accepted method to assess risk of recurrent/persistent disease is described in the 2015 American Thyroid Association (ATA) guidelines. However, recent research has focused on the inclusion of novel features or questioned the relevance of currently included features. OBJECTIVE To develop a comprehensive data-driven model to predict persistent/recurrent disease that can capture all available features and determine the weight of predictors. METHODS In a prospective cohort study, using the Italian Thyroid Cancer Observatory (ITCO) database (NCT04031339), we selected consecutive cases with DTC and at least early follow-up data (n = 4773; median follow-up 26 months; interquartile range, 12-46 months) at 40 Italian clinical centers. A decision tree was built to assign a risk index to each patient. The model allowed us to investigate the impact of different variables in risk prediction. RESULTS By ATA risk estimation, 2492 patients (52.2%) were classified as low, 1873 (39.2%) as intermediate, and 408 as high risk. The decision tree model outperformed the ATA risk stratification system: the sensitivity of high-risk classification for structural disease increased from 37% to 49%, and the negative predictive value for low-risk patients increased by 3%. Feature importance was estimated. Several variables not included in the ATA system significantly impacted the prediction of disease persistence/recurrence: age, body mass index, tumor size, sex, family history of thyroid cancer, surgical approach, presurgical cytology, and circumstances of the diagnosis. CONCLUSION Current risk stratification systems may be complemented by the inclusion of other variables in order to improve the prediction of treatment response. A complete dataset allows for more precise patient clustering.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Michele Gentili
- Department of Computer, Control, and Management Engineering "Antonio Ruberti", Sapienza University of Rome, 00185 Rome, Italy
| | - Federico Siciliano
- Department of Computer, Control, and Management Engineering "Antonio Ruberti", Sapienza University of Rome, 00185 Rome, Italy
| | - Domenico Albano
- Department of Nuclear Medicine, Università e ASST-Spedali Civili- Brescia, 25123 Brescia, Italy
| | - Valentina Zilioli
- Department of Nuclear Medicine, Università e ASST-Spedali Civili- Brescia, 25123 Brescia, Italy
| | - Silvia Morelli
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Efisio Puxeddu
- Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology, Geriatrics and Internal Medicine, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Alice Nervo
- Oncological Endocrinology Unit, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Umberto Crocetti
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Michela Massa
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Maria Teresa Samà
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Chiara Mele
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Maurilio Deandrea
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, 10128 Torino, Italy
| | - Laura Fugazzola
- Department of Endocrinology and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Barbara Puligheddu
- Department of Endocrinology and Andrology, Humanitas Gradenigo, University of Turin, 10153 Turin, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
| | - Ruth Rossetto
- Department of Endocrinology and Metabolic Diseases, AO Città della Salute e della Scienza Turin, University of Turin, 10126 Turin, Italy
| | - Annamaria D'Amore
- Division of Endocrine Surgery, Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Graziano Ceresini
- Department of Medicine and Surgery, University Hospital of Parma, 43121 Parma, Italy
| | - Roberto Castello
- Department of Medicine, Hospital and University of Verona, 37129 Verona, Italy
| | - Erica Solaroli
- Unit of Endocrinology, Department of Medicine, AUSL, 40124 Bologna, Italy
| | - Marco Centanni
- Department of Medico-surgical Sciences and Biotechnologies, Sapienza University of Rome, and UOC Endocrinologia, AUSL Latina, 04100 Latina, Italy
| | - Salvatore Monti
- Endocrinology and Diabetes Unit, Azienda Ospedaliero-Universitaria Sant'Andrea, "Sapienza" University of Rome, 00189 Rome, Italy
| | - Flavia Magri
- Department of Internal Medicine and Therapeutics and Istituti Clinici Scientifici Maugeri IRCCS, Unit of Internal Medicine and Endocrinology, University of Pavia, 27100 Pavia, Italy
| | - Rocco Bruno
- Thyroid Unit, Tinchi Hospital-ASM Matera, 75100 Matera, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50139 Florence, Italy
| | - Luciano Pezzullo
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Anna Crescenzi
- Unit of Endocrine Organs and Neuromuscular Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy
| | - Caterina Mian
- Unit of Endocrinology, Department of Medicine-DIMED University of Padua, 35122 Padua, Italy
| | - Dario Tumino
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Andrea Repaci
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro" School of Medicine, 70121 Bari, Italy
| | - Tommaso Porcelli
- Department of Public Health, University of Naples "Federico II", 80138 Naples, Italy
| | | | - Laura Locati
- Translational Oncology Unit, IRCCS ICS Maugeri, 27100 Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Giovanna Spiazzi
- Endocrinology and Diabetology Unit, Department of Medicine, Azienda Ospedaliera-Universitaria di Verona, 37129 Verona, Italy
| | - Giulia Di Dalmazi
- Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Aris Anagnostopoulos
- Department of Computer, Control, and Management Engineering "Antonio Ruberti", Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Leonardi
- Department of Computer, Control, and Management Engineering "Antonio Ruberti", Sapienza University of Rome, 00185 Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Acitelli E, Maiorca C, Grani G, Maranghi M. Metabolic adverse events of multitarget kinase inhibitors: a systematic review. Endocrine 2023:10.1007/s12020-023-03362-2. [PMID: 37067769 PMCID: PMC10239378 DOI: 10.1007/s12020-023-03362-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Multitargeted kinase inhibitors (MKIs) are used for the treatment of several cancers. By targeting multiple signaling pathways, MKIs have become cornerstones of the oncologic treatment. Although their use leads to important results in terms of survival, treatment with MKIs can determine important side effects the clinician must be aware of. Among those, arterial hypertension, mucositis and skin lesions are universally reported, while data about metabolic alterations are scarce. In our review, we focused on glucose and lipid alterations in MKI-treated patients. METHODS We searched for articles, published between January 2012 and December 2022, evaluating the effects on lipid and glucose metabolism of four MKIs (Cabozantinib, Lenvatinib, Sorafenib, and Vandetanib) in adult patients with cancer. We focused on drugs approved for thyroid malignancies, since a worse metabolic control may potentially impact life expectancy, due to their better overall survival rate. RESULTS As for glucose metabolism, the majority of the studies reported elevation of glucose levels (prevalence: 1-17%) with different grades of severity, including death. As for cholesterol, 12 studies reported worsening or new-onset hypercholesterolemia (prevalence: 4-40%). Finally, 19 studies reported different grades of hypertriglyceridemia (prevalence: 1-86%), sometimes leading to life-threatening events. CONCLUSIONS Despite some inherent limitations, our analysis may cast light upon some of the MKIs metabolic disorders that can impact on patients' health, especially when long-term survival is expected. Future clinical trials should consider routine assessment of glucose and lipid levels, because underdetection and underreporting of alterations can lead to the overlooking of important adverse events.
Collapse
Affiliation(s)
- Elisa Acitelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Maiorca
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
10
|
Grani G, Ciotti L, Del Gatto V, Montesano T, Biffoni M, Giacomelli L, Sponziello M, Pecce V, Verrienti A, Filetti S, Durante C. The legacy of the COVID-19 pandemics for thyroid cancer patients: towards the application of clinical practice recommendations. Endocrine 2023; 79:45-48. [PMID: 35857273 PMCID: PMC9298162 DOI: 10.1007/s12020-022-03132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/30/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Laura Ciotti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Teresa Montesano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Sebastiano Filetti
- School of Health, UNITELMA Sapienza University of Rome, Piazza Sassari, 4, 00161, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| |
Collapse
|
11
|
Grani G, Ciotti L, Del Gatto V, Montesano T, Biffoni M, Giacomelli L, Sponziello M, Pecce V, Lucia P, Verrienti A, Filetti S, Durante C. The COVID-19 outbreak and de-escalation of thyroid cancer diagnosis and treatment. Endocrine 2022; 78:387-391. [PMID: 35802229 PMCID: PMC9264748 DOI: 10.1007/s12020-022-03131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/27/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Laura Ciotti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Teresa Montesano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Piernatale Lucia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Sebastiano Filetti
- School of Health, UNITELMA Sapienza University of Rome, Piazza Sassari, 4, 00161, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| |
Collapse
|
12
|
Grani G, Lamartina L, Montesano T, Giacomelli L, Biffoni M, Trulli F, Filetti S, Durante C. Prevalence of Thyroid Nodules and Thyroid Cancer in Individuals with a First-Degree Family History of Non-Medullary Thyroid Cancer: A Cross-Sectional Study Based on Sonographic Screening. Thyroid 2022; 32:1392-1401. [PMID: 36097761 DOI: 10.1089/thy.2022.0253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The actual rates of suspicious thyroid nodules (TNs) and confirmed thyroid cancer (TC) in putatively "at-risk" selected populations (e.g., individuals with family history of TC) are still uncertain. Methods: Our aim was to explore the prevalence of TC and TN in a cross-sectional study of a consenting population of unaffected individuals (10 years of age or older) with a first-degree relative known to have non-medullary TC (NMTC). Enrolled subjects underwent ultrasonographic studies of the neck between 2009 and 2018. Nodules considered suspicious according to current guidelines were subjected to fine-needle aspiration biopsy (FNAB) for cytology. Results: The screenee population comprised 1176 individuals (median age 42 [26-56] years, 650 females, 55.3%) from 473 kindreds (346 with 1 established NMTC diagnosis at entry, 103 with 2 established NMTC diagnoses, and 24 with 3 or more established NMTC diagnoses at entry). Screening revealed TNs in 500 screenees (42.5%; confidence interval [CI] 39.7-45.4%). Ninety-seven of these (19.4%; CI 16.2-23.1%) underwent FNAB. Only 11 cases of TC were diagnosed in the whole population (0.9%; CI 0.5-1.7%). The prevalence of TC in screenees from kindreds with ≥3 cases (3/24, 12.5%) was higher than that for kindreds with one affected member (6/346, 1.7%; p = 0.01, odds ratio [OR] 7.99; CI 1.21-40.75) and for those with two affected members (2/103, 1.9%; p = 0.05, OR 7.05; CI 0.76-89.44). The prevalence of TNs was 61.8% (CI 56.6-66.8%), 75.7% (CI 66.6-83%), and 66.7% (CI 46.7-82%) in the kindreds with 1, 2, and ≥3 cases, respectively (p = 0.03). Conclusions: On the whole, ultrasound-based screening of unaffected relatives of individuals with established diagnoses of NMTC is likely to reveal a high prevalence of TN and a low prevalence of TC. However, a significantly higher prevalence of TC may be found among screenees from kindreds with at least three established NMTC diagnoses before screening, suggesting that closer surveillance may be warranted in kindreds with this level of familiality.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Livia Lamartina
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Teresa Montesano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabiana Trulli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
13
|
Verrienti A, Grani G, Sponziello M, Pecce V, Damante G, Durante C, Russo D, Filetti S. Precision oncology for RET-related tumors. Front Oncol 2022; 12:992636. [PMID: 36091144 PMCID: PMC9449844 DOI: 10.3389/fonc.2022.992636] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 07/12/2022] [Accepted: 07/29/2022] [Indexed: 12/05/2022] Open
Abstract
Aberrant activation of the RET proto-oncogene is implicated in a plethora of cancers. RET gain-of-function point mutations are driver events in multiple endocrine neoplasia 2 (MEN2) syndrome and in sporadic medullary thyroid cancer, while RET rearrangements are driver events in several non-medullary thyroid cancers. Drugs able to inhibit RET have been used to treat RET-mutated cancers. Multikinase inhibitors were initially used, though they showed modest efficacy and significant toxicity. However, new RET selective inhibitors, such as selpercatinib and pralsetinib, have recently been tested and have shown good efficacy and tolerability, even if no direct comparison is yet available between multikinase and selective inhibitors. The advent of high-throughput technology has identified cancers with rare RET alterations beyond point mutations and fusions, including RET deletions, raising questions about whether these alterations have a functional effect and can be targeted by RET inhibitors. In this mini review, we focus on tumors with RET deletions, including deletions/insertions (indels), and their response to RET inhibitors.
Collapse
Affiliation(s)
- Antonella Verrienti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- *Correspondence: Giorgio Grani,
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Diego Russo
- Department of Health Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | | |
Collapse
|
14
|
Grani G, Filetti S, Durante C. New hope for patients with BRAF V600E-mutant anaplastic thyroid cancer: lights and shadows. Ann Palliat Med 2022; 11:2796-2801. [DOI: 10.21037/apm-22-603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/07/2022] [Indexed: 11/06/2022]
|
15
|
Sorrenti S, Dolcetti V, Radzina M, Bellini MI, Frezza F, Munir K, Grani G, Durante C, D’Andrea V, David E, Calò PG, Lori E, Cantisani V. Artificial Intelligence for Thyroid Nodule Characterization: Where Are We Standing? Cancers (Basel) 2022; 14:cancers14143357. [PMID: 35884418 PMCID: PMC9315681 DOI: 10.3390/cancers14143357] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [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: 05/09/2022] [Revised: 06/24/2022] [Accepted: 07/08/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary In the present review, an up-to-date summary of the state of the art of artificial intelligence (AI) implementation for thyroid nodule characterization and cancer is provided. The opinion on the real effectiveness of AI systems remains controversial. Taking into consideration the largest and most scientifically valid studies, it is possible to state that AI provides results that are comparable or inferior to expert ultrasound specialists and radiologists. Promising data approve AI as a support tool and simultaneously highlight the need for a radiologist supervisory framework for AI provided results. Therefore, current solutions might be more suitable for educational purposes. Abstract Machine learning (ML) is an interdisciplinary sector in the subset of artificial intelligence (AI) that creates systems to set up logical connections using algorithms, and thus offers predictions for complex data analysis. In the present review, an up-to-date summary of the current state of the art regarding ML and AI implementation for thyroid nodule ultrasound characterization and cancer is provided, highlighting controversies over AI application as well as possible benefits of ML, such as, for example, training purposes. There is evidence that AI increases diagnostic accuracy and significantly limits inter-observer variability by using standardized mathematical algorithms. It could also be of aid in practice settings with limited sub-specialty expertise, offering a second opinion by means of radiomics and computer-assisted diagnosis. The introduction of AI represents a revolutionary event in thyroid nodule evaluation, but key issues for further implementation include integration with radiologist expertise, impact on workflow and efficiency, and performance monitoring.
Collapse
Affiliation(s)
- Salvatore Sorrenti
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (S.S.); (V.D.); (E.L.)
| | - Vincenzo Dolcetti
- Department of Radiological, Anatomo-Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.); (V.C.)
| | - Maija Radzina
- Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia;
- Medical Faculty, University of Latvia, Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, LV-1007 Riga, Latvia
| | - Maria Irene Bellini
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (S.S.); (V.D.); (E.L.)
- Correspondence:
| | - Fabrizio Frezza
- Department of Information Engineering, Electronics and Telecommunications, “Sapienza” University of Rome, 00184 Rome, Italy; (F.F.); (K.M.)
- Consorzio Nazionale Interuniversitario per le Telecomunicazioni (CNIT), Viale G.P. Usberti 181/A Sede Scientifica di Ingegneria-Palazzina 3, 43124 Parma, Italy
| | - Khushboo Munir
- Department of Information Engineering, Electronics and Telecommunications, “Sapienza” University of Rome, 00184 Rome, Italy; (F.F.); (K.M.)
| | - Giorgio Grani
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (G.G.); (C.D.); (E.D.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (G.G.); (C.D.); (E.D.)
| | - Vito D’Andrea
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (S.S.); (V.D.); (E.L.)
| | - Emanuele David
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (G.G.); (C.D.); (E.D.)
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, “Policlinico Universitario Duilio Casula”, University of Cagliari, 09042 Monserrato, Italy;
| | - Eleonora Lori
- Department of Surgical Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (S.S.); (V.D.); (E.L.)
| | - Vito Cantisani
- Department of Radiological, Anatomo-Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (V.D.); (V.C.)
| |
Collapse
|
16
|
Abstract
Here, we describe a protocol to generate organoids from human thyroid cancer cells. Starting from the same patient-derived cells, we establish both organoids and primary lines. The organoid medium is supplemented with conditioned medium obtained from the primary cell line. This modification enables culture of the organoid lines for up to 10 months. Even after long-term culture, the organoids retain the genetic and phenotypic characteristics of their tissue of origin. Generate organoids from human thyroid cancer cells Use the conditioned medium obtained from the primary cell line for the growth Generate models that maintain genetic and phenotypic characteristics of their tissue of origin Use the models for translational research approaches
Publisher's note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.
Collapse
Affiliation(s)
- Valeria Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - Simone Bini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161 Roma, Italy
| |
Collapse
|
17
|
Cozzolino A, Filardi T, Simonelli I, Grani G, Virili C, Stramazzo I, Santaguida MG, Locantore P, Maurici M, Gianfrilli D, Isidori AM, Durante C, Pozza C. Diagnostic accuracy of ultrasonographic features in detecting thyroid cancer in the transition age: a meta-analysis. Eur Thyroid J 2022; 11:e220039. [PMID: 35521998 PMCID: PMC9254313 DOI: 10.1530/etj-22-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 11/08/2022] Open
Abstract
Context Significant uncertainty exists about the diagnostic accuracy of ultrasonographic (US) features used to predict the risk of thyroid cancer in the pediatric population. Moreover, there are no specific indications for thyroid nodule evaluation in patients during the transition age. Objective The meta-analysis aimed to address the following question: which thyroid nodule US features have the highest accuracy in predicting malignancy in the transition age. Methods We performed a meta-analysis of observational/cohort/diagnostic accuracy studies dealing with thyroid nodule sonography, reporting US features, and using histology as a reference standard for the diagnosis of malignancy and histology or cytology for the diagnosis of benignity in the transition age (mean/median age 12-21 years). Results The inclusion criteria were met by 14 studies, published between 2005 and 2020, including 1306 thyroid nodules (mean size 17.9 mm) from 1168 subjects. The frequency of thyroid cancer was 36.6%. The US features with the highest diagnostic odds ratio (DOR) for malignancy were the presence of suspicious lymph nodes (DOR: 56.0 (95% CI: 26.0-119.0)), a 'taller than wide' shape of the nodule (6.0 (95% CI: 2.0-16.0)), the presence of microcalcifications (13.0 (95% CI: 6.0-29.0)) and irregular margins (9.0 (95% CI: 5.0-17.0)). Heterogeneity among the studies was substantial. Conclusions Following the diagnosis of a thyroid nodule in the transition age, a thorough US examination of the neck is warranted. The detection of suspicious lymph nodes and/or thyroid nodules with a 'taller than wide' shape, microcalcifications, and irregular margins is associated with the highest risk of malignancy in the selection of nodules candidates for biopsy.
Collapse
Affiliation(s)
- Alessia Cozzolino
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Tiziana Filardi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Ilaria Simonelli
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Camilla Virili
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Ilaria Stramazzo
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Maria Giulia Santaguida
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
| | - Pietro Locantore
- Endocrinology Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - on behalf of TALENT Group
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Service of Medical Statistics and Information Technology, Fatebenefratelli Foundation for Health Research and Education, Rome, Italy
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Endocrinology Unit, Department of Medico-Surgical Sciences and Biotechnologies, ‘Sapienza’ University of Rome, Latina, Italy
- Endocrinology Unit, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
18
|
Cantisani V, De Silvestri A, Scotti V, Fresilli D, Tarsitano MG, Polti G, Guiban O, Polito E, Pacini P, Durante C, Grani G, Isidori AM, Giannetta E, Sorrenti S, Trimboli P, Catalano C, Cirocchi R, Lauro A, D'Andrea V. US-Elastography With Different Techniques for Thyroid Nodule Characterization: Systematic Review and Meta-analysis. Front Oncol 2022; 12:845549. [PMID: 35371974 PMCID: PMC8966910 DOI: 10.3389/fonc.2022.845549] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/29/2021] [Accepted: 02/16/2022] [Indexed: 12/25/2022] Open
Abstract
Background Thyroid nodules are frequent in adult population and thyroid cancer incidence has increased dramatically over the past three decades. The aim of this systematic review and meta-analysis was to evaluate the US-Elastosonography (USE) diagnostic performance in assessing the thyroid nodules malignancy risk. Methods PubMed and Embase databases were searched from January 2011 to July 2021. We extracted data from selected studies and calculated the overall diagnostic accuracy of qualitative USE, semi-quantitative USE and quantitative USE. Summary receiver operating characteristic (ROC) curve was elaborated to show the results. All statistical tests were performed using Metadisc and Medcal software package. Results Finally 72 studies with 13,505 patients and 14,015 thyroid nodules (33% malignant) undergoing elastography were included. The pooled sensitivity, specificity and AUC were 84%, 81%, and 0.89 respectively for qualitative USE; 83%, 80%, and 0.93 for semi-quantitative USE and 78%, 81% and 0.87, for quantitative USE. The qualitative and semiquantitative USE present very similar diagnostic accuracy values and both better than the quantitative USE. Conclusions USE is a useful imaging tool for thyroid nodule characterization. In accordance with recent guidelines and meta-analyses, the USE could be used daily in thyroid nodule malignancy risk stratification. Systematic Review Registration PROSPERO: CRD42021279257.
Collapse
Affiliation(s)
- Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Annalisa De Silvestri
- Servizio di Epidemiologia Clinica e Biometria Direzione Scientifica-Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico san Matteo, Pavia, Italy
| | - Valeria Scotti
- Servizio di Epidemiologia Clinica e Biometria Direzione Scientifica-Fondazione Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico san Matteo, Pavia, Italy
| | - Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Tarsitano
- Department of Clinical and Surgical Science, "Magna Graecia" University, Catanzaro, Italy
| | - Giorgia Polti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Olga Guiban
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Pierpaolo Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Department of Surgery and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Augusto Lauro
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
| | - Vito D'Andrea
- Department of Surgical Sciences, Hospital "Policlinico Umberto I", "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
19
|
Campisi A, Ciarrocchi AP, Grani G, Argnani D, Trotta M, Nesci J, Davoli F, Stella F, Salvi M. Totally thoracoscopic versus standard VATS lobectomies: perioperative differences. Gan To Kagaku Ryoho 2022; 70:642-650. [PMID: 35226297 DOI: 10.1007/s11748-022-01787-6] [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: 10/27/2021] [Accepted: 02/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Minimally invasive surgery is considered the gold standard approach for early stage lung cancer. Techniques range from a standard three-port approach to uniportal lobectomies, with no technique emerging as superior thus far. We retrospectively compared the pain outcomes of a standard approach using a utility incision with a totally thoracoscopic technique. METHODS Between January 2015 and December 2019, 168 patients received a VATS lobectomy in our centers. Two groups were created, Group A (82 patients, totally thoracoscopic approach) and Group B (86 patients, standard approach with utility incision). Perioperative outcomes, such as operative time, complications, length of stay, perioperative and chronic pain using visual analog scale (VAS), and rescue doses of painkillers were examined. A one-way analysis of covariance (ANCOVA) was conducted to investigate the impact of surgical time and days of drainage on VAS score. RESULTS Pain was less on postoperative day (POD) 1 and 2 (p = 0.025 and p = 0.020, respectively) in Group A. No differences were found in the baseline and perioperative characteristics of the two groups, in the mean VAS score at 1 month (p = 0.429), 1 year (p = 0.561), doses of NSAIDs (p = 0.609), and chronic pain (3vs7 patients, p = 0.220). The ANCOVA test showed no significant effect of surgical time and days of drainage on VAS score (p > 0.05). CONCLUSIONS In our experience, a totally thoracoscopic approach may improve acute postoperative pain without compromising the oncological results of the procedure and the safety of the patients.
Collapse
Affiliation(s)
- Alessio Campisi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy.
| | - Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Giorgio Grani
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Desideria Argnani
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Marco Trotta
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Jessica Nesci
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Fabio Davoli
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Franco Stella
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| | - Maurizio Salvi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, G.B. Morgagni-L. Pierantoni Hospital, 34 Carlo Forlanini Street, 47121, Forlì, Italy
| |
Collapse
|
20
|
Rossi G, Spagnolo P, Wuyts WA, Ryerson CJ, Valli M, Valentini I, Grani G, Gennari A, Bizzarro T, Lazzari-Agli L. Pathologic comparison of conventional video-assisted thoracic surgical (VATS) biopsy versus non-intubated/“awake” biopsy in fibrosing interstitial lung diseases. Respir Med 2022; 195:106777. [DOI: 10.1016/j.rmed.2022.106777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
|
21
|
Grani G, Sponziello M, Verrienti A, Durante C. Therapy of non-iodine uptaking metastasis in thyroid cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00201-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
22
|
Durante C, Pecce V, Grani G. Management of cytologically indeterminate thyroid nodules: primum non nocere. Pol Arch Intern Med 2021; 131. [PMID: 34937325 DOI: 10.20452/pamw.16166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Valeria Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
23
|
Forleo R, Grani G, Alfò M, Zilioli V, Giubbini R, Zatelli MC, Gagliardi I, Piovesan A, Ragni A, Morelli S, Puxeddu E, Pagano L, Deandrea M, Ceresini G, Torlontano M, Puligheddu B, Antonelli A, Centanni M, Fugazzola L, Spiazzi G, Monti S, Rossetto R, Monzani F, Tallini G, Crescenzi A, Sparano C, Bruno R, Repaci A, Tumino D, Pezzullo L, Lombardi CP, Ferraro Petrillo U, Filetti S, Durante C, Castagna MG. Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4). Thyroid 2021; 31:1814-1821. [PMID: 34541894 DOI: 10.1089/thy.2021.0248] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The role of minimal extrathyroidal extension (mETE) as a risk factor for persistent papillary thyroid carcinoma (PTC) is still debated. The aims of this study were to assess the clinical impact of mETE as a predictor of worse initial treatment response in PTC patients and to verify the impact of radioiodine therapy after surgery in patients with mETE. Methods: We reviewed all records in the Italian Thyroid Cancer Observatory database and selected 2237 consecutive patients with PTC who satisfied the inclusion criteria (PTC with no lymph node metastases and at least 1 year of follow-up). For each case, we considered initial surgery, histological variant of PTC, tumor diameter, recurrence risk class according to the American Thyroid Association (ATA) risk stratification system, use of radioiodine therapy, and initial therapy response, as suggested by ATA guidelines. Results: At 1-year follow-up, 1831 patients (81.8%) had an excellent response, 296 (13.2%) had an indeterminate response, 55 (2.5%) had a biochemical incomplete response, and 55 (2.5%) had a structural incomplete response. Statistical analysis suggested that mETE (odds ratio [OR] 1.16, p = 0.65), tumor size >2 cm (OR 1.45, p = 0.34), aggressive PTC histology (OR 0.55, p = 0.15), and age at diagnosis (OR 0.90, p = 0.32) were not significant risk factors for a worse initial therapy response. When evaluating the combination of mETE, tumor size, and aggressive PTC histology, the presence of mETE with a >2 cm tumor was significantly associated with a worse outcome (OR 5.27 [95% confidence interval], p = 0.014). The role of radioiodine ablation in patients with mETE was also evaluated. When considering radioiodine treatment, propensity score-based matching was performed, and no significant differences were found between treated and nontreated patients (p = 0.24). Conclusions: This study failed to show the prognostic value of mETE in predicting initial therapy response in a large cohort of PTC patients without lymph node metastases. The study suggests that the combination of tumor diameter and mETE can be used as a reliable prognostic factor for persistence and could be easily applied in clinical practice to manage PTC patients with low-to-intermediate risk of recurrent/persistent disease.
Collapse
Affiliation(s)
- Raffaella Forleo
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, and Sapienza University of Rome, Rome, Italy
| | - Marco Alfò
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Zilioli
- Chair and Nuclear Medicine Unit, University and Spedali Civili Hospital, Brescia, Italy
| | - Raffaele Giubbini
- Chair and Nuclear Medicine Unit, University and Spedali Civili Hospital, Brescia, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Unit of Endocrinology, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Department of Medical Sciences, Unit of Endocrinology, University of Ferrara, Ferrara, Italy
| | - Alessandro Piovesan
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alberto Ragni
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Silvia Morelli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Efisio Puxeddu
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Loredana Pagano
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Maurilio Deandrea
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Graziano Ceresini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Massimo Torlontano
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Barbara Puligheddu
- SCDU Endocrinology, Andrology and Metabolism, Humanitas Gradenigo Hospital, Turin, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Laura Fugazzola
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Spiazzi
- Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Monti
- Department of Endocrinology and Diabetes, Azienda Ospedaliero-Universitaria Sant'Andrea, Sapienza University of Rome, Roma, Italy
| | - Ruth Rossetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Tallini
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Anna Crescenzi
- Pathology Unit, University Hospital Campus Bio-Medico, Rome, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Rocco Bruno
- Endocrinology Unit, Tinchi Hospital, Matera, Italy
| | - Andrea Repaci
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Dario Tumino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Luciano Pezzullo
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
| | | | - Sebastiano Filetti
- Department of Translational and Precision Medicine, and Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, and Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| |
Collapse
|
24
|
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.
Collapse
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.)
| |
Collapse
|
25
|
Madeddu L, Grani G, Velardi P. Integrating categorical and structural proximity in Disease Ontologies. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:2011-2014. [PMID: 34891682 DOI: 10.1109/embc46164.2021.9630114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The purpose of the study described in this paper is to shed more light on disease similarities by analyzing the relationship between categorical proximity of diseases in human-curated ontologies and structural proximity of the related disease module (DM) in the interactome. We propose a methodology (and related algorithms) to automatically induce a hierarchical structure from proximity relations between DMs, and to compare this structure with a human-curated disease taxonomy.Clinical relevance- Disease ontologies are extensively used for diagnostic evaluation and clinical decision support but still reflect the clinical reductionist perspective. We demonstrate that the proposed network-based methodology allows us to analyze commonalities and differences among structural and categorical similarity of human diseases, help refine human disease classification systems, and identify promising network areas where new disease-gene interactions can be discovered.
Collapse
|
26
|
Grani G, Madeddu L, Velardi P. A network-based analysis of disease modules from a taxonomic perspective. IEEE J Biomed Health Inform 2021; 26:1773-1781. [PMID: 34428165 DOI: 10.1109/jbhi.2021.3106787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of the study described in this paper is to shed more light on disease similarities by analyzing the relationship between categorical proximity in human-curated disease ontologies and proximity of disease modules in the human interactome network. We believe that the biomedical understanding of diseases is on the edge of a radical change. The disease module hypothesis (DMH), with its relevant applications to disease-gene discovery and drug repurposing, is leading the revolution of bio-medical research of the future. Human-curated disease ontologies are widely used for diagnostic evaluation, treatment and data comparisons over time, and clinical decision support. However, the recent results of DMH have so far only marginally influenced the disease categorization principles. For these reasons, we deem it fundamental to systematically analyze the degree of correspondence between the anatomical and histological principles at the basis of current disease ontologies and the pathobiological similarity relations discovered in recent network-based studies. Towards this objective, we define a methodology and related algorithms to automatically induce a hierarchical structure of disease modules from proximity relations in the interactome network, and to align, label and systematically compare this structure with a manually defined disease ontology. We demonstrate that our study has some relevant clinical implications: To identify promising regions of the human interactome where new disease-gene relationships could be discovered, either exploiting data-driven methods or clinical experiments; To identify unexplored molecular relationships among diseases; To extend, correct and refine human-curated taxonomies. To the best of our knowledge, this is the first work that presents a methodology to systematically integrate taxonomic and network-based disease classification principles.
Collapse
|
27
|
Fresilli D, David E, Pacini P, Del Gaudio G, Dolcetti V, Lucarelli GT, Di Leo N, Bellini MI, D’Andrea V, Sorrenti S, Mascagni D, Biffoni M, Durante C, Grani G, De Vincentis G, Cantisani V. Thyroid Nodule Characterization: How to Assess the Malignancy Risk. Update of the Literature. Diagnostics (Basel) 2021; 11:diagnostics11081374. [PMID: 34441308 PMCID: PMC8391491 DOI: 10.3390/diagnostics11081374] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 06/30/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022] Open
Abstract
Ultrasound (US) is the first imaging modality for thyroid parenchyma evaluation. In the last decades, the role of ultrasound has been improved with the introduction of new US software, such as contrast-enhanced ultrasound (CEUS) and US-elastography (USE). USE is nowadays recognized as an essential part of the multiparametric ultrasound (MPUS) examination, in particular for the indeterminate thyroid nodule with possible fine-needle aspiration cytology (FNAC) number reduction; even if further and larger studies are needed to validate it. More controversial is the role of CEUS in thyroid evaluation, due to its high variability in sensitivity and specificity. Semi-automatic US systems based on the computer-aided diagnosis (CAD) system are producing interesting results, especially as an aid to less experienced operators. New knowledge on the molecular mechanisms involved in thyroid cancer is allowing practitioners to identify new genomic thyroid markers that could reduce the number of "diagnostic" thyroidectomies. We have therefore drawn up an updated representation of the current evidence in the literature for thyroid nodule multiparametric ultrasound (MPUS) evaluation with particular regard to USE, the US CAD system and CEUS.
Collapse
Affiliation(s)
- Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Emanuele David
- Radiological Sciences, Radiology Unit, Papardo-Hospital, 98158 Messina, Italy;
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Giovanni Del Gaudio
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Vincenzo Dolcetti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Giuseppe Tiziano Lucarelli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Nicola Di Leo
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Maria Irene Bellini
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Domenico Mascagni
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy; (M.I.B.); (V.D.); (S.S.); (D.M.); (M.B.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (C.D.); (G.G.)
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy; (C.D.); (G.G.)
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (D.F.); (P.P.); (G.D.G.); (V.D.); (G.T.L.); (N.D.L.); (G.D.V.)
- Correspondence: author:
| |
Collapse
|
28
|
Trimboli P, Castellana M, Piccardo A, Romanelli F, Grani G, Giovanella L, Durante C. The ultrasound risk stratification systems for thyroid nodule have been evaluated against papillary carcinoma. A meta-analysis. Rev Endocr Metab Disord 2021; 22:453-460. [PMID: 32959174 PMCID: PMC8087557 DOI: 10.1007/s11154-020-09592-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
Thyroid imaging reporting and data systems (TIRADS) are used to stratify the malignancy risk of thyroid nodule by ultrasound (US) examination. We conducted a meta-analysis to evaluate the pooled cancer prevalence and the relative prevalence of papillary, medullary, follicular thyroid cancer (PTC, MTC, and FTC) and other malignancies among nodules included in studies evaluating their performance. Four databases were searched until February 2020. Original articles with at least 1000 nodules, evaluating the performance of at least one TIRADS among AACE/ACE/AME, ACR-TIRADS, ATA, EU-TIRADS, or K-TIRADS, and reporting data on the histological diagnosis of malignant lesions were included. The number of malignant nodules, PTC, FTC, MTC and other malignancies in each study was extracted. For statistical pooling of data, a random-effects model was used. Nine studies were included, evaluating 19,494 thyroid nodules. The overall prevalence of malignancy was 34% (95%CI 21 to 49). Among 6162 histologically proven malignancies, the prevalence of PTC, FTC, MTC and other malignancies was 95%, 2%, 1%, and 1%, respectively. A high heterogeneity was found for all the outcomes. A limited number of studies generally conducted using a retrospective design was found, with possible selection bias. Acknowledging this limitation, TIRADSs should be regarded as accurate tools to diagnose PTC only. Proposed patterns and/or cut-offs should be revised and other strategies considered to improve their performance in the assessment of FTC, MTC and other malignancies.
Collapse
Affiliation(s)
- Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Via Ospedale 12, 6500 Bellinzona, Svizzera Switzerland
- Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Marco Castellana
- National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Castellana Grotte, Bari, Italy
| | | | - Francesco Romanelli
- Department of Experimental Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Via Ospedale 12, 6500 Bellinzona, Svizzera Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
29
|
Grani G, Lamartina L, Alfò M, Ramundo V, Falcone R, Giacomelli L, Biffoni M, Filetti S, Durante C. Selective Use of Radioactive Iodine Therapy for Papillary Thyroid Cancers With Low or Lower-Intermediate Recurrence Risk. J Clin Endocrinol Metab 2021; 106:e1717-e1727. [PMID: 33377969 DOI: 10.1210/clinem/dgaa973] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Current guidelines recommend a selective use of radioiodine treatment (RAI) for papillary thyroid cancer (PTC). OBJECTIVE This work aimed to determine how policy changes affect the use of RAI and the short-term outcomes of patients. METHODS A retrospective analysis of longitudinal data was conducted in an academic referral center of patients with nonaggressive PTC variants; no extrathyroidal invasion or limited to soft tissues, no distant metastases, and 5 or fewer central-compartment cervical lymph node metastases. In cohort 1, standard treatments were total thyroidectomy and RAI (May 2005-June 2011); in cohort 2 decisions on RAI were deferred for approximately 12 months after surgery (July 2011-December 2018). Propensity score matching was used to adjust for sex, age, tumor size, lymph node status, and extrathyroidal extension. Intervention included immediate RAI or deferred choice. Main outcome measures were responses to initial treatment during 3 or more years of follow-up. RESULTS In cohort 1, RAI was performed in 50 of 116 patients (51.7%), whereas in cohort 2, it was far less frequent: immediately in 10 of 156 (6.4%), and in 3 more patients after the first follow-up data. The frequencies of structural incomplete response were low (1%-3%), and there were no differences between the 2 cohorts at any follow-up visit. Cohort 2 patients had higher rates of "gray-zone responses" (biochemical incomplete or indeterminate response). CONCLUSION Selective use of RAI increases the rate of patients with "uncertain" status during early follow-up. The rate of structural incomplete responses remains low regardless of whether RAI is used immediately. Patients should be made aware of the advantages and drawbacks of omitting RAI.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Livia Lamartina
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Alfò
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosa Falcone
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
30
|
Campisi A, Ciarrocchi AP, Congiu S, Mazzarra S, Sanna S, Argnani D, Grani G, Davoli F, Salvi M, Stella F. Sleeve Lobectomy: To Wrap or Not to Wrap the Bronchial Anastomosis? Ann Thorac Surg 2021; 113:250-255. [PMID: 33545148 DOI: 10.1016/j.athoracsur.2021.01.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bronchoplastic procedures have become the reference standard in the lung parenchyma-sparing treatment of centrally located bronchopulmonary tumors. Two schools of thought exist regarding performing a bronchial sleeve resection: those who wrap the anastomosis with a pedicled flap and those who leave the anastomosis unprotected. We performed a study comparing these 2 methods. METHODS This study was a retrospective multicenter observational analysis of 90 consecutive patients undergoing bronchial sleeve resections for neoplastic disease between June 2009 and July 2019. Group A (60 patients) underwent bronchial wrapping and group B (30 patients) did not undergo wrapping. RESULTS The only difference between group A, which had 5 patients (8.3%), and group B, which had 10 patients (33.3%), regarding general characteristics was the presence of diabetes (P = .003). There were no differences in surgical, postoperative, and follow-up characteristics. There was no statistically significant difference between groups (group A, 9 patients [15%]; and group B, 6 patients [20%]) in terms of anastomotic complications at 1 year (P = .425). Diabetes was an independent predictive factor for anastomotic complications at 1 year (P = .035). The number of postoperative complications (P < .001) was an independent risk factor for length of hospital stay. CONCLUSIONS We found no differences between groups in terms of postoperative complications and length of hospital stay, which confirmed previous reports that sleeve resections may be performed safely without bronchial wrapping.
Collapse
Affiliation(s)
- Alessio Campisi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy.
| | - Angelo Paolo Ciarrocchi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Stefano Congiu
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Sara Mazzarra
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Stefano Sanna
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Desideria Argnani
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Giorgio Grani
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Fabio Davoli
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Maurizio Salvi
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| | - Franco Stella
- Thoracic Surgery Unit, Department of Thoracic Diseases, University of Bologna, GB Morgagni-L Pierantoni Hospital, Forlì, Italy
| |
Collapse
|
31
|
Ramundo V, Di Gioia CRT, Falcone R, Lamartina L, Biffoni M, Giacomelli L, Filetti S, Durante C, Grani G. Diagnostic Performance of Neck Ultrasonography in the Preoperative Evaluation for Extrathyroidal Extension of Suspicious Thyroid Nodules. World J Surg 2021; 44:2669-2674. [PMID: 32193621 DOI: 10.1007/s00268-020-05482-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND A preoperative neck ultrasound (US) is recommended for all patients with suspected thyroid cancer, to identify features potentially changing surgical extent. The extrathyroidal extension (ETE) is considered an indication for total thyroidectomy, but there is limited consensus on its US definition, and the interobserver reliability is low. This study aimed to evaluate the predictive value of neck US for ETE before surgery and to estimate the diagnostic performance of different US findings, evaluated during real-time examinations. METHODS Patients referred to surgery between November 1, 2015, and May 31, 2019, for a suspicious thyroid cancer underwent a preoperative neck US, with systematic assessment for ETE. Three definitions were tested: very restrictive (capsular disruption with suspicious images of surrounding tissues invasion), restrictive (including also capsular abutment with evidence of capsular disruption), and nonrestrictive (capsular abutment is sufficient). Histopathology report of ETE involving at least soft tissues was considered positive. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS The study cohort included 128 patients, with 102 (79.7%) confirmed malignancies, and 44 (43.1%) histological ETE. The nonrestrictive definition had good sensitivity (86.4%) but low specificity (29.8%), with an NPV of 80.6%; the restrictive definition had higher specificity (81%), while the very restrictive had specificity and PPV of 100%. CONCLUSIONS A more extensive surgical approach should not be based on US suspicion of ETE alone, with the possible exception of gross invasion appearance. The absence of any sign of ETE, on the other hand, has a substantial negative predictive value.
Collapse
Affiliation(s)
- Valeria Ramundo
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Cira Rosaria Tiziana Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Rosa Falcone
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Livia Lamartina
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| |
Collapse
|
32
|
Grani G, Zatelli MC, Alfò M, Montesano T, Torlontano M, Morelli S, Deandrea M, Antonelli A, Francese C, Ceresini G, Orlandi F, Maniglia CA, Bruno R, Monti S, Santaguida MG, Repaci A, Tallini G, Fugazzola L, Monzani F, Giubbini R, Rossetto R, Mian C, Crescenzi A, Tumino D, Pagano L, Pezzullo L, Lombardi CP, Arvat E, Petrone L, Castagna MG, Spiazzi G, Salvatore D, Meringolo D, Solaroli E, Monari F, Magri F, Triggiani V, Castello R, Piazza C, Rossi R, Ferraro Petrillo U, Filetti S, Durante C. Real-World Performance of the American Thyroid Association Risk Estimates in Predicting 1-Year Differentiated Thyroid Cancer Outcomes: A Prospective Multicenter Study of 2000 Patients. Thyroid 2021; 31:264-271. [PMID: 32475305 DOI: 10.1089/thy.2020.0272] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: One of the most widely used risk stratification systems for estimating individual patients' risk of persistent or recurrent differentiated thyroid cancer (DTC) is the American Thyroid Association (ATA) guidelines. The 2015 ATA version, which has increased the number of patients considered at low or intermediate risk, has been validated in several retrospective, single-center studies. The aims of this study were to evaluate the real-world performance of the 2015 ATA risk stratification system in predicting the response to treatment 12 months after the initial treatment and to determine the extent to which this performance is affected by the treatment center in which it is used. Methods: A prospective cohort of DTC patients collected by the Italian Thyroid Cancer Observatory web-based database was analyzed. We reviewed all records present in the database and selected consecutive cases that satisfied inclusion criteria: (i) histological diagnosis of DTC, with the exclusion of noninvasive follicular thyroid neoplasm with papillary-like nuclear features; (ii) complete data of the initial treatment and pathological features; and (iii) results of 1-year follow-up visit (6-18 months after the initial treatment), including all data needed to classify the estimated response to treatment. Results: The final cohort was composed of 2071 patients from 40 centers. The ATA risk of persistent/recurrent disease was classified as low in 1109 patients (53.6%), intermediate in 796 (38.4%), and high in 166 (8.0%). Structural incomplete responses were documented in only 86 (4.2%) patients: 1.5% in the low-risk, 5.7% in the intermediate-risk, and 14.5% in the high-risk group. The baseline ATA risk class proved to be a significant predictor of structural persistent disease, both for intermediate-risk (odds ratio [OR] 4.67; 95% confidence interval [CI] 2.59-8.43) and high-risk groups (OR 16.48; CI 7.87-34.5). Individual center did not significantly influence the prediction of the 1-year disease status. Conclusions: The ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC in real-world clinical settings characterized by center heterogeneity in terms of size, location, level of care, local management strategies, and resource availability.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Pathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Chiara Zatelli
- Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Alfò
- Department of Statistical Sciences, Pathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy
| | - Teresa Montesano
- Department of Radiological, Pathological, Oncological Sciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Torlontano
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Silvia Morelli
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Maurilio Deandrea
- Division of Endocrinology, Diabetology, and Metabolism, Mauriziano Umberto I Hospital, Turin, Italy
| | - Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cecilia Francese
- Division of Endocrinology, Clinica Salus di Battipaglia, Salerno, Italy
| | - Graziano Ceresini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabio Orlandi
- Division of Endocrinology and Metabolism, Department of Oncology, Humanitas-Gradenigo Hospital, University of Turin, Turin, Italy
| | | | - Rocco Bruno
- Unit of Endocrinology, Tinchi-Pisticci Hospital, Matera, Italy
| | - Salvatore Monti
- Department of Endocrinology, AOU Sant'Andrea, Sapienza Università di Roma, Rome, Italy
| | | | - Andrea Repaci
- Endocrinology, Pathology and Radiotherapy Units, University of Bologna Medical Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni Tallini
- Endocrinology, Pathology and Radiotherapy Units, University of Bologna Medical Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Laura Fugazzola
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Giubbini
- Nuclear Medicine Unit, Spedali Civili Università degli Studi di Brescia, Brescia, Italy
| | - Ruth Rossetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine-DIMED, University Hospital of Padua, Padua, Italy
| | - Anna Crescenzi
- Pathology Unit, University Hospital Campus Bio-Medico, Rome, Italy
| | - Dario Tumino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Loredana Pagano
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Luciano Pezzullo
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, Molinette Hospital, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Luisa Petrone
- Endocrinology Unit, Careggi University Hospital, Florence, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Giovanna Spiazzi
- Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico Salvatore
- Department of Public Health, University of Naples "Federico II," Naples, Italy
| | | | - Erica Solaroli
- Endocrinology Unit, Medical Department, AUSL Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Fabio Monari
- Endocrinology, Pathology and Radiotherapy Units, University of Bologna Medical Center, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Flavia Magri
- Unit of Internal Medicine and Endocrinology, Laboratory for Endocrine Disruptors, Department of Internal Medicine, Istituti Clinici Scientifici Maugeri IRCCS, and Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Vincenzo Triggiani
- Section of Internal Medicine, Geriatrics, Endocrinology and Rare Disease, Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Bari, Italy
| | - Roberto Castello
- Division of General Medicine, University Hospital of Verona, Verona, Italy
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS, National Cancer Institute of Milan, University of Milan, Milan, Italy
| | - Roberta Rossi
- Endocrine Unit, Azienda Ospedaliero Universitaria S. Anna, Ferrara, Italy
| | - Umberto Ferraro Petrillo
- Department of Statistical Sciences, Pathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, Pathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Pathological and Oncological Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
33
|
Giani C, Valerio L, Bongiovanni A, Durante C, Grani G, Ibrahim T, Mariotti S, Massa M, Pani F, Pellegriti G, Porcelli T, Salvatore D, Tavarelli M, Torlontano M, Locati L, Molinaro E, Elisei R. Safety and Quality-of-Life Data from an Italian Expanded Access Program of Lenvatinib for Treatment of Thyroid Cancer. Thyroid 2021; 31:224-232. [PMID: 32907501 DOI: 10.1089/thy.2020.0276] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Lenvatinib, a multikinase inhibitor, is for progressive radioiodine-refractory-differentiated thyroid cancer (RR-DTC) patients. However, there are a lot of drug-related adverse events (AEs) that can affect the quality of life (QoL) of patients. The aims of this study were (a) to evaluate, and compared with other series, the safety of lenvatinib used in RR-DTC patients enrolled in an Italian expanded access program (EAP), and (b) to evaluate their QoL during treatment with lenvatinib. Methods: To evaluate the safety, we recorded and graded all AEs during the 6 months of lenvatinib treatment in 39 RR-DTC patients. We compared the safety profile of lenvatinib observed in our patients with that reported in the study of (E7080) levatinib in differentiated cancer of the thyroid (SELECT) and tumeurs thyroidiennes refractaires (TUTHYREF) network studies. Moreover, we evaluated the QoL in our series by using the European Organization for Research and Treatment (EORTC) Quality of Life Questionnaire-Core 30 and the pain visual analogue scale (VAS). Results: The most frequent AEs among our 39 RR-DTC patients were hypertension (80.5%), fatigue (58.3%), diarrhea (36.1%), stomatitis (33.3%), hand/foot syndrome (33.3%), and weight loss (30.5%). The most prevalent grade 3/4 AE was hypertension (25%). When compared with previous studies (i.e., SELECT and TUTHYREF), a significantly lower percentage of our patients experienced diarrhea, nausea, proteinuria, and weight loss. No statistically significant differences in the QoL of our patients evaluated before, during, and at the end of follow-up (6 months after starting the therapy) were found. However, a slight improvement of the general health and emotional and cognitive status associated with a slightly worsening of physical role and social functioning was observed during these 6 months. Pain, dyspnea, insomnia, and constipation moved toward better values, while fatigue, nausea and vomiting, appetite loss, and diarrhea worsened. By comparing the pain VAS, an overall reduction of the level of pain was found. Conclusions: The safety profile of the drug was similar to that already reported with some differences in the prevalence and severity of the AEs. Regarding the QoL, the EAP showed a trend of improvement of the global health status and a reduction of symptoms correlated to the disease. The clinical impact of fatigue, anorexia/weight loss and stomatitis, mainly due to the drug itself, continues to represent the major issue in the management of these patients.
Collapse
Affiliation(s)
- Carlotta Giani
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Laura Valerio
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST, IRCCS, Meldola, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST, IRCCS, Meldola, Italy
| | - Stefano Mariotti
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Michela Massa
- Department of Medical Science, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Fabiana Pani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Tommaso Porcelli
- Department of Public Health, University of Naples "Federico II," Naples, Italy
| | - Domenico Salvatore
- Department of Public Health, University of Naples "Federico II," Naples, Italy
| | | | - Massimo Torlontano
- Department of Medical Science, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Laura Locati
- Head and Neck Cancer Medical Oncology Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori," Milan, Italy
| | - Eleonora Molinaro
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rossella Elisei
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
34
|
Abstract
CONTEXT Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients. EVIDENCE ACQUISITION We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management. EVIDENCE SYNTHESIS The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques. CONCLUSION Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
- Correspondence and Reprint Requests: Cosimo Durante, MD, PhD, Dipartimento di Medicina Traslazionale e di Precisione, Università di Roma “Sapienza,” Viale del Policlinico 155, 00161, Roma, Italy. E-mail:
| |
Collapse
|
35
|
Castellana M, Grani G, Radzina M, Guerra V, Giovanella L, Deandrea M, Ngu R, Durante C, Trimboli P. Performance of EU-TIRADS in malignancy risk stratification of thyroid nodules: a meta-analysis. Eur J Endocrinol 2020; 183:255-264. [PMID: 32544875 DOI: 10.1530/eje-20-0204] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 06/16/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Several thyroid imaging reporting and data systems (TIRADS) have been proposed to stratify the malignancy risk of thyroid nodule by ultrasound. The TIRADS by the European Thyroid Association, namely EU-TIRADS, was the last one to be published. DESIGN We conducted a meta-analysis to assess the prevalence of malignancy in each EU-TIRADS class and the performance of EU-TIRADS class 5 vs 2, 3 and 4 in detecting malignant lesions. METHODS Four databases were searched until December 2019. Original articles reporting the performance of EU-TIRADS and adopting histology as reference standard were included. The number of malignant nodules in each class and the number of nodules classified as true/false positive/negative were extracted. A random-effects model was used for pooling data. RESULTS Seven studies were included, evaluating 5672 thyroid nodules. The prevalence of malignancy in each EU-TIRADS class was 0.5% (95% CI: 0.0-1.3), 5.9% (95% CI: 2.6-9.2), 21.4% (95% CI: 11.1-31.7), and 76.1% (95% CI: 63.7-88.5). Sensitivity, specificity, PPV, NPV, LR+, LR- and DOR of EU-TIRADS class 5 were 83.5% (95% CI: 74.5-89.8), 84.3% (95% CI: 66.2-93.7), 76.1% (95% CI: 63.7-88.5), 85.4% (95% CI: 79.1-91.8), 4.9 (95% CI: 2.9-8.2), 0.2 (95% CI: 0.1-0.3), and 24.5 (95% CI: 11.7-51.0), respectively. A further improved performance was found after excluding two studies because of limited sample size and low prevalence of malignancy in class 5. CONCLUSIONS A limited number of studies generally conducted using a retrospective design was found. Acknowledging this limitation, the performance of EU-TIRADS in stratifying the risk of thyroid nodules was high. Also, EU-TIRADS class 5 showed moderate evidence of detecting malignant lesions.
Collapse
Affiliation(s)
- Marco Castellana
- National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maija Radzina
- Diagnostic Radiology Institute, Paula Stradina Clinical University Hospital, University of Latvia, Radiology Research laboratory, Riga Stradins University, Riga, Latvia
| | - Vito Guerra
- National Institute of Gastroenterology 'S. de Bellis', Research Hospital, Castellana Grotte, Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Maurilio Deandrea
- Endocrinology, Diabetes and Metabolic Disease Unit, Azienda Ospedaliera Ordine Mauriziano, Torino, Italy
| | - Rose Ngu
- Head Neck and Thyroid Imaging, Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Pierpaolo Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| |
Collapse
|
36
|
Grani G, Brenta G, Trimboli P, Falcone R, Ramundo V, Maranghi M, Lucia P, Filetti S, Durante C. Sonographic Risk Stratification Systems for Thyroid Nodules as Rule-Out Tests in Older Adults. Cancers (Basel) 2020; 12:cancers12092458. [PMID: 32872622 PMCID: PMC7564359 DOI: 10.3390/cancers12092458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/31/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
Ultrasonographic risk-stratification systems (RSS), including various Thyroid Imaging Reporting and Data Systems (TIRADS), were proposed to improve reporting and reduce the number of fine-needle aspiration biopsies. However, age might be a confounder since some suspicious ultrasonographic features lack specificity in elderly patients. We aimed to investigate whether the diagnostic performance of the RSS varied between age groups. All patients consecutively referred for thyroid biopsy between November 1, 2015, and March 10, 2020, were included. The malignancy risk of each nodule was estimated according to five RSS: the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi guidelines, the American College of Radiology (ACR) TIRADS, the American Thyroid Association guidelines, the European TIRADS, and the Korean TIRADS. Overall, 818 nodules (57 malignant) were evaluated. The malignancy rate was higher in patients ≤ 65 years (8.1%) than in patients > 65 years (3.8%; p = 0.02). All RSS confirmed a significant discriminative performance in both age groups, with a negative predictive value of 100% in patients > 65 years, although specificity was lower in older patients. The ACR TIRADS was the best performing in both age groups. RSS could avoid a sizable number of biopsies when applied as rule-out tests in elderly patients.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.G.); (R.F.); (V.R.); (M.M.); (P.L.)
| | - Gabriela Brenta
- Endocrinology Department, Cesar Milstein Hospital, Buenos Aires CABA C1221ACI, Argentina;
| | - Pierpaolo Trimboli
- Clinic of Endocrinology, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Rosa Falcone
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.G.); (R.F.); (V.R.); (M.M.); (P.L.)
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.G.); (R.F.); (V.R.); (M.M.); (P.L.)
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.G.); (R.F.); (V.R.); (M.M.); (P.L.)
| | - Piernatale Lucia
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.G.); (R.F.); (V.R.); (M.M.); (P.L.)
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.G.); (R.F.); (V.R.); (M.M.); (P.L.)
- Correspondence: (S.F.); (C.D.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.G.); (R.F.); (V.R.); (M.M.); (P.L.)
- Correspondence: (S.F.); (C.D.)
| |
Collapse
|
37
|
Verrienti A, Pecce V, Abballe L, Ramundo V, Falcone R, Inanloo Nigi Jak F, Brunelli C, Fadda G, Bosco D, Ascoli V, Carletti R, Di Gioia C, Grani G, Sponziello M. Analytical validation of a novel targeted next-generation sequencing assay for mutation detection in thyroid nodule aspirates and tissue. Endocrine 2020; 69:451-455. [PMID: 32506194 DOI: 10.1007/s12020-020-02372-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/27/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The identification of somatic mutations in cancer specimens enables detection of molecular markers for personalized treatment. We recently developed a novel molecular assay and evaluated its clinical performance as an ancillary molecular method for indeterminate thyroid nodule cytology. Herein we describe the analytical validation of the novel targeted next-generation sequencing (NGS) assay in thyroid samples from different sources. METHODS We present validation data of a novel NGS-based panel on 463 thyroid samples, including 310 fine-needle aspiration (FNA) specimens from different sources (FNA collected in preservative solution, liquid-based, and stained smears), 10 fresh frozen, and 143 formalin-fixed paraffin-embedded (FFPE) thyroid tissue specimens. Sequencing performance in the different samples was evaluated along with reproducibility, repeatability, minimum nucleic acid input to detect variants, and analytical sensitivity of the assay. RESULTS All thyroid samples achieved high sequencing performance, with a mean base coverage depth ranging from 2228 × (in liquid-based FNA) to 3661 × (in FNA stained smears), and coverage uniformity ranging from 86% (in FFPE) to 95% (in FNA collected in preservative solution), with all target regions covered above the minimum depth required to call a variant (500×). The minimum nucleic acid input was 1 ng. Analytic sensitivity for mutation detection was 2-5% mutant allele frequency. CONCLUSIONS This validation study of a novel NGS-based assay for thyroid nodules demonstrated that the assay can be reliably used on multiple thyroid sample types, including FNA from different sources and FF and FFPE thyroid samples, thus providing a robust and reliable assay to genotype thyroid nodules, which may improve thyroid cancer diagnosis and care.
Collapse
Affiliation(s)
- Antonella Verrienti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Luana Abballe
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy.
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Rosa Falcone
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Chiara Brunelli
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital IRCCS, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital IRCCS, Rome, Italy
| | - Daniela Bosco
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Valeria Ascoli
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Raffaella Carletti
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Cira Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
38
|
Cantisani V, Grani G, Tovoli F, Piscaglia F, Catalano C. Artificial Intelligence: What Is It and How Can It Expand the Ultrasound Potential in the Future? Ultraschall Med 2020; 41:356-360. [PMID: 32750719 DOI: 10.1055/a-1173-4315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
39
|
Pecce V, Verrienti A, Abballe L, Carletti R, Grani G, Falcone R, Ramundo V, Durante C, Di Gioia C, Russo D, Filetti S, Sponziello M. Loss of Function SETD2 Mutations in Poorly Differentiated Metastases from Two Hürthle Cell Carcinomas of the Thyroid. Cancers (Basel) 2020; 12:cancers12071892. [PMID: 32674319 PMCID: PMC7409075 DOI: 10.3390/cancers12071892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/23/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 02/06/2023] Open
Abstract
Hürthle cell carcinomas (HCC) are rare differentiated thyroid cancers that display low avidity for radioactive iodine and respond poorly to kinase inhibitors. Here, using next-generation sequencing, we analyzed the mutational status of primary tissue and poorly differentiated metastatic tissue from two HCC patients. In both cases, metastatic tissues harbored a mutation of SETD2, each resulting in loss of the SRI and WW domains of SETD2, a methyltransferase that trimethylates H3K36 (H3K36me3) and also interacts with p53 to promote its stability. Functional studies of the novel p.D1890fs6* mutation (case 1) revealed significantly reduced H3K36me3 levels in SETD2-mutated tissue and primary cell cultures and decreased levels of the active form of p53. Restoration of SETD2-wildtype expression in the SETD2-mutant cells significantly reduced the expression of four well-known stemness markers (OCT-4, SOX2, IPF1, Goosecoid). These findings suggest potential roles for SETD2 loss-of-function mutations in HCC progression, possibly involving p53 destabilization and promotion of stemness. Their prevalence and potential treatment implications in thyroid cancer, especially HCC, require further study.
Collapse
Affiliation(s)
- Valeria Pecce
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
| | - Luana Abballe
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
| | - Raffaella Carletti
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.C.); (C.D.G.)
| | - Giorgio Grani
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
| | - Rosa Falcone
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
| | - Cira Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (R.C.); (C.D.G.)
| | - Diego Russo
- Department of Health Sciences, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (V.P.); (A.V.); (L.A.); (G.G.); (R.F.); (V.R.); (C.D.); (S.F.)
- Correspondence:
| |
Collapse
|
40
|
Falcone R, Grani G, Ramundo V, Melcarne R, Giacomelli L, Filetti S, Durante C. Cancer Care During COVID-19 Era: The Quality of Life of Patients With Thyroid Malignancies. Front Oncol 2020; 10:1128. [PMID: 32714873 PMCID: PMC7344223 DOI: 10.3389/fonc.2020.01128] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 04/29/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The Covid-19 pandemic's potential psychological impact has been widely discussed on the basis of expert opinion and previous experience with emergencies of this type. We conducted a survey of cancer patients to explore more objectively the outbreak's impact on their emotional well-being and quality of life. Methods: Between March 18 and April 4, 2020, at an endocrine cancer center in Rome, Italy, 137 patients were asked to complete an online 6-item questionnaire developed by our staff to explore the emotional effects of the Covid-19 outbreak in Italy (Covid-19 Emotional Impact Survey, C-19EIS). For validation purposes, we also asked participants to complete an online version of the validated Italian translation of the EORTC QLQ-C30 questionnaire. Responses were analyzed in relation to responders' age, sex, and clinical status (advanced/metastatic disease undergoing systemic treatment vs. stable metastatic thyroid cancer in active surveillance vs. low-risk thyroid cancers with no evidence of structural disease during standard follow-up). Results: Response rates were high (51% for the C-19EIS, 44.5% for the EORTC QLQ-C30). Overall C-19EIS scores indicated high concern over the outbreak (median 8/12). Scores were higher in women (8 [IQR 5–9] vs. 6 [IQR 5–8] in men; p = 0.048) and in patients <65 years (8 [IQR 5–9] vs. 6 [IQR 4–8] in older patients; p = 0.013). No differences emerged across clinical status groups. C-19EIS scores were inversely correlated with the EORTC QLQ-C30 Emotional function subscale (rho −0.69; p < 0.001). Conclusions: There is objective evidence that the Covid-19 outbreak is causing substantial emotional distress among cancer patients, regardless of their disease severity or current health-care needs.
Collapse
Affiliation(s)
- Rosa Falcone
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Rossella Melcarne
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
41
|
Lombardi CP, D'Amore A, Grani G, Ramundo V, Boscherini M, Gordini L, Marzi F, Tedesco S, Bocale R. Endocrine surgery during COVID-19 pandemic: do we need an update of indications in Italy? Endocrine 2020; 68:485-488. [PMID: 32500518 PMCID: PMC7270156 DOI: 10.1007/s12020-020-02357-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022]
Abstract
The ongoing spread of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) poses a significant threat to global health. As the coronavirus outbreak began spreading, hospitals were forced to relocate resources to treat the growing number of COVID-19 patients. As a consequence, doctors across the country canceled tens of thousands of nonurgent surgeries. However, recognizing that the COVID-19 situation may be highly variable and fluid in different communities across the country, elective surgery could be still allowed in some centers for patients included in the high-priority class. The majority of endocrine disorders requiring surgical treatment in patients identifiable as first-priority class, or needing hospitalization within 30 days, are generally represented by malignant thyroid tumors, hyperthyroidism, hyperparathyroidism, and some adrenal disorders. The need for urgent intervention is evaluated on a case-by-case basis according to the severity of the symptoms, the likelihood of progression, and global clinical judgment. On the basis of the above indications, during the last 4 weeks, we performed 18 planned surgical treatments in patients with thyroid cancer (total thyroidectomies, plus lymph node dissection if needed) or multinodular toxic goiter. In no case, postoperative ventilatory support was needed, and the average hospital stay was 3 days. The negative COVID-19 status for all the treated patients was appropriately evaluated beforehand. Nobody knows how long the current COVID-19 pandemic will be lasting. Certainly, we will be requested in the next future to incrementally offer surgical services for endocrine disorders that have been deferred for the COVID-19 pandemic.
Collapse
Affiliation(s)
- Celestino Pio Lombardi
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Annamaria D'Amore
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Mauro Boscherini
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Luca Gordini
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Marzi
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Tedesco
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy
| | - Raffaella Bocale
- Division of Endocrine Surgery, "Agostino Gemelli" School of Medicine, University Foundation Polyclinic, Catholic University of the Sacred Heart, Rome, Italy.
| |
Collapse
|
42
|
Grani G, Alfo’ M, Ramundo V, Puxeddu E, Arvat E, Pontecorvi A, Lombardi CP, Torlontano M, Zatelli MC, Antonelli A, Tallini G, Castagna MG, Fugazzola L, Filetti S, Durante C. OR21-07 The 2015 American Thyroid Association Risk Stratification System Is a Predictor of Persistent Disease in Real-World Clinical Practice. J Endocr Soc 2020. [PMCID: PMC7207909 DOI: 10.1210/jendso/bvaa046.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background. Management and follow-up of differentiated thyroid cancer (DTC) are guided by the likelihood of disease persistence or recurrence. The American Thyroid Association (ATA) practice guidelines provide a risk-estimation system based on data mainly derived by retrospective, single-center, and small cohorts. Aim. To validate the ATA risk-stratification system in predicting persistent structural disease. Methods. We analyzed data from the Italian Thyroid Cancer Observatory’s observational, web-based database, which prospectively enrolls newly diagnosed DTC patients in 40 Italian centers. For the present study we selected consecutive cases satisfying the inclusion criteria: 1) histological diagnosis of DTC, including papillary, follicular, and poorly differentiated tumors; 2) registration in the ITCO database between January 1, 2013 and April 23, 2019; 3) clinical evaluation between 6 and 18 month after primary treatment, including enough data to estimate the response to the initial treatment. Exclusion criteria were: histological diagnosis of NIFTP, medullary, or anaplastic thyroid cancer. The response to the initial treatment was categorized as excellent, biochemical incomplete, structural incomplete, or indeterminate based on imaging findings (neck ultrasound and other imaging studies, if performed), basal or stimulated serum thyroglobulin levels, and anti-Tg antibody levels. To model the response to treatment, we used a cumulative link model; given the hierarchical structure of the data, with patients nested within centers, we used a mixed-effect model, with a center-specific intercept summarizing unobserved center-specific characteristics. Results. Complete data about initial treatment and response to treatment after 6-18 months since initial treatment was available for 2071 patients. According to the ATA system, 1109 patients (53.6%) were classified as low-risk, 796 (38.4%) as intermediate, and 166 (8.0%) as high-risk. Excellent response was recorded in 1576 (76.1%) patients, indeterminate in 376 (18.2%), biochemical incomplete in 33 (1.6%), and structural incomplete in 86 (4.2%).The ATA risk stratification system is a significant predictor of response to treatment after 6-18 months: classification as intermediate- and high-risk increased the likelihood of a response worse than excellent (OR 1.68 [95% confidence intervals, CI 1.34-2.10] and 3.23 [95% CI 2.23-4.67], respectively), and a persistent structural disease (OR 4.67 [95% CI 2.59-8.43] and 16.48 [95% CI 7.87-34.5], respectively. In both analyses, the effect of the center (taking into account center-specific features) was negligible and not statistically significant. Conclusion. The 2015 ATA risk stratification system is a reliable predictor of short-term outcomes in patients with DTC, also if applied in a real-world setting consisting of several different clinical sites.
Collapse
Affiliation(s)
| | - Marco Alfo’
- Sapienza University of Rome, Rome, RM, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Grani G, Ramundo V, Armillotta M, Falcone R, Filetti S, Durante C. SUN-420 Spontaneous Changes in TSH Levels After Thyroidectomy During Long-Term Follow-Up. J Endocr Soc 2020. [PMCID: PMC7207280 DOI: 10.1210/jendso/bvaa046.1402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background. Spontaneous serum TSH variations during levothyroxine replacement therapy and multiple dose changes in athyreotic patients seem to be frequent in clinical practice.
Aim. To describe the rate and extent of spontaneous serum TSH variations in patients after total thyroidectomy for differentiated thyroid cancer (DTC) in real-life practice, and the number of resulting levothyroxine (LT4) dose adjustments.
Methods. Data of DTC patients were prospectively collected at a single referral center between January 2005 and May 2019. TSH and fT4 serum levels, LT4 dose and formulation, and concomitant medications were recorded at 1, 3, and 12 months after primary treatment (surgery ± radioiodine therapy), and then yearly; the data were retrospectively evaluated for this study. Visit at one month was used to tailor LT4 dose and was not considered into the data analysis. Patients with structural evidence of disease or during pregnancy were excluded.
Results. Data of 2883 evaluations (472 patients) were collected; at baseline, the median age was 49.7 years, 73.5% were females. The LT4 formulation administered at baseline were tablets (84.9%), liquid solution (11.4%), or soft-gel capsule (3.7%). Overall, in 27.5% of clinical evaluation with unchanged levothyroxine dose (341/1243), there were meaningful spontaneous TSH variations (defined as delta TSH > 1.5 mcUI/ml) at yearly follow-up visit. It is clinically significant: in 6.6% of visits, overt thyrotoxicosis was recorded. Furthermore, the treating clinicians decided to change the LT4 dose in 37.1% of cases. These figures were not significantly higher in the first years, and a rate above 25% persist even after ten years of follow-up. The median maintenance dose needed was 1.61 (interquartile range [IQR] 1.41-1.92) mcg/Kg/day for tablets, 1.54 (IQR 1.39-1.79) mcg/Kg/day for liquid solution, and 1.46 (IQR 1.23-1.71) mcg/Kg/day for soft-gel capsules. After correction for daily dose, there was no difference in the rate of TSH variations > 1.5 mcUI/ml, or in the absolute value of median delta of TSH between the three formulations. In 20.1% of patients, the LT4 formulation was changed during the follow-up: it was more common in patients with a known gastroenteric disease (OR 1.76, p=0.03).
Conclusions. TSH spontaneous variations and dose adjustments are very common in patients after total thyroidectomy, even during long-term follow-up: wide variations happen in more than 1/4 of all visits, and dose changes are needed in more than 1/3 of all evaluations. We were more inclined to change LT4 formulation in patients with known interference in LT4 absorption: however, no difference in TSH variations was recorded between users of three different formulations, even if soft-gel capsules seem to have a lower maintenance dose.
Collapse
|
44
|
Sponziello M, Brunelli C, Verrienti A, Grani G, Pecce V, Abballe L, Ramundo V, Damante G, Russo D, Lombardi CP, Durante C, Rossi ED, Straccia P, Fadda G, Filetti S. Performance of a dual-component molecular assay in cytologically indeterminate thyroid nodules. Endocrine 2020; 68:458-465. [PMID: 32232767 DOI: 10.1007/s12020-020-02271-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Deciding whether patients with a cytologically indeterminate thyroid nodule should be referred for surgery or for active surveillance is an important challenge for clinicians. The aim of this study was to evaluate the performance of a novel dual-component molecular assay as an ancillary molecular method for resolving indeterminate thyroid nodule cytology. METHODS We selected 156 thyroid nodules from those that had undergone fine-needle aspiration processed by liquid-based cytology and surgical resection between June 2016 and December 2017. The sample set included 63 nodules cytologically classified as indeterminate, and 93 other nodules randomly selected from those with non-diagnostic, benign, suspicious, or malignant cytology. Nucleic acids from each nodule were subjected to next-generation sequencing analysis for mutation detection in 23 genes and to digital polymerase chain reaction (PCR) evaluation for miR-146b-5p expression levels. RESULTS Used alone, mutation analysis in the indeterminate subset (cancer prevalence: 22.5%) displayed high sensitivity (89%) and NPV (96%). In contrast, the miR-146b-5p assay offered high specificity (93%) and PPV (93%). Combined use of both analyses improved panel performance by eliminating false-negative results. CONCLUSIONS These preliminary data suggest that a dual-component molecular test can increase the diagnostic accuracy of thyroid cytology alone by reducing the number of nodules that will be classified as indeterminate and increasing those that can be reliably classified as benign. If these findings are confirmed, this test can be considered for use in clinical practice and is expected to reduce diagnostic surgery and health care costs, and to improve patient quality of life.
Collapse
Affiliation(s)
- Marialuisa Sponziello
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Chiara Brunelli
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Rome, Italy
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00161, Rome, Italy.
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Luana Abballe
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Giuseppe Damante
- Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Diego Russo
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, 88100, Catanzaro, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Rome, Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Foundation "Agostino Gemelli" University Hospital, Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| |
Collapse
|
45
|
Verrienti A, Sponziello M, Durante C, Filetti S, Grani G. Comment on: BRAF mutation analysis by ARMS-PCR refines thyroid nodule management. Clin Endocrinol (Oxf) 2020; 92:482-483. [PMID: 31578731 DOI: 10.1111/cen.14103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Antonella Verrienti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
46
|
Barone M, Grani G, Ramundo V, Garritano T, Durante C, Falcone R. Fournier's gangrene during lenvatinib treatment: A case report. Mol Clin Oncol 2020; 12:588-591. [PMID: 32337042 DOI: 10.3892/mco.2020.2031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/31/2019] [Accepted: 02/21/2020] [Indexed: 01/22/2023] Open
Abstract
Fournier's gangrene is a rare and severe complication reported in patients with cancer treated with antiangiogenic drugs, most frequently with bevacizumab. The present report describes the case of an 80-year-old man with radioactive iodine-refractory metastatic thyroid cancer treated with lenvatinib (an oral multikinase inhibitor with antiangiogenic properties) who developed Fournier's gangrene in the absence of other known risk factors. To the best of our knowledge, this is the first case described during treatment with lenvatinib. The condition was likely due to a perturbation of vascular endothelial cells of the skin due to the inhibition of VEGF/VEGFR signaling. Fournier's gangrene may be a class effect of antiangiogenic treatment that clinicians should be aware of, as early diagnosis and treatment are associated with an improved outcome.
Collapse
Affiliation(s)
- Martina Barone
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| | - Tiziana Garritano
- Department of Surgical Sciences, Sapienza University of Rome, I-00161 Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| | - Rosa Falcone
- Department of Translational and Precision Medicine, Sapienza University of Rome, I-00185 Rome, Italy
| |
Collapse
|
47
|
Abstract
Background:
The timely identification of traditional and non-traditional precursors and risk factors for
chronic kidney disease (CKD) (a common systemic disease defined as a decreased kidney function documented
by reduced glomerular filtration rate, or markers of kidney damage, or both) is relevant in clinical practice, as
CKD increases the risk of end-stage renal disease and other serious comorbidities. A possible relationship between
non-alcoholic fatty liver disease (NAFLD) (which is to date the most common chronic disease worldwide)
and CKD has recently gained significant attention of researchers.
Methods :
A systematic literature search using appropriate keywords was made in order to identify relevant articles
that have investigated the association between NAFLD and CKD.
Results:
Several observational studies and meta-analyses have reported the existence of an independent association
between NAFLD and risk of CKD in patients with and without diabetes. However, whilst the association
between NAFLD and risk of prevalent CKD is strong across various patient populations, whether NAFLD is
independently associated with the development and progression of CKD is still debatable. Moreover, emerging
evidence now suggests a potential association between patatin-like phospholipase domain-containing protein-3
(PNPLA3) rs738409 genotype (the most important genetic variant associated to NAFLD) and decreasing kidney
function, independent of NAFLD.
Conclusions :
Convincing evidence now indicates that CKD is increased among patients with NAFLD. For this
reason, patients with NAFLD should be regularly monitored for renal function and, on the other hand , NAFLD
should be considered in all patients with CKD, especially if they are obese or have type 2 diabetes.
Collapse
Affiliation(s)
- Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Chiara Zusi
- Section of Endocrinology, Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Andrea Dalbeni
- Section of General Medicine, Hypertension and Liver Unit, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Elena Buzzetti
- Division of Internal Medicine 2 and Center for Hemochromatosis, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
48
|
Falcone R, Sponziello M, Carletti R, Di Gioia C, Nardi F, Mio C, Pecce V, Abballe L, Grani G, Ramundo V, Damante G, Durante C, Filetti M, Roberto M, Marchetti P, Verrienti A. Exploring the molecular insights of concurrent composite mucoepidermoid carcinoma and papillary thyroid carcinoma. Endocrine 2020; 68:230-232. [PMID: 32048208 DOI: 10.1007/s12020-020-02221-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Rosa Falcone
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy.
| | - Raffella Carletti
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Cira Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Nardi
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Catia Mio
- Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Luana Abballe
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Giuseppe Damante
- Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Marco Filetti
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00189, Rome, Italy
| | - Michela Roberto
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00189, Rome, Italy
| | - Paolo Marchetti
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| |
Collapse
|
49
|
Falcone R, Sponziello M, Carletti R, Di Gioia C, Nardi F, Mio C, Pecce V, Abballe L, Grani G, Ramundo V, Damante G, Durante C, Filetti M, Roberto M, Marchetti P, Verrienti A. Correction to: Exploring the molecular insights of concurrent composite mucoepidermoid carcinoma and papillary thyroid carcinoma. Endocrine 2020; 68:248. [PMID: 32207037 DOI: 10.1007/s12020-020-02262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Collapse
Affiliation(s)
- Rosa Falcone
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy.
| | - Raffella Carletti
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Cira Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Nardi
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Catia Mio
- Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Luana Abballe
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Valeria Ramundo
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Giuseppe Damante
- Department of Medicine, University of Udine, 33100, Udine, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - Marco Filetti
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00189, Rome, Italy
| | - Michela Roberto
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, "Sapienza" University of Rome, 00189, Rome, Italy
| | - Paolo Marchetti
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| |
Collapse
|
50
|
Ramundo V, Sponziello M, Falcone R, Verrienti A, Filetti S, Durante C, Grani G. Low-risk papillary thyroid microcarcinoma: Optimal management toward a more conservative approach. J Surg Oncol 2020; 121:958-963. [PMID: 32189352 DOI: 10.1002/jso.25848] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Abstract
The incidence of papillary thyroid microcarcinoma (microPTC) has dramatically increased in the last decades. Most of these tumors remain small and clinically "silent", only small number progress. Although thyroid surgery used to be the only therapeutic approach, recent guidelines now consider active surveillance for low-risk microPTC. For this reason, more accurate risk stratification of microPTC is needed. The optimal management of low-risk microPTC through accurate risk stratification represents a major clinical issue.
Collapse
Affiliation(s)
- Valeria Ramundo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Rosa Falcone
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|