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Abdulhaleem M, Bandargal S, Pusztaszeri MP, Rajab M, Greenspoon H, Krasner JR, Da Silva SD, Forest VI, Payne RJ. The Impact of BRAF V600E Mutation Allele Frequency on the Histopathological Characteristics of Thyroid Cancer. Cancers (Basel) 2023; 16:113. [PMID: 38201541 PMCID: PMC10777954 DOI: 10.3390/cancers16010113] [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: 10/22/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND A BRAF V600E mutation in papillary thyroid cancer (PTC) has been shown to be associated with aggressive behavior. Nevertheless, not all BRAF V600E PTCs behave aggressively. Allele frequency (AF) is the number of mutated molecules divided by the total number of wild-type molecules at a specific location in the genome. The relationship between BRAF V600E AF and the histopathological features of thyroid malignancies is not well understood. We hypothesized that the BRAF V600E AF will correlate directly with aggressive histopathological behavior. The aim of this study was to examine this relationship. METHODS A retrospective chart review was performed for patients treated for BRAF V600E thyroid malignancies from 2019 to 2022 at McGill University tertiary care hospitals (n = 317). Patients with BRAF V600E-positive malignancies that included information on AF were included (n = 44). The correlation between AF and tumor histopathological features was analyzed. RESULTS Out of the 44 nodules with a BRAF V600E mutation, those with aggressive features of PTC had a mean AF of 25.8%, which was significantly higher than the non-aggressive group with a mean AF of 10.25% (p = 0.020). Additionally, there was a statistically significant difference in mean AF between patients with a positive sentinel LN (29%) and those with a negative sentinel LN (17.8%) (p = 0.021). Classical PTC was present in 29.5% (13/44) of nodules, with a mean AF of 15.6%. The tall cell subtype was found in 64% (28/44) of nodules, with a mean AF of 23%. Solid and hobnail subtypes were less common in this study, and there was no statistically significant relationship between AF and histopathological subtypes (p = 0.107). Nodules smaller than 1cm had a mean AF of 13.3%, while nodules ranging from 1 2cm had a mean AF of 20.6%, and those larger than 2cm had a mean AF of 27.7%. However, no statistical difference was observed between AF and nodule size (p = 0.160). CONCLUSION In this study, BRAF V600E mutations in conjunction with AF help to determine whether thyroid malignancies will display aggressive behavior. This pre-operative finding can help thyroid specialists to determine the extent of thyroidectomy and whether lymph node dissection is required.
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Affiliation(s)
- Mawaddah Abdulhaleem
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, QC H4A 3J1, Canada
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Saruchi Bandargal
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | | | - Mohannad Rajab
- Department of Otolaryngology—Head and Neck Surgery, King Faisal Specialist Hospital & Research Center, Al Madinah Al Munawwarah 42523, Saudi Arabia
| | - Hannah Greenspoon
- Faculty of Arts and Science, Queen’s University, Kingston, ON K7L 3N6, Canada
| | | | - Sabrina Daniela Da Silva
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Véronique-Isabelle Forest
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, QC H4A 3J1, Canada
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Richard J. Payne
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, QC H4A 3J1, Canada
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
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Hudson TJ, Pusztaszeri MP, Hier MP, Forest VI, Yang JW, Payne RJ. Does the likelihood of malignancy in thyroid nodules with RAS mutations increase in direct proportion with the allele frequency percentage? J Otolaryngol Head Neck Surg 2023; 52:12. [PMID: 36774522 PMCID: PMC9921308 DOI: 10.1186/s40463-022-00611-8] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/06/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Genomic testing has enhanced pre-surgical decision making for cytologically indeterminate thyroid nodules, but there remains uncertainty regarding RAS mutations. The addition of extra genetic alterations to previous driver mutation panels has been shown to improve predictive value. This study aims to evaluate the relationship between the mutant allele frequency (AF) and likelihood of malignancy in thyroid nodules with RAS mutations. METHODS A retrospective cohort review was performed evaluating patients with indeterminate cytology (Bethesda categories III, IV and V) and ThyroSeq® v3 testing demonstrating a RAS mutation, who underwent surgery. Univariate and multivariate regression analyses were used to evaluate relationships between AF, other genetic alterations, and malignancy. RESULTS Thirty-nine patients met criteria, 77% of the thyroid nodules (30/39) were found to be malignant. None demonstrated aggressive pathology. On univariate regression, there was no relationship between AF and likelihood of malignancy. There was, however, a significant correlation between AF and the rate of an additional genetic alteration. Multivariate analysis found a trend between RAS, a second genetic alteration and malignancy, but it did not reach statistical significance. CONCLUSIONS There was no direct relationship between the level of allelic frequency in thyroid nodules expressing RAS mutations and the likelihood of malignancy. There was a statistically significant relationship between increasing AF and the presence of a second genetic abnormality, suggesting a possible progression from initial driver mutation and then a second genetic alteration prior to malignant transformation.
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Affiliation(s)
- Thomas J Hudson
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la Côte-Sainte-Catherine Rd., Montreal, QC, H3T 1E2, Canada.,nt of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada
| | | | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la Côte-Sainte-Catherine Rd., Montreal, QC, H3T 1E2, Canada
| | - Veronique-Isabelle Forest
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la Côte-Sainte-Catherine Rd., Montreal, QC, H3T 1E2, Canada
| | - Ji-Wei Yang
- Division of Endocrinology, McGill University Health Centre, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Ch. de la Côte-Sainte-Catherine Rd., Montreal, QC, H3T 1E2, Canada. .,nt of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, QC, Canada.
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Rajab M, Bandargal S, Pusztaszeri MP, Forest VI, Alohali S, da Silva SD, Tamilia M, Payne RJ. Coexisting Molecular Alterations Increase the Risk of Malignancy in Thyroid Nodules with Copy Number Alterations. Cancers (Basel) 2022; 14:cancers14246149. [PMID: 36551633 PMCID: PMC9776079 DOI: 10.3390/cancers14246149] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Molecular mutations and alterations play a role in thyroid tumorigenesis. Different alterations are associated with different clinical and pathological characteristics. Copy number alterations (CNAs) are known to be present in some thyroid tumors; however, their idiosyncratic clinicopathological implications are not yet well elucidated. A retrospective chart review was performed to identify patients with CNAs on pre-operative molecular testing results who subsequently underwent surgical treatment between January 2016 and April 2022 at McGill University teaching hospitals. Of the 316 patients with thyroid nodules who opted for molecular testing with ThyroSeqV3 followed by surgery, 67 (21.2%) nodules were positive for CNAs, including 23 Bethesda III, 31 Bethesda IV, 12 Bethesda V and 1 Bethesda VI nodules. On surgical pathology, 29.9% were benign and 70.1% were malignant or non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Among those that were malignant/NIFTP, 17.02% were considered to be aggressive cancers. The presence of other molecular alterations was found to be an independent predictor of malignancy in multivariate analysis (OR = 5.087, 95% C.I. = 1.12-23.04, p = 0.035). No unique factor was correlated with aggressiveness; however, CNA-positive thyroid nodules that were associated with high-risk mutations such as BRAF V600E, TP53, NTRK1/3 fusion, or PTEN mutation with high allele frequency (AF) ended up being aggressive cancers. Most of the CNA-positive thyroid nodules resulted in follicular patterned tumors in 41 (65.2%) cases and oncocytic tumors in 20 (29.9%) cases. This study demonstrates that 70.1% of surgically resected thyroid nodules with CNAs were malignant/NIFTP. Most CNA-positive thyroid nodules were either oncocytic patterned tumors or follicular patterned tumors. Furthermore, CNA-positive thyroid nodules were more likely to be malignant if they were associated with other molecular alterations or mutations.
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Affiliation(s)
- Mohannad Rajab
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
- Departments of Otolaryngology—Head and Neck Surgery, Royal Victoria Hospital, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
- Department of Otolaryngology—Head and Neck Surgery, King Faisal Specialist Hospital & Research Center, Al Madinah Al Munawwarah 42523, Saudi Arabia
| | - Saruchi Bandargal
- Faculty of Medicine, McGill University, 845 Rue Sherbrooke O, Montral, QC H3A 0G4, Canada
| | - Marc Philippe Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Véronique-Isabelle Forest
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Sama Alohali
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
- Departments of Otolaryngology—Head and Neck Surgery, Royal Victoria Hospital, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
- Department of Otolaryngology—Head and Neck Surgery, King Faisal Specialist Hospital & Research Center, Al Madinah Al Munawwarah 42523, Saudi Arabia
| | - Sabrina Daniela da Silva
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Michael Tamilia
- Department of Endocrinology and Metabolism, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
| | - Richard J. Payne
- Department of Otolaryngology—Head and Neck Surgery, Jewish General Hospital, McGill University, 3755 Côte-Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada
- Departments of Otolaryngology—Head and Neck Surgery, Royal Victoria Hospital, McGill University, 1001 Decarie Blvd, Montreal, QC H4A 3J1, Canada
- Correspondence:
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Bandargal S, Chen T, Pusztaszeri MP, Forest VI, da Silva SD, Payne RJ. Prognostic Indicators of EIF1AX-Mutated Thyroid Tumor Malignancy and Cancer Aggressiveness. Cancers (Basel) 2022; 14:cancers14246097. [PMID: 36551583 PMCID: PMC9776054 DOI: 10.3390/cancers14246097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
The risk of malignancy (ROM) of EIF1AX-mutated thyroid nodules has been theorized to be contingent on the position of the mutation within the gene and the presence of co-existing mutations. However, due to EIF1AX's low mutation frequency, sample sizes currently reported in the literature are too diminutive to appraise the clinical utility of molecular diagnostic testing. The objective of this study was to elucidate prognostic indicators of EIF1AX-mutated thyroid tumors and cancer aggressiveness by examining a large cohort of cytologically indeterminate thyroid nodules (CITNs) that underwent molecular testing and subsequent surgical resection. This is a multicenter study involving 764 subtotal and total thyroidectomy patients that underwent preoperative molecular testing at two quaternary care hospitals. A five-year retrospective review was performed on the 42 charts of patients that opted for surgery following a positive EIF1AX mutation on ThyroseqV3 results from January 2018 to May 2022. Patient demographics, cytopathology results, molecular testing results, and postoperative histopathology were reviewed. Of the 42 surgically resected nodules that harbored an EIF1AX mutation, 16 (38.1%) were benign, six (14.3%) were non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTPs) or well-differentiated thyroid neoplasms of uncertain malignant potential (WDT-UMPs), and 20 (47.6%) were malignant. An isolated EIF1AX mutation conferred a ROM of 47.6%, whereas the ROM for nodules with at least one additional molecular alteration was 72.7%. The ROM increased to 100% for nodules with at least one additional molecular alteration and the A113_splice site mutation. Six malignant nodules were aggressive, with five having variegated components of poorly differentiated thyroid carcinoma (PDTC). EIF1AX-mutated thyroid nodules are more susceptible to malignancy in the presence of the A113_splice site mutation and when co-mutated with RAS and/or TP53. This deleterious amalgam is associated with aggressive disease and renders these nodules PDTC. A preoperative molecular test finding of an EIF1AX mutation can be a useful tool for thyroid specialists to optimize clinical management.
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Affiliation(s)
- Saruchi Bandargal
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Tanya Chen
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, ON M5S, Canada
| | | | - Véronique-Isabelle Forest
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Sabrina Daniela da Silva
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
| | - Richard J. Payne
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Department of Otolaryngology–Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, QC H4A 3J1, Canada
- Correspondence:
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Mascarella MA, Peeva M, Forest VI, Pusztaszeri MP, Avior G, Tamilia M, Mlynarek AM, Hier MP, Payne RJ. Association of Bethesda category and molecular mutation in patients undergoing thyroidectomy. Clin Otolaryngol 2021; 47:75-80. [PMID: 34510770 DOI: 10.1111/coa.13859] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/11/2021] [Revised: 07/22/2021] [Accepted: 08/28/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The aim of this study was to ascertain the relationship between Bethesda category and molecular mutation of thyroid nodules in patients undergoing thyroidectomy. DESIGN A retrospective cohort of patients who underwent thyroidectomy following needle biopsy and molecular profile testing was performed. SETTING Two tertiary care academic hospitals. PARTICIPANTS Consecutive patients with a dominant thyroid nodule who underwent both USFNA and molecular profile testing followed by thyroidectomy were included in the study. MAIN OUTCOME AND MEASURES The main outcome was postoperative diagnosis of thyroid cancer and aggressivity of disease based on histopathological variants, nodal metastasis or extra-thyroidal extension. Associations between Bethesda category, molecular mutation and postoperative pathology was assessed using descriptive analysis and chi-square testing. RESULTS Four hundred fifty-one patients were included. 95.9% (93/97) of patients with a BRAFV600E mutation had a Bethesda category V or VI (p < .001), and all had confirmed thyroid cancer on postoperative pathology. Those with H, K or N RAS or EIF1AX mutations, gene expression profiling (GEP) or copy number alterations showed an association with Bethesda categories III and IV (p ≤ .01). Those with no identified molecular mutation had a lower incidence of aggressive thyroid cancer compared to those with an identified mutation (12.6% vs. 44.3%, p < .01). CONCLUSION BRAFV600E mutations were associated with thyroid cancer subtypes known to be more aggressive whereas RAS and EIF1AX mutations, copy number alterations, and GEP were related to Bethesda categories III and IV. These findings may help thyroid specialists better identify aggressive thyroid nodules associated with indeterminate Bethesda categories.
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Affiliation(s)
- Marco Antonio Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research of the Jewish General Hospital, Montreal, QC, Canada.,Department of Biomedical Sciences, University of Montreal, Montreal, QC, Canada
| | - Magdalena Peeva
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | | | | | - Galit Avior
- Department of Otolaryngology - Head and Neck Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Michael Tamilia
- Division of Endocrinology, Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alex M Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
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Liu X, Maleki F, Muthukrishnan N, Ovens K, Huang SH, Pérez-Lara A, Romero-Sanchez G, Bhatnagar SR, Chatterjee A, Pusztaszeri MP, Spatz A, Batist G, Payabvash S, Haider SP, Mahajan A, Reinhold C, Forghani B, O’Sullivan B, Yu E, Forghani R. Site-Specific Variation in Radiomic Features of Head and Neck Squamous Cell Carcinoma and Its Impact on Machine Learning Models. Cancers (Basel) 2021; 13:cancers13153723. [PMID: 34359623 PMCID: PMC8345201 DOI: 10.3390/cancers13153723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Head and neck squamous cell carcinoma (HNSCC) is the most common mucosal malignancy of the head and neck and a leading cause of cancer death. HNSCC arises from different primary anatomical locations that are typically combined during radiomic analyses assuming that the radiomic features, i.e., quantitative image-based features, are similar based on histopathologic characteristics. However, whether these quantitative features are comparable across tumor sites remains unknown. The aim of our retrospective study was to assess if systematic differences exist between radiomic features based on different tumor sites in HNSCC and how they might affect machine learning model performance in endpoint prediction. Using a population of 605 HNSCC patients, we observed significant differences in radiomic features of tumors from different locations and showed that these differences can impact machine learning model performance. This suggests that tumor site should be considered when developing and evaluating radiomics-based models. Abstract Current radiomic studies of head and neck squamous cell carcinomas (HNSCC) are typically based on datasets combining tumors from different locations, assuming that the radiomic features are similar based on histopathologic characteristics. However, molecular pathogenesis and treatment in HNSCC substantially vary across different tumor sites. It is not known if a statistical difference exists between radiomic features from different tumor sites and how they affect machine learning model performance in endpoint prediction. To answer these questions, we extracted radiomic features from contrast-enhanced neck computed tomography scans (CTs) of 605 patients with HNSCC originating from the oral cavity, oropharynx, and hypopharynx/larynx. The difference in radiomic features of tumors from these sites was assessed using statistical analyses and Random Forest classifiers on the radiomic features with 10-fold cross-validation to predict tumor sites, nodal metastasis, and HPV status. We found statistically significant differences (p-value ≤ 0.05) between the radiomic features of HNSCC depending on tumor location. We also observed that differences in quantitative features among HNSCC from different locations impact the performance of machine learning models. This suggests that radiomic features may reveal biologic heterogeneity complementary to current gold standard histopathologic evaluation. We recommend considering tumor site in radiomic studies of HNSCC.
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Affiliation(s)
- Xiaoyang Liu
- Princess Margaret Hospital, University of Toronto, University Health Network, Toronto, ON M5G 2C1, Canada; (X.L.); (S.H.H.); (B.O.)
- Department of Radiology, Brigham and Women’s Hospital, Harvard University, Cambridge, MA 02115, USA
- Department of Medical Imaging, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Farhad Maleki
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada; (F.M.); (N.M.); (K.O.); (S.R.B.); (C.R.); (B.F.)
| | - Nikesh Muthukrishnan
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada; (F.M.); (N.M.); (K.O.); (S.R.B.); (C.R.); (B.F.)
| | - Katie Ovens
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada; (F.M.); (N.M.); (K.O.); (S.R.B.); (C.R.); (B.F.)
| | - Shao Hui Huang
- Princess Margaret Hospital, University of Toronto, University Health Network, Toronto, ON M5G 2C1, Canada; (X.L.); (S.H.H.); (B.O.)
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Almudena Pérez-Lara
- Segal Cancer Centre & Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (A.P.-L.); (G.R.-S.); (G.B.)
| | - Griselda Romero-Sanchez
- Segal Cancer Centre & Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (A.P.-L.); (G.R.-S.); (G.B.)
| | - Sahir Rai Bhatnagar
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada; (F.M.); (N.M.); (K.O.); (S.R.B.); (C.R.); (B.F.)
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada
| | | | | | - Alan Spatz
- Division of Pathology, Jewish General Hospital, Montreal, QC H3Y 1E2, Canada; (M.P.P.); (A.S.)
| | - Gerald Batist
- Segal Cancer Centre & Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (A.P.-L.); (G.R.-S.); (G.B.)
| | - Seyedmehdi Payabvash
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520, USA; (S.P.); (S.P.H.); (A.M.)
| | - Stefan P. Haider
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520, USA; (S.P.); (S.P.H.); (A.M.)
| | - Amit Mahajan
- Section of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520, USA; (S.P.); (S.P.H.); (A.M.)
| | - Caroline Reinhold
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada; (F.M.); (N.M.); (K.O.); (S.R.B.); (C.R.); (B.F.)
| | - Behzad Forghani
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada; (F.M.); (N.M.); (K.O.); (S.R.B.); (C.R.); (B.F.)
- Segal Cancer Centre & Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (A.P.-L.); (G.R.-S.); (G.B.)
| | - Brian O’Sullivan
- Princess Margaret Hospital, University of Toronto, University Health Network, Toronto, ON M5G 2C1, Canada; (X.L.); (S.H.H.); (B.O.)
- Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Eugene Yu
- Princess Margaret Hospital, University of Toronto, University Health Network, Toronto, ON M5G 2C1, Canada; (X.L.); (S.H.H.); (B.O.)
- Department of Medical Imaging, University of Toronto, Toronto, ON M5S 1A1, Canada
- Correspondence: (E.Y.); (R.F.)
| | - Reza Forghani
- Augmented Intelligence & Precision Health Laboratory (AIPHL), Department of Radiology and the Research Institute of the McGill University Health Centre, McGill University, Montreal, QC H4A 3J1, Canada; (F.M.); (N.M.); (K.O.); (S.R.B.); (C.R.); (B.F.)
- Segal Cancer Centre & Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada; (A.P.-L.); (G.R.-S.); (G.B.)
- Correspondence: (E.Y.); (R.F.)
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Larouche V, Pusztaszeri MP, Filimon S, Payne R, Hier M, Tamilia M. Preoperative prediction of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: a Canadian single-Centre experience. J Otolaryngol Head Neck Surg 2020; 49:1. [PMID: 31898554 PMCID: PMC6941342 DOI: 10.1186/s40463-019-0397-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/06/2018] [Accepted: 12/23/2019] [Indexed: 12/14/2022] Open
Abstract
Background An international group of experts recommended reclassifying non-invasive follicular variant of papillary thyroid cancers (FVPTC) as ‘non-invasive follicular thyroid neoplasm with papillary-like nuclear features’ (NIFTP) in April 2016. The purpose of this study was to establish preoperative clinical, laboratory, ultrasonographic, and cytological variables, which can differentiate NIFTP from FVPTC. Methods We conducted a retrospective chart review of consecutive patients from a single institution evaluated between January 2012 and December 2017. 203 adult patients underwent lobectomy or total thyroidectomy for a FVPTC during that period. Each patient’s medical chart was reviewed and information on pre-operative variables was recorded. An expert pathologist reviewed all surgical specimens and reclassified a subset of FVPTC as NIFTP according to the specific criteria. Results Overall, 44 patients were included in the NIFTP group and 159 in the non-NIFTP group. Mean age was 50.1 years in the NIFTP group and 50.7 in the non-NIFTP group. Most patients were female (86.4% (38/44) in the NIFTP group vs 79.8% (127/159) in the non-NIFTP group). More patients underwent lobectomy in the NIFTP group (50% (22/44) vs 16.4% (26/159) in the non-NIFTP group, p = < 0.0001). Less patients received radioactive iodine in the NIFTP group (31.8% (14/44) vs 52.2% (83/159) in the non-NIFTP group, p = 0.0177). Preoperative thyroglobulin levels were lower in NIFTP patients (Median 25.55 mcg/L +/− 67.8 vs 76.06 mcg/L +/− 119.8 in Non-NIFTP, p = 0.0104). NIFTP nodules were smaller (Mean size 22.97 mm +/− 12.3 vs 25.88 mm +/− 11.2 for non-NIFTP, p = 0.0448) and more often solid than non-NIFTP (93.2% (41/44) vs 74.8% (119/159) for non-NIFTP, p = 0.0067). 2017 ACR TIRADS nodule category of 1–4 on ultrasound had a negative predictive value and a sensitivity of 100% for NIFTP. ROC Curve Analysis demonstrated that a preoperative thyroglobulin level of 31.3 mcg/L had a sensitivity of 75% and a specificity of 62.5% to differentiate NIFTP from non-NIFTP cancers. Conclusion Lower preoperative thyroglobulin levels, smaller nodule size, solid texture and 2017 ACR TIRADS Category of 1–4 are more strongly associated with NIFTP than FVPTC and can favour less invasive surgical options such as lobectomy.
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Affiliation(s)
- Vincent Larouche
- Division of Endocrinology and Metabolism, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada.
| | - Marc Philippe Pusztaszeri
- Division of Pathology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Sabin Filimon
- Internal Medicine Residency Training Program, McGill University, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Richard Payne
- Division of Oto-Rhino-Laryngology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Michael Hier
- Division of Oto-Rhino-Laryngology, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
| | - Michael Tamilia
- Division of Endocrinology and Metabolism, Jewish General Hospital, 3755, Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3Y 1E2, Canada
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