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Sun Z, Feng D, Jiang L, Tian J, Wang J, Zhu W. Integrated proteomic and metabolomic analysis of plasma reveals regulatory pathways and key elements in thyroid cancer. Mol Omics 2023; 19:800-809. [PMID: 37642188 DOI: 10.1039/d3mo00142c] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/31/2023]
Abstract
Thyroid cancer (TC) is the most common endocrine malignancy with increasing incidence in recent years. Fine-needle aspiration biopsy (FNAB), as a gold standard for the initial evaluation of thyroid nodules, fails to cover all the cytopathologic conditions resulting in overdiagnosis. There is an urgent need for a better classification of thyroid cancer from benign thyroid nodules (BTNs). Here, data independent acquisition (DIA)-based proteomics and untargeted metabolomics in plasma samples of 10 patients with TC and 15 patients with BTNs were performed. Key proteins and metabolites were identified specific to TC, and an independent cohort was used to validate the potential biomarkers using enzyme-linked immunosorbent assay (ELISA). In total, 1429 proteins and 1172 metabolites were identified. Principal component analysis showed a strong overlap at the proteomic level and a significant discrimination at the metabolomic level between the two groups, indicating a more drastic disturbance in the metabolome of thyroid cancer. Integrated analysis of proteomics and metabolomics shows glycerophospholipid metabolism and arachidonic acid metabolism as key regulatory pathways. Furthermore, a multi-omics biomarker panel was developed consisting of LCAT, GPX3 and leukotriene B4. Based on the AUC value for the discovery set, the classification performance was 0.960. The AUC value of the external validation set was 0.930. Altogether, our results will contribute to the clinical application of potential biomarkers in the diagnosis of thyroid cancer.
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Affiliation(s)
- Zijian Sun
- Key Laboratory for Molecular Medicine and Chinese Medicine Preparations, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China.
| | - Dongdong Feng
- Department of Head and Neck Surgery, Center of Otolaryngology-head and neck surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, 310014, China.
| | - Liehao Jiang
- Department of Head and Neck Surgery, Center of Otolaryngology-head and neck surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, 310014, China.
| | - Jingkui Tian
- Key Laboratory for Molecular Medicine and Chinese Medicine Preparations, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China.
| | - Jiafeng Wang
- Department of Head and Neck Surgery, Center of Otolaryngology-head and neck surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, 310014, China.
| | - Wei Zhu
- Key Laboratory for Molecular Medicine and Chinese Medicine Preparations, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China.
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Macerola E, Poma AM, Proietti A, Rago T, Romani R, Vignali P, Ugolini C, Torregrossa L, Basolo A, Santini F, Basolo F. Down-regulation of miR-7-5p and miR-548ar-5p predicts malignancy in indeterminate thyroid nodules negative for BRAF and RAS mutations. Endocrine 2022; 76:677-686. [PMID: 35347579 PMCID: PMC9156468 DOI: 10.1007/s12020-022-03034-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The value of molecular markers in refining preoperative risk assessment of indeterminate thyroid nodules is being widely investigated. MicroRNAs (miRNA) are emerging as promising biomarkers for diagnostic and prognostic purposes. The aim of this study is to identify miRNAs specifically deregulated in mutation-negative indeterminate thyroid nodules. METHODS Ninety-eight nodules preoperatively diagnosed as TIR 3A or TIR 3B with available histological diagnosis of follicular adenoma (FA), noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP), and follicular variant papillary thyroid carcinoma (FV-PTC) have been retrospectively selected. Mutations in BRAF and RAS genes have been tested in all samples by real-time PCR; miRNAs were purified from cytology slides of 60 samples; expression analysis of 798 miRNAs was measured by the nCounter system. RESULTS Point mutations in BRAF and RAS genes were detected in 32 out of 98 nodules (32.7%), the majority of which in FV-PTCs. Differential expression of miRNA in wild-type nodules highlighted that two miRNAs, namely miR-7-5p and miR-548ar-5p, were downregulated in FV-PTCs compared to FAs. The combined expression of these miRNAs, tested by ROC analysis, showed an area under the curve of 0.79. Sensitivity and negative predictive value were high both in wild-type (93% and 92%, respectively) and in mutated nodules (94% and 85%, respectively). CONCLUSION The analysis of miR-7-5p and miR-548ar-5p expression in indeterminate thyroid nodules demonstrated a promising value in ruling out malignancy.
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Affiliation(s)
- Elisabetta Macerola
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Anello Marcello Poma
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Agnese Proietti
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Teresa Rago
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Rossana Romani
- University Hospital of Pisa - via Roma, 67 56126, Pisa, Italy
| | - Paola Vignali
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Clara Ugolini
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Liborio Torregrossa
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy
| | - Alessio Basolo
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Ferruccio Santini
- University of Pisa, Department of Clinical and Experimental Medicine - via Roma, 67 56126, Pisa, Italy
| | - Fulvio Basolo
- University of Pisa, Department of Surgical, Medical, Molecular Pathology and Critical Area - via Savi, 10 56126, Pisa, Italy.
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Tessler I, Shochat I, Cohen O, Meir A, Avior G. Positive Correlation of Thyroid Nodule Cytology with Molecular Profiling-a Single-Center Experience. Endocr Pathol 2021; 32:480-488. [PMID: 34086262 DOI: 10.1007/s12022-021-09680-3] [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] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
Despite several reports on the association between molecular profiling, aggressive histology, and clinical outcomes, the association between mutation expression and pre-operative cytology is yet to be demonstrated. Therefore, we performed a retrospective, single-center study, including all patients who underwent molecular profiling of thyroid nodules in Bethesda System for Reporting Thyroid Cytopathology (BSRTC) categories III to VI, between 2018 and 2019. Medical records were reviewed to collect demographics, cytology results according to BSRTC, final pathology (presence of malignancy and its type, as well as presence of aggressive features, including extrathyroidal extension, positive neck lymph nodes, and multifocality), and the identified genetic variants stratified by risk levels, according to the 2015 ATA guidelines. We supplemented this analysis with a systematic review to identify the variant distributions across the literature. We included data on 55 nodules from 48 patients for the final analysis. A significant positive correlation was found between BSRTC categories and the mutation risk level, shown by an increase in the intermediate to high-risk mutation rate in the higher BSRTC categories (Rs = 0.660, p ≤ 0.001). A significant positive correlation was also found between mutation risk levels and the presence of malignancy and aggressive tumor features (Rs = 0.637, p < 0.001 and Rs = 0.459, p = 0.006, respectively). This novel positive and significant correlation between BSRTC categories and the mutation risk level provides additional insight to aid clinicians in the interpretation of BSRTC results and may contribute to the discussion of appropriate management of thyroid nodule with patients.
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Affiliation(s)
- Idit Tessler
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Isaac Shochat
- Department of Otolaryngology Head and Neck Surgery, Technion Faculty of Medicine, Hillel Yaffe Medical Center, 38100, Haifa, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Oded Cohen
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Alona Meir
- Faculty of Medicine, Technion, Haifa, Israel
- Department of Pathology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Galit Avior
- Department of Otolaryngology Head and Neck Surgery, Technion Faculty of Medicine, Hillel Yaffe Medical Center, 38100, Haifa, Israel.
- Faculty of Medicine, Technion, Haifa, Israel.
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Vargas-Ortega G, Romero-Gameros CA, Rendón-Macias ME, Balcázar-Hernández L, Sosa-Eroza E, Mercado M, de Los Monteros-Sánchez ALE, Pérez-Aguilar B, Paredes-Manjarrez C, Reyes-Olhagaray FB, Serrano-Ramírez DL, la Cruz EVMD, González-Virla B. Risk factors associated with thyroid nodular disease in acromegalic patients: A case-cohort study in a tertiary center. Growth Horm IGF Res 2021; 60-61:101431. [PMID: 34740022 DOI: 10.1016/j.ghir.2021.101431] [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: 07/09/2021] [Revised: 09/24/2021] [Accepted: 10/08/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Goiter is very common in patients with acromegaly; its development is correlated to the duration of the disease. Thyroid cells express the IGF-1 receptor and the TSH/IGF-1 interaction has been demonstrated to have a synergistic effect in thyroid cell growth. There is a correlation between IGF-1 levels and the thyroid volume of patients with acromegaly. The aim of this study was to evaluate, in a retrospective case-cohort study of patients with acromegaly, the associated risk factors for thyroid nodules disease in this population. METHODS This was a case-cohort study matched by age, gender, and growth hormone at diagnosis. Cases consisted of acromegalic patients that developed thyroid nodules during the follow up, and controls consisted in acromegalic patients without thyroid nodules. A Cox proportional hazard estimation was carried out for measure the associated risk factors for thyroid nodules disease in acromegalic patients. A nodular thyroid disease-free survival analysis was estimated using the Kaplan-Meier analysis. RESULTS We recruited 49 cases and 56 controls. In a multivariate Cox proportional hazard analysis age and IGF-1 ≥ 2.2 x ULN were significantly related with the presence of thyroid nodules [HR of 2.21 (95% CI; 1.15-4.25, p = 0.01)]. Nodularity-free survival rates in patients who had an IGF-1 X ULN ≥ 2.2 was found to be lower in comparison to those who had IGF-1 X ULN < 2.2, according to a Kaplan-Meier survival analysis. CONCLUSIONS Our findings support that exist more probability to develop thyroid nodular disease in patients with acromegaly that present IGF-1 X ULN ≥ 2.2, suggesting a possible direct effect between the time of exposure to the IGF-1 axis hyperactivity and the genesis of thyroid nodules.
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Affiliation(s)
- Guadalupe Vargas-Ortega
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Carlos Alfonso Romero-Gameros
- Otorhinolaryngology Head and Neck Surgery Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Lourdes Balcázar-Hernández
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ernesto Sosa-Eroza
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Moises Mercado
- Medical Research Unit in Endocrine Diseases, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Barbara Pérez-Aguilar
- Endocrinology Service, Hospital General de Mexico, Secretaria de Salud, Mexico City, Mexico
| | - Carlos Paredes-Manjarrez
- Radiology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Fernando Bernardo Reyes-Olhagaray
- Radiology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Diana Laura Serrano-Ramírez
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Erick Vladimir Martínez-De la Cruz
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Baldomero González-Virla
- Endocrinology Service, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Xu L, Zeng F, Wang Y, Bai Y, Shan X, Kong L. Prevalence and associated metabolic factors for thyroid nodules: a cross-sectional study in Southwest of China with more than 120 thousand populations. BMC Endocr Disord 2021; 21:175. [PMID: 34452638 PMCID: PMC8400405 DOI: 10.1186/s12902-021-00842-2] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/16/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To explore the prevalence and its associated metabolic factors of thyroid nodules (TNs) among subjects who participated in the physical examinations in Chongqing, China. METHODS The participants from the Health Management Center of JinShan Hospital of Chongqing Medical University, between September 2015 and May 2020, were included in this study. All of the participants underwent thyroid ultrasonography, anthropometric measurements, and serum examinations. Differences in the TNs prevalence were compared with the chi-square test or Wilcoxon rang-sum test. Multivariable logistic regression analyses were used to estimate the metabolic factors associated with TNs and multiple thyroid nodules (MTNs). RESULTS Of the included 121,702 participants, 41,547 had TNs, and 20,899 had MTNs, with the prevalence of 34.1 and 17.0 %, respectively. Women had a significantly higher prevalence of TNs than men (40.6 % vs. 29.8 %; χ2 = 1517.33, P < 0.001), and TNs prevalence was gradually increased with age (P for trend < 0.001). Female gender, advanced age, and metabolic factors including central obesity, hypertension, diabetes and fatty liver were positively associated with TNs; BMI, hyperlipoidemia and hyperuricemia were not independent risk factors of TNs. While female gender, advanced age, central obesity, hypertension and diabetes were independent risk factors of MTNs. CONCLUSIONS The prevalence of thyroid nodules was relatively high. The associated factors identified in this study could help the clinicians to detect the high-risk patients and make targeted screening strategies for the preventing of the occurrence of TNs.
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Affiliation(s)
- Li Xu
- Health Management Centre, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Fanling Zeng
- Health Management Centre, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China
| | - Yutong Wang
- Department of Health Management Centre (Epidemiology and Biostatistics), First Affiliated Hospital, Army Medical University, 400038, Chongqing, China
| | - Ye Bai
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, 400016, Chongqing, China
| | - Xuefeng Shan
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Lingxi Kong
- Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
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Cannarella R, Condorelli RA, Barbagallo F, Aversa A, Calogero AE, La Vignera S. TSH lowering effects of metformin: a possible mechanism of action. J Endocrinol Invest 2021; 44:1547-1550. [PMID: 33058005 PMCID: PMC8195970 DOI: 10.1007/s40618-020-01445-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 08/08/2020] [Accepted: 10/07/2020] [Indexed: 01/28/2023]
Abstract
Preliminary clinical evidence suggests that metformin has TSH lowering effects in patients with T2DM and hypothyroidism or in those with TSH serum levels in the upper normal value. Also, metformin may exert a protective role against thyroid nodules growth in patients without insulin-resistance. The cross-talk between tyrosine kinase receptors and the G protein-coupled receptors (which the TSHR belongs to) has been already shown and IRS1 may represent the hub link between TSHR and IR pathways. By influencing IRS1 phosphorylation pattern, metformin may sensitize TSHR to TSH, thus explaining the findings of clinical studies. However, the existence of this molecular pathway must be confirmed through proper studies and further prospective randomized placebo-controlled studies are needed to confirm this hypothesis.
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Affiliation(s)
- R Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
| | - R A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - F Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, "Magna Graecia" University, Catanzaro, Italy
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123, Catania, Italy
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Silaghi CA, Lozovanu V, Georgescu CE, Georgescu RD, Susman S, Năsui BA, Dobrean A, Silaghi H. Thyroseq v3, Afirma GSC, and microRNA Panels Versus Previous Molecular Tests in the Preoperative Diagnosis of Indeterminate Thyroid Nodules: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:649522. [PMID: 34054725 PMCID: PMC8155618 DOI: 10.3389/fendo.2021.649522] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/13/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Molecular tests are being used increasingly as an auxiliary diagnostic tool so as to avoid a diagnostic surgery approach for cytologically indeterminate thyroid nodules (ITNs). Previous test versions, Thyroseq v2 and Afirma Gene Expression Classifier (GEC), have proven shortcomings in malignancy detection performance. OBJECTIVE This study aimed to evaluate the diagnostic performance of the established Thyroseq v3, Afirma Gene Sequencing Classifier (GSC), and microRNA-based assays versus prior iterations in ITNs, in light of "rule-in" and "rule-out" concepts. It further analyzed the impact of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) reclassification and Bethesda cytological subtypes on the performance of molecular tests. METHODS Pubmed, Scopus, and Web of Science were the databases used for the present research, a process that lasted until September 2020. A random-effects bivariate model was used to estimate the summary sensitivity, specificity, positive (PLR) and negative likelihood ratios (NLR), and area under the curve (AUC) for each panel. The conducted sensitivity analyses addressed different Bethesda categories and NIFTP thresholds. RESULTS A total of 40 eligible studies were included with 7,831 ITNs from 7,565 patients. Thyroseq v3 showed the best overall performance (AUC 0.95; 95% confidence interval: 0.93-0.97), followed by Afirma GSC (AUC 0.90; 0.87-0.92) and Thyroseq v2 (AUC 0.88; 0.85-0.90). In terms of "rule-out" abilities Thyroseq v3 (NLR 0.02; 95%CI: 0.0-2.69) surpassed Afirma GEC (NLR 0.18; 95%CI: 0.10-0.33). Thyroseq v2 (PLR 3.5; 95%CI: 2.2-5.5) and Thyroseq v3 (PLR 2.8; 95%CI: 1.2-6.3) achieved superior "rule-in" properties compared to Afirma GSC (PLR 1.9; 95%CI: 1.3-2.8). Evidence for Thyroseq v3 seems to have higher quality, notwithstanding the paucity of studies. Both Afirma GEC and Thyroseq v2 performance have been affected by NIFTP reclassification. ThyGenNEXT/ThyraMIR and RosettaGX show prominent preliminary results. CONCLUSION The newly emerged tests, Thyroseq v3 and Afirma GSC, designed for a "rule-in" purpose, have been proved to outperform in abilities to rule out malignancy, thus surpassing previous tests no longer available, Thyroseq 2 and Afirma GEC. However, Thyroseq v2 still ranks as the best rule-in molecular test. SYSTEMATIC REVIEW REGISTRATION http://www.crd.york.ac.uk/PROSPERO, identifier CRD42020212531.
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Affiliation(s)
- Cristina Alina Silaghi
- Department of Endocrinology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Vera Lozovanu
- Department of Endocrinology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
- *Correspondence: Vera Lozovanu, ; Raluca Diana Georgescu,
| | - Carmen Emanuela Georgescu
- Department of Endocrinology, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Raluca Diana Georgescu
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- *Correspondence: Vera Lozovanu, ; Raluca Diana Georgescu,
| | - Sergiu Susman
- Department of Morphological Sciences-Histology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Pathology, IMOGEN Research Center, Cluj-Napoca, Romania
| | - Bogdana Adriana Năsui
- Department of Community Health, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Anca Dobrean
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Horatiu Silaghi
- Department of Surgery V, “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
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Notsu M, Yamauchi M, Sugimoto T, Kanasaki K. A pregnant woman with an autonomously functioning thyroid nodule: a case report. Gynecol Endocrinol 2020; 36:1140-1143. [PMID: 32954874 DOI: 10.1080/09513590.2020.1822798] [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] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The epidemiology and natural history of autonomously functioning thyroid nodules (AFTNs) have not been elucidated. Here we report the pregnant Japanese woman with an AFTN. CASE PRESENTATION The patient was a 31-year-old woman who was hospitalized due to the placenta previa associated with threatened abortion at the 16 weeks of her third pregnancy. At her second pregnancy, she was euthyroid but had a single, 2.3 cm nodule on her right thyroid lobe. Her thyroid hormone level was trended increased with her pregnancy progression, and the thyrotoxic state was remained after delivery. Before her third pregnancy, her hyper-vascular nodule enlarged to 3.4 cm at regular monitoring. When she visited our hospital, she was at 16 weeks of pregnancy and had thyrotoxicosis with negative TSH-receptor antibody. She delivered a baby weighing 2615 g without hypothyroidism at 39 weeks of pregnancy by natural delivery. After delivery, a 99mTc scintigram showed a hot spot in her right thyroid lobe. She was diagnosed with AFTN and treated with methimazole while nursing. CONCLUSIONS This case showed that hCG stimulation during pregnancy caused thyroid nodule enlargement and enhanced thyroid hormone production. The pregnancy could be the pathological stimulus and provides chance to diagnosis for AFTNs.
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Affiliation(s)
- Masakazu Notsu
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Mika Yamauchi
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | | | - Keizo Kanasaki
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Stephenson A, Eszlinger M, Stewardson P, McIntyre JB, Boesenberg E, Bircan R, Sancak S, Gozu HI, Ghaznavi S, Krohn K, Paschke R. Sensitive Sequencing Analysis Suggests Thyrotropin Receptor and Guanine Nucleotide-Binding Protein G Subunit Alpha as Sole Driver Mutations in Hot Thyroid Nodules. Thyroid 2020; 30:1482-1489. [PMID: 32284013 DOI: 10.1089/thy.2019.0648] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Constitutively activating mutations in the thyrotropin receptor (TSHR) and the guanine nucleotide-binding protein G subunit alpha (GNAS) are the primary cause of hot thyroid nodules (HTNs). The reported prevalence of TSHR and GNAS mutations in HTNs varies. Previous studies show TSHR mutations in 8-82% of HTNs and GNAS mutations in 8-75% of HTNs. With sensitive and comprehensive targeted next-generation sequencing (tNGS), we re-evaluated the prevalence of TSHR and GNAS mutations in HTNs. Methods: Samples from three previous studies found to be TSHR and GNAS mutation negative were selected and re-evaluated using high-resolution melting (HRM) PCR. Remaining mutation negative samples were further reanalyzed by tNGS with a sequencing depth between 3000 × and 10,000 × . Our tNGS panel covered the entire TSHR coding sequence along with mutation hot spots in GNAS. Sequencing reads were aligned to reference and variants were called using Torrent Suite software v5.8. Results: In total, 154 of 182 previously mutation negative HTNs were positive for TSHR or GNAS mutations, resulting in an 85% prevalence of TSHR and GNAS mutations in HTNs, 79% and 6%, respectively. In a subset of 25 HTNs with multiple samples per nodule, and analyzed by tNGS at high sequencing depth, TSHR mutations were detected in 23 (92%) HTNs and 1 GNAS mutation was detected in 1 (4%) HTN, 96% mutation positive HTNs in this subset. Conclusions: Owing to the higher sensitivity of tNGS as compared with denaturing gradient gel electrophoresis and HRM-PCR, TSHR or GNAS mutations could be detected in 85% of HTNs. The detection of TSHR and GNAS mutations occurred in 96% of HTNs in a sample set with multiple samples per nodule analyzed by tNGS. Taken together with the fact that no other driver mutations could be identified by whole exome sequencing, our study strongly supports the hypothesis that TSHR and GNAS mutations are the main somatic mutations leading to HTNs.
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Affiliation(s)
- Alexandra Stephenson
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Markus Eszlinger
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Oncology, Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Paul Stewardson
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medical Science, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - John B McIntyre
- Precision Oncology Hub Laboratory, Alberta Health Services, Tom Baker Cancer Center, Calgary, Canada
| | - Eileen Boesenberg
- Division of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany
| | - Rifat Bircan
- Department of Molecular Biology and Genetics, Namik Kemal University, Tekirdag, Turkey
| | - Seda Sancak
- Department of Internal Medicine, Endocrinology and Metabolism Disorders, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Hulya I Gozu
- Department of Endocrinology and Metabolism, School of Medicine, Marmara University, Istanbul, Turkey
| | - Sana Ghaznavi
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Knut Krohn
- IZKF Leipzig, University of Leipzig, Germany
| | - Ralf Paschke
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Oncology, Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Division of Endocrinology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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10
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Abstract
The present study aimed to investigate the correlation between ultrasonographic features, basic fibroblast growth factor (bFGF), and the local invasiveness of papillary thyroid carcinoma (PTC).A total of 350 samples of thyroid nodules were collected. Routine ultrasonography was performed before the operation and routine pathological diagnosis and bFGF detection were performed after the operation.'These 350 samples of thyroid nodules included 90 samples of nodular goiter, 36 samples of focal thyroiditis, and 224 samples of PTC. A total of 326 thyroid nodules were examined for bFGF. The results revealed that the difference in the expression of bFGF between the benign and malignant groups was statistically significant (P < .05) and the difference in the positive expression of bFGF between the invasive and non-invasive PTC groups was statistically significant (P < .05).Whether the shape of PTC is regular or not and whether there is micro-calcification in PTC and other ultrasonographic features, the size and location of the lesions and the age of the patient help make a preliminary prediction of local invasiveness before the operation. Postoperative detection of bFGF is helpful for further risk assessments of PTC.
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Affiliation(s)
| | | | | | - Bin-Lin Ma
- Department of Breast and Head-neck Surgery, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
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11
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Affiliation(s)
- Linwah Yip
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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Li X, Li E, Du J, Wang J, Zheng B. BRAF mutation analysis by ARMS-PCR refines thyroid nodule management. Clin Endocrinol (Oxf) 2019; 91:834-841. [PMID: 31441082 DOI: 10.1111/cen.14079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 05/06/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fine-needle aspiration (FNA) of thyroid nodules leads to nearly 25% indeterminate nodules, while BRAFV600E mutation helps to predicting papillary thyroid carcinoma (PTC). However, the clinical validity and utility of the BRAFV600E mutation detected using preoperative FNA samples in a large cohort were rarely reported. AIM To explore the clinical significance of the BRAFV600E mutation on preoperative diagnosis and decision-making in a large FNA cohort in China. DESIGN This was a prospective study of BRAFV600E mutation analysis using an amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) in FNA samples. PATIENTS The study involved 2640 samples from 2307 patients undergoing FNA procedures in a Chinese medical centre. RESULTS A high mutation rate of 86.7% was found in the PTC population. For indeterminate thyroid nodules, the malignant rate of BRAFV600E+ and BRAFV600E- was 87.8% and 39.5% in the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) III, and 88.2% and 31.8% in the BSRTC IV, respectively. A cost-effective diagnostic model combining both BSRTC grading and BRAFV600E mutation status showed the highest sensitivity of 82.9% and specificity of 85.4%. Central lymph node metastasis (CLNM) was independent of the BRAF mutation status and accounted for 34.2% of the patients with PTC. CT values of BRAFV600E of patients with PTMC were significantly lower in young patients and patients with CLNM. CONCLUSIONS The combined analysis of cytological results and BRAFV600E mutation is highly recommended in BRAFV600E high-prevalence regions, including China. Prophylactic central neck dissection should be performed in selected patients without regard to the BRAF mutation status.
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Affiliation(s)
- Xinyang Li
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Enling Li
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jing Du
- Department of Ultrasonography, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiadong Wang
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bing Zheng
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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13
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He T, Wang H, Sun J, Wu J, Gong F, Li S, Wang H, Li Y. Altered expression of DLG1-AS1 distinguished papillary thyroid carcinoma from benign thyroid nodules. BMC Endocr Disord 2019; 19:122. [PMID: 31718630 PMCID: PMC6852766 DOI: 10.1186/s12902-019-0440-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 10/09/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Benign thyroid nodules (BTN) are frequently diagnosed as papillary thyroid carcinoma (PTC), leading to unnecessary treatment. We found that plasma lncRNA DLG1-AS1 was upregulated in PTC patients but not in BTN patients and healthy controls. METHODS In this study DLG1-AS1 and miR-199a-3p in plasma of both PTC patients and BTN patients were detected by qPCR. ROC curve analysis was performed for diagnostic analysis. Overexpression experiments were performed to analyze the interaction between DLG1-AS1 and miR-199a-3p. CCK-8 assay was performed to analyze cell proliferation. RESULTS In this study, upregulation of DLG1-AS1 distinguished PTC patients from BTN patients and healthy controls. Plasma miR-199a-3p was downregulated in PTC patients compared with healthy controls and BTN patients. Plasma levels of miR-199a-3p were inversely correlated in PTC patients, but not in BTN patients and healthy controls. miR-199a-3p overexpression failed to significantly affect DLG1-AS1, while DLG1-AS1 overexpression resulted in downregulated miR-199a-3p, In addition, DLG1-AS1 overexpression promoted the proliferation of PTC cells. miR-199a-3p overexpression played an opposite role and attenuated the effects of DLG1-AS1 overexpression. CONCLUSIONS Therefore, DLG1-AS1 may promote PTC by downregulating miR-199a-3p.
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Affiliation(s)
- Tao He
- Department of Nuclear Medicine, Panzhihua Central Hospital, Sichuan Province, 617067, Panzhihua City, People's Republic of China
| | - Huan Wang
- Department of Nuclear Medicine, Panzhihua Central Hospital, Sichuan Province, 617067, Panzhihua City, People's Republic of China
| | - Jiangming Sun
- Department of Nuclear Medicine, Panzhihua Central Hospital, Sichuan Province, 617067, Panzhihua City, People's Republic of China
| | - Jie Wu
- Department of Nuclear Medicine, Panzhihua Central Hospital, Sichuan Province, 617067, Panzhihua City, People's Republic of China
| | - Fakuo Gong
- Department of Nuclear Medicine, Panzhihua Central Hospital, Sichuan Province, 617067, Panzhihua City, People's Republic of China
| | - Shujun Li
- Department of Nuclear Medicine, Panzhihua Central Hospital, Sichuan Province, 617067, Panzhihua City, People's Republic of China
| | - Hui Wang
- Department of Nuclear Medicine, Panzhihua Central Hospital, Sichuan Province, 617067, Panzhihua City, People's Republic of China
| | - Yufeng Li
- Department of Ultrasound, Panzhihua Central Hospital, No. 34 YiKang street, Eastern District, Sichuan Province, 617067, Panzhihua City, People's Republic of China.
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14
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Zhu YQ, Hu Y, He K, Li N, Jiang P, Pan YQ, Zhou H, Mao XM. Expression of thyroglobulin by regulatory T cells in thyroid tissue. J Mol Endocrinol 2019; 63:261-271. [PMID: 31525728 DOI: 10.1530/jme-19-0110] [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: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 11/08/2022]
Abstract
The follicles are the minimal functional unit of the thyroid; the morphology and the function of each follicle can vary significantly. However, the reasons for the apparent follicular heterogeneity are poorly understood. Some tissue-resident regulatory T cells (Tregs) have a special phenotype that expresses unique molecules related to local tissue and regulates the tissue functions. The aim of this study was to identify the phenotype of thyroid Tregs and the roles of thyroid Tregs in thyroid physiological regulation. Thyroid tissue and peripheral blood samples were obtained from patients with benign thyroid nodules. Microarray-based gene expression, flow cytometry, immunofluorescence microscopy, and functional analysis of thyroid Tregs were performed. Here, we demonstrated that human thyroid Tregs expressed high level of thyroglobulin (Tg), both gene and protein. The immunofluorescence microscopy of thyroid section showed that the FOXP3+Tg+ cells concentrated in some of the thyroid follicles, at the side of the thyroid follicle. The peripheral blood Tregs expressed minimal levels of Tg, and low levels of Tg could effectively induce peripheral blood Tregs to express Tg, which was independent of thyrotropin simulation. Furthermore, the Tg secreted freely from thyroid Tregs that negatively regulated some thyroid-related genes expression. Our results revealed that the thyroid Tregs was a distinct population of Tregs, which expressed high level of Tg. The thyroid Tregs regulate thyroid function by Tg that is paracrine from the cells.
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Affiliation(s)
- Yun-Qing Zhu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ke He
- Department of Endocrinology, Wuxi Traditional Chinese Medicine Hospital, Wuxi, China
| | - Na Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Peng Jiang
- Department of Thyroid and Breast Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Qin Pan
- Central Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hong Zhou
- Department of Immunology, Nanjing Medical University, Nanjing, China
| | - Xiao-Ming Mao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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15
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Xu D, Wu B, Li X, Cheng Y, Chen D, Fang Y, Du Q, Chen Z, Wang X. Evaluation of the thyroid characteristics of patients with growth hormone-secreting adenomas. BMC Endocr Disord 2019; 19:94. [PMID: 31477080 PMCID: PMC6720980 DOI: 10.1186/s12902-019-0424-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 05/07/2019] [Accepted: 08/26/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acromegaly is highly associated with thyroid disorders. However, the clinical characteristics of thyroid nodules in individuals with acromegaly who present with thyroid diseases have not been completely elucidated. METHODS Overall, 134 consecutive participants with growth hormone (GH)-secreting adenoma (n = 67) and non-functioning (NF) pituitary adenoma (n = 67) were recruited from the outpatient and inpatient patient department of The First Affiliated Hospital, Jinan University from August 2015 to August 2017. Thyroid ultrasonography was performed using an ultrasound system. The cytopathological results of fine-needle aspiration biopsy were analyzed by a pathologist according to the Bethesda system. Twenty-one patients with GH-secreting adenoma and thyroid disease underwent transsphenoidal pituitary adenoma resection and were followed up for 1 year. RESULTS The prevalence of thyroid disease increased in the GH-secreting adenoma group compared with that in the NF pituitary adenoma group. The number of hypoechoic, isoechogenic, heterogeneous, and vascular thyroid nodules increased in patients with GH-secreting adenoma plus thyroid disease compared with that in patients with NF pituitary adenoma plus thyroid disease. Finally, we found significant decreases in the morphology of solid nodules and significant increases in the morphology of cystic nodules after surgery compared with those before surgery in the cured group. Moreover, the numbers of heterogeneous and vascular thyroid nodules decreased significantly after surgery compared with those before surgery in the cured group. However, the characteristics of the thyroid nodules did not change after surgery compared with those before surgery in the non-cured group. CONCLUSIONS The numbers of hypoechoic, isoechoic, heterogeneous, and vascular thyroid nodules increased in patients with GH-secreting adenomas. In these patients, surgery resulted in significant changes from solid to cystic nodules and also reduced the numbers of heterogeneous and vascular thyroid nodules.
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Affiliation(s)
- Dianshuang Xu
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province, 510630, People's Republic of China
| | - Bolin Wu
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province, 510630, People's Republic of China
| | - Xiaoju Li
- Department of Medical Ultrasound, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510632, China
| | - Yunjiu Cheng
- Department of cardiology, The First Affiliated Hospital, SunYat-sen University, Guangzhou, 510632, China
| | - Dubo Chen
- Department of laboratory medicine, The first affiliated hospital, Sun Yat-sen university, Guangzhou, 510632, China
| | - Yuefeng Fang
- Asset Management Division, Guangdong University of Foreign Studies, Guangzhou, 510420, China
| | - Qiu Du
- Department of Neurosurgery, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China
| | - Zhiyong Chen
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province, 510630, People's Republic of China.
| | - Xiaodong Wang
- Department of Neurosurgery, The First Affiliated Hospital, Jinan University, No. 613 Huangpu Avenue West, Tianhe District, Guangzhou 510632, Guangdong Province, 510630, People's Republic of China.
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16
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Singarayer R, Mete O, Perrier L, Thabane L, Asa SL, Van Uum S, Ezzat S, Goldstein DP, Sawka AM. A Systematic Review and Meta-Analysis of the Diagnostic Performance of BRAF V600E Immunohistochemistry in Thyroid Histopathology. Endocr Pathol 2019; 30:201-218. [PMID: 31300997 DOI: 10.1007/s12022-019-09585-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 01/08/2023]
Abstract
Immunohistochemistry (IHC) in evaluating thyroid surgical specimens may facilitate diagnostic and prognostic evaluation, with potential therapeutic implications. We performed a systematic review and meta-analysis examining the analytic validity of IHC in detecting BRAFV600E mutations in thyroid cancer (primary or metastatic). We screened citations from three electronic databases (until December 20, 2018), supplemented by a hand search of authors' files and cross-references of reviews. Citations and full-text papers were independently reviewed in duplicate, and consensus was achieved on inclusion of papers. Two reviewers independently critically appraised and abstracted data from included papers. Random-effect meta-analyses were conducted for sensitivity and specificity estimates. We reviewed 1499 unique citations and 93 full-text articles. We included 1 systematic review and 30 original articles. The published review (from 2015) needed to be updated as there were multiple subsequent original studies. The pooled sensitivity of IHC in detecting a BRAFV600E mutation was 96.8% (95% confidence interval [CI] at 94.1%, 98.3%) (29 studies, including 2659 BRAFV600E mutant tumors). The IHC pooled specificity was 86.3% (95% CI 80.7%, 90.4%) (28 studies, including 1107 BRAFV600E wild-type specimens). These meta-analyses were subject to statistically significant heterogeneity, partly explained by antibody type (sensitivity and specificity) and tissue/tumor type (specificity). In conclusion, BRAF IHC is highly sensitive and reasonably specific in detecting the BRAFV600E mutation; however, there is some variability in analytic performance.
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Affiliation(s)
- Ranjit Singarayer
- Thyroid Fellow, University of Toronto, Toronto, Canada
- Toronto General Hospital, 200 Elizabeth Street, 12 EN-212, Toronto, Ontario, M5G 2C, Canada
| | - Ozgur Mete
- Department of Pathology, University Health Network and University of Toronto, Toronto, Canada
- Toronto General Hospital, 200 Elizabeth Street, 11 EN-422, Toronto, Ontario, M5G 2C4, Canada
| | - Laure Perrier
- University of Toronto Libraries, University of Toronto, 130 St. George St, Toronto, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- St. Joseph's Healthcare Hamilton, Biostatistics Unit, 3rd Floor, Martha Wing, Room H-325, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada
| | - Sylvia L Asa
- Department of Pathology, University Health Network and University of Toronto, Toronto, Canada
- Toronto General Hospital, 200 Elizabeth Street, 11 EN-422, Toronto, Ontario, M5G 2C4, Canada
| | - Stan Van Uum
- Division of Endocrinology, Western University, London, Ontario, Canada
- Division of Endocrinology & Metabolism, St Joseph's Health Care London, Room B5-130, 268 Grosvenor Street, London, Ontario, Canada
| | - Shereen Ezzat
- Department of Endocrine Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Toronto General Hospital, 585 University Avenue, 9NU-986, Toronto, Ontario, M5G 2N2, Canada
| | - David P Goldstein
- Department of Otolaryngology, Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Canada
- Princess Margaret Cancer Centre, 610 University Avenue, Suite 3-950, Toronto, Ontario, M5G 2M9, Canada
| | - Anna M Sawka
- Division of Endocrinology, University Health Network and University of Toronto, Toronto, Canada.
- Toronto General Hospital, 200 Elizabeth Street, 12 EN-212, Toronto, Ontario, M5G 2C4, Canada.
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17
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Li XJ, Mao XD, Chen GF, Wang QF, Chu XQ, Hu X, Ding WB, Zeng Z, Wang JH, Xu SH, Liu C. High BRAFV600E mutation frequency in Chinese patients with papillary thyroid carcinoma increases diagnostic efficacy in cytologically indeterminate thyroid nodules. Medicine (Baltimore) 2019; 98:e16343. [PMID: 31305422 PMCID: PMC6641833 DOI: 10.1097/md.0000000000016343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
To estimate the BRAFV600E mutation frequency in Chinese patients with papillary thyroid carcinoma (PTC), and the diagnostic value of BRAFV600E mutation status in thyroid nodules with indeterminate TBSRTC categories.A total of 4875 consecutive samples for thyroid ultrasound-guided fine-needle aspiration cytology (FNAC) and BRAF mutation analysis were collected from patients at Jiangsu Province Hospital on Integration of Chinese and Western Medicine. Among all the cases, 314 underwent thyroidectomy. According to TBSRTC categories, FNAC was performed for a preoperative diagnosis. ROC of the subject was constructed to evaluate the diagnostic value of these 2 methods and their combination.BRAF mutation in FNAC of thyroid nodules occurred in 2796 samples (57.35%). Of 353 nodule samples from 314 patients with thyroid operation, 333 were pathologically diagnosed as PTC. Of these PTC patients, 292 (87.69%) were found to have BRAF mutation in their preoperative FNAC. In 175 cytologically indeterminate thyroid nodules, BRAF mutation identified 88% of PTC. According to ROC data, BRAF mutation testing had an obviously higher sensitivity (87.69%) and specificity (100.00%) than TBSRTC. Combining BRAF mutation testing and TBSRTC achieved the largest AUC (0.954). For 41 PTC with a negative BRAF mutation in preoperative evaluation, the repeated BRAF mutation testing found out 12 samples with BRAF mutation. The true BRAF mutation rate of Chinese PTC patients was 91.29%.Chinese patients with PTC have a higher frequency of BRAF mutation. The BRAF mutation testing affords a high diagnostic value in thyroid nodules with indeterminate cytology.
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Affiliation(s)
- Xing-Jia Li
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine
| | - Xiao-dong Mao
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine
| | - Guo-fang Chen
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine
| | - Qi-feng Wang
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine
| | - Xiao-qiu Chu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine
| | - Xin Hu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine
| | | | | | - Jian-hua Wang
- Department of General Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine (Jiangsu Province Academy of Traditional Chinese Medicine), Nanjing, Jiangsu, China
| | - Shu-hang Xu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine
| | - Chao Liu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine
- Key Laboratory of TCM Syndrome & Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine
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18
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Abooshahab R, Gholami M, Sanoie M, Azizi F, Hedayati M. Advances in metabolomics of thyroid cancer diagnosis and metabolic regulation. Endocrine 2019; 65:1-14. [PMID: 30937722 DOI: 10.1007/s12020-019-01904-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 01/16/2019] [Accepted: 03/13/2019] [Indexed: 12/24/2022]
Abstract
Thyroid cancers (TCs) are the most frequent endocrine malignancy with an unpredictable fast-growing incidence, especially in females all over the world. Fine-needle aspiration biopsy (FNAB) analysis is an accurate diagnostic method for detecting thyroid nodules and classification of TC. Though simplicity, safety, and accuracy of FNAB, 15-30% of cases are indeterminate, and it is not possible to determine the exact cytology of the specimen. This demands the need for innovative methods capable to find crucial biomarkers with adequate sensitivity for diagnosis and prediction in TC researches. Cancer-based metabolomics is a vast emerging field focused on the detection of a large set of metabolites extracted from biofluids or tissues. Using analytical chemistry procedures allows for the potential recognition of cancer-based metabolites for the purposes of advancing the era of personalized medicine. Nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry (MS) coupled with separation techniques e.g., gas chromatography (GC) and liquid chromatography (LC) are the main approaches for metabolic studies in cancers. The immense metabolite profiling has provided a chance to discover novel biomarkers for early detection of thyroid cancer and reduce unnecessary aggressive surgery. In this review, we recapitulate the recent advances and developed methods of diverse metabolomics tools and metabolic phenotypes of thyroid cancer, following a brief discussion of recent challenges in the thyroid cancer diagnosis.
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Affiliation(s)
- Raziyeh Abooshahab
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Gholami
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Chemistry, Faculty of Science, Golestan University, Gorgan, Iran
| | - Maryam Sanoie
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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19
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Abstract
Cytologically indeterminate thyroid nodules are associated with a broad range (5%-75%) of malignant risk and accurately informing definitive management poses a challenge. Advancements in molecular testing of fine-needle aspiration biopsies have improved preoperative diagnostic accuracy and prognostication. For indeterminate nodules, such testing ideally will reduce the need for surgery for benign nodules and potentially guide appropriate extent of initial surgery for malignancy.
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Affiliation(s)
- Janeil Mitchell
- Fox Valley Surgical Associates, Endocrine Surgery, 1818 North Meade Street, Appleton, WI 54911, USA
| | - Linwah Yip
- Department of Surgery, Division of Endocrine Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, 3471 Fifth Avenue, Suite 101, Pittsburgh, PA 15213, USA.
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20
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Abstract
Ancillary molecular testing has emerged as a promising way to refine the preoperative risk stratification of thyroid nodules with indeterminate fine needle aspiration (FNA) biopsy results. Commercially available molecular tests for thyroid FNAs include those that analyze samples for mutations and gene fusions, gene expression alterations, microRNA expression alterations, chromosomal copy number alterations, or a combination thereof. This review summarizes the performance characteristics of the most current iterations of three tests currently marketed for cytologically indeterminate thyroid nodules: ThyroSeq v3, ThyGeNEXT/ThyraMIR, and Afirma Gene Sequencing Classifier.
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Affiliation(s)
- Michiya Nishino
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA,
| | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Abstract
PURPOSE To investigate the nodular thyroid disease (NTD) and the natural course of thyroid nodules in patients with acromegaly. METHODS 138 patients with acromegaly (73 F/65 M), whose initial thyroid ultrasonography performed in our university hospital, were included in this study. The frequencies of NTD, papillary thyroid cancer (PTC) and associated factors on nodule formation were investigated at initial assessment. Patients who had NTD continued to follow-up (n = 56) were re-evaluated with a ultrasonography performed after a mean 7-years follow-up period. The nodule size changes were compared with the initial data and the factors affecting nodule growth were investigated. RESULTS The frequency of NTD was found 69%. Patients with NTD were older (p = 0.05), with higher baseline IGF-1%ULN (upper limit of normal) (p = 0.01). In patients with NTD, the majority had similar nodule size (45%), decreased nodule size in 30% and nodule growth in 25%. In patients with active acromegaly at last visit, nodule growth was more significant (p < 0.001). For one unit change in the IGF-1 levels, nodule growth increased by 1.01 folds and presence of active acromegaly disease was related with ninefolds increase in nodule growth. The frequency of PTC was 14% in patients with nodule growth and PTC was diagnosed 11% of all acromegalic patients. CONCLUSION Both NTD and nodule growth is more frequent in active acromegalic patients. Thyroid nodules may show dynamic changes according to the disease activity and nodule growth should be closely monitored due to the risk of malignancy in patients with active acromegaly disease.
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Affiliation(s)
- Sema Ciftci Dogansen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, 34090, Istanbul, Turkey.
| | - Artur Salmaslioglu
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gulsah Yenidunya Yalin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, 34090, Istanbul, Turkey
| | - Seher Tanrikulu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, 34090, Istanbul, Turkey
| | - Sema Yarman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, 34090, Istanbul, Turkey
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22
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Kim BH, Kim SJ, Kim M, Lee SW, Jeong SY, Pak K, Kim K, Kim IJ. Diagnostic performance of HMGA2 gene expression for differentiation of malignant thyroid nodules: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2018; 89:856-862. [PMID: 30223300 DOI: 10.1111/cen.13853] [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: 08/01/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of the current study was to investigate the diagnostic performance of high mobility group A2 (HMGA2) gene expression for differentiation of malignant thyroid nodules through a systematic review and meta-analysis. DESIGN The MEDLINE/PubMed and EMBASE database, from the earliest available date of indexing through 10 April 2018, were searched for studies evaluating the diagnostic performance of HMGA2 expression for differentiation of thyroid nodules. METHODS We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR-), and constructed summary receiver operating characteristic (ROC) curves. RESULTS Across 7 studies, the pooled sensitivity for HMGA2 expression was 0.78 (95% CI; 0.67-0.86) with heterogeneity (I2 = 86.6) and a pooled specificity of 0.94 (95% CI: 0.85-0.98) with heterogeneity (I2 = 94.7). Likelihood ratio (LR) syntheses gave an overall positive likelihood ratio (LR+) of 12.6 (95% CI: 5.1-31.3) and negative likelihood ratio (LR-) of 0.24 (95% CI: 0.15-0.36). The pooled diagnostic odds ratio (DOR) was 53 (95% CI: 18-159). Hierarchical summary ROC curve indicates that the areas under the curve were 0.92 (95% CI: 0.89-0.94). In meta-regression analysis, no definite variable was the source of the study heterogeneity. CONCLUSION The current meta-analysis showed the moderate sensitivity and high specificity of HMGA2 expression for differentiation of malignant thyroid nodules. The likelihood ratio scatter-gram suggested that HMGA2 expression analysis could be useful for confirmation of the presence of malignant thyroid nodules. Considering the heterogeneity of included studies, further large prospective studies are necessary to confirm these results.
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Affiliation(s)
- Bo Hyun Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Seong Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, Korea
| | - Mijin Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sang-Woo Lee
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - In Joo Kim
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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23
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Aydoğan Y, Altay M, Ünsal O, Kaplanoğlu V, Çağır Y, Yıldız C, Beyan E, Ramadan SU. An assessment of the relationship between thyroid nodule characteristics, insulin resistance and arterial stiffness in euthyroid nodular goiter. Endocrine 2018; 62:440-447. [PMID: 30084100 DOI: 10.1007/s12020-018-1701-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/27/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Publications suggesting that thyroid nodule might be associated with insulin resistance and metabolic syndrome are quite interesting. There is a need for studies assessing the relationship between nodule presence and cardiovascular risk in individuals with non-functioning nodular goiter. The purpose of the present study is to reveal whether or not insulin resistance, nodule presence, and nodule stiffness affect arterial stiffness, which is a reliable and valid cardiovascular risk indicator, in individuals with euthyroid nodular goiter using the pulse wave analysis (PWA). MATERIALS AND METHODS 50 patients with euthyroid nodular goiter and 50 healthy volunteers were included in the study. All participants were examined by B-mode thyroid ultrasound, and the participants in the nodular goiter group were also examined by strain elastography (SE). The strain index of nodules was calculated according to the Rago scoring. Also, fasting plasma glucose (FPG) and insulin levels were measured, and HOMA-IR. Arterial stiffness measurements of the participants were performed using a PWA device which employs a cuff-based oscillometric method from the brachial artery. RESULTS PWV was found to be significantly higher in the euthyroid nodular goiter group (p < 0.001). PWV was found to be positively correlated with FPG and waist circumference. Fasting plasma glucose was found to be higher in the group with nodular goiter (p = 0.03). However, no difference was found between the groups in terms of HOMA-IR and insulin level. HOMA-IR was not correlated with thyroid volume, nodule volume, and nodule count. Also, HOMA-IR was not correlated with strain index value and PWA data. CONCLUSION We found that PWV was significantly higher in patients with euthyroid nodular goiter. This result suggests that these patients may be at risk for cardiovascular disease.
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Affiliation(s)
| | - Mustafa Altay
- Department of Endocrinology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Oktay Ünsal
- Department of Nefrology, Uludağ University Medical Faculty Hospital, Bursa, Turkey
| | - Veysel Kaplanoğlu
- Department of Radiology, Keçiören Training ad Research Hospital, Ankara, Turkey
| | - Yavuz Çağır
- Çankırı Çerkeş State Hospital, Çankırı, Turkey
| | - Canan Yıldız
- Aydın Didim State Hospital, Aydın, Didim, Turkey
| | - Esin Beyan
- Department of Internal Medicine, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Selma Uysal Ramadan
- Deparment of Radiology, Keçiören Training and Research Hospital, Ankara, Turkey
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24
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Rezig L, Servadio A, Torregrossa L, Miccoli P, Basolo F, Shintu L, Caldarelli S. Diagnosis of post-surgical fine-needle aspiration biopsies of thyroid lesions with indeterminate cytology using HRMAS NMR-based metabolomics. Metabolomics 2018; 14:141. [PMID: 30830426 DOI: 10.1007/s11306-018-1437-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 07/19/2018] [Accepted: 10/04/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Ultrasound examination coupled with fine-needle aspiration (FNA) cytology is the gold standard for the diagnosis of thyroid cancer. However, about 10-40% of these analyses cannot be conclusive on the malignancy of the lesions and lead to surgery. The cytological indeterminate FNA biopsies are mainly constituted of follicular-patterned lesions, which are benign in 80% of the cases. OBJECTIVES The development of a FNAB classification approach based on the metabolic phenotype of the lesions, complementary to cytology and other molecular tests in order to limit the number of patients undergoing unnecessary thyroidectomy. METHODS We explored the potential of a NMR-based metabolomics approach to improve the quality of the diagnosis from FNABs, using thyroid tissues collected post-surgically. RESULTS The NMR-detected metabolites were used to produce a robust OPLSDA model to discriminate between benign and malignant tumours. Malignancy was correlated with amino acids such as tyrosine, serine, alanine, leucine and phenylalanine and anti-correlated with myo-inositol, scyllo-inositol and citrate. Diagnosis accuracy was of 84.8% when only indeterminate lesions were considered. CONCLUSION These results on model FNAB indicate that there is a clear interest in exploring the possibility to export NMR metabolomics to pre-surgical diagnostics.
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Affiliation(s)
- Lamya Rezig
- Aix Marseille Univ, CNRS, Centrale Marseille, iSm2, Marseille, France
| | - Adele Servadio
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Laetitia Shintu
- Aix Marseille Univ, CNRS, Centrale Marseille, iSm2, Marseille, France.
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25
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Trimboli P, Paone G, Zatelli MC, Ceriani L, Giovanella L. Real-time elastography in autonomously functioning thyroid nodules: relationship with TSH levels, scintigraphy, and ultrasound patterns. Endocrine 2017; 58:488-494. [PMID: 28285385 DOI: 10.1007/s12020-017-1277-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 10/11/2016] [Accepted: 02/24/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Real-time elastography has been proposed to increase the sensitivity of ultrasound and improve the detection of thyroid nodules at risk of malignancy. To date sparse data on real-time elastography assessment of autonomously functioning thyroid nodules exist. Here, we investigated the potential role of real-time elastography in autonomously functioning thyroid nodule assessment. Specifically, the correlation between serum hormones and real-time elastography score, as well as other clinical and ultrasound features, was analyzed. METHODS Patients with autonomously functioning thyroid nodule identified by I-123 scintigraphy from September 2015 to July 2016 and undergoing ultrasound, real-time elastography, and thyroid function evaluation were selected. All autonomously functioning thyroid nodule were classified as RTE I (prevalence of red or green color with blue in up to 25% of the nodule area), RTE II (blue in 25-75%), or RTE III (blue in more than 75%). The association between suppressed thyroid stimulating hormone and patient's age, nodule's size, ultrasound presentation, and real-time elastography scoring was analyzed by Odds Ratio in univariate fashion and multivariate model. RESULTS A number of 47 subjects with single autonomously functioning thyroid nodule were enrolled. Median age of 63 years, median size of 2.0 cm, and suppressed thyroid stimulating hormone levels in 32% of cases were found. Those nodules classified by ultrasound at high risk underwent fine-needle aspiration cytology and cancer was excluded. At real-time elastography evaluation, a 45% of autonomously functioning thyroid nodule had a hard appearance (RTE III) and had thyroid stimulating hormone significantly lower than the other (p < 0.0001). A model of multivariate logistic regression including nodule's size, ultrasound characteristics, and elastographic presentation showed that only RTE III was significantly associated with suppressed thyroid stimulating hormone (Odds Ratio of 50). CONCLUSIONS Autonomously functioning thyroid nodule may have variable elasticity at real-time elastography examination, being hard score associated with reduced/suppressed thyroid stimulating hormone. For clinical practice, the presence of autonomously functioning thyroid nodule should be considered in patients with hard lesions. Also, as quoted by the most recent ATA guidelines, elastography should not be accounted for risk stratification of thyroid nodules.
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Affiliation(s)
- Pierpaolo Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Gaetano Paone
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Section of Endocrinology & Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Luca Ceriani
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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26
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Takada N, Hirokawa M, Ito M, Ito A, Suzuki A, Higuchi M, Kuma S, Hayashi T, Kishikawa M, Horikawa S, Miyauchi A. Papillary thyroid carcinoma with desmoid-type fibromatosis: A clinical, pathological, and immunohistochemical study of 14 cases. Endocr J 2017; 64:1017-1023. [PMID: 28794344 DOI: 10.1507/endocrj.ej17-0242] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/23/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) with desmoid-type fibromatosis (DTF) is characterized by genetic alterations of the fibroblasts. PTC-DTF is extremely rare, and the reports on such cases have been sporadic. Immunohistochemical staining using the antibody for beta-catenin is useful in diagnosing the variant. This report aims to describe the clinical, pathological, and immunohistochemical findings in 14 cases of PTC-DTF and to clarify the diagnostic significance of the variant. The patients included 9 women and 5 men, with a mean age of 49.3 years. PTCs with focal DTF components and with extensive DTF components included 7 cases each. No significant differences were noted in terms of age, gender, and serum thyroglobulin levels between extensive and focal DTF cases. On aspiration cytology, 12 cases were reported as suspicious for malignancy or malignant, and schwannoma or fibroma was suggested in 1 case each. The DTF components were histologically classified into 4 types, namely, central (4 cases), peripheral (1 case), mixed (7 cases), and diffuse type (2 cases). The stromal components were consistent with those of DTF. Immunohistochemically, fibroblasts in the DTF components showed nuclear and cytoplasmic expression for beta-catenin in 12 cases. The features are observed even in cases in which stromal components focally exist. Neither carcinoma cells nor the fibroblasts with Ki-67 labeling index >5% were found in all cases. We agree that PTC with nodular fasciitis-like stroma should be renamed to PTC-DTF.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/metabolism
- Biopsy, Needle
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/metabolism
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Diagnosis, Differential
- Fasciitis/diagnosis
- Fasciitis/metabolism
- Fasciitis/pathology
- Fasciitis/surgery
- Female
- Fibroma/diagnosis
- Fibroma/metabolism
- Fibroma/pathology
- Fibroma/physiopathology
- Fibromatosis, Aggressive/diagnosis
- Fibromatosis, Aggressive/metabolism
- Fibromatosis, Aggressive/pathology
- Fibromatosis, Aggressive/surgery
- Follow-Up Studies
- Hospitals, Urban
- Humans
- Immunohistochemistry
- Japan
- Male
- Middle Aged
- Neurilemmoma/diagnosis
- Neurilemmoma/metabolism
- Neurilemmoma/pathology
- Neurilemmoma/physiopathology
- Terminology as Topic
- Thyroid Cancer, Papillary
- Thyroid Gland/metabolism
- Thyroid Gland/pathology
- Thyroid Gland/surgery
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroid Nodule/diagnosis
- Thyroid Nodule/metabolism
- Thyroid Nodule/pathology
- Thyroid Nodule/surgery
- Young Adult
- beta Catenin/metabolism
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Affiliation(s)
- Nami Takada
- Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan
| | | | - Masahiro Ito
- Department of Pathology, Clinical Research Center, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Aki Ito
- Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan
| | - Ayana Suzuki
- Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan
| | - Miyoko Higuchi
- Department of Clinical Laboratory, Kuma Hospital, Kobe, Japan
| | - Seiji Kuma
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | | | - Shuichi Horikawa
- Department of Surgery, Nagasaki Kamigoto Hospital, Minamimatsuura, Japan
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27
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Barabadze E, Munjishvili V, Burkadze G. BRAF ANTIBODY EXPRESSION IN DIFFERENT TYPES OF THYROID NODULAR LESIONS. Georgian Med News 2017:107-113. [PMID: 29099711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Major problems haunt the physicians who need to delineate the best management strategy for their patients with thyroid nodule is the identification of the most aggressive cases, especially among papillary thyroid cancers, which would benefit from more aggressive therapy and follow up. Beyond its strong correlation with PTC, the BRAF mutation is well described to associate with poor prognosis. The aim of our study was to identify BRAF antibody expression in different hystotypes of the thyroid nodules and assessment of it expression according to the tumor aggressiveness. Immunohistochemical staining was performed in 54 of surgically resected thyroid nodules, including malignant and benign cases, grouped according to the tumor aggressiveness. We have used selected thyroid specific markers: BRAF antibody, CD-56, CK-19, HBME-1 and KI-67. Adenomatous hyperplasia's and follicular lesions doesn't reveal positivity to the expression of BRAF antibody. Encapsulated papillary carcinomas included in our work revealed negative or very poor positivity of BRAF antibody. This fact strengthen the hypothesis that encapsulated papillary carcinomas have an indolent behavior and is genetically distinct from infiltrative tumors. We revealed 55,5% positivity of BRAF antibody in the cases of papillary microcarcinomas, this fact creates a need for more cautious approach to this type of tumors. The degree of BRAF antibody expression increased with a rising of tumor aggressiveness in our histopathologic groups (P<0,005). All cases of papillary carcinoma with multinodular involvement and extrathyroid extension revealed moderate or strong positivity of BRAF antibody expression.
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Affiliation(s)
- E Barabadze
- Davit Tvildiani Medical University, Tbilisi, Georgia
| | - V Munjishvili
- Davit Tvildiani Medical University, Tbilisi, Georgia
| | - G Burkadze
- Davit Tvildiani Medical University, Tbilisi, Georgia
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28
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Rekvava M, Dundua T, Kobulia M, Javashvili L, Giorgadze E. INSULIN LIKE GROWTH FACTOR 1 POSSIBLE DEPENDENCE IN PATIENTS WITH METABOLIC SYNDROME OF NODULAR PATHOLOGY OF THE THYROID GLAND. Georgian Med News 2017:46-50. [PMID: 28972482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Metabolic syndrome and nodular pathology of the thyroid gland is a widespread problem nowadays. Recently there has been a notable coincidence between metabolic syndrome and nodular pathology of thyroid gland. Hence, it is interesting to reveal the connection between these two diseases. It is possible that insulin-like growth factor system (IGF), namely IGF 1 is connecting link between metabolic syndrome and nodular pathology of thyroid gland, because IGF1 stimulates growth and proliferation of cells in the body. We have investigated18-82 years of age 71 patients. group 1 n27- subjects with thyroid nodular disease, and metabolic syndrome, group 2 n31- subjects with thyroid nodular disease and without metabolic syndrome. group 3 n13 - subjects with metabolic syndrome and no thyroid pathology. In all groups were assessed thyroid structural data, defined parameters of carbohydrate metabolism, thyroid function and blood concentration of IGF1. In patients with hyperinsulinemia IGF 1 was noted in normal or reduced concentration. In I group IGF1 was normal in 70,4% (n=19), decreased in 29,6% (n=8), In II group was normal in 77,4 % (n=24), decreased in 22,6% (n=7) and in III group was normal in 76,9% (n=10), decreased in 23,1% (n=3). Increase of IGF 1 in patients with thyroid nodular disease patients was not noted. Statistically significant connection between IGF1 and thyroid nodules was not revealed. For the further investigation of this connection we plan to measure IGF1 in the thyroid histological samples in the future studies.
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Affiliation(s)
- M Rekvava
- Cortex Clinic ltd, Tbilisi, Georgia; National Institute of Endocrinology, Tbilisi, Georgia
| | - T Dundua
- Cortex Clinic ltd, Tbilisi, Georgia; National Institute of Endocrinology, Tbilisi, Georgia
| | - M Kobulia
- Cortex Clinic ltd, Tbilisi, Georgia; National Institute of Endocrinology, Tbilisi, Georgia
| | - L Javashvili
- Cortex Clinic ltd, Tbilisi, Georgia; National Institute of Endocrinology, Tbilisi, Georgia
| | - E Giorgadze
- Cortex Clinic ltd, Tbilisi, Georgia; National Institute of Endocrinology, Tbilisi, Georgia
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29
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González HE, Martínez JR, Vargas-Salas S, Solar A, Veliz L, Cruz F, Arias T, Loyola S, Horvath E, Tala H, Traipe E, Meneses M, Marín L, Wohllk N, Diaz RE, Véliz J, Pineda P, Arroyo P, Mena N, Bracamonte M, Miranda G, Bruce E, Urra S. A 10-Gene Classifier for Indeterminate Thyroid Nodules: Development and Multicenter Accuracy Study. Thyroid 2017; 27:1058-1067. [PMID: 28521616 PMCID: PMC5564024 DOI: 10.1089/thy.2017.0067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND In most of the world, diagnostic surgery remains the most frequent approach for indeterminate thyroid cytology. Although several molecular tests are available for testing in centralized commercial laboratories in the United States, there are no available kits for local laboratory testing. The aim of this study was to develop a prototype in vitro diagnostic (IVD) gene classifier for the further characterization of nodules with an indeterminate thyroid cytology. METHODS In a first stage, the expression of 18 genes was determined by quantitative polymerase chain reaction (qPCR) in a broad histopathological spectrum of 114 fresh-tissue biopsies. Expression data were used to train several classifiers by supervised machine learning approaches. Classifiers were tested in an independent set of 139 samples. In a second stage, the best classifier was chosen as a model to develop a multiplexed-qPCR IVD prototype assay, which was tested in a prospective multicenter cohort of fine-needle aspiration biopsies. RESULTS In tissue biopsies, the best classifier, using only 10 genes, reached an optimal and consistent performance in the ninefold cross-validated testing set (sensitivity 93% and specificity 81%). In the multicenter cohort of fine-needle aspiration biopsy samples, the 10-gene signature, built into a multiplexed-qPCR IVD prototype, showed an area under the curve of 0.97, a positive predictive value of 78%, and a negative predictive value of 98%. By Bayes' theorem, the IVD prototype is expected to achieve a positive predictive value of 64-82% and a negative predictive value of 97-99% in patients with a cancer prevalence range of 20-40%. CONCLUSIONS A new multiplexed-qPCR IVD prototype is reported that accurately classifies thyroid nodules and may provide a future solution suitable for local reference laboratory testing.
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Affiliation(s)
- Hernán E. González
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José R. Martínez
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Vargas-Salas
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Antonieta Solar
- Department of Anatomic Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Loreto Veliz
- Department of Physiology, Faculty of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Cruz
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tatiana Arias
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Soledad Loyola
- Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eleonora Horvath
- Department of Radiology, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Hernán Tala
- Department of Radiology, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Eufrosina Traipe
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Manuel Meneses
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Luis Marín
- Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile
| | - Nelson Wohllk
- Department of Endocrinology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - René E. Diaz
- Department of Endocrinology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Jesús Véliz
- Department of Endocrinology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Pedro Pineda
- Sección Endocrinología y Diabetes, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santiago, Chile
| | | | | | | | | | | | - Soledad Urra
- Department of Surgical Oncology, Pontificia Universidad Católica de Chile, Santiago, Chile
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30
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Rago T, Scutari M, Loiacono V, Santini F, Tonacchera M, Torregrossa L, Giannini R, Borrelli N, Proietti A, Basolo F, Miccoli P, Piaggi P, Latrofa F, Vitti P. Low Elasticity of Thyroid Nodules on Ultrasound Elastography Is Correlated with Malignancy, Degree of Fibrosis, and High Expression of Galectin-3 and Fibronectin-1. Thyroid 2017; 27:103-110. [PMID: 27809694 DOI: 10.1089/thy.2016.0341] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 10/20/2022]
Abstract
BACKGROUND Thyroid ultrasound (US) elastography provides an estimation of tissue stiffness and is helpful to differentiate malignant from benign lesions. Tissue proprieties and molecules causing stiffness are not established. The aim of the study was to correlate US elastography findings with tissue properties in thyroid nodules. METHODS A total of 115 thyroid nodules from 112 patients who underwent surgery for the presence of Thy 3 (indeterminate) cytology (n = 67), Thy 4-5 (suspicious-indicative of carcinoma) cytology (n = 47), or large goiter in the presence of Thy 2 cytology (n = 1) and suspicious US features were examined by US elastography. Tissues obtained after surgery were characterized for cell number, microvessel density, fibrosis, and expression of galectin-3 (Gal-3) and fibronectin-1 (FN-1). RESULTS Low elasticity on qualitative US elastography (LoEl) was found in 66 nodules (one benign and 65 carcinomas); high elasticity (HiEl) was found in 49 nodules (46 benign and three carcinomas; p < 0.0001). Quantitative analysis, performed in 24 nodules and expressed as elastic ratio between the strain of the nodule and that of the surrounding thyroid parenchyma, showed a mean of 1.90 (interquartile range [IQR] 1.18-2.77) in 14 nodules with LoEl, and a mean of 1.01 (IQR 0.91-1.10) in 10 nodules with HiEl (p = 0.002). Stiffness did not correlate with cell number and was inversely correlated with microvessel density. Fibrosis was higher in nodules with LoEl than in those with HiEl (p = 0.009) and in carcinomas than in benign nodules (p = 0.02). Fibrosis was higher in nodules with high expression of Gal-3 (p < 0.001) and FN-1 (p = 0.004). Fibrosis and expression of Gal-3 and FN-1 were higher in the classic compared with the follicular variant of papillary thyroid carcinoma and lower in follicular adenomas. CONCLUSIONS Low elasticity at US elastography is highly correlated with malignancy. Nodule stiffness is correlated with fibrosis and expression of Gal-3 and FN-1. These features are more evident in the classic than in the follicular variant of papillary thyroid carcinoma.
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Affiliation(s)
- Teresa Rago
- 1 Department of Clinical and Experimental Medicine, Endocrinology Section, University of Pisa , Pisa, Italy
| | - Maria Scutari
- 1 Department of Clinical and Experimental Medicine, Endocrinology Section, University of Pisa , Pisa, Italy
| | - Valeria Loiacono
- 1 Department of Clinical and Experimental Medicine, Endocrinology Section, University of Pisa , Pisa, Italy
| | - Ferruccio Santini
- 1 Department of Clinical and Experimental Medicine, Endocrinology Section, University of Pisa , Pisa, Italy
| | - Massimo Tonacchera
- 1 Department of Clinical and Experimental Medicine, Endocrinology Section, University of Pisa , Pisa, Italy
| | - Liborio Torregrossa
- 2 Department of Oncology Section of Cytopathology, Pathology, University of Pisa , Italy
| | - Riccardo Giannini
- 2 Department of Oncology Section of Cytopathology, Pathology, University of Pisa , Italy
| | - Nicla Borrelli
- 2 Department of Oncology Section of Cytopathology, Pathology, University of Pisa , Italy
| | - Agnese Proietti
- 2 Department of Oncology Section of Cytopathology, Pathology, University of Pisa , Italy
| | - Fulvio Basolo
- 2 Department of Oncology Section of Cytopathology, Pathology, University of Pisa , Italy
| | | | - Paolo Piaggi
- 4 Department of Electric Systems and Automation, University of Pisa , Italy
| | - Francesco Latrofa
- 1 Department of Clinical and Experimental Medicine, Endocrinology Section, University of Pisa , Pisa, Italy
| | - Paolo Vitti
- 1 Department of Clinical and Experimental Medicine, Endocrinology Section, University of Pisa , Pisa, Italy
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Zheng B, Liu J, Gu J, Du J, Wang L, Gu S, Cheng J, Yang J, Lu H. Classification of Benign and Malignant Thyroid Nodules Using a Combined Clinical Information and Gene Expression Signatures. PLoS One 2016; 11:e0164570. [PMID: 27776138 PMCID: PMC5077123 DOI: 10.1371/journal.pone.0164570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 09/27/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND A key challenge in thyroid carcinoma is preoperatively diagnosing malignant thyroid nodules. A novel diagnostic test that measures the expression of a 3-gene signature (DPP4, SCG5 and CA12) has demonstrated promise in thyroid carcinoma assessment. However, more reliable prediction methods combining clinical features with genomic signatures with high accuracy, good stability and low cost are needed. METHODOLOGY/PRINCIPAL FINDINGS 25 clinical information were recorded in 771 patients. Feature selection and validation were conducted using random forest. Thyroid samples and clinical data were obtained from 142 patients at two different hospitals, and expression of the 3-gene signature was measured using quantitative PCR. The predictive abilities of three models (based on the selected clinical variables, the gene expression profile, and integrated gene expression and clinical information) were compared. Seven clinical characteristics were selected based on a training set (539 patients) and tested in three test sets, yielding predictive accuracies of 82.3% (n = 232), 81.4% (n = 70), and 81.9% (n = 72). The predictive sensitivity, specificity, and accuracy were 72.3%, 80.5% and 76.8% for the model based on the gene expression signature, 66.2%, 81.8% and 74.6% for the model based on the clinical data, and 83.1%, 84.4% and 83.8% for the combined model in a 10-fold cross-validation (n = 142). CONCLUSIONS These findings reveal that the integrated model, which combines clinical data with the 3-gene signature, is superior to models based on gene expression or clinical data alone. The integrated model appears to be a reliable tool for the preoperative diagnosis of thyroid tumors.
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Affiliation(s)
- Bing Zheng
- Shanghai Institute of Medical Genetics, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Liu
- Department of Otolaryngology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Ear Institute, Shanghai Jiaotong University, Shanghai, China
| | - Jianlei Gu
- Shanghai Institute of Medical Genetics, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Molecular Embryology, Ministry of Health and Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai, China
| | - Jing Du
- Department of Ultrasonography, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lin Wang
- Department of Ultrasonography, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shengli Gu
- Department of Ultrasonography, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Cheng
- Department of Ultrasonography, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Yang
- Department of Otolaryngology-Head and Neck Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Ear Institute, Shanghai Jiaotong University, Shanghai, China
| | - Hui Lu
- Shanghai Institute of Medical Genetics, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Molecular Embryology, Ministry of Health and Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai, China
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, United States of America
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Sciacchitano S, Lavra L, Ulivieri A, Magi F, Porcelli T, Amendola S, De Francesco GP, Bellotti C, Trovato MC, Salehi LB, Bartolazzi A. Combined clinical and ultrasound follow-up assists in malignancy detection in Galectin-3 negative Thy-3 thyroid nodules. Endocrine 2016; 54:139-147. [PMID: 26475496 DOI: 10.1007/s12020-015-0774-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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] [Received: 07/13/2015] [Accepted: 10/08/2015] [Indexed: 12/29/2022]
Abstract
The use of galectin-3 ThyroTest in the preoperative evaluation of cytologically indeterminate (Thy-3) thyroid nodules has been largely validated by retrospective and prospective multicentre studies. Here we report the results of galectin-3 ThyroTest routinely applied in the management of Thy-3 nodules in combination with clinical and ultrasonography (US) examination, in which galectin-3 positive nodules were directly referred to surgery whereas galectin-3 negative lesions were considered for clinical and US long-term follow-up. A cohort of 331 patients, bearing 340 thyroid Thy-3 nodules, was enrolled and subjected to galectin-3 expression analysis. A total of 256 galectin-3 negative nodules were directed to periodical clinical and US examination, while 84 galectin-3 positive cases were referred to surgery. Excluding 63 dropout patients plus 15 patients that were operated because of clinical reasons the remaining 176 galectin-3 negative nodules were followed with clinical and US examination for an average period of 31 months. During the follow-up, the volume of galectin-3 negative nodules was unchanged in 85 cases (48 %), reduced in 47 (27 %), and increased in 44 (25 %). Based on combined clinical features and US follow-up results, a total of 36 out of 191 galectin-3 negative nodules (19 %) were referred to surgery, with a final histological finding of 28 benign lesions, three follicular tumor of uncertain malignant potential (FT-UMP), and five malignant lesions, corresponding to a 7 % false negative rate. In the group of 84 galectin-3 positive nodules, we detected 65 thyroid cancers with a prevalence of 77 %, 12 FT-UMPs, and 7 false positive lesions, corresponding to a 4 % false positive rate. A total of 150 patients were not operated and are still under clinical and US monitoring while surgery was performed in 118 patients with a final 70 thyroid cancers diagnosed, corresponding to a 59 % prevalence of malignancy detected at surgery and to a 26 % prevalence of malignancy among the entire Thy-3 nodule population. Galectin-3 ThyroTest is an easy and cheap diagnostic procedure that integrates conventional fine-needle-aspiration cytology, reduces the number of unnecessary thyroidectomies and increases the rate of malignancy at surgery. Clinical and US follow-up of galectin-3 negative lesions allows to further reduce false negative cases.
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Affiliation(s)
- Salvatore Sciacchitano
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy.
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy.
| | - Luca Lavra
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Alessandra Ulivieri
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Fiorenza Magi
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
| | - Tommaso Porcelli
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Stefano Amendola
- Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy
| | - Gian Paolo De Francesco
- Department of Oncological Science, Breast Unit, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
| | - Carlo Bellotti
- Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
| | - Maria Concetta Trovato
- Department of Clinical and Experimental Medicine, University of Messina, Policlinico Universitario "G. Martino", via Consolare Valeria, Gazzi, 98125, Messina, Italy
| | - Leila B Salehi
- Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy
- Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy
| | - Armando Bartolazzi
- Laboratory of Surgical and Experimental Pathology, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy
- Department of Oncology-Pathology, Cancer Center Karolinska Universitetssjukhuset Solna, 17176, Stockholm, Sweden
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Wuertz FG, Kresnik E, Malle P, Hyden M, Lind P, Rogatsch H, Gallowitsch HJ. Fine-Needle Aspiration with Immunohistochemistry Using a Modified Scrape Cell Block Technique for the Diagnosis of Thyroid and Parathyroid Nodules. Acta Cytol 2016; 60:118-30. [PMID: 27231232 DOI: 10.1159/000446466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 04/25/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of a modified scrape cell block (SCB) technique in a large series of patients. The technique was especially developed and tested for fine-needle aspiration of thyroid and parathyroid nodules. STUDY DESIGN Eighty-two ultrasound-guided fine-needle aspiration specimens with the sonographic aspect of a thyroid (n = 33) or a possible parathyroid nodule (n = 49) were studied. Immunohistochemistry (IHC) was used on cell blocks containing plasma, thromboplastin, and selected 3-dimensional cell aggregates scraped off Papanicolaou-stained smears. Antibodies for chromogranin A, thyroglobulin, parathyroid hormone, calcitonin, and carcinoembryonic antibody (CEA) were used. In cases of reduced immunosensitivity or suspected metastases or rare primary tumors, additional IHC markers were employed. RESULTS Chromogranin A was expressed in all 28 parathyroid adenomas (PA), in 7 of 8 hyperplastic parathyroid glands, and in 13 of 14 medullary thyroid carcinomas (MTC). When combining positivity for chromogranin A and calcitonin/CEA, the specificity for the detection of MTC was 100%. Parathyroid hormone was expressed in 26 of 36 parathyroid nodules (72.2%). When combining follicular microarchitecture and expression of chromogranin A, the specificity for the detection of parathyroid tissue was 97%. CONCLUSION With the modified SCB technique, accurate cytological diagnoses were obtained in 97.6% of 82 patients.
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Affiliation(s)
- Franz G Wuertz
- Institute of Pathology, State Hospital Klinikum Klagenfurt am Wx00F6;rthersee, Klagenfurt, Austria
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Trimboli P, Guidobaldi L, Amendola S, Nasrollah N, Romanelli F, Attanasio D, Ramacciato G, Saggiorato E, Valabrega S, Crescenzi A. Galectin-3 and HBME-1 improve the accuracy of core biopsy in indeterminate thyroid nodules. Endocrine 2016; 52:39-45. [PMID: 26142180 DOI: 10.1007/s12020-015-0678-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 05/19/2015] [Accepted: 06/29/2015] [Indexed: 01/21/2023]
Abstract
Core needle biopsy (CNB) has been recently described as an accurate second-line test in thyroid inconclusive cytology (FNA). Here we retrospectively investigated the potential improvement given by Galectin-3, Cytokeratin-19, and HBME-1 on the accuracy of CNB in thyroid nodules with prior indeterminate FNA report. The study included 74 nodules. At CNB diagnosis, 15 were cancers, 40 were benign, and 19 had uncertain/non-diagnostic CNB report. The above immunohistochemical (IHC) panel was analyzed in all cases. After surgery, 19 malignant and 55 benign lesions were found. All 15 cancers and all 40 benign nodules diagnosed at CNB were confirmed at final histology. Regarding the uncertain CNB group, 4 (21 %) were malignant and 15 (79 %) benign. When we considered all the series, the most accurate IHC combination was Galectin-3 plus HBME-1, while HBME-1 was the most sensitive marker in those nodules with uncertain CNB report. The combination of CNB plus IHC could indentify 19/19 cancers and 53/55 benign lesions. Sensitivity and specificity of CNB increased from 79 to 100 % and from 73 to 96 %, respectively, by adding IHC. CNB can diagnose the majority of thyroid nodules with previous indeterminate FNA cytology, while the accuracy of CNB is increased by adding Galectin-3, Cytokeratin-19, and HBME-1 panel. We suggest to adopt CNB as a second-line approach to indeterminate thyroid FNA, and apply IHC in those lesions with uncertain/non-diagnostic CNB report. This approach should improve the pre-surgical diagnosis of patients. These results should be confirmed in larger prospective series.
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Affiliation(s)
- Pierpaolo Trimboli
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Via Fulda, 14, 00148, Rome, Italy.
| | | | - Stefano Amendola
- Section of Endocrinology and Diabetology, Ospedale Israelitico, Via Fulda, 14, 00148, Rome, Italy
| | | | | | | | - Giovanni Ramacciato
- Department of Surgical and Medical Science, Sapienza University, Ospedale S. Andrea, Rome, Italy
| | - Enrico Saggiorato
- Service d'Endocrinologie, Pôle de Médecine, Centre Hospitalier des Escartons, Briançon, France
| | - Stefano Valabrega
- Department of Surgical and Medical Science, Sapienza University, Ospedale S. Andrea, Rome, Italy
| | - Anna Crescenzi
- Section of Pathology, University Hospital Campus Bio Medico, Rome, Italy
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Woliński K, Stangierski A, Szczepanek-Parulska E, Gurgul E, Budny B, Wrotkowska E, Biczysko M, Ruchala M. VEGF-C Is a Thyroid Marker of Malignancy Superior to VEGF-A in the Differential Diagnostics of Thyroid Lesions. PLoS One 2016; 11:e0150124. [PMID: 26900960 PMCID: PMC4762679 DOI: 10.1371/journal.pone.0150124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/09/2016] [Indexed: 12/26/2022] Open
Abstract
Introduction Thyroid nodular goiter is one of the most common medical conditions affecting even over a half of adult population. The risk of malignancy is rather small but noticeable–estimated by numerous studies to be about 3–10%. The definite differentiation between benign and malignant ones is a vital issue in endocrine practice. The aim of the current study was to assess the expression of vascular endothelial growth factor A (VEGF-A) and VEGF-C on the mRNA level in FNAB washouts in case of benign and malignant thyroid nodules and to evaluate the diagnostic value of these markers of malignancy. Materials and Methods Patients undergoing fine-needle aspiration biopsy (FNAB) in our department between January 2013 and May 2014 were included. In case of all patients who gave the written consent, after ultrasonography (US) and fine-needle aspiration biopsy (FNAB) performed as routine medical procedure the needle was flushed with RNA Later solution, the washouts were frozen in -80 Celsius degrees. Expression of VEGF-A and VEGF-C and GADPH (reference gene) was assessed in washouts on the mRNA level using the real-time PCR technique. Probes of patients who underwent subsequent thyroidectomy and were diagnosed with differentiated thyroid cancer (DTC; proved by post-surgical histopathology) were analyzed. Similar number of patients with benign cytology were randomly selected to be a control group. Results Thirty one DTCs and 28 benign thyroid lesions were analyzed. Expression of VEGF-A was insignificantly higher in patients with DTCs (p = 0.13). Expression of VEGF-C was significantly higher in patients with DTC. The relative expression of VEGF-C (in comparison with GAPDH) was 0.0049 for DTCs and 0.00070 for benign lesions, medians – 0.0036 and 0.000024 respectively (p<0.0001). Conclusions Measurement of expression VEGF-C on the mRNA level in washouts from FNAB is more useful than more commonly investigated VEGF-A. Measurement of VEGF-C in FNAB washouts do not allow for fully reliable differentiation of benign and malignant thyroid nodules and should be interpreted carefully. Further studies on larger groups are indicated. However, measurement of VEGF-C on mRNA level can bring important information without exposing patient for additional risk and invasive procedures.
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Affiliation(s)
- Kosma Woliński
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail:
| | - Adam Stangierski
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewelina Szczepanek-Parulska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Edyta Gurgul
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartłomiej Budny
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Elzbieta Wrotkowska
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Biczysko
- Department of General, Gastroenterological and Endocrine Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Ruchala
- Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Li Y, Wang Y, Wu Q, Hu B. Transforming Growth Factor β1 Could Influence Thyroid Nodule Elasticity and Also Improve Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma. Ultrasound Med Biol 2015; 41:2866-2872. [PMID: 26306431 DOI: 10.1016/j.ultrasmedbio.2015.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/27/2015] [Accepted: 07/09/2015] [Indexed: 06/04/2023]
Abstract
Ultrasound elastography has been a very useful tool in predicting the risk of malignant thyroid tumor for several years. The objective of this study was to determine if there is a correlation between strain ratio (SR), collagen deposition and transforming growth factor β1 (TGF-β1) expression in different types of thyroid nodules and if TGF-β1 is related to cervical lymph node metastasis. 102 nodules from 81 patients who underwent thyroid resection surgery in our hospital were retrospectively studied. All of these patients had undergone ultrasound elastography scanning before surgery. Masson staining and immunohistochemical staining were used to evaluate the ratio of expression of collagen deposition and TGF-β1. There was a significant difference between benign and malignant thyroid nodules in SR (8.913 ± 11.021 vs. 1.732 ± 0.727, p = 0.000), collagen content (0.371 ± 0.125 vs. 0.208 ± 0.057, p = 0.000) and TGF-β1 expression (0.336 ± 0.093 vs. 0.178 ± 0.071, p = 0.000). A cutoff of 2.99 for SR measurement was selected for the highest Youden index for predicting malignant thyroid nodules, which yielded 87.88% sensitivity, 100% specificity, 100% positive predictive value, 83.72% negative predictive value and 92.15% accuracy. Expression of collagen and TGF-β1 was positively correlated with SR measurements (coefficient = 0.839 for collagen and 0.855 for TGF-β1, p = 0.000). Among 61 nodules with papillary thyroid carcinoma, the average SR for the metastasis group was higher than that for the non-metastasis group (10.955 ± 13.805 and 7.852 ± 7.931, respectively), but without statistical significance (p = 0.287). Collagen deposition was significantly higher in the metastasis group than in the non-metastasis group (0.421 ± 0.091 vs. 0.353 ± 0.118, p = 0.011). TGF-β1 expression was also significantly higher in the metastasis group than in the non-metastasis group (0.378 ± 0.0.69 vs. 0.328 ± 0.091, p = 0.016). To conclude, TGF-β1 may contribute to thyroid nodule elasticity by promoting collagen deposition. In papillary thyroid carcinoma, overexpression of TGF-β1, as well as collagen deposition, may be a risk factor for cervical lymph node metastasis.
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Affiliation(s)
- Yi Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yan Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China.
| | - Qiong Wu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
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Angell TE, Frates MC, Medici M, Liu X, Kwong N, Cibas ES, Kim MI, Marqusee E. Afirma Benign Thyroid Nodules Show Similar Growth to Cytologically Benign Nodules During Follow-Up. J Clin Endocrinol Metab 2015; 100:E1477-83. [PMID: 26353010 PMCID: PMC4702458 DOI: 10.1210/jc.2015-2658] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
CONTEXT The Afirma gene expression classifier (GEC) is a molecular diagnostic test that has a high negative predictive value for ruling out malignancy in thyroid nodules with indeterminate cytology. Many patients with a cytologically indeterminate and GEC benign (Cyto-I/GEC-B) nodule undergo monitoring instead of diagnostic surgery, but few data describe their follow-up. OBJECTIVE The objective of the study was to determine the sonographic changes and clinical outcomes for patients with Cyto-I/GEC-B nodules compared with patients with cytologically benign (Cyto-B) nodules. DESIGN This was a retrospective analysis of consecutive Cyto-I/GEC-B nodules evaluated at Brigham and Women's Hospital compared with Cyto-B nodules. MAIN OUTCOMES Nodule growth of 20% or greater in two dimensions or of 50% or greater in volume, change in sonographic features, and rates of repeat fine-needle aspiration, thyroidectomy, and malignancy. RESULTS Ninety-five Cyto-I/GEC-B nodules in 90 patients were identified. Five patients underwent primary surgical resection. Of the remaining 90 nodules, 58 (64.4%) had sonographic follow-up available at a median of 13 months (range 4-40 mo). Cyto-I/GEC-B nodules showed similar growth compared with 1224 Cyto-B nodules using either of the following criteria: 20% or greater in two dimensions (8.6% vs 8.3%, P = .80) or 50% or greater in volume (17.2% vs 13.8%, P = .44). Thyroidectomies were more frequent in the Cyto-I/GEC-B group (13.8% vs 0.9%, P < .0001), but cancer was found in only one patient, with no evidence of persistent disease after initial treatment. CONCLUSIONS Cyto-I/GEC-B nodules demonstrate similar growth to Cyto-B nodules during follow-up. Although Cyto-I/GEC-B nodules were more frequently resected, only one malignancy was found. These data suggest that reassessment of Cyto-I/GEC-B nodules may be performed similarly to those with benign cytology.
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Affiliation(s)
- Trevor E Angell
- Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Mary C Frates
- Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Marco Medici
- Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Xiaoyun Liu
- Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Norra Kwong
- Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Edmund S Cibas
- Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Matthew I Kim
- Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
| | - Ellen Marqusee
- Thyroid Section (T.E.A., M.M., X.L., N.K., M.I.K., E.M.), Division of Endocrinology, Hypertension, and Diabetes, and Departments of Radiology (M.C.F.) and Pathology (E.S.C.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115; Rotterdam Thyroid Center and Department of Internal Medicine (M.M.), Erasmus University Medical Center, 3000 DR Rotterdam, The Netherlands; and Department of Endocrinology (X.L.), First Affiliated Hospital of Nanjing Medical University, Nanjing 210008, Jiangsu Province, China
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Ralhan R, Veyhl J, Chaker S, Assi J, Alyass A, Jeganathan A, Somasundaram RT, MacMillan C, Freeman J, Vescan AD, Witterick IJ, Walfish PG. Immunohistochemical Subcellular Localization of Protein Biomarkers Distinguishes Benign from Malignant Thyroid Nodules: Potential for Fine-Needle Aspiration Biopsy Clinical Application. Thyroid 2015; 25:1224-34. [PMID: 26131603 DOI: 10.1089/thy.2015.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is of critical clinical importance to select accurately for surgery thyroid nodules at risk for malignancy and avoid surgery on those that are benign. Using alterations in subcellular localization for seven putative biomarker proteins (identified by proteomics), this study aimed to define a specific combination of proteins in surgical tissues that could distinguish benign from malignant nodules to assist in future surgical selection by fine-needle aspiration biopsy (FNAB). METHODS Immunohistochemical subcellular localization (IHC) analyses of seven proteins were retrospectively performed on surgical tissues (115 benign nodules and 114 papillary-based thyroid carcinomas [TC]), and a risk model biomarker panel was developed and validated. The biomarker panel efficacy was verified in 50 FNAB formalin-fixed and paraffin-embedded cell blocks, and 26 cytosmears were prepared from fresh surgically resected thyroid nodules. RESULTS Selection modeling using these proteins resulted in nuclear phosphoglycerate kinase 1 (PGK1) loss and nuclear Galectin-3 overexpression as the best combination for distinguishing TC from benign nodules (area under the curve [AUC] 0.96 and 0.95 in test and validation sets, respectively). A computed malignancy score also accurately identified TC in benign and indeterminate nodules (test and validation sets: AUC 0.94, 0.90; specificity 98%, 99%). Its efficacy was confirmed in surgical FNAB cell blocks and cytosmears. CONCLUSION Using surgical tissues, it was observed that a combination of PGK1 and Galectin-3 had high efficiency for distinguishing benign from malignant thyroid nodules and could improve surgical selection for TC among indeterminate nodules. Further validation in prospective preoperative FNAB will be required to confirm such a clinical application.
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Affiliation(s)
- Ranju Ralhan
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
- 2 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital , Toronto, Canada
- 3 Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Canada
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 5 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital , Toronto, Canada
- 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto , Toronto, Canada
| | - Joe Veyhl
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Seham Chaker
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Jasmeet Assi
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Akram Alyass
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Ajitha Jeganathan
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Raj Thani Somasundaram
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
| | - Christina MacMillan
- 2 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital , Toronto, Canada
- 3 Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Canada
| | - Jeremy Freeman
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 5 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital , Toronto, Canada
- 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto , Toronto, Canada
| | - Allan D Vescan
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 5 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital , Toronto, Canada
- 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto , Toronto, Canada
| | - Ian J Witterick
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 5 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital , Toronto, Canada
- 6 Department of Otolaryngology-Head and Neck Surgery, University of Toronto , Toronto, Canada
| | - Paul G Walfish
- 1 Alex and Simona Shnaider Research Laboratory in Molecular Oncology, Mount Sinai Hospital , Toronto, Canada
- 2 Department of Pathology and Laboratory Medicine, Mount Sinai Hospital , Toronto, Canada
- 3 Laboratory Medicine and Pathobiology, University of Toronto , Toronto, Canada
- 4 Joseph and Mildred Sonshine Family Centre for Head and Neck Diseases, Department of Otolaryngology-Head and Neck Surgery Program, Mount Sinai Hospital , Toronto, Canada
- 7 Department of Medicine, Endocrine Division, Mount Sinai Hospital , Toronto, Canada
- 8 Department of Medicine, University of Toronto Medical School , Toronto, Canada
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Bizzarro T, Martini M, Marrocco C, D’Amato D, Traini E, Lombardi CP, Pontecorvi A, Fadda G, Larocca LM, Rossi ED. The Role of CD56 in Thyroid Fine Needle Aspiration Cytology: A Pilot Study Performed on Liquid Based Cytology. PLoS One 2015; 10:e0132939. [PMID: 26186733 PMCID: PMC4505897 DOI: 10.1371/journal.pone.0132939] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/21/2015] [Indexed: 01/21/2023] Open
Abstract
Background Fine needle aspiration Cytology (FNAC) fulfills a reliable role in the evaluation of thyroid lesions. Although the majority of nodules are quite easily diagnosed as benign or malignant, 30% of them represent an indeterminate category whereby the application of ancillary techniques (i.e. immunocytochemistry-ICC and molecular testing) has been encouraged. The search for a specific immunomarker of malignancy sheds light on a huge number of ICC stains although none of them attempt to yield 100% conclusive results. Our aim was to define in a pilot study on thyroid FNAC whether CD56 might be a valid marker also in comparison with HBME-1 and Galectin-3. Materials and Methods Inasmuch as this is the largest pilot study using only liquid based cytology (LBC), we selected all the cases only in the categories of benign nodules (BN) and positive for malignancy (PM) for validation purposes. Eighty-five consecutive (including 50 PM and 35 BN) out of 950 thyroid FNACs had surgical follow-up. The ICC panel (HBME-1, Galectin-3 and CD56) was carried out on LBC and histology. Results All BNs and PMs were histological confirmed. CD56 was negative in 96% of the PM while 68.5% of the BNs showed cytoplasmic positivity for this marker, with an overall high sensitivity (96%) but lower specificity (69%). In specific, our 96% of the PMs did not show any follicular cell with CD56 expression. Different ICC combinations were evaluated showing that the panel made up of CD56 plus HBME-1 and Galectin-3 had the highest sensitivity (98%) and specificity (86%). Conclusions Our pilot study suggests that CD56 may be a good marker for ruling out PTC and its variants. The low specificity suggests that an immunopanel including also HBME-1 and Galectin-3 could obtain the highest diagnostic accuracy in thyroid lesions. Our results suggest that CD56 may be a feasible additional marker for identifying malignancies also in the FNs and SMs.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/metabolism
- Adenocarcinoma, Follicular/pathology
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Biopsy, Fine-Needle/methods
- Blood Proteins
- CD56 Antigen/genetics
- CD56 Antigen/metabolism
- Carcinoma/diagnosis
- Carcinoma/genetics
- Carcinoma/metabolism
- Carcinoma/pathology
- Carcinoma, Papillary
- Diagnosis, Differential
- Galectin 3/genetics
- Galectin 3/metabolism
- Galectins
- Humans
- Middle Aged
- Pilot Projects
- Sensitivity and Specificity
- Thyroid Cancer, Papillary
- Thyroid Gland/metabolism
- Thyroid Gland/pathology
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/metabolism
- Thyroid Neoplasms/pathology
- Thyroid Nodule/diagnosis
- Thyroid Nodule/genetics
- Thyroid Nodule/metabolism
- Thyroid Nodule/pathology
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Affiliation(s)
- Tommaso Bizzarro
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Maurizio Martini
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Carla Marrocco
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Donato D’Amato
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Emanuela Traini
- Division of Endocrine Surgery, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica del Sacro Cuore, “Agostino Gemelli” School of Medicine, Rome, Italy
- * E-mail:
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40
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Guo Z, Hardin H, Montemayor-Garcia C, Asioli S, Righi A, Maletta F, Sapino A, Lloyd RV. In Situ Hybridization Analysis of miR-146b-5p and miR-21 in Thyroid Nodules: Diagnostic Implications. Endocr Pathol 2015; 26:157-63. [PMID: 25771986 DOI: 10.1007/s12022-015-9363-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Some thyroid nodules such as follicular adenomas (FAs), follicular variant of papillary thyroid carcinomas (FVPTCs), and follicular thyroid carcinomas (FTCs) exhibit similar clinical presentations and gross morphologic appearances. The differential diagnosis of these lesions is sometimes difficult based on morphologic, cytologic, or clinical features alone. miR-146b-5p and miR-21 deregulation has been associated with progression and metastasis of thyroid cancers. However, the utility of in situ hybridization (ISH) to determine the cellular localization, diagnostic, and prognostic significance of miR-146b-5p and miR-21 expression in thyroid tumors has not been extensively analyzed. In order to examine the expression of miR-146b-5p and miR-21 in benign and malignant thyroid tissues and to determine if these microRNAs could be assigned to distinct histomorphological types of thyroid nodules, we analyzed miR-146b-5p and miR-21 expression in thyroid nodules on tissue microarrays (TMAs) with 193 thyroid specimens by ISH. miR-146b-5p and miR-21 expression in thyroid tissues was also analyzed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). miR-146b-5p was highly expressed (89%) in papillary thyroid carcinomas (PTCs) and 41% of FVPTC. The expression of miR-146b-5p was not expressed in most FTCs, anaplastic thyroid carcinomas (ATCs), poorly differentiated thyroid carcinomas (PDTCs), or FAs (7, 8, 0, and 0%, respectively). MiR-21 was overexpressed in 83% of ATCs, 79 % of PTCs, 34% of FVPTCs, and 19% of PDTCs. The expression of miR-21 was not expressed in most FAs (9%) or FTCs (4%). Normal thyroid tissues and most benign goiters were negative for miR-146b-5p and miR-21. qRT-PCR analysis supported the ISH findings. PTC cases with positive expression of miR-146b-5p and miR-21 had significantly poorer disease-free survival rates. Immunohistochemical staining for HBME-1 showed positive staining in PTCs (100 %) and FVPTCs (92 %) with a subset of FTC (40%) staining positive, while all FAs were negative. Since miR-146b-5p was mainly expressed in PTC including FVPTC and was not expressed in most FTC, PDTC, or ATC, it may serve as a useful diagnostic marker for PTC. ISH is a useful method to analyze microRNA expression in formalin-fixed paraffin-embedded thyroid tissues.
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Affiliation(s)
- Zhenying Guo
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Wu G, Guo JJ, Ma ZY, Wang J, Zhou ZW, Wang Y. Correlation between calcification and bone sialoprotein and osteopontin in papillary thyroid carcinoma. Int J Clin Exp Pathol 2015; 8:2010-2017. [PMID: 25973097 PMCID: PMC4396203] [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] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/05/2014] [Indexed: 06/04/2023]
Abstract
The correlation between calcification and papillary thyroid carcinoma has received increasing attention. We investigated the ability of bone sialoprotein (BSP) and osteopontin (OPN) protein levels to diagnose papillary thyroid carcinoma (PTC), and explored the correlation between BSP and OPN protein levels and calcification in PTC. Archival PTC specimens from patients with PTC with calcification and lateral cervical lymph node metastasis (LNM) were included in this retrospective immunohistochemical study. The protein levels of BSP and OPN were analysed immunohistochemically using routinely prepared tissue sections. PTC specimens from 66 patients with PTC were reviewed retrospectively (25 patients with histological calcification seen in paraffin sections, 41 patients without calcification; 35 patients with lateral cervical LNM, 31 patients without LNM). The percentage of samples that had cells that demonstrated positive protein staining differed significantly between PTC specimens, benign thyroid nodules, and adjacent normal follicular epithelium (BSP: 87.88%, 55.00%, and 42.50%, respectively; OPN: 83.33%, 70.00% and 50.00%, respectively). There was a significant difference in the immunohistochemical score (IHS) for BSP and OPN protein staining between PTC specimens with and without calcification (P < 0.05). The level of BSP protein staining was found to be significantly correlated with the level of OPN protein staining in PTC specimens. We conclude that the strong correlation between BSP and OPN and PTC suggests a role for BSP and OPN in calcification and tumor progression of PTC. BSP and OPN might be useful tumour markers for the diagnosis of PTC with limited value, because both of them had low specificity.
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Affiliation(s)
- Gang Wu
- Depratment of General Surgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Jing-Jing Guo
- Depratment of General Surgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
- Depratment of General Surgery, Renhe HospitalBaoshan District, Shanghai 200431, China
| | - Zhen-Yu Ma
- Depratment of General Surgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Jie Wang
- Depratment of General Surgery, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Zhong-Wen Zhou
- Department of Pathology, Huashan Hospital, Fudan UniversityShanghai 200040, China
| | - Yi Wang
- Department of Ultrasound, Huashan Hospital, Fudan UniversityShanghai 200040, China
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Wang K, Yang Y, Wu Y, Chen J, Zhang D, Mao X, Wu X, Long X, Liu C. The association between insulin resistance and vascularization of thyroid nodules. J Clin Endocrinol Metab 2015; 100:184-92. [PMID: 25368977 DOI: 10.1210/jc.2014-2723] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT Insulin resistance (IR) is an important factor for the growth and progression of thyroid nodules, which might be associated with the distribution, construction, and density of nodular vascularization. OBJECTIVE The objective of the study was to explore the association between IR and the vascularization of thyroid nodules. DESIGN AND SETTING A cross-sectional, population-based study was conducted in Nanjing, China, from June to November 2011. PARTICIPANTS Among 10 050 participants aged 40-79 years, 2886 thyroid nodule cases were detected and 2532 cases met eligibility criteria for enrollment in the study. MAIN OUTCOME MEASURES Power Doppler was performed to measure the flow patterns, resistive index (RI), and vascular index (VI) of thyroid nodular vascularization. Fasting insulin, fasting glucose, 2-hour oral glucose tolerance test, glycosylated hemoglobin (HbA1c), homeostasis model assessment of IR (HOMA-IR), and body mass index were also tested. RESULTS HOMA-IR (R = 0.35, P < .001) and HbA1c (R = 0.19, P < .001) were positively correlated with thyroid nodular flow patterns, and the positive correlations were more significant in participants with large nodules (volume ≥ 0.2 mL). Additionally, in participants with large nodules, HOMA-IR and HbA1c were positively correlated with RI (HOMA-IR: β = .42, SE = .03, R = 0.43, P < .001; HbA1c: β = .22, SE = .04, R = 0.23, P < .001) and VI (HOMA-IR: β = .49, SE = 0.05, R = 0.53, P < .001; HbA1c: β = .34, SE = 0.11, R = 0.37, P < .001). CONCLUSIONS IR and hyperglycemia were positively correlated with the flow patterns, RI, and VI of thyroid nodules, especially in large nodules. The findings suggest a pivotal role of IR in the distribution, construction, and density of thyroid nodular vascularization, which might contribute to the growth and the progression of thyroid nodules.
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Affiliation(s)
- Kun Wang
- Departments of Endocrinology (K.W., Y.Y., J.C., D.Z., X.M., C.L.) and Ultrasonography (X.W., X.L.), Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210028, China; and Department of Endocrinology (Y.W.), The First People's Hospital of Changzhou, Third Affiliated Hospital of Suzhou University, Changzhou 213003, China
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Olifirova OS, Knalian SV. [RESULTS OF RESEARCH OF GALECTIN-3 AND THYROGLOBULIN IN PATIENTS WITH THYROID NODULES]. Vestn Khir Im I I Grek 2015; 174:81-83. [PMID: 26234070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An investigation of galectin-3 and thyroglobulin using IFA was conducted in 80 patients. A lavage of aspirate from the thyroid gland was obtained by fine-needle aspiration biopsy. It was stated that significant increase of galectin-3 and thyroglobulin was noted in case of high differentiated thyroid carcinoma in comparison with benign nodules. Galectin-3 and thyroglobulin from the lavage of thyroid gland aspirate could be used as an oncological marker for complex differentiated diagnostics of high differentiated thyroid carcinoma and benign nodules.
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Abstract
PURPOSE We investigated the merit of ultrasound (US) features and BRAF(V600E) mutation as an additional study of cytology and compared the diagnostic performances of cytology alone, cytology with US correlation, cytology with BRAFV600E mutation, and a combination of cytology, US, and BRAFV600E mutation all together. MATERIALS AND METHODS This study included 185 patients (mean age, 48.4 years; range 20-77 years) with 191 thyroid nodules who underwent US-guided fine-needle aspiration (FNA) with an additional BRAFV600E mutation test. Three radiologists highly experienced in thyroid imaging retrospectively reviewed US images and classified each nodule into two categories (positive for malignancy or negative for malignancy). Interobserver variability (IOV) of US assessment between the three readers was estimated using the generalized kappa statistic of Landis and Koch. We also calculated the diagnostic performances of these studies. RESULTS There were 131 cases of malignancy (131/191, 68.6%) and 60 cases of benign nodules (60/191, 31.4%). In terms of IOV of US assessment, the generalized kappa value was 0.242, indicating fair agreement was reached. The combination of cytology with BRAFV600E showed higher specificity (100%) and positive predictive value (PPV) (100%) compared to the combination of cytology, BRAFV600E, and US (specificity 28.3%, 66.7%, 68.3%; PPV 74.6%, 86.6%, 86.8%, respectively; p<0.001). However, cytology with BRAFV600E showed lower sensitivity (84.7%) than cytology with BRAFV600E and US (96.2%, 98.5%, 95.4%, respectively; p<0.001). CONCLUSION Considering the diagnostic performance and low reproducibility of US, the combination of FNA with BRAFV600E is the most reliable and objective method for diagnosing thyroid malignancy.
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Affiliation(s)
- Jae Young Seo
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea. ; Department of Radiology, Konyang University Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Hwa Han
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
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Westphal JG, Winkens T, Kühnel C, Freesmeyer M. Low-activity (124)I-PET/low-dose CT versus (131)I probe measurements in pretherapy assessment of radioiodine uptake in benign thyroid diseases. J Clin Endocrinol Metab 2014; 99:2138-45. [PMID: 24606104 DOI: 10.1210/jc.2013-4390] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT Radioiodine therapy of benign thyroid diseases requires pretherapy assessment of radioactive iodine uptake (RAIU) for reliable therapy planning. OBJECTIVE Our objective was to assess RAIU by low-activity (124)I-positron emission tomography/low-dose computed tomography ((124)I-PET/CT) in comparison with standard (131)I probe measurements. DESIGN/SETTING This prospective comparative study was conducted at the Jena University Hospital, Jena, Germany, in a referral center setting. PATIENTS A total of 79 patients with benign thyroid diseases were screened, 40 of whom met the inclusion criteria (stable TSH, free T3 and free T4 levels; no thyroid-specific medication, no iodine contamination) and 24 of whom agreed to participate by signing an informed consent. INTERVENTIONS All patients received the standard (131)I scintillation probe uptake test 30 hours after administration of 3 MBq (131)I. Seven days later, all patients were subjected to (124)I-PET/CT uptake measurement 30 hours after administration of 1 MBq (124)I. MAIN OUTCOME MEASURES The decay-corrected uptake values of both techniques were compared. Additionally, 3 different volume-of-interest-based evaluation methods in PET/CT (whole neck [WN], automatic isocontour [IC], and manually contoured [MC]) were evaluated. RESULTS The (131)I probe measurement and (124)I-PET.WN method provided very similar mean RAIU (30.7% ± 10.3%; 31.7% ± 8.9%), resulting in a significant positive correlation (r = 0.93, P < .001). Compared with (124)I-PET.WN, the (124)I-PET.IC (29.8% ± 8.6%) and the (124)I-PET.MC (24.5% ± 7.1%) demonstrated lower uptake values. CONCLUSIONS Using activities as low as 1 MBq, the (124)I-PET.WN method shows a good correlation with conventional (131)I probe measurement. Thus, (124)I-PET/CT is a suitable alternative for pretherapy RAIU evaluations. This may offer potential additional benefits such as PET/ultrasound fusion imaging and CT volumetry.
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Affiliation(s)
- Julian G Westphal
- Clinic of Nuclear Medicine (J.G.W., T.W., C.K., M.F.), Jena University Hospital, 07743 Jena, Germany and Ernst-Abbe-Fachhochschule Jena (C.K.), University of Applied Sciences, 07740 Jena, Germany
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Abstract
Molecular diagnostics offers great promise for the evaluation of cytologically indeterminate thyroid nodules. Numerous molecular genetic and immunohistochemical tests have been developed that may be performed on thyroid specimens obtained during standard fine-needle aspiration, some of which may greatly improve diagnostic yield. A sound understanding of the diagnostic performance of these tests, and how they can enhance clinical practice, is important. This article reviews the diagnostic utility of immunohistochemical and molecular testing for the clinical assessment of thyroid nodules, and makes recommendations about how these tests can be integrated into clinical practice for patients with cytologically indeterminate thyroid nodules.
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Affiliation(s)
- Sann Yu Mon
- Division of Endocrinology, University of Pittsburgh School of Medicine, 200 Lothrop Street, BST 1140, Pittsburgh, PA 15213, USA
| | - Steven P Hodak
- Division of Endocrinology, Center for Diabetes and Endocrinology, University of Pittsburgh School of Medicine, 3601 Fifth Avenue, Suite 587, Pittsburgh, PA 15213, USA.
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Shao H, Yu X, Wang C, Wang Q, Guan H. Midkine expression is associated with clinicopathological features and BRAF mutation in papillary thyroid cancer. Endocrine 2014; 46:285-91. [PMID: 24272599 DOI: 10.1007/s12020-013-0068-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [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: 07/03/2013] [Accepted: 09/16/2013] [Indexed: 12/28/2022]
Abstract
The objective of this study is to detect the expression of midkine (MK) in papillary thyroid cancer (PTC) and to evaluate whether MK expression is associated with clinicopathological features and BRAF mutation in PTC. The expression of MK in samples from 200 cases of PTC, 60 cases of adenomatoid nodule of thyroid, and 40 samples of tumor-adjacent normal thyroid tissue were assessed with immunohistochemistry. The BRAF mutation was detected by direct sequencing. The relationships between MK expression and the clinicopathological features of PTC and BRAF mutation were analyzed. The results demonstrated that MK was not expressed in tumor-adjacent normal tissue. The positive expression rates and MK scores were both higher in PTC than in adenomatoid nodule (positive expression rates: 88 vs. 8.3 %, P < 0.001; MK scores: 2.02 ± 0.93 vs. 0.08 ± 0.28, P < 0.001). The expression level of MK in PTC with extrathyroidal invasion, lymph node metastasis, or stage III/IV was significantly higher than that in PTC without such biological features (all P < 0.01). The overall prevalence of BRAF mutation was 66.5 % in PTC. The expression level of MK in PTC with BRAF mutation was significantly higher than that in PTC with wild-type BRAF (P < 0.001). We can conclude that MK is specifically expressed in PTC tissues and is associated with clinicopathological features and BRAF mutation. MK may be a helpful diagnostic and prognostic marker for PTC.
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Affiliation(s)
- Hua Shao
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China
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Chami R, Moreno-Reyes R, Corvilain B. TSH measurement is not an appropriate screening test for autonomous functioning thyroid nodules: a retrospective study of 368 patients. Eur J Endocrinol 2014; 170:593-9. [PMID: 24451082 DOI: 10.1530/eje-13-1003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Based on the assumption that normal TSH concentration rules out the presence of autonomous functioning thyroid nodules (AFTNs), clinical guidelines on the management of thyroid nodules only recommend a thyroid scan if TSH concentration is subnormal. However, the proportion of AFTN presenting with a normal TSH is unknown. Our objective is therefore to determine the proportion of AFTNs with a normal TSH level to ascertain whether a normal TSH really rules out an AFTN. DESIGN Retrospective study on 368 patients with an AFTN. METHODS Thyroid scans with a diagnosis of AFTN were reviewed retrospectively by one of us (R Moreno-Reyes), blinded to the clinical data. The diagnosis of solitary AFTN was confirmed in 368 patients. Among them, we selected 217 patients based on the absence of another thyroid nodule >10 mm, the absence of medical conditions able to interfere with thyroid function, and the completeness of the data. RESULTS The proportion of AFTNs with normal TSH was 49%. This proportion increased to 71% in patients for whom thyroid scan was performed in the workup of a thyroid nodule. CONCLUSIONS Our data suggest that serum TSH is not an effective screening tool to diagnose AFTNs. Using 'TSH-only' screening, as recommended by the majority of guidelines, the diagnosis of AFTN would have been missed in 71% of our patients in the workup of a thyroid nodule. Thyroid scan remains the gold standard for detecting AFTN and should be considered before performing fine-needle aspiration cytology (FNAC), as the reliability of FNAC in an unsuspected AFTN remains unclear.
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Guo H, Sun M, He W, Chen H, Li W, Tang J, Tang W, Lu J, Bi Y, Ning G, Yang T, Duan Y. The prevalence of thyroid nodules and its relationship with metabolic parameters in a Chinese community-based population aged over 40 years. Endocrine 2014; 45:230-5. [PMID: 23720025 DOI: 10.1007/s12020-013-9968-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [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: 11/25/2012] [Accepted: 04/20/2013] [Indexed: 10/26/2022]
Abstract
To investigate the prevalence of thyroid nodules (TN) among a community population aged >40 years and to explore the association between TN and its metabolic risk factors. Data from 9,533 adults aged over 40 years who participated in the epidemiological investigation of thyroid nodules in a Chinese community-based population from June to December 2011 were included in the analyses. We compared the levels of metabolic indices between the TN group and healthy controls. The prevalence of TN was 46.6% (39.7%, men; 50.3%, women) and it increased significantly with increasing age (P < 0.001). It was significantly higher in the group with hypertension than in that with normotension (P < 0.001) and was 43.0% in the normal blood glucose group, 49.4% in the prediabetes group, and 50.9% in the diabetes group (P < 0.001). Logistic regression analysis indicated that hypertension [odds ratio (OR) = 1.121 (1.025-1.225)] as well as prediabetes and diabetes [OR = 1.130 (1.036-1.233)] were all independent risk factors for TN after adjustment for sex, age, body mass index, blood lipid levels, smoking status, and alcohol consumption. The elderly population had a high prevalence of TN. Hypertension as well as prediabetes and diabetes might be independent risk factors for TN.
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Affiliation(s)
- Hongwei Guo
- Department of Endocrinology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, China
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Guerra A, Di Stasi V, Zeppa P, Faggiano A, Marotta V, Vitale M. BRAF(V600E) assessment by pyrosequencing in fine needle aspirates of thyroid nodules with concurrent Hashimoto's thyroiditis is a reliable assay. Endocrine 2014; 45:249-55. [PMID: 23775008 DOI: 10.1007/s12020-013-9994-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 04/08/2013] [Accepted: 05/27/2013] [Indexed: 01/21/2023]
Abstract
Detection of BRAF mutation in cytology specimens has been proposed as a diagnostic adjunctive tool in evaluation of thyroid nodules with indeterminate cytology findings. Concurrent papillary thyroid carcinoma and Hashimoto's thyroiditis (HT), a disease characterized by thyroid lymphocytic infiltration, is a frequent occurrence. A large lymphocytic infiltrate might reduce the sensitivity of methods employed to detect BRAF mutation in thyroid cytology specimens. To determine whether testing for BRAF mutational status in fine needle aspirates (FNA) is reliable also in the presence of HT lymphocytic infiltration, we assessed the BRAF status by direct sequencing and pyrosequencing in a series of FNAs with and without concomitant HT lymphocytic infiltration. We also performed the same assessment by pyrosequencing in the corresponding tissue samples. Pyrosequencing demonstrated to be more sensitive than direct sequencing. The percentage of mutant BRAF(V600E) alleles was higher in FNAs than in the corresponding tissues, probably because of the lower stromal contamination in FNA than in the sections. In the presence of lymphocytic infiltration, the percentage of mutant BRAF(V600E) alleles determined by pyrosequencing was higher in FNAs than in the corresponding tissue samples (P < 0.0001), indicating a minor lymphocytic contamination in FNA. The diagnostic value of BRAF(V600E) in inconclusive FNAs was not hampered by thyroid lymphocytic infiltration. These results indicate that BRAF(V600E) assessment by pyrosequencing is a reliable assay useful to refine inconclusive cytology of thyroid nodules also in the presence of concurrent HT.
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Affiliation(s)
- Anna Guerra
- Department of Medicine and Surgery, University of Salerno, Via Allende, 84081, Baronissi, Salerno, Italy
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