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Jia JL, Han JH, Pang R, Bi W, Liu B, Yang K. Predictors of poor prognosis in long-term survivors of differentiated thyroid cancer with psychiatric disorders. World J Psychiatry 2025; 15:103628. [DOI: 10.5498/wjp.v15.i5.103628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 03/14/2025] [Accepted: 04/08/2025] [Indexed: 04/30/2025] Open
Abstract
BACKGROUND Thyroid malignancies, while accounting for a small proportion of cancer diagnoses globally, have demonstrated a consistent upward trend in occurrence across diverse populations, with gender-specific analyses revealing a disproportionate burden among women. Despite the characteristically indolent nature of most thyroid carcinomas and their associated high survival rates, emerging evidence points to significant unmet needs regarding psychosocial adaptation and neuropsychiatric sequelae in this growing survivor population. The spectrum of mental health conditions, ranging from affective and anxiety disorders to cognitive impairments, presents substantial barriers to functional recovery and may potentially influence disease trajectories through complex psychoneuroimmunological pathways. Clinical observations consistently report elevated rates of mood disturbances and executive function deficits persisting throughout the cancer continuum, from active treatment into extended follow-up periods. These findings highlight a critical knowledge gap in understanding the dynamic interplay between thyroid cancer biology, its therapeutic interventions, and the development of treatment-resistant psychiatric manifestations that complicate long-term patient care.
AIM To analyse the factors influencing the poor prognosis of patients surviving long-term differentiated thyroid cancer with psychiatric disorders and to construct a prediction model.
METHODS Forty-eight patients with mental disorders combined with differentiated thyroid cancer who were treated in our hospital during the period of March 2018 to March 2023 were retrospectively selected as the study subjects (thyroid cancer group), and 30 cases each of patients with mental disorders combined with benign thyroid nodules (benign nodules group) and patients with mental disorders alone (mental disorders group), who were treated during the same time period, were selected as controls. The patients with differentiated thyroid cancer were further divided into a poor prognosis group (10 cases) and a good prognosis group (38 cases). The study outcome was poor prognosis as shown by whole body bone imaging within 2 years after thyroid cancer surgery. Factors influencing poor prognosis in survivors of differentiated thyroid cancer were analyzed by univariate and multivariate logistic regression analyses, receiver operating characteristic (ROC) curve analysis was used to assess the predictive efficacy of these factors for poor prognosis, and the DeLong test was used to determine whether there was a statistically significant difference in the area under the curve (AUC) of the model.
RESULTS One-way logistic regression analysis showed that tumour diameter [odds ratio (OR) = 19.190, P = 0.002], T-stage (OR = 7.692, P = 0.018), extra-glandular infiltration (OR = 37.000, P = 0.003), degree of differentiation (OR = 24.667, P = 0.008), serum free T3 (OR = 22.348, P = 0.025), serum free T4 (FT4) (OR = 1.158, P = 0.002), total bilirubin (TBil) (OR = 1.792, P = 0.004), albumin (OR = 0.675, P = 0.003), cortisol (OR = 1.180, P = 0.003), norepinephrine (OR = 1.047, P = 0.002), angiotensin II (OR = 1.975, P = 0.002), and superoxide dismutase (OR = 0.515, P = 0.005) all increased the risk of poor prognosis in patients with psychiatric disorders and long-term differentiated thyroid cancer. Multifactorial logistic regression analysis showed that tumour diameter (OR = 16.570, P = 0.021), extra-glandular infiltration (OR = 53.145, P = 0.010), FT4 (OR = 1.186, P = 0.007), and TBil (OR = 2.823, P = 0.048) were independent risk factors for poor prognosis of patients with psychiatric disorders with long-term differentiated thyroid cancer, and the regression equation was: Y = 2.808 × tumour diameter + 3.973 × extra-glandular infiltration + 0.171 × FT4 + 1.038 × TBil - 88.138. ROC analysis showed that the predictive power of the overall model (AUC = 0.992, P = 0.000) was significantly higher than that of independent risk factors (DeLong test P < 0.05).
CONCLUSION Tumour diameter, extra-glandular infiltration, FT4, and TBil are independent risk factors for poor prognosis in patients with psychiatric disorders with long-term differentiated thyroid cancer, and the combination of these factors is of higher value in predicting the prognosis of patients. These risk factors can be used as a basis to develop a reasonable prognostic management plan in clinical practice for patients with long-term differentiated thyroid cancer with mental disorders, so as to improve the prognosis and quality of life of patients.
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Affiliation(s)
- Jin-Liang Jia
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Ji-Hua Han
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Rui Pang
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Wen Bi
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Bo Liu
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, Heilongjiang Province, China
| | - Kun Yang
- Department of Anesthesiology, Harbin Medical University Affiliated Cancer Hospital, Harbin 150081, Heilongjiang Province, China
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Walczyk A, Gąsior-Perczak D, Pałyga I, Kopczyński J, Kuchareczko A, Niedziela E, Suligowska A, Płachta I, Chrapek M, Góźdź S, Kowalska A. Risk characteristics of papillary thyroid cancer > 1-4 cm is associated with increased tumour size. Clin Exp Med 2025; 25:155. [PMID: 40353915 PMCID: PMC12069152 DOI: 10.1007/s10238-025-01596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Accepted: 02/10/2025] [Indexed: 05/14/2025]
Abstract
Recent guidelines recommend total thyroidectomy for papillary thyroid cancers (PTC) larger than 4 cm. For papillary macrocarcinoma with a diameter >1-4 cm, less intensive surgery can be managed, but this is still a matter for debate. The aim of our study was to assess the prevalence of risk factors such as vascular invasion, positive margin, extrathyroidal extension, aggressive histology, lymph nodes and distant metastases associated with a primary PTC tumour with a diameter >1-4 cm, and the association between tumour size and the risk of having one or more of these factors. A retrospective analysis of the medical records of 857 patients who underwent total thyroidectomy between 2000 and 2020, with a final post-operative diagnosis of a PTC >1-4 cm. Overall, less than a half (47.0%) of tumours were associated with at least one risk factor. The prevalence of analysed risk factors, except aggressive histology and a positive margin status, was significantly associated with larger tumour size (>2-4 cm). The optimal cut-off value for a cumulative risk of having one or more risk factors was estimated as 2.0 cm. Patients with a primary tumour < 2.0 cm had almost double less risk (p-value < 0.0001; OR 1.95; 95% CI 1.47-2.58) of having one or more risk factors than patients with PTC ≥ 2.0 cm. In an era of de-escalation, the cut-off value of 2 cm can be helpful in identifying patients with PTC >1-4 cm and lower risk of having aggressive disease providing less extensive treatment approach.
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Affiliation(s)
- Agnieszka Walczyk
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.
- Endocrinology Clinic of Holycross Cancer Centre, Stefana Artwińskiego Street 3, 25-734, Kielce, Poland.
| | - Danuta Gąsior-Perczak
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Stefana Artwińskiego Street 3, 25-734, Kielce, Poland
| | - Iwona Pałyga
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Stefana Artwińskiego Street 3, 25-734, Kielce, Poland
| | | | - Artur Kuchareczko
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Stefana Artwińskiego Street 3, 25-734, Kielce, Poland
| | - Emilia Niedziela
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Stefana Artwińskiego Street 3, 25-734, Kielce, Poland
| | - Agnieszka Suligowska
- Endocrinology Clinic of Holycross Cancer Centre, Stefana Artwińskiego Street 3, 25-734, Kielce, Poland
| | - Izabela Płachta
- Endocrinology Clinic of Holycross Cancer Centre, Stefana Artwińskiego Street 3, 25-734, Kielce, Poland
| | - Magdalena Chrapek
- Faculty of Natural Sciences, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Góźdź
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Clinical Oncology, Holycross Cancer Centre, Kielce, Poland
| | - Aldona Kowalska
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Stefana Artwińskiego Street 3, 25-734, Kielce, Poland
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Regan A, Boyd A, Patel N, Stechman MJ, Scott-Coombes D. Thy1c Cytology Is a Reliable Method of Excluding Thyroid Cancer in Dominant Cystic Nodules. Cytopathology 2025; 36:236-239. [PMID: 39846789 DOI: 10.1111/cyt.13471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 12/31/2024] [Accepted: 01/12/2025] [Indexed: 01/24/2025]
Abstract
BACKGROUND Traditional teaching dictated that patients with recurrent thyroid cysts undergo excision owing to a 12% risk malignancy. Ultrasound evaluation now determines management of these patients augmented by fine needle biopsy. In UK, a non-diagnostic category for thyroid cysts (Thy1c) exists, whereas the Bethesda system combines 'non-diagnostic-cyst fluid only' into Category I along with paucicellular and acellular results. The aim was to assess the ability of Thy1c cytology to exclude malignancy. METHODS We undertook a retrospective study of patients undergoing thyroidectomy with Thy1c cytology from analysis of the Unit database. Additionally, we made a retrospective search in our pathology database for reports combining 'papillary thyroid carcinoma' with 'cyst' or 'cystic' and compared histology with cytology. RESULTS Between 2003 and 2023 115 patients (97 women, median age 44y, range 16-72) underwent thyroidectomy following Thy1c cytology. Indications for surgery included recurrent cyst (90%); compressive symptoms (9%) and one thyrotoxicosis. In no patient was the primary diagnosis malignant; multinodular goitre was commonest (87.76%); benign cyst (19.16%); follicular adenoma (5.4%) and coincidental pT1a classical papillary thyroid carcinoma (PTC) (4.3%). In the retrospective audit, 61 pathology reports contained 'PTC' and 'cyst'/'cystic'. The cystic element was in primary tumour (31.51%); nodal metastasis (17.28%) and adjacent benign disease (13.21%). Only 5 (8%) patients had Thy1c cytology; 4 had pT1a tumours and one a benign cyst and a 19 mm PTC. CONCLUSION Thy1c category reliably excludes significant malignancy. For patients with symptomatic cysts, ultrasound assessment and Thy1c cytology can guide the clinician to treat with either ablation or resection without the fear of mistreating a thyroid cancer.
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Affiliation(s)
- A Regan
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, UK
| | - A Boyd
- Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - N Patel
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, UK
| | - M J Stechman
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, UK
| | - D Scott-Coombes
- Department of Endocrine Surgery, University Hospital of Wales, Cardiff, UK
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Teliti M, Chytiris S, Coperchini F, Cerutti M, Grillini B, Gallo M, Calì B, Arpa G, Rotondi M, Magri F. Natural History of Cytologically Low-Risk Indeterminate Thyroid Nodules. J Clin Endocrinol Metab 2025; 110:e1297-e1302. [PMID: 39879628 PMCID: PMC12012805 DOI: 10.1210/clinem/dgaf052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 12/16/2024] [Accepted: 01/29/2025] [Indexed: 01/31/2025]
Abstract
CONTEXT Thyroid nodules classified cytologically as low-risk indeterminate lesions (TIR3A) on fine-needle aspiration biopsy (FNAB) present a clinical challenge due to their uncertain malignancy risk. OBJECTIVE This single-center study aimed to evaluate the natural history of TIR3A nodules. METHODS FNABs performed between July 2017 and December 2019 were retrospectively retrieved and patients, with TIR3A nodules were evaluated at baseline and throughout a follow-up based on ultrasound (US) parameters and clinical data. RESULTS The final study group encompassed 371 patients with an initial TIR3A cytological result. Among them, 102 were directed to surgery after the first endocrinological evaluation, and 269 were directed to conservative follow-up. Repeat FNAB was performed in 120 out of 269 and 13 further patients underwent surgery following FNAB repetition. The malignancy rate among TIR3A nodules was 16.5%, with most interventions being performed for reasons unrelated to the TIR3A result. Repeat FNAB provided a more definitive diagnosis in 40% of cases, with a 5% increase in malignancy risk. The remaining patients were monitored with clinical and US follow-up. Among all patients with TIR3A cytology managed conservatively (149 without FNAB repetition and 66 with at least one FNAB repetition), no significant changes in nodule size and/or US pattern were observed during a median follow-up of 3.3 years. CONCLUSION These findings suggest that active surveillance is a safe option for managing TIR3A nodules, particularly when no additional risk factors are present. The study highlights the role of repeat FNAB in reducing unnecessary surgeries and underscores the generally indolent nature of TIR3A nodules.
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Affiliation(s)
- Marsida Teliti
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Spyridon Chytiris
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Francesca Coperchini
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Matteo Cerutti
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Beatrice Grillini
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Maria Gallo
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Benedetto Calì
- Istituti Clinici Scientifici Maugeri IRCCS, Department of General and Minimally Invasive Surgery, 27100 Pavia, Italy
| | - Giovanni Arpa
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Anatomic Pathology, 27100 Pavia, Italy
| | - Mario Rotondi
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
| | - Flavia Magri
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
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Silva GO, Romeiro FG, Moriguchi SM, Mazeto GMFS, Koga KH. Low-iodine diet: what to eat and avoid before iodine-131 procedures? Ann Nucl Med 2025:10.1007/s12149-025-02043-6. [PMID: 40253663 DOI: 10.1007/s12149-025-02043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 03/11/2025] [Indexed: 04/22/2025]
Abstract
OBJECTIVE The aim of this study was to compile a list of low-iodine foods for use in the Low-Iodine Diet (LID) to optimize the uptake of Iodine-131 by cells, which is used in the diagnosis and treatment of thyroid gland disorders. METHODS A bibliographic research was conducted focusing on the most commonly consumed foods in Brazil. Iodine quantification was derived from both national and international food composition tables, with an emphasis on sources indicating the highest concentrations of this microelement. The foods were organized into categories, and their iodine levels were presented in micrograms per 100 grams of food. RESULTS The compiled list includes foods classified into categories such as cereals, legumes, vegetables, fruits, flours, oils, fats, meats, dairy products, and beverages. Foods with more than 50 μg of iodine per 100 g were identified and classified separately. Based on the findings, marine-derived foods should be avoided, while dairy products and eggs can be consumed, provided substitutions are made. CONCLUSION Identifying and quantifying low-iodine foods is essential for guiding the LID, making it more effective and better suited to the population's needs. Legumes, vegetables, and most fruits can be consumed in larger quantities, forming the core of the diet.
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Affiliation(s)
- Gabriela O Silva
- Sao Paulo State University - Unesp, Graduate Program in Clinical Research, Botucatu, 18618-687, Brazil
| | - Fernando G Romeiro
- Internal Medicine Department, Sao Paulo State University - Unesp, Botucatu, 18618-687, Brazil
| | - Sonia Marta Moriguchi
- Department of Infectious Diseases, Dermatology, Sao Paulo State University - Unesp, Imaging Diagnostic and Radiotherapy, Botucatu, 18618-687, Brazil
| | | | - Katia H Koga
- Department of Infectious Diseases, Dermatology, Sao Paulo State University - Unesp, Imaging Diagnostic and Radiotherapy, Botucatu, 18618-687, Brazil.
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Chan SY, Marsh MS, Gilbert J, Boelaert K, Evans C, Dhillon-Smith R. Management of Thyroid Disorders in Pregnancy: Green-top Guideline No. 76. BJOG 2025. [PMID: 40240075 DOI: 10.1111/1471-0528.18088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2025]
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Song X, Zhi X, Qian L. Tailoring TSH suppression in differentiated thyroid carcinoma: evidence, controversies, and future directions. Endocrine 2025:10.1007/s12020-025-04223-w. [PMID: 40199841 DOI: 10.1007/s12020-025-04223-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Accepted: 03/24/2025] [Indexed: 04/10/2025]
Abstract
PURPOSE This review focus on the controversial benefits of thyroid hormone suppression therapy (THST) in differentiated thyroid carcinoma (DTC) and its associated risks, highlighting the need for individualized strategies to optimize therapeutic outcomes and guide future research. METHODS A systematic literature search on TSH suppression in DTC over the past 10 years was conducted, prioritizing RCTs, large cohort studies, and non-inferiority trials, with additional references identified from retrieved articles. RESULTS Tailored postoperative TSH strategies should consider factors such as risk stratification, treatment modality, histologic subtype, and adverse effect risks. In this context, mechanistic studies offer potential insights that could inform personalized TSH management, though further validation is required. Clinical evidence on THST in DTC remains controversial, particularly for high-risk patients, where support for stringent TSH suppression (<0.1 mU/L) is limited. Data for intermediate-risk DTC are insufficient due to cohort heterogeneity, while TSH suppression in low-risk DTC is largely discouraged. The well-documented adverse effects of excessive THST, including cardiovascular complications and osteoporosis, further provide a strong rationale against its routine use. Additionally, achieving and maintaining target TSH levels in real-world practice remains challenging, underscoring the need for refined approaches. CONCLUSION Current evidence provides limited support for the TSH targets recommended by the 2015 ATA guidelines. Optimizing postoperative TSH management should account for individualized factors, including risk stratification, treatment modalities, histologic subtypes, and susceptibility to adverse effects. Future research should prioritize well-designed studies with clearly defined suppression levels and appropriate confounder adjustments, emphasizing personalized approaches to balance therapeutic benefits and adverse effects.
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Affiliation(s)
- Xinxin Song
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xin Zhi
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Habeeb A, Lim KH, Kochilas X, Bhat N, Amen F, Chan S. Can Artificial Intelligence Software be Utilised for Thyroid Multi-Disciplinary Team Outcomes? Clin Otolaryngol 2025. [PMID: 40109024 DOI: 10.1111/coa.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 02/28/2025] [Accepted: 03/06/2025] [Indexed: 03/22/2025]
Abstract
OBJECTIVES ChatGPT is one of the most publicly available artificial intelligence (AI) softwares. Ear, nose and throat (ENT) services are often stretched due to the increasing incidence of thyroid malignancies. This study aims to investigate whether there is a role for AI software in providing accurate thyroid multidisciplinary team (MDT) outcomes. METHODS A retrospective study looking at unique thyroid MDT outcomes between October 2023 and May 2024. ChatGPT-4TM was used to generate outcomes based on the British Thyroid Association (BTA) Guidelines for Management of Thyroid Cancer. Concordance levels were collected and analysed. RESULTS Thirty thyroid cases with a mean age of 58 (n = 24 female, n = 6 male) were discussed. The MDT's outcome had a 100% concordance with BTA Guidelines. When comparing ChatGPT-4TM and our MDT the highest level of concordance Y1 was seen in 67% of case while 13% of cases were completely discordant. CONCLUSIONS/SIGNIFICANCE AI is cheap, easy to use can optimise complex thyroid MDT decision making. This could free some clinicians allowing them to meet other demands of the ENT service. Some key issues are the inability to completely rely on the AI software for outcomes without being counterchecked by a clinician.
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Affiliation(s)
- Amir Habeeb
- Academic Clinical Fellow Association, Queen Mary University of London, London, UK
| | - Kim Hui Lim
- Ear, Nose and Throat Surgery Department, Peterborough City Hospital, Peterborough, UK
| | - Xenofon Kochilas
- Ear, Nose and Throat Surgery Department, Peterborough City Hospital, Peterborough, UK
| | - Nazir Bhat
- Ear, Nose and Throat Surgery Department, Peterborough City Hospital, Peterborough, UK
| | - Furrat Amen
- Ear, Nose and Throat Surgery Department, Peterborough City Hospital, Peterborough, UK
| | - Samuel Chan
- Ear, Nose and Throat Surgery Department, Peterborough City Hospital, Peterborough, UK
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Marotta V, Scafuri L, Manso J. Editorial: Papillary thyroid cancer: prognostic factors and risk assessment. Front Endocrinol (Lausanne) 2025; 16:1578271. [PMID: 40099256 PMCID: PMC11911168 DOI: 10.3389/fendo.2025.1578271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Accepted: 02/24/2025] [Indexed: 03/19/2025] Open
Affiliation(s)
- Vincenzo Marotta
- Unità Operativa Complessa (UOC) Clinica Endocrinologica e Diabetologica, Azienda Ospedaliera Universitaria (AOU) San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Luca Scafuri
- Oncology Unit, “Andrea Tortora” Hospital, Azienda Sanitaria Locale (ASL) Salerno, Pagani, Italy
- Associazione Oncology Research Assistance (O.R.A.) Ente Terzo Settore (ETS)-Oncology Research Assistance, Salerno, Italy
| | - Jacopo Manso
- Endocrinology Unit, Azienda sanitaria Universitaria Friuli Centrale (ASUFC), Oncology Area Department, University-Hospital S. Maria della Misericordia, Udine, Italy
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Díez JJ, Anda E, Bretón I, González-Blanco C, Miguélez M, Zugasti A, Fernández A. Recommendations of the Spanish Society of Endocrinology and Nutrition (SEEN) on "what not to do" in clinical practice. ENDOCRINOL DIAB NUTR 2025; 72:101531. [PMID: 40037943 DOI: 10.1016/j.endien.2025.101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 11/06/2024] [Accepted: 11/10/2024] [Indexed: 03/06/2025]
Abstract
Quality healthcare should be grounded on clinical practice with the highest benefit-risk ratio and cost-effectiveness according to the available scientific evidence. The overuse of unproven diagnostic or therapeutic procedures is common in our setting and leads to increased healthcare spending and even iatrogenic harm. Previous cost-effectiveness initiatives have proposed identifying diagnostic and therapeutic measures that are better 'not done' in certain clinical contexts under the lens of the available scientific evidence. In this regard, the Spanish Society of Endocrinology and Nutrition (SEEN) has compiled a series of 'not-to-do' recommendations from its various working groups. These recommendations cover common clinical situations classified into the following thematic areas: diabetes, nutrition, pituitary gland, neuroendocrine tumors, thyroid, and hormone replacement therapy in postmenopausal women.
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Affiliation(s)
- Juan José Díez
- Servicio de Endocrinología y Nutrición, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Emma Anda
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Navarra, Pamplona, Spain
| | - Irene Bretón
- Servicio de Endocrinología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cintia González-Blanco
- Servicio de Endocrinología y Nutrición, Hospital General Universitario de Valencia, Valencia, Spain
| | - María Miguélez
- Servicio de Endocrinología y Nutrición, Fundación Jiménez Díaz, Madrid, Spain
| | - Ana Zugasti
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Navarra, Pamplona, Spain
| | - Alberto Fernández
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Móstoles, Madrid, Spain
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Lukas J, Hintnausova B, Sykorova V, Syrucek M, Maly M, Lukas D, Duskova J. Clinical and molecular genetic analysis of cytologically uncertain thyroid nodules in patients with thyroid disease. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2025; 169:26-31. [PMID: 38058193 DOI: 10.5507/bp.2023.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The current requirement is to establish the preoperative diagnosis accurately as possible and to achieve an adequate extent of surgery. The aim of this study was to define the preoperative clinical and molecular genetic risks of malignancy in indeterminate thyroid nodules (Bethesda III and IV) and to determine their impact on the surgical strategy. METHODS Prospectively retrospective analysis of 287 patients provided the basis of preoperative laboratory examination, sonographic stratification of malignancy risks and cytological findings. Molecular tests focused on pathogenic variants of genes associated with thyroid oncogenesis in cytologically indeterminate nodules (Bethesda III and IV). The evaluation included clinical risk factors: positive family history, radiation exposure and growth in size and/or number of nodules. RESULTS Preoperative FNAB detected 52 cytologically indeterminate nodules (28.7%) out of 181 patients. Postoperative histopathological examination revealed malignancy in 12 cases (23.7%) and there was no significant difference between Bethesda III and IV categories (P=0.517). Clinical risk factors for malignancy were found in 32 patients (61.5%) and the presence of at least one of them resulted in a clearly higher incidence of malignancy than their absence (31.3% vs. 10.0%, respectively). Pathogenic variants of genes were detected in 12/49 patients in Bethesda III and IV, and in 4 cases (33.3%) thyroid carcinoma was revealed. The rate of malignancies was substantially higher in patients with pathogenic variants than in those without (33.3% vs. 16.2%, respectively). CONCLUSIONS Our experience implies that molecular genetic testing is one of several decision factors. We will continue to monitor and enlarge our patient cohort to obtain long-term follow-up data.
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Affiliation(s)
- Jindrich Lukas
- Department of Otolaryngology - Head and Neck Surgery, Na Homolce Hospital, Prague, Czech Republic
- Ear, Nose, and Throat Department Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Barbora Hintnausova
- Department of Internal Medicine, Endocrinology Centre, Na Homolce Hospital, Prague, Czech Republic
| | - Vlasta Sykorova
- Institute of Endocrinology, Department of Molecular Endocrinology, Prague, Czech Republic
| | - Martin Syrucek
- Department of Pathology, Na Homolce Hospital, Prague, Czech Republic
| | - Marek Maly
- Department of Biostatistics, National Institute of Public Health, Prague, Czech Republic
| | - David Lukas
- Department of General Surgery, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jaroslava Duskova
- Institute of Pathology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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12
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Ansley W, Kamyab A, Noden L, Odutoye B, Williamson P, Wong KH, Dent P, Sharma A, Weller A, Pitiyage G, Ofo E. Does the extent of neck surgery based on preoperative calcitonin level influence survival in medullary thyroid carcinoma: a retrospective tertiary centre experience. Ann R Coll Surg Engl 2025; 107:199-205. [PMID: 38661438 PMCID: PMC11872159 DOI: 10.1308/rcsann.2024.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Medullary thyroid carcinoma (MTC) is a rare thyroid cancer arising from the calcitonin-secreting parafollicular cells. Previous studies suggested a preoperative calcitonin level >200ng/l is an indication for prophylactic lateral neck dissection (LND) to remove micrometastases and improve survival outcomes. METHODS This retrospective single-centre study assessed the efficacy of preoperative calcitonin levels as a marker for determining need for prophylactic LND in MTC. Data were obtained on demographics, preoperative calcitonin levels, size and laterality of index tumour, type of neck dissection (central neck dissection (CND), LND), nodes removed, levels with involved nodes, number of nodes histologically involved, mortality, adjuvant therapy and locoregional recurrence. RESULTS A total of 33 patients were identified from St George's University Hospitals NHS Foundation Trust between 1 January 2001 and 19 August 2021; 8 were excluded for data quality issues. Of the 18 classified with a high preoperative calcitonin level (>200ng/l), 10 (56%) had a LND and 8 (44%) had a CND. In the low-calcitonin group, three (43%) patients had a CND only and four (57%) had a LND. There was no difference in absolute or disease-free survival between the low and high groups (p=0.960, p=0.817), or between those who had a CND and LND in the high-calcitonin group (p=0.607, hazard ratio (HR) 0.55; p=0.129, HR 8.78). CONCLUSION There was no statistically significant difference in outcomes between high and low calcitonin groups. A selective approach to performing LND in MTC patients based on clinical and imaging findings suggesting disease presence in the lateral neck should be explored further.
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Affiliation(s)
| | | | | | - B Odutoye
- St George’s University Hospitals NHS Foundation Trust, UK
| | - P Williamson
- St George’s University Hospitals NHS Foundation Trust, UK
| | - KH Wong
- Royal Marsden NHS Foundation Trust, UK
| | - P Dent
- St George’s University Hospitals NHS Foundation Trust, UK
| | - A Sharma
- St George’s University Hospitals NHS Foundation Trust, UK
| | - A Weller
- St George’s University Hospitals NHS Foundation Trust, UK
| | - G Pitiyage
- St George’s University Hospitals NHS Foundation Trust, UK
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13
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Codrich M, Biasotto A, D’Aurizio F. Circulating Biomarkers of Thyroid Cancer: An Appraisal. J Clin Med 2025; 14:1582. [PMID: 40095491 PMCID: PMC11900207 DOI: 10.3390/jcm14051582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 02/16/2025] [Accepted: 02/23/2025] [Indexed: 03/19/2025] Open
Abstract
Thyroid cancer is the most prevalent endocrine cancer. The prognosis depends on the type and stage at diagnosis. Thyroid cancer treatments involve surgery, possibly followed by additional therapeutic options such as hormone therapy, radiation therapy, targeted therapy and chemotherapy. Besides the well-known thyroid tumor biomarkers, new circulating biomarkers are now emerging. Advances in genomic, transcriptomic and proteomic technologies have allowed the development of novel tumor biomarkers. This review explores the current literature data to critically analyze the benefits and limitations of routinely measured circulating biomarkers for the diagnosis and monitoring of thyroid cancer. The review also sheds light on new circulating biomarkers, focusing on the challenges of their use in the clinical management of thyroid cancer, underlining the need for the identification of a new generation of circulating biomarkers.
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Affiliation(s)
- Marta Codrich
- Department of Medicine (DMED), University of Udine, 33100 Udine, Italy; (M.C.); (A.B.)
| | - Alessia Biasotto
- Department of Medicine (DMED), University of Udine, 33100 Udine, Italy; (M.C.); (A.B.)
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Federica D’Aurizio
- Department of Medicine (DMED), University of Udine, 33100 Udine, Italy; (M.C.); (A.B.)
- Institute of Clinical Pathology, Academic Hospital “Santa Maria della Misericordia”, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
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14
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Liu Y, Huang S, Li X, Tian T, Huang R. Therapeutic efficacies of remnant ablation and radioiodine adjuvant therapy in differentiated thyroid cancer. Endocrine 2025; 87:734-743. [PMID: 39379773 DOI: 10.1007/s12020-024-04064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 09/30/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND Successful ablation in 131I therapy for differentiated thyroid cancer (DTC) includes both remnant ablation (RA) and radioiodine adjuvant therapy (RAT). This study aimed to differentiate between the therapeutic efficacies of RA and RAT, investigate the factors associated with their effectiveness, and assess their impact on prognosis. METHODS This retrospective study included patients with DTC who underwent initial 131I therapy at our tertiary center. The successful RA (SRA) and successful RAT (SRAT) was determined based on the 131I-diagnostic whole-body scan (Dx-WBS), TSH-stimulated thyroglobulin (sTg) levels, and neck ultrasound at the 6th month after 131I therapy. The patients were divided into complete response and persistent/recurrent disease groups during the follow-up period. RESULTS A total of 232 patients were included, 91.8% (213/232) of patients achieved SRA, only 8.1% (19/232) failed RA (FRA). Among the 213 patients in the SRA group, 70.4% (150/213) achieved SRAT and 29.6% (63/213) failed RAT (FRAT). Only pre-ablation sTg >10 ng/mL (OR = 46.968, 95% CI 9.731-226.699, P < 0.001) was an independent risk factor predicting the failure of RAT. The prognostic analysis included 215 patients, and 6.1% (13/215) were classified as persistent/recurrent disease at the last follow-up. Both pre-ablation sTg >10 ng/mL (HR = 4.765, 95% CI 1.371-16.566, P = 0.014) and FRAT (HR = 10.104, 95% CI 1.071-95.304, P = 0.043) independently predicted persistent/recurrent disease. CONCLUSIONS RA is easy to achieve successfully, whereas RAT evaluation provides greater value than RA for prognosis prediction. For patients with low Tg levels and no imaging evidence of disease, routine Dx-WBS during follow-up has minimal significance.
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Affiliation(s)
- Yanlin Liu
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Shuhui Huang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaohui Li
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Tian Tian
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China.
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15
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Sopuschek MP, Freesmeyer M, Winkens T, Kühnel C, Petersen M, Gühne F, Werner A, Seifert P. Standard operating procedure (SOP) for cervical ultrasound cine loop video sequences in the follow-up of differentiated thyroid carcinoma (DTC). Endocrine 2025; 87:635-647. [PMID: 39225873 PMCID: PMC11811240 DOI: 10.1007/s12020-024-04021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
RATIONALE AND OBJECTIVES Cervical ultrasound (US) is crucial in the follow-up of differentiated thyroid cancer (DTC). However, there are no guidelines for its acquisition and documentation, particularly concerning the role of additional video sequences, known as US cine loops (UCL). The aim of this study is to examine the clinical relevance (CR) of a new Standard Operating Procedure (SOP) for cervical UCL in DTC follow-up. MATERIALS AND METHODS A retrospective analysis was conducted on all UCL examinations of DTC follow-up patients at a tertiary care center between January 2010 and February 2018 to determine their clinical significance. The patients were divided into two groups: those with no documented CR (UCL-nCR) and those with documented CR (UCL-CR). The study reviewed the respective written medical US reports that were validated by experienced residents. The UCL-CR were categorized in: confirmation of a suspicious finding that was identified during conventional live US (UCL-CRcon), identification of a suspicious finding that was not identified during conventional live US (UCL-CRide), and invalidation of a suspicious finding that was identified during conventional live US (UCL-CRinv). RESULTS A total of 5512 UCLs in 652 DTC patients were analyzed, with 71.5% women and a mean age of 50 years. More than 90% of the tumors were low-risk at initial staging. The mean number of UCLs per patient was 8.5 ± 4.6. Overall, 95 cases of UCL-CR were identified in 82 patients (12.6%), with a patient-based number needed to scan of 8. UCL-CRinv was the most common type of UCL-CR, accounting for 77 (81.1%) of cases. The occurrences of 12 UCL-CRcon (12.6%) and 6 UCL-CRide (6.3%) were correspondingly less frequent. The diagnosis of UCL-CR was confirmed in 91.6% of cases during the clinical course. CONCLUSIONS In 12.6% of the patients, the additional acquisition and archiving of cervical UCL revealed clinical relevance in the course of DTC disease. The invalidation of suspicious findings through the retrospective analysis of former UCL occurred as the most significant benefit of this method. The UCL SOP can be easily and quickly integrated into the US workflow.
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Affiliation(s)
| | - Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany.
| | - Thomas Winkens
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Christian Kühnel
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Manuela Petersen
- Department of General Visceral Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg, Germany
| | - Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Anke Werner
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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16
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Dureja RF, Casey C, Barry J, Tuthill A. The clinical significance and burden of thyroid nodules discovered incidentally. Ir J Med Sci 2025; 194:101-106. [PMID: 39724405 DOI: 10.1007/s11845-024-03858-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 12/18/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND The majority of thyroid nodules are benign; however current guidelines suggest that thyroid incidentalomas should be appropriately evaluated to rule out malignancy. AIMS This study aims to determine the incidence of thyroid incidentalomas and the likelihood that they harbour sinister pathology in the largest Irish cohort studied to-date. METHODS A retrospective observational chart review was conducted using data from July 2018 to December 2018 using the Radiology Database in use at Cork University Hospital. The text of 1000 imaging reports (500 carotid Doppler and 500 computed tomography thorax) was manually screened for phrases such as "thyroid mass" or "thyroid nodule". RESULTS On 1000 scans, 14 (1.4%) thyroid incidentalomas were discovered. The occurrence of incidentalomas by imaging was 2/500 (0.4%) for ultrasound and 12/500 (2.4%) for computed tomography. Three of these nodules (21.4%) were further evaluated with a subsequent ultrasound and due to a size of more than 1 cm underwent fine needle aspiration. Using the Thy classification, all three were given a Thy 2 (non-neoplastic) grading. CONCLUSION This study found that there was no clinical benefit to reporting the presence of thyroid incidentalomas incidentally noted on radiology investigations. Although the overall percentage of thyroid incidentalomas is low, this number may be enough to cause unnecessary strain on the healthcare system and burden patients with invasive investigations in addition to causing unnecessary anxiety.
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Affiliation(s)
- Rohil F Dureja
- School of Medicine, University College of Cork, Cork, Ireland
| | - Caoimhe Casey
- School of Medicine, University College of Cork, Cork, Ireland
- Endocrinology Department, Cork University Hospital, Wilton, Cork, Ireland
| | - Josephine Barry
- Radiology Department, Cork University Hospital, Wilton, Cork, Ireland
| | - Antoinette Tuthill
- School of Medicine, University College of Cork, Cork, Ireland.
- Endocrinology Department, Cork University Hospital, Wilton, Cork, Ireland.
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17
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Saito Y, Matsuzu K, Abdelhamid Ahmed AH, Inoue K, Shibuya H, Matsui A, Kuga Y, Ono R, Yoshioka K, Masaki C, Akaishi J, Hames KY, Okamura R, Tomoda C, Suzuki A, Kitagawa W, Nagahama M, Sugino K, Takami H, Randolph GW, Ito K. Lobectomy vs Total Thyroidectomy With Ipsilateral Lateral Neck Dissection for N1b Intermediate-Risk Papillary Thyroid Carcinoma. JAMA Otolaryngol Head Neck Surg 2025; 151:105-112. [PMID: 39602155 PMCID: PMC11826362 DOI: 10.1001/jamaoto.2024.3860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 09/11/2024] [Indexed: 11/29/2024]
Abstract
Importance The management of papillary thyroid carcinoma (PTC), particularly in cases with clinically apparent lateral neck lymph node metastasis (cN1b), remains an area of debate. The surgical options for PTC, including total thyroidectomy and lobectomy, have distinct impacts on patients' outcomes and quality of life. Objective To compare survival and recurrence outcomes between patients who underwent a lobectomy plus ipsilateral lateral neck dissection (LND) and those who underwent a total thyroidectomy plus ipsilateral LND for intermediate-risk cN1b PTC with both primary tumors and lymph node metastases in the ipsilateral neck region. Design, Setting, and Participants This retrospective cohort study was conducted at Ito Hospital, Tokyo, Japan. Patients who underwent surgery for PTC between January 2005 and December 2012 were included, and those with high-risk PTCs and concurrent other thyroid cancers were excluded. Data were analyzed from April to August 2024. Exposures Lobectomy plus LND vs total thyroidectomy plus LND. Main Outcomes and Measures An inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier analysis and a Cox proportional hazards regression analysis were performed to compare the patients' overall survival, recurrence-free survival (RFS), and modified RFS (which considered the potential need for a future contralateral lobectomy). Results Of 401 included patients, 317 (79.1%) were female, and the median (IQR) age was 47 (36-59) years. A total of 157 patients underwent lobectomy plus ipsilateral LND and 244 underwent total thyroidectomy plus ipsilateral LND. The median (IQR) follow-up time was 13.0 (11.2-15.0) years. The IPTW-adjusted overall survival rates at 5, 10, and 15 years were 98.0% (95% CI, 93.9-99.3), 97.5% (95% CI, 93.2-99.1), and 96.8% (95% CI, 92.2-98.7), respectively, for the lobectomy group vs 99.4% (95% CI, 97.0-99.9), 97.4% (95% CI, 94.4-98.8), and 96.9% (95% CI, 93.3-98.5), respectively, for the total thyroidectomy group (hazard ratio [HR], 1.10; 95% CI, 0.35-3.47). The IPTW-adjusted RFS rates at 5, 10, and 15 years were 93.8% (95% CI, 88.5-96.7), 88.4% (95% CI, 82.0-92.6), and 84.1% (95% CI, 76.8-89.3), respectively, for the lobectomy group vs 95.4% (95% CI, 91.8-97.4), 92.9% (95% CI, 88.8-95.5), and 87.8% (95% CI, 80.8-92.4), respectively, for the total thyroidectomy group (HR, 1.41; 95% CI, 0.79-2.54). The IPTW-adjusted modified RFS rates at 5, 10, and 15 years were 96.7% (95% CI, 92.2-98.6), 93.8% (95% CI, 88.5-96.7), and 88.9% (95% CI, 82.4-93.1), respectively, for the lobectomy group vs 95.4% (95% CI, 91.8-97.4), 92.9% (95% CI, 88.8-95.5), and 87.8% (95% CI, 80.8-92.4), respectively, for the total thyroidectomy group (HR, 0.93; 95% CI, 0.49-1.76). Conclusions and Relevance In this study, for these selected intermediate-risk cN1b PTC cases, total thyroidectomy and lobectomy provided comparable outcomes in terms of prognosis and recurrence. These data may help inform future guideline revisions and support joint decision-making between patients and their clinicians.
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Affiliation(s)
| | | | - Amr H. Abdelhamid Ahmed
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health/Hakubi Center, Kyoto University, Kyoto, Japan
| | | | - Ai Matsui
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | - Yoko Kuga
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | - Reiko Ono
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | | | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo, Japan
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18
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Barraud S, Lopez AG, Sokol E, Menegaux F, Briet C. Chapter 14: Post surgical follow-up of primary hyperparathyroidism. ANNALES D'ENDOCRINOLOGIE 2025; 86:101703. [PMID: 39818299 DOI: 10.1016/j.ando.2025.101703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2025]
Abstract
Primary hyperparathyroidism is treated surgically. Postoperatively, close monitoring of blood calcium levels is necessary to detect any hypocalcemia. Postoperative PTH assays can be performed within 24hours to identify patients who will not develop permanent hypoparathyroidism. Hypocalcemia may be caused by hypoparathyroidism (especially in the case of multi-glandular surgery or revision surgery) or by hungry bone syndrome. The latter should be suspected in case of major skeletal damage or severe preoperative vitamin D deficiency. It leads to severe hypocalcemia with normal or elevated PTH concentration, hypophosphatemia, hypomagnesemia, and low calciuria despite high doses of calcium and 1-25 OH vitamin D. Treatment of postoperative hypocalcemia depends on severity, symptoms and surgical procedure. In uni-glandular surgery, symptomatic treatment with calcium alone is recommended (0.5 to 1g/day). In multi-glandular involvement or repeat surgery, treatment with calcium (1 to 3g/day) is recommended if hypocalcemia is symptomatic or profound (<1.9mmol/L) (i.e. 76mg/L). If it is insufficient, the potential contribution of active vitamin D treatment should be assessed with an endocrinologist. If hypocalcemia is treated, patients should preferably be monitored by an endocrinologist (blood calcium level, calciuria and possibly phosphatemia and PTH). Under medical treatment of hypoparathyroidism, blood calcium levels should be monitored at least every 3 months for the first year, then at least twice a year.
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Affiliation(s)
- Sara Barraud
- Department of Endocrinology, Reims University Hospital, hôpital Robert-Debré, rue du Général-Koenig, 51100 Reims, France; CRESTIC EA 3804, Reims Champagne-Ardenne University, Moulin de la Housse, 51687 Reims, France
| | - Antoine Guy Lopez
- Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, Rouen, France.
| | | | - Fabrice Menegaux
- Department of Diabetology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - Claire Briet
- Department of Endocrinology, Diabetes and Metabolic Diseases, Reference Center for Rare Thyroid and Hormone Receptor Diseases, Angers University Hospital, 49933 Angers cedex, France; Inserm, équipe CarMe, CNRS, MITOVASC, SFR ICAT, University Angers, 49000 Angers, France.
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Turra V, Manzi J, Rombach S, Zaragoza S, Ferreira R, Guerra G, Conzen K, Nydam T, Livingstone A, Vianna R, Abreu P. Donors With Previous Malignancy: When Is It Safe to Proceed With Organ Transplantation? Transpl Int 2025; 38:13716. [PMID: 39926359 PMCID: PMC11802283 DOI: 10.3389/ti.2025.13716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 01/07/2025] [Indexed: 02/11/2025]
Abstract
The growing number of organ donors in the United States, from 14,011 in 2012 to 21,374 in 2022, highlights progress in addressing the critical issue of organ shortages. However, the demand remains high, with 17 patients dying daily while on the waiting list. As of August 2023, over 103,544 individuals are awaiting transplants, predominantly for kidneys (85.7%). To expand the donor pool, the inclusion of elderly donors, including those with a history of malignancies, is increasingly considered. In 2022, 7% of all donors were aged 65 and above, despite the complexities their medical histories may introduce, particularly the risk of donor-transmitted cancer (DTC). This review examines the challenges and potential benefits of using donors with known malignancy histories, balancing the risks of DTC against the urgency for transplants. A critical analysis is presented on current knowledge and the decision-making processes that consider cancer types, stages, and patient survival outcomes. The goal is to identify missed opportunities and improve strategies for safe and effective organ transplantation from this donor demographic.
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Affiliation(s)
- Vitor Turra
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Joao Manzi
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Sarah Rombach
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Simone Zaragoza
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Raphaella Ferreira
- HCA Healthcare–HealthOne Internal Medicine Residency Program, Sky Ridge Medical Center, Denver, CO, United States
| | - Giselle Guerra
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Kendra Conzen
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Trevor Nydam
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alan Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Rodrigo Vianna
- Miami Transplant Institute, Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Phillipe Abreu
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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20
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Cowen J, Dave R, Neale J, Ward M, Repanos C, Nasef H, Vigneswaran G, Brennan PA, Bekker J. Comparison of British Thyroid Association and TIRADS classifications and their impact on the radiological and surgical management of indeterminate thyroid nodules. Clin Radiol 2025; 80:106725. [PMID: 39626569 DOI: 10.1016/j.crad.2024.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/08/2024] [Accepted: 08/19/2024] [Indexed: 01/18/2025]
Abstract
AIM The British Thyroid Association (BTA) Guidelines for the Management of Thyroid Cancer advocate for fine-needle aspiration cytology for all thyroid nodules graded indeterminate (U3) at ultrasound assessment. This approach raises concerns regarding potential over-diagnosis of low-risk lesions. Conversely, equivalent Thyroid Imaging Reporting and Data Systems (TIRADS) guidelines permit surveillance or discharge of indeterminate thyroid nodules of certain sizes. This service analysis analyses how guideline choice impacts the fine-needle aspiration cytology rate and subsequent surgical management of indeterminate thyroid nodules. MATERIALS AND METHODS All patients with an indeterminate (U3) thyroid nodule identified on ultrasound over a 12-month period were included. Indeterminate thyroid nodules were retrospectively rescored using three equivalent TIRADS classifications by three independent reviewers, blinded to the histopathology. Hypothetical differences in fine-needle aspiration cytology rates and surgical activity were then compared. RESULTS Ninety-six nodules were identified. Retrospective application of TIRADS guidelines resulted in a hypothetical 44.8-55.2% reduction in fine-needle aspiration cytology performed for indeterminate thyroid nodules compared to BTA. A statistically significant increase in rates of surgical activity for indeterminate thyroid nodules was observed between BTA guidance and all retrospectively applied TIRADS guidelines (p < 0.001). Of four confirmed thyroid cancers, three would have been unanimously removed. CONCLUSION Under BTA guidance, increased fine-needle aspiration cytology rates for indeterminate thyroid nodules resulted in significantly increased surgical activity in our cohort compared to retrospectively applied TIRADS guidelines.
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Affiliation(s)
- J Cowen
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK.
| | - R Dave
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - J Neale
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - M Ward
- Department of Ear, Nose & Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - C Repanos
- Department of Ear, Nose & Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - H Nasef
- Department of Ear, Nose & Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - G Vigneswaran
- Department of Radiology, Southampton General Hospital, Southampton, UK; Department of Cancer Sciences, University of Southampton, Southampton, UK
| | - P A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - J Bekker
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
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21
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Madani G. The quandary of the indeterminate thyroid nodule: commentary on "comparison of British thyroid association and thyroid imaging reporting and data system (TIRADS) classifications and their impact on the radiological and surgical management of indeterminate thyroid nodules". Clin Radiol 2025; 80:106744. [PMID: 39616885 DOI: 10.1016/j.crad.2024.106744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Accepted: 11/01/2024] [Indexed: 01/18/2025]
Affiliation(s)
- G Madani
- Imperial College Healthcare NHS Trust, UK.
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22
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van de Berg DJ, Mooij CF, van Trotsenburg ASP, van Santen HM, Terwisscha van Scheltinga SCEJ, Vriens MR, Kruijff S, Nieveen van Dijkum EJM, Engelsman AF, Derikx JPM. Long-term oncological outcomes of follicular thyroid cancer in adolescents and young adults: A nationwide population-based study. World J Surg 2025; 49:98-105. [PMID: 38972979 PMCID: PMC11711111 DOI: 10.1002/wjs.12279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Follicular thyroid carcinoma (FTC) in adolescents and young adults (AYAs) is rare and data on long-term oncological outcomes are scarce. This study aimed to describe the long-term recurrence and survival rates of AYAs with FTC, and identify risk factors for recurrence. METHODS This is a retrospective cohort study combining two national databases, including all patients aged 15-39 years, diagnosed with FTC in The Netherlands between 2000 and 2016. Age, sex, tumor size, focality, positive margins, angioinvasion, pT-stage, and pN-stage were included in a Cox proportional hazard model to identify risk factors for recurrence. RESULTS We included 192 patients. Median age was 31.0 years (IQR 24.7-36.3) and the male to female ratio was 1:4.1. Most patients presented with a minimally invasive FTC (MI-FTC) (95%). Five patients presented with synchronous metastases (2.6%), including two with locoregional metastases (1%) and three with distant metastases (1.6%). During a median follow-up of 12.0 years, three patients developed a recurrence (1.6%), of which one patient developed a local recurrence (33%), and two patients a distant recurrence (67%). Five patients died during follow-up (2.6%). Cause of death was not captured. A Cox proportional hazard model could not be performed due to the low number of recurrences. CONCLUSIONS FTC in AYAs is generally characterized as a low-risk tumor, as it exhibits a very low recurrence rate, a high overall survival, and it typically presents as MI-FTC without synchronous metastases. These findings underscore the favorable long-term oncological prognosis of FTC in AYAs.
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Affiliation(s)
- Daniël J. van de Berg
- Department of Pediatric SurgeryEmma Children's HospitalAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Christiaan F. Mooij
- Department of Pediatric EndocrinologyEmma Children's HospitalAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - A. S. Paul van Trotsenburg
- Department of Pediatric EndocrinologyEmma Children's HospitalAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Hanneke M. van Santen
- Department of Pediatric EndocrinologyWilhelmina Children's HospitalUtrecht University Medical CenterUniversity of UtrechtUtrechtThe Netherlands
- Department of Pediatric OncologyPrincess Máxima CenterUtrechtThe Netherlands
| | | | - Menno R. Vriens
- Department of SurgeryUniversity Medical Center UtrechtUniversity of UtrechtUtrechtThe Netherlands
| | - Schelto Kruijff
- Department of SurgeryUniversity Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | | | - Anton F. Engelsman
- Department of SurgeryAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Joep P. M. Derikx
- Department of Pediatric SurgeryEmma Children's HospitalAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
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Cowen J, Dave R, Neale J, Ward M, Repanos C, Nasef H, Vigneswaran G, Poller D, Brennan PA, Bekker J. Re: 'The quandary of the indeterminate thyroid nodule'. Clin Radiol 2024; 82:106781. [PMID: 39874924 DOI: 10.1016/j.crad.2024.106781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 12/13/2024] [Indexed: 01/30/2025]
Affiliation(s)
- J Cowen
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK.
| | - R Dave
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - J Neale
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - M Ward
- Department of Ear, Nose and Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - C Repanos
- Department of Ear, Nose and Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - H Nasef
- Department of Ear, Nose and Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - G Vigneswaran
- Department of Radiology, Southampton General Hospital, Southampton, UK; Department of Cancer Sciences, University of Southampton, Southampton, UK
| | - D Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, UK
| | - P A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - J Bekker
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
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24
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Zhou G, Xu D, Zhang B, Su R, Xu K, Zhang X, Li F, Zhao W, Cai T. Is ultrasound-guided radiofrequency ablation a reliable treatment option for unifocal T1aN0M0 papillary thyroid carcinoma in the isthmus: a retrospective comparative study based on large-sample data. Int J Hyperthermia 2024; 41:2438853. [PMID: 39658025 DOI: 10.1080/02656736.2024.2438853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 12/01/2024] [Accepted: 12/02/2024] [Indexed: 12/12/2024] Open
Abstract
OBJECTIVE To evaluate whether ultrasound-guided radiofrequency ablation (RFA) is reliable for unifocal T1aN0M0 papillary thyroid carcinoma in the isthmus (PTCI). METHODS 431 patients who underwent ultrasound-guided RFA for unifocal T1aN0M0 papillary thyroid carcinoma (PTC) were divided by location of the lesion into the PTCI group (52 females, 7 males, mean age 43.79 ± 12.04 years, range 22-74 years) and the PTCL group ((291 females, 81 males, mean age 43.42 ± 10.87 years, range 18-75 years) for comparative analysis. The efficacy of ultrasound-guided RFA was evaluated by volume reduction rate (VRR), complete disappearance rate (CDR) and disease progression, and the safety was evaluated by incidence of complications. RESULTS The two groups exhibited a consistent trend of change, with the PTCI group performing better in volume, VRR and CDR at all follow-up time points expect 1 month, but the differences were not statistically significant (p > 0.05). The mean initial volume of the PTCI group vs the PTCL group decreased significantly from 65.4 ± 69.79 vs 86.38 ± 87.09 mm³ (range 10.92-427.58 vs 3.05-471.6 mm³) to 0 vs 0 mm³ at a mean follow-up time of 31.12 ± 12.5 months (range 12-60 months); their VRR increased significantly from -618.62 ± 655.61% vs -789.85 ± 1135.07% at 1 month to 100% vs 100% at 48 months. No disease progression was found in the two groups. The PTCI group had no complications, whereas the PTCL group had a total of 7 complications (1.88%). CONCLUSIONS Ultrasound-guided RFA is reliable for unifocal T1aN0M0 PTCI. It can be promoted as an alternative to immediate surgery for selected PTC patients.
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Affiliation(s)
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, TaiZhou, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou, China
| | | | | | - Ke Xu
- Hangzhou Weja Hospital, Hangzhou, China
| | | | - Feng Li
- Hangzhou Weja Hospital, Hangzhou, China
| | - Wei Zhao
- Hangzhou Weja Hospital, Hangzhou, China
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25
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Barnes A, White R, Venables H, Lam V, Vaidhyanath R. Investigation of artificial intelligence-based clinical decision support system's performance in reducing the fine needle aspiration rate of thyroid nodules: A pilot study. ULTRASOUND (LEEDS, ENGLAND) 2024:1742271X241299220. [PMID: 39654847 PMCID: PMC11625399 DOI: 10.1177/1742271x241299220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 10/25/2024] [Indexed: 12/12/2024]
Abstract
Introduction This pilot study aims to evaluate the clinical impact of artificial intelligence-based decision support, Koios Decision Support™, on the diagnostic performance of ultrasound assessment of thyroid nodules, and as a result to avoid fine needle aspiration. Methods This retrospective pilot study was conducted on ultrasound images of thyroid nodules investigated with fine needle aspiration from January 2022 to December 2022. Orthogonal ultrasound images of thyroid nodules, previously investigated with fine needle aspiration, were compared with the Koios Decision Support™ suggestion to perform fine needle aspiration. Surgical histology was used as ground truth. Results A total of 29 patients (76% women) with a mean age of 48 ± 16.5 years were evaluated, n = 15 (52%) were histologically proven benign and n = 14 (48%) were malignant. In the benign group, Koios Decision Support™ suggested avoidable fine needle aspiration in n = 8 (53%). In the malignant group, Koios Decision Support™ suggested follow-up or no fine needle aspiration in n = 2 (14%). Sensitivity is 85.7% (n = 12) (p = 0.027), whereas specificity is 53.3% (n = 8) (p = 0.027). The positive predictive value is 63.2% (n = 12), negative predictive value is 80% (n = 8), false-negative value is 20% (n = 2) and false-positive value is 36.8% (n = 7). Based on artificial intelligence decision, one cancer would have been missed. Conclusion Artificial intelligence can improve specificity without significantly compromising sensitivity. There was a suggested reduction in the fine needle aspiration rate, in the histologically proven benign nodules, by 53%. This had no statistical significance, likely due to the small population, however, it is thought to be the largest study to date. Further investigation with wider-ranging studies is suggested.
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Affiliation(s)
- Amy Barnes
- Consultant Radiographer, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Vincent Lam
- Consultant Radiologist, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ram Vaidhyanath
- Consultant Radiologist, University Hospitals of Leicester NHS Trust, Leicester, UK
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26
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Sipos JA. The History of Thyroid Ultrasound: Past, Present, and Future Directions. Endocr Pract 2024; 30:1220-1226. [PMID: 39236787 DOI: 10.1016/j.eprac.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/07/2024]
Abstract
The rapid evolution of ultrasound (US) technology has dramatically changed the medical field. Ideally suited for evaluation of anatomic disorders of the thyroid, coupled with its ease of use at the bedside, US has become an essential tool for endocrinologists over the last 50 years. This noninvasive technology provides a sensitive and specific instrument for malignancy risk prediction of thyroid nodules, surveillance for recurrent thyroid cancer, and diagnosis of autoimmune thyroid disorders. While US has proven invaluable for such diagnostic purposes, its extensive use also has resulted in important negative consequences. This review will discuss the evolution of US equipment for the evaluation of thyroid disorders, its use in interventional procedures, and the unintended outcomes from the widespread adoption of this technology. Finally, this article will explore the potential future applications for US technology and its related advancements.
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Affiliation(s)
- Jennifer A Sipos
- Division of Endocrinology and Metabolism, Ohio State University Wexner Medical Center, Columbus, Ohio.
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Borysewicz-Sańczyk H, Bossowski F, Anikiej K, Sawicka B, Michalak J, Dzięcioł J, Bossowski A. Application of shear wave elastography in the management of thyroid nodules in children and adolescents: our experience and a review of the literature. Front Endocrinol (Lausanne) 2024; 15:1486285. [PMID: 39634183 PMCID: PMC11614656 DOI: 10.3389/fendo.2024.1486285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Accepted: 10/25/2024] [Indexed: 12/07/2024] Open
Abstract
Introduction Shear wave elastography (SWE) is an ultrasound diagnostic method used to measure tissue stiffness. Since the mechanical properties of tissue involved in the pathological process change, SWE might indicate regions of the examined tissue covered by the disease. It is well documented that SWE helps to differentiate benign and malignant nodules in thyroid glands in adults, however, there are few studies on the application of SWE in thyroid diagnosis in children. The purpose of the study was to assess the application of SWE based on Young's modulus expressed in kPa in the management of thyroid nodules in children and adolescents. Methods In total, 116 pediatric patients (81 girls and 35 boys) with 168 thyroid nodules were enrolled in the study and qualified for SWE followed by fine needle aspiration biopsy. Results According to the result of the cytological examination presented in the Bethesda System, nodules were classified as benign (147 nodules classified as category II according to the Bethesda System) or indeterminate or suspicious (21 nodules classified as categories III, IV, and V according to the Bethesda System). Benign cytological diagnoses were nodular goiter, parenchymal goiter, nodular colloid goiter, or lymphocytic inflammation. Among the indeterminate or suspicious nodules, 15 were diagnosed as category III according to the Bethesda System (atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS) in cytology), 1 nodule was diagnosed as category IV according to the Bethesda System (suspicious for follicular neoplasm - oxyphilic cell tumor), and 5 as category V according to the Bethesda System (suspicious for malignancy). There were no significant differences in thyrotropin (TSH) and free thyroxine (fT4) concentrations between the benign and suspicious groups. Patients with benign and indeterminate or suspicious thyroid nodules were of comparable age. Mean SWE in benign nodules was statistically significantly lower than in nodules with indeterminate or suspicious cytology (42.22 ± 16.69 vs. 57.4 ± 24.0 kPa, p=0.0004). Six patients from the indeterminate or suspicious group were revealed to be malignant in the final histopathological examination. Conclusion Our results suggest that SWE is a viable diagnostic method, however, it still seems to need some adjustment for pediatric patients.
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Affiliation(s)
- Hanna Borysewicz-Sańczyk
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Filip Bossowski
- Student Research Group by the Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Anikiej
- Student Research Group by the Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Beata Sawicka
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Justyna Michalak
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
| | - Janusz Dzięcioł
- Department of Human Anatomy, Medical University of Bialystok, Bialystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Divisions, Medical University of Bialystok, Bialystok, Poland
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Wei B, Chang S, Wang WL. ASO Author Reflections: The Minimum Number of Examined Lymph Nodes in Thyroidectomy. Ann Surg Oncol 2024:10.1245/s10434-024-16535-8. [PMID: 39556182 DOI: 10.1245/s10434-024-16535-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Accepted: 10/30/2024] [Indexed: 11/19/2024]
Affiliation(s)
- Bo Wei
- Division of Thyroid Surgery, General Surgery Department, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shi Chang
- Division of Thyroid Surgery, General Surgery Department, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Hunan Provincial Clinical Medical Research Centre for Thyroid Diseases, Changsha, Hunan, China.
- Hunan Engineering Research Center for Thyroid and Related Diseases Diagnosis and Treatment Technology, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Furong Laboratory, Changsha, Hunan, China.
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China.
| | - Wen-Long Wang
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Clinical Research Center for Breast Cancer in Hunan Province, Changsha, Hunan, China.
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Wang Y, Zhang S, Zhang M, Zhang G, Chen Z, Wang X, Yang Z, Yu Z, Ma H, Wang Z, Sang L. Prediction of lateral lymph node metastasis with short diameter less than 8 mm in papillary thyroid carcinoma based on radiomics. Cancer Imaging 2024; 24:155. [PMID: 39548590 PMCID: PMC11566407 DOI: 10.1186/s40644-024-00803-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Accepted: 11/11/2024] [Indexed: 11/18/2024] Open
Abstract
OBJECTIVE The aim of this study was to establish an ensemble learning model based on clinicopathological parameter and ultrasound radomics for assessing the risk of lateral cervical lymph node with short diameter less than 8 mm (small lymph nodes were used instead) metastasis in patients with papillary thyroid cancer (PTC), thereby guiding the selection of surgical methods. METHODS This retrospective analysis was conducted on 454 patients diagnosed with papillary thyroid carcinoma who underwent total thyroidectomy and lateral neck lymph node dissection or lymph node intraoperative frozen section biopsy at the First Hospital of China Medical University between January 2015 and April 2022. In a ratio of 8:2, 362(80%) patients were assigned to the training set and 92(20%) patients were assigned to the test set. Clinical pathological features and radomics features related to ultrasound imaging were extracted, followed by feature selection using recursive feature elimination (RFE). Based on distinct feature sets, we constructed ensemble learning models comprising random forest (RF), extreme gradient boosting (XGBoost), categorical boosting (CatBoost), gradient boosting decision tree (GBDT), and light gradient boosting machine (Lightgbm) to develop clinical models, radiomics models, and clinical-radiomic models. Through the comparison of performance metrics such as area under curve (AUC), accuracy (ACC), specificity (SPE), precision (PRE), recall rate, F1 score, mean squared error (MSE) etc., we identified the optimal model and visualized its results using shapley additive exPlanations (SHAP). RESULTS In this study, a total of 454 patients were included, among whom 342 PTC patients had small lymph node metastasis in the lateral neck region, while 112 did not have any metastasis. A total of 1035 features were initially considered for inclusion in this study, which were then narrowed down to 10 clinical features, 8 radiomics features, and 17 combined clinical-omics features. Based on these three feature sets, a total of fifteen ensemble learning models were established. In the test set, RF model in the clinical model is outperforms other models (AUC = 0.72, F1 = 0.75, Jaccard = 0.60 and Recall = 0.84), while CatBoost model in the radiomics model is superior to other models (AUC = 0.91, BA = 0.83 and SPE = 0.76). Among the clinical-radiomic models, Catboost exhibits optimal performance (AUC = 0.93, ACC = 0.88, BA = 0.87, F1 = 0.91, SPE = 0.83, PRE = 0.88, Jaccard = 0.83 and Recall = 0.92). Using the SHAP algorithm to visualize the operation process of the clinical-omics CatBoost model, we found that clinical omics features such as central lymph node metastasis (CLNM), Origin_Shape_Sphericity (o_shap_sphericity), LoG-sigma3_first order_ Skewness (log-3_fo_skewness), wavelet-HH_first order_Skewness (w-HH_fo_skewness) and wavelet-HH_first order_Skewness (sqr_gldm_DNUN) had the greatest impact on predicting the presence of lateral cervical small lymph node metastasis in PTC patients. CONCLUSIONS (1) In this study, among the ensemble learning models established based on clinicopathological features and radiomics features for predicting PTC lateral small lymph node metastasis, the clinical-radiomic CatBoost model has the best performance. (2) SHAP can visualize how the clinical and radiomics features affect the results and realize the interpretation of the model. (3) The combined CatBoost model can improve the diagnostic accuracy of suspicious lymph nodes with short diameter < 8 mm that are difficult to obtain accurate puncture results. The combined application of radiomics features is more accurate and reasonable than the prediction of clinical data alone, which helps to accurately evaluate the surgical scope and provide support for individual clinical decision making.
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Affiliation(s)
- Yan Wang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuangqingyue Zhang
- School of Medical and Bioengineering Information, Northeastern University, Shenyang, Liaoning, China
| | - Minghui Zhang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Gaosen Zhang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhiguang Chen
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xuemei Wang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ziyi Yang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zijun Yu
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - He Ma
- School of Medical and Bioengineering Information, Northeastern University, Shenyang, Liaoning, China.
| | - Zhihong Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
| | - Liang Sang
- Department of Ultrasonography, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
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Wei B, Tan HL, Chen L, Chang S, Wang WL. How Many Lymph Nodes are Enough in Thyroidectomy? A Cohort Study Based on Real-World Data. Ann Surg Oncol 2024:10.1245/s10434-024-16391-6. [PMID: 39521741 DOI: 10.1245/s10434-024-16391-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 10/08/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Thyroidectomy with only limited examination of lymph nodes is considered to pose potential risk for harboring occult nodal disease in patients with papillary thyroid cancer (PTC). However, the optimal number of examined lymph nodes (ELNs) in patients with PTC with clinically lateral lymph node metastasis (cN1b) remains unclear. PATIENTS AND METHODS Patients with cN1b PTC who underwent therapeutic neck dissection were retrospectively enrolled. A β-binomial distribution was utilized to calculate the likelihood of occult nodal disease as a function of total number of ELNs, and recurrence-free survival analysis was performed using the Kaplan-Meier method. RESULTS Together 982 patients met the inclusion criteria for this study, of which 853 patients had node-positive disease. The median ELN count was 23 (interquartile range 14-33). Increased ELN counts were associated with a decreased rate of occult nodal disease. The prevalence of nodal metastasis was 84%, while the corrected prevalence was 90%. The estimated probability of false-negative nodal disease was 67% for patients with PTC when only a single node was examined. Survival analysis revealed that populations with higher probability of occult nodal diseases experienced significantly higher recurrence rate. For patient with cN1b PTC, 20 ELNs were required to achieve 95% confidence of having no occult nodal disease. Minimum thresholds of 24, 14, 14, and 15 ELNs were selected for patients with pT1, pT2, pT3, and pT4 diseases, respectively. CONCLUSIONS Our findings robustly conclude that a minimum of 20 ELNs is essential to assess the quality of neck dissection and acquire accurate staging for patients with cN1b PTC.
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Affiliation(s)
- Bo Wei
- Division of Thyroid Surgery, General Surgery Department, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hai-Long Tan
- Division of Thyroid Surgery, General Surgery Department, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lu Chen
- Division of Thyroid Surgery, General Surgery Department, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shi Chang
- Division of Thyroid Surgery, General Surgery Department, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Hunan Provincial Clinical Medical Research Centre for Thyroid Diseases, Changsha, Hunan, China.
- Hunan Engineering Research Center for Thyroid and Related Diseases Diagnosis and Treatment Technology, Changsha, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Furong Laboratory, Changsha, Hunan, China.
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, Hunan, China.
| | - Wen-Long Wang
- Department of Breast Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
- Clinical Research Center for Breast Cancer in Hunan Province, Changsha, Hunan, China.
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31
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Rossi ED, Pantanowitz L. Are we ready to bridge classification systems? A comprehensive review of different reporting systems in thyroid cytology. Cytopathology 2024; 35:674-681. [PMID: 39056560 DOI: 10.1111/cyt.13411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 07/28/2024]
Abstract
The evaluation of thyroid lesions is common in the daily practice of cytology. While the majority of thyroid nodules are benign, in recent decades, there has been increased detection of small and well-differentiated thyroid cancers. Combining ultrasound evaluation with fine-needle aspiration cytology (FNAC) is extremely useful in the management of thyroid nodules. Furthermore, the adoption of specific terminology, introduced by different thyroid reporting systems, has helped effectively communicate thyroid FNAC diagnoses in a clear and understandable way. In 1996, the Papanicolaou Society thyroid cytological classification was introduced. This was followed in 2005 by the first Japanese and then in 2007 by the Bethesda System for Reporting Thyroid Cytopathology, which subsequently underwent two revisions. Other international thyroid terminology classifications include the British, Italian, Australasian and other Japanese cytology systems. This review covers similarities and differences among these cytology classification systems and highlights key points that unify these varied approaches to reporting thyroid FNAC diagnoses.
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Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, Rome, Italy
| | - Liron Pantanowitz
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Chan WH, Chiang PL, Lin AN, Chang YH, Lin WC. Thermal ablation for Bethesda III and IV thyroid nodules: current diagnosis and management. Ultrasonography 2024; 43:395-406. [PMID: 39397446 PMCID: PMC11532522 DOI: 10.14366/usg.24083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 10/15/2024] Open
Abstract
The diagnosis and management of Bethesda III and IV thyroid nodules remain clinical dilemmas. Current guidelines from academic societies suggest active surveillance or diagnostic lobectomy. However, the extent of surgery is often inappropriate, and a considerable percentage of patients experience under- or over-treatment. Thermal ablation has gained popularity as a safe and effective alternative treatment option for benign thyroid nodules. This review explores the feasibility of thermal ablation for Bethesda III or IV thyroid nodules, aiming to preserve the thyroid organ and avoid unnecessary surgery. It emphasizes individualized management, the need to consider factors including malignancy risk, clinical characteristics, and sonographic features, and the importance of supplemental tests such as repeat fine needle aspiration cytology, core needle biopsy, molecular testing, and radioisotope imaging.
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Affiliation(s)
- Wen-Hui Chan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - An-Ni Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Thyroid Head and Neck Ablation Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Wadsley J, Balasubramanian SP, Madani G, Munday J, Roques T, Rowe CW, Touska P, Boelaert K. Consensus statement on the management of incidentally discovered FDG avid thyroid nodules in patients being investigated for other cancers. Clin Endocrinol (Oxf) 2024; 101:557-561. [PMID: 36878888 DOI: 10.1111/cen.14905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023]
Abstract
With the widespread use of 18F-fluorodeoxyglucose positron emission tomography (FDG PET/CT) in the investigation and staging of cancers, incidental discovery of FDG-avid thyroid nodules is becoming increasingly common, with a reported incidence in the range 1%-4% of FDG PET/CT scans. The risk of malignancy in an incidentally discovered FDG avid thyroid nodule is not clear due to selection bias in reported retrospective series but is likely to be less than 15%. Even in cases where the nodule is found to be malignant, the majority will be differentiated thyroid cancers with an excellent prognosis even without treatment. If, due to index cancer diagnosis, age and co-morbidities, it is unlikely that the patient will survive 5 years, further investigation of an incidental FDG avid thyroid nodule is unlikely to be warranted. We provide a consensus statement on the circumstances in which further investigation of FDG avid thyroid nodules with ultrasound and fine needle aspiration might be appropriate.
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Affiliation(s)
| | | | - Gitta Madani
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Tom Roques
- Norfolk and Norwich Hospital, Norwich, UK
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Zajkowska K, Cegla P, Dedecjus M. Role of [ 18F]FDG PET/CT in the management of follicular cell-derived thyroid carcinoma. Cancer Imaging 2024; 24:147. [PMID: 39468677 PMCID: PMC11514821 DOI: 10.1186/s40644-024-00791-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Accepted: 10/17/2024] [Indexed: 10/30/2024] Open
Abstract
Follicular cell-derived thyroid carcinomas constitute the majority of thyroid malignancies. This heterogeneous group of tumours includes well differentiated, poorly differentiated, and undifferentiated forms, which have distinct pathological features, clinical behaviour, and prognosis. Positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose combined with computed tomography ([18F]FDG PET/CT) is an imaging modality used in routine clinical practice for oncological patients. [18F]FDG PET/CT has emerged as a valuable tool for identifying patients at high risk of poor clinical outcomes and for facilitating individualized clinical decision-making. The aim of this comprehensive review is to summarize current knowledge regarding the role of [18F]FDG PET/CT in primary diagnosis, treatment, and follow-up of follicular cell-derived thyroid carcinomas considering the degree of differentiation. Controversial issues, including significance of accidentally detected [18F]FDG uptake in the thyroid, the role of [18F]FDG PET/CT in the early assessment of response to molecular targeted therapies, and its prognostic value are discussed in detail.
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Affiliation(s)
- Klaudia Zajkowska
- Department of Endocrine Oncology and Nuclear Medicine, Maria Skłodowska-Curie National Research Institute of Oncology, Roentgena Street 5, Warsaw, 02-781, Poland.
| | - Paulina Cegla
- Department of Endocrine Oncology and Nuclear Medicine, Maria Skłodowska-Curie National Research Institute of Oncology, Roentgena Street 5, Warsaw, 02-781, Poland
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Skłodowska-Curie National Research Institute of Oncology, Roentgena Street 5, Warsaw, 02-781, Poland
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Wang B, Huang J, Chen L. Management of medullary thyroid cancer based on variation of carcinoembryonic antigen and calcitonin. Front Endocrinol (Lausanne) 2024; 15:1418657. [PMID: 39449744 PMCID: PMC11499115 DOI: 10.3389/fendo.2024.1418657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 09/25/2024] [Indexed: 10/26/2024] Open
Abstract
Carcinoembryonic antigen (CEA) and calcitonin (Ctn) are pivotal biomarkers in the diagnosis and management of medullary thyroid carcinoma (MTC). However, their diagnostic reliability in perioperative period remains a topic of ongoing debate. This review synthesizes researches on perioperative fluctuations in CEA and Ctn levels, and evaluates the impact of their different combinations on MTC diagnosis, treatment decisions, and prognosis. Our findings highlight it is crucial to understand and interpret the various combinations of CEA and Ctn fluctuations within a clinical context. Furthermore, to reduce diagnostic errors and improve patient outcomes, we recommend follow-up diagnostic and treatment protocols designed to address the potential pitfalls associated with the use of these biomarkers.
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Affiliation(s)
- Bo Wang
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Huang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Chen
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilian University of Munich, Munich, Germany
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Sexton GP, Crotty TJ, Staunton SM, Healy ML, O'Neill JP, Timon C, Kinsella JB, Lennon P, Fitzgerald CW. Thyroid cancer epidemiology in Ireland from 1994 to 2019 - Rising diagnoses without mortality benefit. Surgeon 2024:S1479-666X(24)00122-7. [PMID: 39379266 DOI: 10.1016/j.surge.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/27/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND The epidemiology and management of thyroid cancer has changed radically in the recent past, with rising international incidence of early-stage papillary thyroid cancer (PTC) in particular. In this paper, we review the epidemiology of thyroid cancer in Ireland. METHODS A retrospective cohort study of National Cancer Registry of Ireland data, 1994-2019. RESULTS Records from 4158 patients were analysed. 73 % (n = 3040) were female. The average age was 50.4 years. Patient sex did not change over time (p = 0.662), while age decreased significantly (p < 0.0001). The most common diagnoses were PTC (n = 2,905, 70 %) and follicular thyroid carcinoma (n = 549, 13 %). Incidence rose over threefold (1.8-6.2 cases/100000 person-years). The incidence of T1 PTC rose over twelvefold (0.169-2.1 cases/100000 person-years), while the incidence of stage III and IV disease did not change significantly. Five-year disease-specific survival (DSS) was 85 % and varied significantly by diagnosis - 97 % for PTC versus 5 % for anaplastic thyroid carcinoma. Survival did not change significantly over time. Male sex was a risk factor for more advanced disease (p < 0.0001) but did not independently predict overall survival except in PTC (HR 1.6, p = 0.03). The use of radioactive iodine declined markedly from 49 % to 12.5 %. RAI improved DSS for PTC patients aged over 55 years (p = 0.02) without a notable effect on survival for those under 55 years (p = 0.99). CONCLUSION The epidemiology and management of thyroid cancer in Ireland has changed dramatically in a manner reflective of international trends.
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Affiliation(s)
- Gerard P Sexton
- Department of Otolaryngology, Head & Neck Surgery, St James's Hospital, Dublin 8, Ireland; Royal College of Surgeons in Ireland, Ireland.
| | - Thomas J Crotty
- Department of Otolaryngology, Head & Neck Surgery, St James's Hospital, Dublin 8, Ireland
| | | | | | - James Paul O'Neill
- Department of Otolaryngology, Head & Neck Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Conrad Timon
- Department of Otolaryngology, Head & Neck Surgery, St James's Hospital, Dublin 8, Ireland
| | - John B Kinsella
- Department of Otolaryngology, Head & Neck Surgery, St James's Hospital, Dublin 8, Ireland
| | - Paul Lennon
- Department of Otolaryngology, Head & Neck Surgery, St James's Hospital, Dublin 8, Ireland
| | - Conall Wr Fitzgerald
- Department of Otolaryngology, Head & Neck Surgery, St James's Hospital, Dublin 8, Ireland
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Mehanna H, Sidhu PS, Madani G, Woolley R, Boelaert K, Nankivell P, Da Forno P, Moreman K, Palmer A, Fulton-Lieuw T, Sharma N, Taylor J, Rajaguru K, Bekker J, Vaidhyanath R, Rehman T, Deeks J. Evaluation of US Elastography in Thyroid Nodule Diagnosis: The ElaTION Randomized Control Trial. Radiology 2024; 313:e240705. [PMID: 39404634 DOI: 10.1148/radiol.240705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
Background There is variable evidence and no randomized trials on the benefit of US elastography-guided fine-needle aspiration cytology (FNAC) over conventional US-guided FNAC alone for thyroid nodules. Purpose To compare the efficacy of US elastography-guided FNAC versus US-guided FNAC in reducing nondiagnostic rates for thyroid nodules. Materials and Methods A pragmatic, multicenter randomized controlled trial was performed at 18 secondary and tertiary hospitals across England between February 2015 and September 2018. Eligible adults with single or multiple thyroid nodules who had not previously undergone FNAC were randomized (1:1 ratio) to US elastography FNAC (intervention) or conventional US FNAC (control). The primary outcome was the proportion of patients who have a nondiagnostic cytologic Thy1 (British Thyroid Association system) result following the first FNAC. Results A total of 982 participants (mean age, 51.3 years ± 15 [SD] [IQR, 39-63]; male-to-female ratio, 1:4) were randomized. Of the 493 participants who underwent US elastography, 467 (94.7%) were examined with strain US elastography. There was no difference between the two arms in the nondiagnostic (Thy1) rate following the first FNAC (19% vs 16%; risk difference [RD], 0.03 [95% CI: -0.01, 0.07]; P = .11) or in the median time to reach the final definitive diagnosis (3.3 months [IQR, 1.5-6.4] for US elastography FNAC vs 3.4 months [IQR, 1.5-6.2] for US FNAC). All sensitivity analyses supported the primary analysis. Fewer participants in the US elastography FNAC arm underwent diagnostic hemithyroidectomy than in the US FNAC arm (183 of 493 [37%] vs 196 of 489 [40%]), but this was not statistically significant (adjusted RD, 0.02 [95% CI: -0.06, 0.01]; P = 0.15). There was no evidence of a difference in malignancy rates between the two arms: 70 of 493 (14%) in US elastography FNAC arm versus 79 of 489 (16%) in US FNAC arm (P = .39). There was also no difference in the rate of benign histologic findings between the groups (RD, -0.01 [95% CI: -0.04, 0.03]; P = .7). Conclusion Strain US elastography does not appear to have additional benefit over conventional US FNAC in the diagnosis of malignancy in thyroid nodules. Clinical trial registration no. ISRCTN18261857 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Isikbay and Harwin in this issue.
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Affiliation(s)
- Hisham Mehanna
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Paul S Sidhu
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Gitta Madani
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Rebecca Woolley
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Kristien Boelaert
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Paul Nankivell
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Phil Da Forno
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Kate Moreman
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Andrew Palmer
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Tessa Fulton-Lieuw
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Neil Sharma
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Judith Taylor
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Kanchana Rajaguru
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Jasper Bekker
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Ram Vaidhyanath
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Thaj Rehman
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
| | - Jon Deeks
- From the Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences (H.M., P.N., T.F.L.), Birmingham Clinical Trials Unit (R.W., A.P., J.T., J.D.), and Institute of Applied Health Research (K.B., A.P.), University of Birmingham, Robert Aitken Building, 2nd Floor, Birmingham, UK, B15 2TT; Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK (P.S.S.); Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK (P.S.S.); Department of Imaging, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK (G.M.); Department of Pathology, University Hospitals Leicester, Leicester, UK (P.D.F., K.M.); Department of Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK (N.S.); Department of Radiology, Lister Hospital, Stevenage, UK (K.R.); Department of Radiology, Portsmouth Hospitals University NHS Trust, Portsmouth UK (J.B.); Department of Radiology, Leicester Royal Infirmary, Leicester, UK (R.V.); and Department of Radiology, Mid and South Essex NHS Foundation Trust, Basildon University Hospital, Basildon, UK (T.R.)
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Sarkar R, Bolel P, Kapoor A, Eliseeva E, Dulcey AE, Templin JS, Wang AQ, Xu X, Southall N, Klubo-Gwiezdzinska J, Neumann S, Marugan JJ, Gershengorn MC. An Orally Efficacious Thyrotropin Receptor Ligand Inhibits Growth and Metastatic Activity of Thyroid Cancers. J Clin Endocrinol Metab 2024; 109:2306-2316. [PMID: 38421044 PMCID: PMC11318999 DOI: 10.1210/clinem/dgae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
CONTEXT Thyroid-stimulating hormone (or thyrotropin) receptor (TSHR) could be a selective target for small molecule ligands to treat thyroid cancer (TC). OBJECTIVE We report a novel, orally efficacious ligand for TSHR that exhibits proliferation inhibitory activity against human TC in vitro and in vivo, and inhibition of metastasis in vivo. METHODS A35 (NCATS-SM4420; NCGC00241808) was selected from a sublibrary of >200 TSHR ligands. Cell proliferation assays including BrdU incorporation and WST-1, along with molecular docking studies were done. In vivo activity of A35 was assessed in TC cell-derived xenograft (CDX) models with immunocompromised (NSG) mice. Formalin-fixed, paraffin-embedded sections of tumor and lung tissues were observed for the extent of cell death and metastasis. RESULTS A35 was shown to stimulate cAMP production in some cell types by activating TSHR but not in TC cells, MDA-T32, and MDA-T85. A35 inhibited proliferation of MDA-T32 and MDA-T85 in vitro and in vivo, and pulmonary metastasis of MDA-T85F1 in mice. In vitro, A35 inhibition of proliferation was reduced by a selective TSHR antagonist. Inhibition of CDX tumor growth without decreases in mouse weights and liver function showed A35 to be efficacious without apparent toxicity. Lastly, A35 reduced levels of Ki67 in the tumors and metastatic markers in lung tissues. CONCLUSION We conclude that A35 is a TSHR-selective inhibitor of TC cell proliferation and metastasis, and suggest that A35 may be a promising lead drug candidate for the treatment of differentiated TC in humans.
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Affiliation(s)
- Rhitajit Sarkar
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Priyanka Bolel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Abhijeet Kapoor
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Elena Eliseeva
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrés E Dulcey
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Jay S Templin
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amy Q Wang
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Xin Xu
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Noel Southall
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Joanna Klubo-Gwiezdzinska
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Susanne Neumann
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Juan J Marugan
- National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Marvin C Gershengorn
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Raffaelli M, Voloudakis N, Barczynski M, Brauckhoff K, Durante C, Gomez-Ramirez J, Koutelidakis I, Lorenz K, Makay O, Materazzi G, Pandev R, Randolph GW, Tolley N, Vriens M, Musholt T. European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. Br J Surg 2024; 111:znae199. [PMID: 39158073 PMCID: PMC11331340 DOI: 10.1093/bjs/znae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità (CREO), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joaquin Gomez-Ramirez
- Endocrine Surgery Unit, General Surgery Department, Hospital Universitario La Paz, IdiPaz Madrid, Madrid, Spain
| | - Ioannis Koutelidakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ozer Makay
- Centre for Endocrine Surgery, Ozel Saglik Hospital, Izmir, Turkey
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Rumen Pandev
- Department of General Surgery, University Hospital St Marina, Medical University Pleven, Pleven, Bulgaria
| | - Gregory W Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Tolley
- Endocrine Surgery Service, Imperial College NHS Healthcare Trust, London, UK
| | - Menno Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thomas Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Mainz, Germany
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Mehanna H, Deeks JJ, Boelaert K, Madani G, Sidhu P, Nankivell P, Sharma N, Woolley R, Taylor J, Fulton-Lieuw T, Palmer A. Real-time ultrasound elastography in the diagnosis of newly identified thyroid nodules in adults: the ElaTION RCT. Health Technol Assess 2024; 28:1-51. [PMID: 39252469 PMCID: PMC11403383 DOI: 10.3310/pleq4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Background Strain and shear wave elastography which is commonly used with concurrent real-time imaging known as real-time ultrasound shear/strain wave elastography is a new diagnostic technique that has been reported to be useful in the diagnosis of nodules in several organs. There is conflicting evidence regarding its benefit over ultrasound-guided fine-needle aspiration cytology alone in thyroid nodules. Objectives To determine if ultrasound strain and shear wave elastography in conjunction with fine-needle aspiration cytology will reduce the number of patients who have a non-diagnostic first fine-needle aspiration cytology results as compared to conventional ultrasound-only guided fine-needle aspiration cytology. Design A pragmatic, unblinded, multicentre randomised controlled trial. Setting Eighteen centres with a radiology department across England. Participants Adults who had not undergone previous fine-needle aspiration cytology with single or multiple nodules undergoing investigation. Interventions Ultrasound shear/strain wave elastography-ultrasound guided fine-needle aspiration cytology (intervention arm) - strain or shear wave elastography-guided fine-needle aspiration cytology. Ultrasound-only guided fine-needle aspiration cytology (control arm) - routine ultrasound-only guided fine-needle aspiration cytology (the current standard recommended by the British Thyroid Association guidelines). Main outcome measure The proportion of patients who have a non-diagnostic cytology (Thy 1) result following the first fine-needle aspiration cytology. Randomisation Patients were randomised at a 1 : 1 ratio to the interventional or control arms. Results A total of 982 participants (80% female) were randomised: 493 were randomised to ultrasound shear/strain wave elastography-ultrasound guided fine-needle aspiration cytology and 489 were randomised to ultrasound-only guided fine-needle aspiration cytology. There was no evidence of a difference between ultrasound shear/strain wave elastography and ultrasound in non-diagnostic cytology (Thy 1) rate following the first fine-needle aspiration cytology (19% vs. 16% respectively; risk difference: 0.030; 95% confidence interval -0.007 to 0.066; p = 0.11), the number of fine-needle aspiration cytologies needed (odds ratio: 1.10; 95% confidence interval 0.82 to 1.49; p = 0.53) or in the time to reach a definitive diagnosis (hazard ratio: 0.94; 95% confidence interval 0.81 to 1.10; p = 0.45). There was a small, non-significant reduction in the number of thyroid operations undertaken when ultrasound shear/strain wave elastography was used (37% vs. 40% respectively; risk difference: -0.02; 95% confidence interval -0.06 to 0.009; p = 0.15), but no difference in the number of operations yielding benign histology - 23% versus 24% respectively, p = 0.70 (i.e. no increase in identification of malignant cases) - or in the number of serious adverse events (2% vs. 1%). There was no difference in anxiety and depression, pain or quality of life between the two arms. Limitations The study was not powered to detect differences in malignancy. Conclusions Ultrasound shear/strain wave elastography does not appear to have additional benefit over ultrasound-guided fine-needle aspiration cytology in the diagnosis of thyroid nodules. Future work The findings of the ElaTION trial suggest that further research into the use of shear wave elastography in the diagnostic setting of thyroid nodules is unlikely to be warranted unless there are improvements in the technology. The diagnostic difficulty in distinguishing between benign and malignant lesions still persists. Future studies might examine the role of genomic testing on fine-needle aspiration samples. There is growing use of targeted panels of molecular markers, particularly aimed at improving the diagnostic accuracy of indeterminate (i.e. Thy3) cytology results. The application of these tests is not uniform, and their cost effectiveness has not been assessed in large-scale trials. Study registration This study is registered as ISRCTN (ISRCTN18261857). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/19/04) and is published in full in Health Technology Assessment; Vol. 28, No. 46. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Kristien Boelaert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gitta Madani
- Imperial College Healthcare NHS Trust, London, UK
| | - Paul Sidhu
- King's College Hospital NHS Foundation Trust, London, UK
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Neil Sharma
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Tessa Fulton-Lieuw
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Andrew Palmer
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Marzukie MS, Shapira-Zaltsberg G, Martinez-Rios C. Assessment of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS™) with modification of the management recommendations for pediatric thyroid nodules. Pediatr Radiol 2024; 54:1476-1485. [PMID: 38981907 DOI: 10.1007/s00247-024-05982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 06/10/2024] [Accepted: 06/21/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Thyroid nodules are unusual in children, but when present, they carry a higher risk for malignancy, as compared to adults. Several guidelines have been created to address the risk stratification for malignancy of thyroid nodules in adults, but none has been completely validated in children. A few authors have proposed lowering the size threshold to the American College of Radiology Thyroid Imaging, Reporting and Data System (ACR TI-RADS™) management guidelines to decrease missed carcinomas at presentation in children; however, little information is known regarding their accuracy. OBJECTIVE To assess the performance of proposed modifications of the ACR TI-RADS™ size criteria to guide management decisions in pediatric thyroid nodules and to assess the associated increase in number of fine needle aspiration (FNA) and follow-up exams. MATERIALS AND METHODS This is a retrospective study of children under 18 years old who underwent ultrasound assessment of a thyroid nodule at a tertiary care pediatric institution between January 2006 and August 2021. The largest dimension, maximum ACR TI-RADS™ score, and final thyroid nodules' diagnoses were documented. The course of action based on the adult ACR TI-RADS™ and after modifying the size threshold for management recommendations was documented and compared. Statistics included descriptive analysis, weighted Kappa statistics, sensitivity, specificity, accuracy, and positive/negative predictive values of the ACR TI-RADS™ presented with 95% confidence intervals (CI) using either Clopper-Pearson or standard logit methods. RESULTS Of 116 nodules, 18 (15.5%) were malignant. Most malignant nodules (94.4%, n = 17) were ACR TI-RADS™ 4 and ACR TI-RADS™ 5 categories. Based on the adult ACR TI-RADS™ criteria, 24 (24.5%) benign and 15 (83.3%) malignant nodules would have undergone FNA; 14 (14.3%) benign and 3 (16.7%) malignant nodules would have been followed up; and 60 (61.2%) benign and none of malignant nodules would have been dismissed. Three (16.7%) malignant nodules would not have been recommended FNA at presentation, delaying their diagnoses. By lowering the size-threshold criteria of the ACR TI-RADS™ guidelines, no malignancy would have been missed at presentation, but this also resulted in a higher number of FNA from 24 (24.5%) to 36 (36.7%) and follow-up ultrasound exams from 14 (14.3%) to 62 (63.3%). CONCLUSION Applying potential modifications to the ACR TI-RADS™ guideline lowering the size threshold criteria of the thyroid nodule to guide management decisions for pediatric thyroid nodules can lead to early detection of malignant nodules in children, but at the cost of a significantly increased number of biopsies or ultrasound exams. Further tailoring of the guideline with larger multicentric studies is needed, before warranting its acceptance and general use in the pediatric population.
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Affiliation(s)
- Marina S Marzukie
- Department of Medical Imaging at Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, ON, Canada
| | - Gali Shapira-Zaltsberg
- Department of Medical Imaging at Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, ON, Canada
| | - Claudia Martinez-Rios
- Department of Medical Imaging at Children's Hospital of Eastern Ontario (CHEO), University of Ottawa, Ottawa, ON, Canada.
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
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Yi Y, Zhu Y, Wu Y, Hu F. Investigation on low-iodine diet implementation by medical staff before radioactive iodine treatment for differentiated thyroid carcinoma. Ann Nucl Med 2024; 38:639-646. [PMID: 38874877 DOI: 10.1007/s12149-024-01952-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To explore the implementation of low-iodine diets by medical staff caring for patients with differentiated thyroid carcinoma prior to 131I therapy across 58 hospitals, and offer valuable insights for the development of guidelines on low-iodine diets. METHODS Convenience sampling was utilized to conduct a survey among 163 medical staff members working in nuclear medicine departments across 58 tertiary hospitals using a self-designed questionnaire. RESULTS Concerning the duration of the low-iodine diet prior to treatment, the medical staff's recommendations were as follows: 58.28% suggested 2-4 weeks, 31.29% recommended more than 4 weeks, 9.2% opted for 7-13 days, and 1.23% favored less than 1 week. Regarding the timing of resuming a normal diet, the respondents' recommendations ranged from immediately after treatment (1.84%) to 3 months post-treatment (8.58%), with intermediate recommendations of 2 h (8.58%), 24-48 h (14.11%), post-discharge (12.26%), and 1 month (42.94%). Furthermore, the surveyed medical staff unanimously recommended abstaining from seafood, with 90.8% also advising against the consumption of iodized salt, 91.41% recommending avoidance of iodine-containing medications, and 71.17% advising caution with moderately high-iodine foods. Notably, 75.46% of the medical staff evaluated patient compliance with the low-iodine diet. When patients failed to adhere to the diet preparation, 33.74% of healthcare workers chose to proceed with treatment. In terms of guidance sources, 96.93% of respondents relied on relevant guidelines, 66.26% referred to the literature, and 49.69% drew upon their clinical experience. During hospitalization, 58.28% of the medical staff continued to guide patients on the low-iodine diet, while only 8.59% provided such guidance after discharge. Notably, only 20.25% of the staff considered consulting the nutrition department. CONCLUSION This study underscored substantial variations in the duration and selection criteria for low-iodine diets, which were linked to a scarcity of standardized evaluations. Consequently, there is an urgent need for further research to establish detailed, practical, accessible, comprehensive, and dependable implementation programs for low-iodine diets.
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Affiliation(s)
- Yupin Yi
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, China
| | - Yuquan Zhu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, China
| | - Youfeng Wu
- Department of Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, China.
| | - Fengqiong Hu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, China.
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Kayhan Y, Azizova L, Yılmaz M, Bakış M, Kefeli M, Kan EK, Atmaca A, Çolak R. Prognostic factors for aggressiveness in subcentimeter papillary thyroid carcinoma: impact of tumor size and lymph node metastases. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230422. [PMID: 39420875 PMCID: PMC11326733 DOI: 10.20945/2359-4292-2023-0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/26/2024] [Indexed: 10/19/2024]
Abstract
Objective Subcentimeter papillary thyroid carcinoma (sPTC), also known as papillary thyroid microcarcinoma, is associated with a good prognosis and low mortality risk. However, some sPTCs exhibit biologically aggressive characteristics. The aim of this study was to identify factors affecting the prognosis and aggressiveness of sPTC by considering the demographic characteristics of patients with sPTC and the pathologic characteristics of the tumors. Subjects and methods The study included 255 patients aged ≥ 18 years who were operated on at Ondokuz Mayis University, Faculty of Medicine (Samsun, Turkey) between June 2008 and December 2021. All patients had histopathologic confirmation of sPTC (≤10 mm) and underwent regular follow-up for at least 36 months. Results The tumors had a mean size of 5 mm (0.1-10 mm) and were multifocal in 53.7% of patients. Capsular invasion was observed in 9% of patients. Vascular invasion, lymphatic invasion, and extrathyroidal invasion were present in 2%, 5.5%, and 0.8% of patients, respectively. Metastatic cervical lymph nodes were observed in 9.4% of patients. On multivariate logistic regression analysis, tumor size (odds ratio [OR] 1.380, 95% confidence interval [CI] 1.106-1.722, p = 0.004) and sex (OR 4.233, 95% CI 1.355-13.226, p = 0.013) were the main predictive factors influencing lymph node metastasis. Tumors > 5 mm, compared with tumors ≤ 5 mm, had higher rates of multifocality (p = 0.009), parenchymal invasion (p = 0.008), calcifications (p = 0.001), microscopic lymphatic invasion (p = 0.002), and presence of metastatic lymph nodes (p < 0.001). Conclusion The findings of this study highlight important factors to consider in making decisions about prophylactic central compartment neck dissection in patients with sPTCs, particularly those with clinically node-negative tumors.
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Affiliation(s)
- Yusuf Kayhan
- Ondokuz Mayis UniversityFaculty of MedicineDepartment of Endocrinology and MetabolismSamsunTurkey Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Leyla Azizova
- Ondokuz Mayis UniversityFaculty of MedicineDepartment of Internal MedicineSamsunTurkey Ondokuz Mayis University, Faculty of Medicine, Department of Internal Medicine, Samsun, Turkey
| | - Merve Yılmaz
- Samsun State Gazi HospitalEndocrinology and Metabolism ClinicSamsunTurkeySamsun State Gazi Hospital, Endocrinology and Metabolism Clinic, Samsun, Turkey
| | - Muhsine Bakış
- Ondokuz Mayis UniversityFaculty of MedicineDepartment of Internal MedicineSamsunTurkey Ondokuz Mayis University, Faculty of Medicine, Department of Internal Medicine, Samsun, Turkey
| | - Mehmet Kefeli
- Ondokuz Mayis UniversityFaculty of MedicineDepartment of Medical PathologySamsunTurkey Ondokuz Mayis University, Faculty of Medicine, Department of Medical Pathology, Samsun, Turkey
| | - Elif Kılıç Kan
- Ondokuz Mayis UniversityFaculty of MedicineDepartment of Endocrinology and MetabolismSamsunTurkey Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Ayşegül Atmaca
- Ondokuz Mayis UniversityFaculty of MedicineDepartment of Endocrinology and MetabolismSamsunTurkey Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
| | - Ramis Çolak
- Ondokuz Mayis UniversityFaculty of MedicineDepartment of Endocrinology and MetabolismSamsunTurkey Ondokuz Mayis University, Faculty of Medicine, Department of Endocrinology and Metabolism, Samsun, Turkey
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Sahin C, Inan MA, Bilezikci B, Bostanci H, Taneri F, Kozan R. Interstitial Fibrosis as a Common Counterpart of Histopathological Risk Factors in Papillary Thyroid Microcarcinoma: A Retrospective Analysis. Diagnostics (Basel) 2024; 14:1624. [PMID: 39125500 PMCID: PMC11311513 DOI: 10.3390/diagnostics14151624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
PURPOSE Interstitial fibrosis in papillary thyroid microcarcinoma is a subject which is under-investigated. The aim of this study is to determine the relationship between interstitial fibrosis, the subtypes of papillary microcarcinoma, and the established prognostic factors. MATERIAL AND METHODS A total of 75 patients diagnosed with papillary microcarcinoma of the thyroid from January 2011 to December 2020 have been evaluated retrospectively, using demographic features, tumor size, subtype of the tumor, surgical margin status, unifocality, lymphovascular invasion, extracapsular spread and lymph node metastasis as parameters. Hematoxylin and eosin slides were reviewed for interstitial fibrosis. RESULTS The study includes 13 males and 62 females, in a total of 75 patients. There were 51 patients (68%) with interstitial fibrosis and 24 (32%) patients without interstitial fibrosis. Among them, 45 (60%) were classic, 27 (36%) were follicular variant and 3 (4%) were other subtypes. Interstitial fibrosis is significantly associated with bilaterality (p = 0.023), multifocality (p = 0.004), capsule invasion (p < 0.001) and lymph node metastasis (p = 0.043). Evaluation of tumor sub groups showed significant increased risk of lymphovascular invasion in the follicular variant (p = 0.019). CONCLUSION Although the relationship of interstitial fibrosis and prognosis of other cancer types has been discussed, there are few studies in the literature regarding its effect on the prognosis of papillary microcarcinoma. Our results show that interstitial fibrosis can be used as a risk factor. However, new studies are needed to clearly reveal the physiopathology of interstitial fibrosis and its effect on tumorigenesis.
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Affiliation(s)
- Can Sahin
- Department of General Surgery, Yenimahalle Training and Research Hospital, Ankara 06370, Türkiye
| | - Mehmet Arda Inan
- Department of Pathology, Gazi University Faculty of Medicine, Ankara 06500, Türkiye;
| | - Banu Bilezikci
- Department of Pathology, Guven Hospital, Ankara 06540, Türkiye;
| | - Hasan Bostanci
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara 06500, Türkiye; (H.B.); (F.T.); (R.K.)
| | - Ferit Taneri
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara 06500, Türkiye; (H.B.); (F.T.); (R.K.)
| | - Ramazan Kozan
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara 06500, Türkiye; (H.B.); (F.T.); (R.K.)
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Volpi F, Alcalde J, Larrache J, Alegre E, Argueta A, Lozano MD, Colombo C, Galofré JC. Tracking dynamic evolution of low- and intermediate-risk differentiated thyroid cancer: Identification of individuals at risk of recurrence. Clin Endocrinol (Oxf) 2024. [PMID: 39038163 DOI: 10.1111/cen.15111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/27/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE The generally good prognosis of low- and intermediate-risk differentiated thyroid cancer (DTC) underscored the need to identify those few patients who relapse. DESIGN Records of 299 low- or intermediate-risk DTC patients (mean follow-up 8.2 ± 6.2 years) were retrospectively reviewed. The sample was classified following the American Thyroid Association (ATA) dynamic risk stratification (DRS) system. PATIENTS AND MEASUREMENT After classifying patients according to DRS at the first visit following initial therapy (FU1), structural recurrence occurred in 2/181 (1.1%), 5/81 (6.2%) and 13/26 (50.0%) with excellent, indeterminate and biochemical incomplete response to treatment, respectively. All relapses but one happened within 5 years from FU1. Univariate analysis comparing excellent, indeterminate and biochemical incomplete with structural incomplete responses at the end of the follow-up, identified tumour size (p < .001), T status (<0.001), positive lymph nodes (N) (p < .01), multifocality (p < .004), need of additional radioactive iodine (RAI) (p < .0001) and first DRS status (p < .0003) as risk factors of recurrence. In the multivariate analysis, only RAI remained statistically significant (p < .02). Comparison between excellent and indeterminate with biochemical and structural incomplete responses, identified tumour size (p < .0004), T (p < .01), N (p < .0001), bilaterality (p < .03), first DRS status (p < .0001) and RAI (p < .001) as recurrence risk factors. T (p < .01) and first DRS (p < .0006) were confirmed in the multivariate analysis. CONCLUSIONS Patients with DTC classified as low- or intermediate-risk of recurrence with excellent response to treatment at FU1 rarely develop structural disease and this occurs almost exclusively in the first 5 years. Initial DRS status is an accurate tool for determining the risk of recurrence.
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Affiliation(s)
- Federico Volpi
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Juan Alcalde
- Department of Otorhinolaryngology-Head and Neck Surgery, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Javier Larrache
- Department of Radiology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Estíbaliz Alegre
- Service of Biochemistry, Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Allan Argueta
- Department of Pathology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - María D Lozano
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Pathology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
- Centro de Investigación Biomedica en Red de Oncología (CIBERONC), Madrid, Spain
| | - Carla Colombo
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Juan C Galofré
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
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Kaleva AI, Patel A, Sooriyamoorthy T, Dimitriadis PA, Rajaguru K, Mochloulis G. Utility of intra-operative ultrasound in revision neck dissection for loco-regional thyroid cancer recurrence. Clin Otolaryngol 2024; 49:490-494. [PMID: 38468458 DOI: 10.1111/coa.14153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/13/2024]
Affiliation(s)
- A I Kaleva
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
| | - A Patel
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
| | - T Sooriyamoorthy
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
| | - P A Dimitriadis
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
| | - K Rajaguru
- Department of Radiology, Lister Hospital, Stevenage, Herts, UK
| | - G Mochloulis
- Department of Otorhinolaryngology, Lister Hospital, Stevenage, Herts, UK
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Giovanella L, Tuncel M, Aghaee A, Campenni A, De Virgilio A, Petranović Ovčariček P. Theranostics of Thyroid Cancer. Semin Nucl Med 2024; 54:470-487. [PMID: 38503602 DOI: 10.1053/j.semnuclmed.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/21/2024]
Abstract
Molecular imaging is pivotal in evaluating and managing patients with different thyroid cancer histotypes. The existing, pathology-based, risk stratification systems can be usefully refined, by incorporating tumor-specific molecular and molecular imaging biomarkers with theranostic value, allowing patient-specific treatment decisions. Molecular imaging with different radioactive iodine isotopes (ie, I131, I123, I124) is a central component of differentiated carcinoma (DTC)'s risk stratification while [18F]F-fluorodeoxyglucose ([18F]FDG) PET/CT is interrogated about disease aggressiveness and presence of distant metastases. Moreover, it is particularly useful to assess and risk-stratify patients with radioiodine-refractory DTC, poorly differentiated, and anaplastic thyroid cancers. [18F]F-dihydroxyphenylalanine (6-[18F]FDOPA) PET/CT is the most specific and accurate molecular imaging procedure for patients with medullary thyroid cancer (MTC), a neuroendocrine tumor derived from thyroid C-cells. In addition, [18F]FDG PET/CT can be used in patients with more aggressive clinical or biochemical (ie, serum markers levels and kinetics) MTC phenotypes. In addition to conventional radioiodine therapy for DTC, new redifferentiation strategies are now available to restore uptake in radioiodine-refractory DTC. Moreover, peptide receptor theranostics showed promising results in patients with advanced and metastatic radioiodine-refractory DTC and MTC, respectively. The current appropriate role and future perspectives of molecular imaging and theranostics in thyroid cancer are discussed in our present review.
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Affiliation(s)
- Luca Giovanella
- Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco, Lugano, Switzerland; Clinic for Nuclear Medicine, University Hospital Zürich, Zürich, Switzerland.
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Ankara, Turkey
| | - Atena Aghaee
- Department of Nuclear Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alfredo Campenni
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Armando De Virgilio
- Department of Head and Neck Surgery Humanitas Research Hospital, Rozzano, Italy
| | - Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
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Leoncini F, Sotgiu G, Cancellieri A, Puci M, Cortese S, Livi V, Simonetti J, Paioli D, Magnini D, Cappuzzo F, Bria E, Trisolini R. Intrathoracic Lymph Node Microcalcifications are Associated With a High Prevalence of Malignancy and Anaplastic Lymphoma Kinase Rearrangement: The "Calce" Study. J Bronchology Interv Pulmonol 2024; 31:e0973. [PMID: 38946295 DOI: 10.1097/lbr.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/20/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Microcalcifications are acknowledged as a malignancy risk factor in multiple cancers. However, the prevalence and association of intrathoracic lymph node (ILN) calcifications with malignancy remain unexplored. METHODS In this cross-sectional study, we enrolled patients with known/suspected malignancy and an indication for endosonography for diagnosis or ILN staging. We assessed the prevalence and pattern of calcified ILNs and the prevalence of malignancy in ILNs with and without calcifications. In addition, we evaluated the genomic profile and PD-L1 expression in lung cancer patients, stratifying them based on the presence or absence of ILN calcifications. RESULTS A total of 571 ILNs were sampled in 352 patients. Calcifications were detected in 85 (24.1%) patients and in 94 (16.5%) ILNs, with microcalcifications (78/94, 83%) being the predominant type. Compared with ILNs without calcifications (214/477, 44.9%), the prevalence of malignancy was higher in ILNs with microcalcifications (73/78, 93.6%; P<0.0001) but not in those with macrocalcifications (7/16, 43.7%; P=0.93). In patients with lung cancer, the high prevalence of metastatic involvement in ILNs displaying microcalcifications was independent of lymph node size (< or >1 cm) and the clinical stage (advanced disease; cN2/N3 disease; cN0/N1 disease). The anaplastic lymphoma kinase (ALK) rearrangement was significantly more prevalent in patients with than in those without calcified ILNs (17.4% vs. 1.7%, P<0.001), and all of them exhibited microcalcifications. CONCLUSION ILN microcalcifications are common in patients undergoing endosonography for suspected malignancy, and they are associated with a high prevalence of metastatic involvement and ALK rearrangement.
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Affiliation(s)
- Fausto Leoncini
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari
| | | | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari
| | - Stefania Cortese
- Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Vanina Livi
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Jacopo Simonetti
- Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS
| | - Daniela Paioli
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Daniele Magnini
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | - Federico Cappuzzo
- Medical Oncology Division, IRCCS Regina Elena National Cancer Institute
| | - Emilio Bria
- Thoracic Oncology Division, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
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Lee WY, Wang HC, Huang LE, Tseng MH, Chiang SH, Lee CC. Diagnostic values of SurePath liquid-based cytology versus conventional smear in thyroid aspiration samples: A 13-year experience at a single institution. Diagn Cytopathol 2024; 52:369-376. [PMID: 38595067 DOI: 10.1002/dc.25319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/06/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Fine needle aspiration cytology (FNAC) is the most useful tool in the diagnosis of thyroid nodules. Liquid-based cytology (LBC) is replacing the conventional smear (CS) for evaluation of thyroid FNAC. In our institution, thyroid FNAC preparation was changed from CS to LBC SurePath in July 2016. This study aimed to compare the diagnostic value of SurePath with that of CS in thyroid lesions. METHODS A total of 35,406 samples of thyroid FNAC (11,438 CS and 23,968 SurePath), collected from January 2010 to December 2022, were included in this study. We also examined the malignant rate using the surgical pathology diagnosis as the gold standard. RESULTS The distribution of TBSRTC cytological categories was equivalent between CS and SurePath. The rate of nondiagnostic/unsatisfactory category was higher in CS compared to SurePath (43.4% vs. 22.3%; p < .05). After routine use of SurePath, the surgical resection rate was reduced from 12.0% to 8.6% (p < .05) and the malignant rate increased from 32.2% to 41.5% (p < .05). The sensitivities of CS and SurePath were 71.0% and 82.0%, respectively, and the specificities were 99.0% and 97.3%, respectively, whereas the positive predictive values were 97.8% and 96.8%, respectively, and the negative predictive values were 85.0% and 84.6%, respectively. Diagnostic accuracy of CS and SurePath were 88.5% and 89.7% respectively. CONCLUSION SurePath can increase the sample adequacy, increase the sensitivity and reduce the workload and avoid unnecessary surgeries with similar accuracy to CS.
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Affiliation(s)
- Wen-Ying Lee
- Division of Cytopathology, Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsiu-Chu Wang
- Division of Cytopathology, Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
| | - Lee-E Huang
- Division of Cytopathology, Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
| | - Min-Hui Tseng
- Division of Cytopathology, Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
| | - Shu-Hui Chiang
- Division of Cytopathology, Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ching-Chien Lee
- Division of Cytopathology, Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan
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50
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Kamyab AA, Weller A, Hulley K, Bano G. Misrepresented multiple endocrine neoplasia 2: Do the British Thyroid Association guidelines accurately predict thyroid cancer risk in high-risk groups with multiple endocrine neoplasia 2? A case series. ULTRASOUND (LEEDS, ENGLAND) 2024:1742271X241260225. [PMID: 39555152 PMCID: PMC11563518 DOI: 10.1177/1742271x241260225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/23/2024] [Indexed: 11/19/2024]
Abstract
Introduction The incidence of thyroid nodules in the general population is around 40%. The British Thyroid Association U-grading has high sensitivity for identifying the common thyroid cancer subtypes (papillary and follicular). However, ultrasound features of the rarer medullary thyroid cancer differ, with lower sensitivity for ultrasound detection.Hereditary medullary thyroid cancer accounts for 25% of cases, forming part of the multiple endocrine neoplasia syndromes (multiple endocrine neoplasia 2) and is associated with RET proto-oncogene mutation, for which gene testing is increasingly available. This study aims to evaluate British Thyroid Association U-grading for thyroid cancer risk stratification in this high-risk population. Case report This was a retrospective review of four multiple endocrine neoplasia 2 patients referred for thyroid ultrasound. A total of 10 thyroid nodules were graded as part of routine evaluation, taken from an endocrine and genetics tertiary referral centre. Patients with identifiable RET mutation from March 2017 to February 2023 were reviewed. Discussion Six patients had 10 thyroid nodules, of which 8 were graded as U2, 2 graded U3-5 and 8 confirmed as medullary thyroid cancer. However, two patients had no pathology data at the time of writing. For this cohort, U-grading and genetics were discordant, with RET gene testing more effective than ultrasound in cancer detection. All nodules should be considered high risk for medullary thyroid cancer, regardless of U-grade. Conclusion Our data demonstrate that British Thyroid Association U-score has limited value for medullary thyroid cancer detection in this high-risk group and cannot be used for risk stratification or surveillance. As a rarer thyroid cancer subtype, medullary thyroid cancer and the high-risk multiple endocrine neoplasia 2 population are under-represented in British Thyroid Association 2014 guidance and deserve consideration in future editions.
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Affiliation(s)
| | - Alex Weller
- St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Kate Hulley
- St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Gul Bano
- St George’s University Hospitals NHS Foundation Trust, London, UK
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