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Academic Radiology Dec 2023This study is based on multicenter cohorts and aims to utilize computed tomography (CT) images to construct a radiomics nomogram for predicting the lateral neck lymph...
RATIONALE AND OBJECTIVES
This study is based on multicenter cohorts and aims to utilize computed tomography (CT) images to construct a radiomics nomogram for predicting the lateral neck lymph node (LNLN) metastasis in the papillary thyroid carcinoma (PTC) and further explore the biological basis under its prediction.
MATERIALS AND METHODS
In the multicenter study, 1213 lymph nodes from 409 patients with PTC who underwent CT examinations and received open surgery and lateral neck dissection were included. A prospective test cohort was used in validating the model. Radiomics features were extracted from the CT images of each patient's LNLNs. Selectkbest, maximum relevance and minimum redundancy and the least absolute shrinkage and selection operator (LASSO) algorithm were used in reducing the dimensionality of radiomics features in the training cohort. Then, a radiomics signature (Rad-score) was calculated as the sum of each feature multiplied by the nonzero coefficient from LASSO. A nomogram was generated using the clinical risk factors of the patients and Rad-score. The nomograms' performance was analyzed in terms of accuracy, sensitivity, specificity, confusion matrix, receiver operating characteristic curves, and areas under the receiver operating characteristic curve (AUCs). The clinical usefulness of the nomogram was evaluated by decision curve analysis. Moreover, three radiologists with different working experiences and nomogram were compared to one another. Whole transcriptomics sequencing was performed in 14 tumor samples; the correlation of biological functions and high and low LNLN samples predicted by the nomogram was further investigated.
RESULTS
A total of 29 radiomics features were used in constructing the Rad-score. Rad-score and clinical risk factors (age, tumor diameter, location and number of suspected tumors) compose the nomogram. The nomogram exhibited good discrimination performance of the nomogram for predicting LNLN metastasis in the training cohort (AUC, 0.866), internal test cohort (0.845), external test cohort (0.725), and prospective test cohort (0.808) and showed diagnostic capability comparable to senior radiologists, significantly outperforming junior radiologists (p < 0.05). Functional enrichment analysis suggested that the nomogram can reflect the ribosome-related structures of cytoplasmic translation in patients with PTC.
CONCLUSION
Our radiomics nomogram provides a noninvasive method that incorporates radiomics features and clinical risk factors for predicting LNLN metastasis in patients with PTC.
Topics: Humans; Nomograms; Thyroid Cancer, Papillary; Lymphatic Metastasis; Prospective Studies; Tomography, X-Ray Computed; Lymph Nodes; Thyroid Neoplasms; Retrospective Studies
PubMed: 37210266
DOI: 10.1016/j.acra.2023.03.039 -
Endocrine Journal Jan 2024We analyzed the outcomes of genetic testing to study the frequency of mutations in advanced thyroid cancer in Japan. Patients (n = 96) with unresectable or metastatic...
We analyzed the outcomes of genetic testing to study the frequency of mutations in advanced thyroid cancer in Japan. Patients (n = 96) with unresectable or metastatic thyroid carcinoma were included for retrospective chart review. Results of gene panel testing, which was performed between May 2020 and April 2023, were analyzed. The median age of the patients was 73.5 years (range, 17-88); 59 were women, and 39 were men. Overall, 17 patients had anaplastic thyroid carcinoma (ATC), 68 had papillary thyroid carcinoma (PTC), 7 had follicular thyroid carcinoma, and 6 had poorly differentiated thyroid carcinoma (PDTC). Of the 81 patients with differentiated thyroid carcinoma (DTC) and PDTC, 88.9% were radioactive iodine-refractory, and 32.7% of all cases had previously been treated with multiple kinase inhibitors. Of ATC cases, 52.9% had BRAF mutations, and 5.9% had RET fusion. Of PTC cases, 83.1% had BRAF mutations, 9.2% had RET fusion, and 1.5% had NTRK fusion. One case each of ATC and PTC had a tumor mutation burden of ≥10. ATC cases had a significantly higher prevalence of TP53 alterations than the other cases (82.3% vs. 11.8%), whereas the frequencies of TERT promoter mutations were 88.2% in ATC cases and 64.7% in the other cases, albeit without a significant difference. In conclusion, 58.8% of ATC, 93.8% of PTC, and 42.9% of PDTC had genetic alterations linked to therapeutic agents. Active gene panel testing is required to increase treatment options.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Thyroid Neoplasms; Proto-Oncogene Proteins B-raf; Retrospective Studies; Iodine Radioisotopes; Japan; Thyroid Carcinoma, Anaplastic; Thyroid Cancer, Papillary; Adenocarcinoma; Mutation; Proline; Thiocarbamates
PubMed: 38044137
DOI: 10.1507/endocrj.EJ23-0342 -
Frontiers in Endocrinology 2023To study the clinicopathological characteristics of patients with synchronous medullary and papillary thyroid carcinomas. (Review)
Review
OBJECTIVE
To study the clinicopathological characteristics of patients with synchronous medullary and papillary thyroid carcinomas.
METHODS
The clinical data of patients with medullary thyroid carcinoma (MTC) operated in our hospital (Department of Thyroid Surgery, China-Japan Union Hospital, Jilin University) from February 2009 to February 2023 were evaluated using an analytical review approach. They were divided into an observation group (patients with synchronous MTC and papillary thyroid carcinoma PTC) and a control group (simple MTC) according to whether the clinical data were associated with MTC, in order to compare the clinical features, pathological types, stage characteristics and molecular biology characteristics of the two groups and to investigate the follow-up of the two groups.
RESULTS
The study included 122 MTC, 30 with synchronous MTC/PTC and 92 simple MTC. When the data were compared, the sex ratio, preoperative calcitonin level, preoperative CEA level, presence of calcifications in the MTC lesions, surgical methods, number of MTC lesions, presence of nodular goitre and presence of thyroiditis were higher in the observation group than in the control group. There was a significant difference between the groups when the MTC lesion diameter was ≤1cm in terms of preoperative CEA value (P<0.05); when the MTC lesion diameter was >1cm, there was a statistical difference between the two groups in terms of preoperative Ctn value (P<0.05). Type III was significantly different from the simple group, while type IV was more similar to the simple group. The preoperative serum Ctn value was positively correlated with maximum tumour diameter in both groups, although the correlation was stronger in the easy group. Preoperative CEA was positively correlated with maximum tumour diameter in both groups, with a stronger correlation in the combination group. Preoperative Ctn and CEA were positively correlated with lymph node metastasis in the simple group, whereas there was no apparent correlation with lymph node metastasis in the combination group. The cut-off value of preoperative serum Ctn for cervical lymph node metastases in the simple group was 39.2pg/ml and for lateral cervical lymph node metastases 195.5pg/ml. The cut-off value of preoperative serum Ctn for cervical lymph node metastases in the combination group was 60.79pg/ml and for lateral cervical lymph node metastases 152.6pg/ml. In the simple group, prognosis was significantly worse in the progression group (P<0.001), with no statistical difference between the remission and stable groups. In the combination group, the prognosis of the progression and stable groups was significantly worse than that of the remission group (P<0.001), with no statistical difference between the progression and stable groups.
CONCLUSION
In patients with synchronous medullary and papillary thyroid carcinomas, preoperative Ctn and CEA levels, calcifications, solitary lesions, combined goitre or thyroiditis differ significantly from simple MTC. Therefore, clinical management should pay attention to the above factors and early risk screening should be performed to improve prognosis as much as possible.
Topics: Humans; Thyroid Cancer, Papillary; Lymphatic Metastasis; Cross-Sectional Studies; Thyroid Neoplasms; Thyroiditis; Carcinoma, Neuroendocrine
PubMed: 38317715
DOI: 10.3389/fendo.2023.1301200 -
Pediatric Radiology Jun 2024Identifying the associations between BRAF mutation, the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) and clinicopathological...
Associations of BRAF mutation with the American College of Radiology Thyroid Imaging Reporting and Data System and clinicopathological characteristics in pediatric patients with papillary thyroid carcinoma.
BACKGROUND
Identifying the associations between BRAF mutation, the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) and clinicopathological characteristics could assist in making appropriate treatment strategies for pediatric patients with papillary thyroid carcinoma.
OBJECTIVE
To retrospectively assess the associations between BRAF mutation, TI-RADS, and clinicopathological characteristics in pediatric patients with papillary thyroid carcinoma.
MATERIALS AND METHODS
Between May 2013 and May 2023, pediatric patients with papillary thyroid carcinoma who underwent thyroidectomy were retrospectively evaluated. Univariate and multivariate logistic regression analyses were performed to determine the associations between BRAF mutation, TI-RADS, and clinicopathological characteristics. The diagnostic performance of TI-RADS to predict BRAF mutation was assessed.
RESULTS
The BRAF mutation was found in 59.1% (39/66) of pediatric patients with papillary thyroid carcinoma. Multivariate analyses showed that hypoechoic/very hypoechoic [odds ratio (OR) = 8.48; 95% confidence interval (CI) = 1.48-48.74); P-value = 0.02] and punctate echogenic foci (OR = 24.3; 95% CI = 3.80-155.84; P-value = 0.001) were independent factors associated with BRAF mutation. In addition, BRAF mutation was significantly associated with TI-RADS 5 (OR = 12.61; 95% CI = 1.28-124.49; P-value = 0.03). There were no associations between BRAF mutation and nodule size, composition, shape, margin, cervical lymph node metastasis, or Hashimoto's thyroiditis (P-value > 0.05). Combined with hypoechoic/very hypoechoic and punctate echogenic foci, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.7%, 85.2%, 89.7%, 85.2%, and 87.9%, respectively.
CONCLUSIONS
Hypoechoic/very hypoechoic, punctate echogenic foci, and TI-RADS 5 are independently associated with BRAF mutation in pediatric patients with papillary thyroid carcinoma.
Topics: Humans; Male; Female; Proto-Oncogene Proteins B-raf; Thyroid Cancer, Papillary; Child; Thyroid Neoplasms; Retrospective Studies; Mutation; Adolescent; United States; Radiology Information Systems; Thyroidectomy; Child, Preschool
PubMed: 38771344
DOI: 10.1007/s00247-024-05943-3 -
Frontiers in Endocrinology 2024Papillary thyroid cancer (PTC) is the most common type of thyroid malignancy, and its global incidence has been gradually increasing. For advanced PTC, the mortality... (Review)
Review
Papillary thyroid cancer (PTC) is the most common type of thyroid malignancy, and its global incidence has been gradually increasing. For advanced PTC, the mortality rates are also increasing yearly. Despite advancements in diagnosis and treatment, some advanced PTC exhibit aggressive behaviors, leading to a poor prognosis. CircRNAs are a class of non-coding RNAs characterized by a covalently closed loop structure. Their stability and abundance have positioned them as promising diagnostic and prognostic biomarkers. Numerous studies have identified dysregulated circRNAs in PTC tissues and cell lines, suggesting their involvement in PTC initiation and progression. In this review, we provide an overview of circRNAs and systematically discuss their role in PTC. CircRNAs affect cancer progression by regulating the Wnt/β-catenin, PI3K/AKT, MAPK pathways, and others. Furthermore, circRNAs have been implicated in PTC metastasis and chemoresistance. We highlight their potential value as diagnostic markers, therapeutic targets, and prognostic indicators. In conclusion, circRNAs play a critical role in PTC, and dysregulated circRNAs influence multiple signaling pathways and cellular processes involved in tumorigenesis and metastasis. It represents a promising avenue for advancing the diagnosis, management, and treatment of PTC.
Topics: Humans; Thyroid Cancer, Papillary; RNA, Circular; Phosphatidylinositol 3-Kinases; Clinical Relevance; Thyroid Neoplasms
PubMed: 38544689
DOI: 10.3389/fendo.2024.1351776 -
Frontiers in Endocrinology 2024
Topics: Humans; Thyroid Cancer, Papillary; Thyroid Neoplasms; Carcinoma
PubMed: 38304465
DOI: 10.3389/fendo.2024.1363836 -
BMC Cancer Jan 2024To evaluate the value of an integrated model incorporating deep learning (DL), hand-crafted radiomics and clinical and US imaging features for diagnosing central lymph...
An integrated model incorporating deep learning, hand-crafted radiomics and clinical and US features to diagnose central lymph node metastasis in patients with papillary thyroid cancer.
OBJECTIVE
To evaluate the value of an integrated model incorporating deep learning (DL), hand-crafted radiomics and clinical and US imaging features for diagnosing central lymph node metastasis (CLNM) in patients with papillary thyroid cancer (PTC).
METHODS
This retrospective study reviewed 613 patients with clinicopathologically confirmed PTC from two institutions. The DL model and hand-crafted radiomics model were developed using primary lesion images and then integrated with clinical and US features selected by multivariate analysis to generate an integrated model. The performance was compared with junior and senior radiologists on the independent test set. SHapley Additive exPlanations (SHAP) plot and Gradient-weighted Class Activation Mapping (Grad-CAM) were used for the visualized explanation of the model.
RESULTS
The integrated model yielded the best performance with an AUC of 0.841. surpassing that of the hand-crafted radiomics model (0.706, p < 0.001) and the DL model (0.819, p = 0.26). Compared to junior and senior radiologists, the integrated model reduced the missed CLNM rate from 57.89% and 44.74-27.63%, and decreased the rate of unnecessary central lymph node dissection (CLND) from 29.87% and 27.27-18.18%, respectively. SHAP analysis revealed that the DL features played a primary role in the diagnosis of CLNM, while clinical and US features (such as extrathyroidal extension, tumour size, age, gender, and multifocality) provided additional support. Grad-CAM indicated that the model exhibited a stronger focus on thyroid capsule in patients with CLNM.
CONCLUSION
Integrated model can effectively decrease the incidence of missed CLNM and unnecessary CLND. The application of the integrated model can help improve the acceptance of AI-assisted US diagnosis among radiologists.
Topics: Humans; Thyroid Cancer, Papillary; Thyroid Neoplasms; Retrospective Studies; Lymphatic Metastasis; Deep Learning; Radiomics; Carcinoma, Papillary; Risk Factors; Lymph Nodes
PubMed: 38216936
DOI: 10.1186/s12885-024-11838-1 -
Current Oncology (Toronto, Ont.) Aug 2023While papillary thyroid carcinoma (PTC) is associated with high occult central neck metastasis (CNM) rates, prophylactic central neck dissection (pCND) is controversial.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
While papillary thyroid carcinoma (PTC) is associated with high occult central neck metastasis (CNM) rates, prophylactic central neck dissection (pCND) is controversial. This meta-analysis aims to look at the occult CNM rate according to tumor size.
METHODS
A literature search was conducted in PubMed from inception to April 2023. Inclusion criteria were primary studies that determined occult CNM rates in cN0 PTC by tumor size. Heterogeneity, influential case diagnostics, and proportion data were evaluated with Cochran's Q-test, Baujat plots and Forest plots, respectively.
RESULTS
Fifty-two studies were included in this meta-analysis. The findings demonstrated an occult CNM rate of 30.3% for tumors ≤ 5 mm, 32.7% for tumors ≤ 1 cm, 46.0% for tumors between 1 and 2 cm, 43.1% for tumors between 2 and 4 cm, and 61.2% for tumors > 4 cm. The heterogeneity of each study group was high, though no publication bias was noted. While there was a trend towards increased occult CNM rates with larger tumors, comparisons between different size cutoffs varied in significance.
CONCLUSION
This comprehensive review affirms that occult CNM is high and that an ipsilateral pCND can be justified in all PTC patients for accurate differentiation between Stage I and Stage II disease and its clinical implications.
Topics: Thyroid Cancer, Papillary; Lymph Nodes; Neoplasm Metastasis; Humans; Head and Neck Neoplasms
PubMed: 37623013
DOI: 10.3390/curroncol30080532 -
Clinical and Experimental Medicine Dec 2023Thyroid cancer is the endocrine tumor with the highest incidence at present. It originates from the thyroid follicular epithelium or follicular paraepithelial cells....
Thyroid cancer is the endocrine tumor with the highest incidence at present. It originates from the thyroid follicular epithelium or follicular paraepithelial cells. There is an increasing incidence of thyroid cancer all over the world. We found that SRPX2 expression level was higher in papillary thyroid tumors than in normal thyroid tissues, and SRPX2 expression was closely related to tumor grade and clinical prognosis. Previous reports showed that SRPX2 could function by activating PI3K/AKT signaling pathway. In addition, in vitro experiments showed that SRPX2 promoted the proliferation and migration of papillary thyroid cancer (PTC). In conclusion, SRPX2 could promote the malignant development of PTC. This may be a potential treatment target for PTC.
Topics: Humans; Cell Line, Tumor; Cell Movement; Cell Proliferation; Gene Expression Regulation, Neoplastic; Phosphatidylinositol 3-Kinases; Signal Transduction; Thyroid Cancer, Papillary; Thyroid Neoplasms
PubMed: 37306872
DOI: 10.1007/s10238-023-01113-1 -
Frontiers in Endocrinology 2023Papillary thyroid cancer (PTC) is the most common type of thyroid cancer, and angioinvasion, the invasion of blood vessels by cancer cells, is a crucial pathological... (Review)
Review
Papillary thyroid cancer (PTC) is the most common type of thyroid cancer, and angioinvasion, the invasion of blood vessels by cancer cells, is a crucial pathological feature associated with disease progression and poor prognosis. Thus, a comprehensive search of scientific databases was conducted to identify relevant studies investigating angioinvasion markers in PTC. The selected studies were reviewed and analyzed to assess the clinical significance and potential utility of these markers in predicting angioinvasion and guiding treatment decisions. Numerous studies have investigated various markers associated with angioinvasion in PTC, including oxidative stress, vascular endothelial growth factor (VEGF), matrix metalloproteinases (MMPs), and other angiogenic factors. The results indicate that increased expression of these markers is correlated with the presence and extent of angioinvasion in PTC. Moreover, some studies suggest that these markers can serve as prognostic indicators and guide therapeutic strategies, such as selecting patients for more aggressive treatment approaches or targeted therapies. The findings from the reviewed literature highlight the potential clinical utility of angioinvasion markers in PTC. The identification and validation of reliable markers can aid in assessing the risk of angioinvasion, predicting disease progression, and optimizing treatment decisions for patients with PTC. However, further research and validation on larger patient cohorts are necessary to establish the robustness and generalizability of these markers in clinical practice.
Topics: Humans; Thyroid Cancer, Papillary; Vascular Endothelial Growth Factor A; Carcinoma, Papillary; Thyroid Neoplasms; Disease Progression
PubMed: 38089632
DOI: 10.3389/fendo.2023.1261860