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Current Opinion in Endocrinology,... Oct 2017Thyroid cancer incidence and mortality trends have been identified as being consistent with overdiagnosis, and several recent efforts have been made to mitigate this... (Review)
Review
PURPOSE OF REVIEW
Thyroid cancer incidence and mortality trends have been identified as being consistent with overdiagnosis, and several recent efforts have been made to mitigate this problem.
RECENT FINDINGS
Major guidelines for thyroid nodule management recommend against general biopsy of nodules less than 1 cm in size. Data supporting the safety of active surveillance of low-risk thyroid cancers is now recognized. Tumors previously labeled as encapsulated follicular variant papillary thyroid cancers are now recommended to be called noninvasive follicular thyroid neoplasm with papillary-like nuclear features.
SUMMARY
Workup, diagnostic, and management of papillary thyroid cancer are changing rapidly to accommodate the recognition that many thyroid cancers are low risk and do not require aggressive, immediate intervention.
Topics: Biopsy; Carcinoma, Papillary; Humans; Medical Overuse; Neoplasm Invasiveness; Risk; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroid Nodule
PubMed: 28692457
DOI: 10.1097/MED.0000000000000359 -
Frontiers in Endocrinology 2021Thermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally,... (Review)
Review
Thermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally, Radiofrequency ablation (RFA) is among one of the most widely used thermal ablative techniques, and is gaining traction in North America. Surgery remains the standard of care for most thyroid cancer, and in the right clinical setting, Active Surveillance (AS) can be a reasonable option for low risk disease. Minimally invasive techniques have emerged as an alternative option for patients deemed high risk for surgery, or for those patients who wish to receive a more active treatment approach compared to AS. Herein, we review the literature on the safety and efficacy of RFA for treating benign non-functioning thyroid nodules, autonomously functioning thyroid nodules, primary small low risk thyroid cancer (namely papillary thyroid cancer) as well as recurrent thyroid cancer.
Topics: Catheter Ablation; History, 21st Century; Humans; Neoplasm Recurrence, Local; Radiofrequency Ablation; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroid Nodule; Treatment Outcome
PubMed: 34248853
DOI: 10.3389/fendo.2021.698689 -
The Medical Clinics of North America Mar 2012Thyroid nodules are common entities, clinically important primarily because of their malignant potential. Serum thyrotropin and thyroid ultrasonography are pivotal in... (Review)
Review
Thyroid nodules are common entities, clinically important primarily because of their malignant potential. Serum thyrotropin and thyroid ultrasonography are pivotal in evaluating thyroid nodules. Fine-needle aspiration biopsy is the most accurate tool for diagnosing malignancy and selecting candidates for surgery. An approach to the initial evaluation and management of single nodules, functioning nodules, multinodular glands, incidental nodules, and cysts is discussed, as are therapeutic interventions for benign nodules. Thyroid cancer discovered during pregnancy is also discussed.
Topics: Diagnosis, Differential; Humans; Incidental Findings; Neoplasm Staging; Risk Factors; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography, Interventional
PubMed: 22443979
DOI: 10.1016/j.mcna.2012.02.002 -
CA: a Cancer Journal For Clinicians Mar 2018Incidental thyroid nodules that are found on an imaging study performed for reasons other than thyroid pathology represent a common scenario encountered by health care... (Review)
Review
Incidental thyroid nodules that are found on an imaging study performed for reasons other than thyroid pathology represent a common scenario encountered by health care providers. The initial workup for these nodules comprises a thorough history and physical examination, thyroid function tests, a dedicated thyroid ultrasound, and fine-needle aspiration of any suspicious lesions. Management ranges from observation and reassurance to surgical resection and depends on the cytologic diagnosis. In cases of cytologically indeterminate or discordant nodules, surgical excision (lobectomy) offers a definitive diagnosis, although molecular testing or a reasonable period of observation may be useful as less invasive adjuncts. CA Cancer J Clin 2018;68:97-105. © 2018 American Cancer Society.
Topics: Biopsy, Fine-Needle; Diagnosis, Differential; Humans; Incidental Findings; Molecular Diagnostic Techniques; Positron-Emission Tomography; Practice Guidelines as Topic; Thyroid Function Tests; Thyroid Neoplasms; Thyroid Nodule; Ultrasonography
PubMed: 29369334
DOI: 10.3322/caac.21447 -
JAMA Oncology Aug 2016Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients with EFVPTC are...
IMPORTANCE
Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients with EFVPTC are treated as having conventional thyroid cancer.
OBJECTIVE
To evaluate clinical outcomes, refine diagnostic criteria, and develop a nomenclature that appropriately reflects the biological and clinical characteristics of EFVPTC.
DESIGN, SETTING, AND PARTICIPANTS
International, multidisciplinary, retrospective study of patients with thyroid nodules diagnosed as EFVPTC, including 109 patients with noninvasive EFVPTC observed for 10 to 26 years and 101 patients with invasive EFVPTC observed for 1 to 18 years. Review of digitized histologic slides collected at 13 sites in 5 countries by 24 thyroid pathologists from 7 countries. A series of teleconferences and a face-to-face conference were used to establish consensus diagnostic criteria and develop new nomenclature.
MAIN OUTCOMES AND MEASURES
Frequency of adverse outcomes, including death from disease, distant or locoregional metastases, and structural or biochemical recurrence, in patients with noninvasive and invasive EFVPTC diagnosed on the basis of a set of reproducible histopathologic criteria.
RESULTS
Consensus diagnostic criteria for EFVPTC were developed by 24 thyroid pathologists. All of the 109 patients with noninvasive EFVPTC (67 treated with only lobectomy, none received radioactive iodine ablation) were alive with no evidence of disease at final follow-up (median [range], 13 [10-26] years). An adverse event was seen in 12 of 101 (12%) of the cases of invasive EFVPTC, including 5 patients developing distant metastases, 2 of whom died of disease. Based on the outcome information for noninvasive EFVPTC, the name "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) was adopted. A simplified diagnostic nuclear scoring scheme was developed and validated, yielding a sensitivity of 98.6% (95% CI, 96.3%-99.4%), specificity of 90.1% (95% CI, 86.0%-93.1%), and overall classification accuracy of 94.3% (95% CI, 92.1%-96.0%) for NIFTP.
CONCLUSIONS AND RELEVANCE
Thyroid tumors currently diagnosed as noninvasive EFVPTC have a very low risk of adverse outcome and should be termed NIFTP. This reclassification will affect a large population of patients worldwide and result in a significant reduction in psychological and clinical consequences associated with the diagnosis of cancer.
Topics: Adenocarcinoma, Follicular; Adult; Aged; Aged, 80 and over; Carcinoma; Carcinoma, Papillary; Female; Humans; Male; Medical Overuse; Middle Aged; Neoplasm Invasiveness; Retrospective Studies; Terminology as Topic; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroid Nodule; Young Adult
PubMed: 27078145
DOI: 10.1001/jamaoncol.2016.0386 -
Asian Pacific Journal of Cancer... Dec 2022This study evaluated differences in Claudin-1 expression between follicular adenoma (FA), follicular thyroid carcinoma (FTC), follicular variant papillary thyroid...
OBJECTIVE
This study evaluated differences in Claudin-1 expression between follicular adenoma (FA), follicular thyroid carcinoma (FTC), follicular variant papillary thyroid carcinoma (FV-PTC), and papillary thyroid carcinoma (PTC).
MATERIAL AND METHODS
This study used a cross-sectional approach. Immunostaining using the polyclonal antibody Claudin-1 was performed on 75 samples divided into 20 samples for follicular adenoma, follicular thyroid carcinoma, papillary carcinoma, and 15 samples of follicular variant thyroid carcinoma, respectively.
RESULTS
Claudin-1 expression is detected on the cytoplasmic membrane of tumor cells and appears to be varied among thyroid neoplasms. The claudin-1 expression score revealed a statistically significant difference between FA against FV-PTC, FA versus (vs) PTC, and FTC vs PTC, with median values of 4 vs 6 (p = 0.016), 4 vs 8 (p = 0.001), and 5 vs 8 (p = 0.002), respectively. However, there was no statistically significant difference in scores between the FA and the FTC (4 vs 5), or between the FTC and the FV-PTC groups (5 vs 6 (p=1,000).
CONCLUSION
These results suggest that Claudin-1 may be capable of discriminating follicular adenoma from classic and follicular variant of papillary thyroid carcinoma. It can also differentiate follicular thyroid carcinoma and papillary thyroid carcinoma, especially for cases challenging to assess by hematoxylin and eosin staining. It still holds promise in providing targeted cancer therapy.
Topics: Humans; Thyroid Cancer, Papillary; Claudin-1; Thyroid Neoplasms; Adenocarcinoma, Follicular; Adenoma
PubMed: 36579982
DOI: 10.31557/APJCP.2022.23.12.4023 -
Frontiers in Endocrinology 2022Immunotherapy has changed the treatment of patients with advanced cancer, with different phase III trials showing durable responses across different histologies. This... (Review)
Review
Immunotherapy has changed the treatment of patients with advanced cancer, with different phase III trials showing durable responses across different histologies. This review focuses on the preclinical and clinical evidence of potential predictive biomarkers of response and efficacy of immunotherapy in thyroid neoplasms. Programmed death-ligand 1 (PD-L1) staining by immunohistochemistry has shown higher expression in anaplastic thyroid cancer (ATC) compared to other subtypes. The tumor mutational burden in thyroid neoplasms is low but seems to be higher in ATC. Immune infiltrates in the tumor microenvironment (TME) differ between the different thyroid neoplasm subtypes. In general, differentiated thyroid cancer (DTC) has a higher number of tumor-associated lymphocytes and regulatory T cells (Tregs), while ATC and medullary thyroid cancer (MTC) display a high density of tumor-associated macrophages (TAMs). Nevertheless, results from clinical trials with immunotherapy as monotherapy or combinations have shown limited efficacy. Further investigation into new strategies aside from anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4)/programmed death 1 (PD-1)/PD-L1 antibodies, validation of predictive biomarkers, and better population selection for clinical trials in thyroid neoplasms is more than needed in the near future.
Topics: B7-H1 Antigen; Humans; Immunotherapy; Thyroid Carcinoma, Anaplastic; Thyroid Neoplasms; Tumor Microenvironment
PubMed: 35992118
DOI: 10.3389/fendo.2022.929091 -
European Journal of Surgical Oncology :... Mar 2018An increased incidence of differentiated thyroid cancer (DTC) has resulted in an increased population of thyroid cancer survivors requiring ongoing disease surveillance.... (Review)
Review
An increased incidence of differentiated thyroid cancer (DTC) has resulted in an increased population of thyroid cancer survivors requiring ongoing disease surveillance. Our institution's risk-adapted surveillance strategy is based on a contemporary understanding of disease biology, guided by analysis of prognostic factors and balanced application of available surveillance modalities. The goal of this strategy is to detect recurrent disease early, identify patients who would benefit from further treatment and reduce over investigation of low-risk patients. This article describes our center's risk-stratified approach to the postoperative surveillance of patients with differentiated thyroid cancer with reference to the recent 2015 American Thyroid Association management guidelines.
Topics: Biomarkers, Tumor; Carcinoma, Papillary; Humans; Lymphatic Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Population Surveillance; Practice Guidelines as Topic; Prognosis; Risk Assessment; Thyroid Neoplasms; United States
PubMed: 28754228
DOI: 10.1016/j.ejso.2017.07.004 -
Acta Medica (Hradec Kralove) 2017The double innervation of the thyroid comes from the sympathetic and parasympathetic nervous system. Injury rates during surgery are at 30% but can be minimized by... (Review)
Review
The double innervation of the thyroid comes from the sympathetic and parasympathetic nervous system. Injury rates during surgery are at 30% but can be minimized by upwardly preparing the thyroid vessels at the level of thyroid capsule. Several factors have been accused of increasing the risk of injury including age and tumor size. Our aim was to investigate of there is indeed any possible correlations between these factors and a possible increase in injury rates following thyroidectomy. Seven studies were included in the meta-analysis. Statistical correlation was observed for a positive relationship between injury of the sympathetic nerve and thyroid malignancy surgery (p 2 = 74%) No statistical correlations were observed for a negative or positive relationship between injury of the sympathetic nerve and tumor size. There was also no statistically significant value observed for the correlation of the patients' age with the risk of sympathetic nerve injury (p = 0.388). Lack of significant correlation reported could be due to the small number of studies and great heterogeneity between them.
Topics: Humans; Intraoperative Complications; Peripheral Nerve Injuries; Sympathetic Nervous System; Thyroid Gland; Thyroid Neoplasms; Thyroidectomy
PubMed: 29716678
DOI: 10.14712/18059694.2018.8 -
International Journal of Molecular... Sep 2023Thyroid cancer has become more common in recent years all around the world. Many issues still need to be urgently addressed in the diagnosis, treatment, and prognosis of... (Review)
Review
Thyroid cancer has become more common in recent years all around the world. Many issues still need to be urgently addressed in the diagnosis, treatment, and prognosis of thyroid cancer. Liquid biopsy (mainly circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and circulating exosomes) may provide a novel and ideal approach to solve these issues, allows us to assess the features of diseases more comprehensively, and has a function in a variety of malignancies. Recently, liquid biopsy has been shown to be critical in thyroid cancer diagnosis, treatment, and prognosis in numerous previous studies. In this review, by testing CTCs, ctDNA, and exosomes, we focus on the possible clinical role of liquid biopsy in thyroid cancer, including diagnostic and prognostic biomarkers and response to therapy. We briefly review how liquid biopsy components have progressed in thyroid cancer by consulting the existing public information. We also discuss the clinical potential of liquid biopsy in thyroid cancer and provide a reference for liquid biopsy research. Liquid biopsy has the potential to be a useful tool in the early detection, monitoring, or prediction of response to therapies and prognosis in thyroid cancer, with promising clinical applications.
Topics: Humans; Exosomes; Thyroid Neoplasms; DNA, Neoplasm; Liquid Biopsy
PubMed: 37762070
DOI: 10.3390/ijms241813767