Abstract
Carcinoma of the thyroid gland is the most common cancer of the endocrine system. It accounts for approximately 10% of thyroid focal lesions, and the incidence of this cancer is increasing. A valuable technique for differentiating cancerous from benign nodules is fine-needle aspiration biopsy (FNA) with cytological verification. Unfortunately, in 30% of cases, FNA results are not sufficient to determine the proper method of treatment. Therefore, many patients are referred for diagnostic surgery and histopathologic examination. Despite the development of new imaging and molecular diagnostic techniques, no universal marker for pre-surgery identification of malignant changes in the thyroid is available. Modern measuring techniques, such as nuclear magnetic resonance spectroscopy - NMR - and mass spectrometry – MS, in combination with chemometric analysis led to the development of a new field of biology – metabolomics. Metabolomics allows for the analysis of biochemical processes in biological systems by assessing the metabolome (set of all metabolites - small molecular compounds with a molecular weight <1000 Da - contained in measured biological material). The metabolite profile quantitatively and qualitatively changes in response to disturbances of homeostasis. The promising results of the use of metabolomics methods as diagnostic tools for certain cancers and our experience with using metabolomics methods to differentiate benign from malignant thyroid tumors suggest that this field of science, which has been growing for several years, will improve the diagnosis and differentiation of thyroid cancer.
Highlights
Focal thyroid lesions in the form of individual nodules or multinodular goiters are one of the most common problems for endocrinologists and endocrine surgeons
There was no significant difference in the level of let-7e between benign nodules and cancerous tissue, which may suggest that the increased serum concentration of let-7e could be due to other factors that are not necessarily related to the presence of a malignant tumor in the thyroid gland [6,18,19]
Ninety-three samples from patients after subtotal or total thyroidectomy were used in that study, and the results indicated that the incidence of cholesterol/cholesteryl esters and di-/triglycerides cross peaks could be used to distinguish carcinomas from benign lesions [41]
Summary
Focal thyroid lesions in the form of individual nodules or multinodular goiters are one of the most common problems for endocrinologists and endocrine surgeons. Available sources show that they affect a large population of patients. They are identified by palpation in 2-6% of cases, by ultrasound in 19-35% of cases and by autopsy in 8-65% of cases [1]. It is estimated that approximately 4-12% of thyroid lesions are cancerous, with most being papillary carcinoma lesions [2]. The morbidity of thyroid cancer has increased in both women and men [3,4,5]. Large tumors with compression symptoms and quickly growing tumors clearly require surgery. Wide access to imaging diagnostics has made it possible to frequently detect small nodules in the thyroid parenchyma in patients without clinical symptoms. A commonly adopted diagnostic and therapeutic strategy sequence is the following: ultrasound - fine-needle biopsy under ultrasound control - decision to perform surgery on the basis of cytology or active surveillance
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