Benign Thyroid Lesions Research Articles

The Multifaceted Profile of Thyroid Disease in the Background of DICER1 Germline and Somatic Mutations: Then, Now and Future Perspectives

DICER1 protein is a member of the ribonuclease (RNAse) III family with a key role in the biogenesis of microRNAs (miRNA) and in microRNA processing, potentially affecting gene regulation at the post-transcriptional level. The role of DICER1 and its relevance to thyroid cellular processes and tumorigenesis have only recently been explored, following the acknowledgement that DICER1 germline and somatic changes can contribute not only to non-toxic multinodule goiter (MNG) lesions detected in individuals of affected families but also to a series of childhood tumours, including thyroid neoplasms, which can be identified from early infancy up until the decade of 40s. In a context of DICER1 germline gene mutation, thyroid lesions have recently been given importance, and they may represent either an index event within a syndromic context or the isolated event that may trigger a deeper and broader genomic analysis screening of individuals and their relatives, thereby preventing the consequences of a late diagnosis of malignancy. Within the syndromic context MNG is typically the most observed lesion. On the other hand, in a DICER1 somatic mutation context, malignant tumours are more common. In this review we describe the role of DICER protein, the genomic events that affect the DICER1 gene and their link to tumorigenesis as well as the frequency and pattern of benign and malignant thyroid lesions and the regulation of DICER1 within the thyroidal environment.

Is surgery necessary in benign thyroid lesions?

Is surgery necessary in benign thyroid lesions?

Contrast-Enhanced Ultrasonography for Differential Diagnosis of Benign and Malignant Thyroid Lesions: Single-Institutional Prospective Study of Qualitative and Quantitative CEUS Characteristics.

Objectives To extend and revise the diagnostic value of contrast-enhanced ultrasonography (CEUS) for differentiation between malignant and benign thyroid nodules. Methods This single-institution prospective study aims to compare CEUS qualitative and objective quantitative parameters in benign and malignant thyroid nodules. Consecutive cohort of 100 patients was examined by CEUS, 68 out of them were further analysed in detail. All included patients underwent cytological and/or histopathological verification of the diagnosis. Results Fifty-five (81%) thyroid nodules were benign, and 13 (19%) were malignant. Ring enhancement pattern was strongly associated with a benign aetiology (positive predictive value 100%) and heterogeneous enhancement pattern with malignant aetiology (positive predictive value 72.7%). The shape of the TIC (time-intensity curve) was more often identical in the benign lesion (98.2%) than in malignant lesions (69.2%), p=0.004. Conclusions This study indicates that CEUS enhancement patterns were significantly different in benign and malignant lesions. Ring enhancement was a very strong indicator of benign lesions, whereas heterogeneous enhancement was valuable to detect malignant lesions.

EIF1AX mutation in thyroid tumors: a retrospective analysis of cytology, histopathology and co-mutation profiles

BackgroundThe EIF1AX mutation has been identified in various benign and malignant thyroid lesions, with a higher prevalence in poorly differentiated thyroid carcinoma (PDTC) and anaplastic thyroid carcinoma, especially when combined with RAS or TP53 mutation. However, data and clinical significance of EIF1AX mutations in thyroid nodules is still limited. We investigated the prevalence of EIF1AX mutations and co-mutations in cytologically indeterminate thyroid nodules at our institution.MethodsA 5-year retrospective analysis was performed on surgically resected thyroid nodules with identified EIF1AX mutations on molecular testing with ThyroseqV3®. Mutation type and presence of co-mutations were correlated with histopathologic diagnosis and clinical characteristics. Histopathology diagnoses were subsequently categorized as benign, borderline, malignant or aggressive malignant (≥ 10% PDTC component). Chi-square test was used to compare the malignancy associations of the: 1) A113_splice mutation compared to non-A113_splice mutations 2) singular A113_splice mutations compared to singular non-A113_splice mutations. Fisher’s Exact Test was used to determine the association of A113_splice mutation with aggressive malignancies compared to non-A113_splice mutations. A p value of 0.05 or less was considered statistically significant.ResultsOut of 1583 patients who underwent FNA, 621 had further molecular testing. 31 cases (5%) harbored EIF1AX mutations. Of these cases, 12 (38.7%) were malignant, 2 (6.5%) were borderline, and 17 (55%) were benign. 4/31 cases (13%) were aggressive malignant (≥ 10% PDTC component). The most prevalent mutation was the A113_splice mutation at the junction of intron 5 and exon 6 (48%). All other mutations, except one, were located at the N-terminal in exon 2. 7/31 cases (22.6%) harbored ≥ 1 co-mutation(s), including 4 RAS, 3 TP53, 1 TERT and 1 PIK3CA, with 86% of them being malignant. All 4 nodules with RAS co-mutations were malignant including one PDTC.ConclusionOur study reports the largest cohort of EIF1AX mutations in Bethesda III/IV FNA samples with surgical follow-up to our knowledge. The presence of the EIF1AX mutation confers a 45.2% risk of malignancy (ROM) or borderline after surgery. However, the coexistence of EIF1AX mutations with other driver mutations such as RAS, TERT or TP53 conferred an 86% ROM. While 55% of thyroid nodules were benign at the time of surgery, the possible malignant transformation of these nodules, had they not been resected, is unknown. Finally, 13% of the nodules with EIF1AX mutations were aggressive with a significant PDTC component. These findings can further aid in clinical decisions for patients with thyroid nodules.Graphic

Relationship between vascular endothelial growth factor expression and thyroid stimulating hormone level in benign and malignant thyroid lesions.

ABSTRACTBackground:Vascular endothelial growth factor (VEGF) stimulates angiogenesis, increases vascular permeability and seems to correlate to aggressiveness of tumors. Thyroid cancer has been found to have higher levels of VEGF expression. Thyroid stimulating hormone (TSH) is the most important thyroid hormone, yet few researches have been done on its relationship with VEGF.Aim:To study the clinical and demographic profile of thyroid lesions (benign and malignant) and to explored the relationship between VEGF expression (using immunochemistry) and serum TSH level.Methods:This prospective, observational study includes 61 patients of thyroid lesions who underwent partial, hemi, subtotal or total thyroidectomy as the primary treatment from June 2014 and July 2016. Tissue specimens of thyroid lesions for immunohistochemistry study of VEGF expression were done. Serum TSH was done using Chemiluminiscence technique and correlated to VEGF expression.Results:The mean age of patient was 36.26 ± 11.53 years (range 20-50 years) with female preponderance. Swelling was the most common presenting symptom. Of 61 patients, 37 (60.65%) patients were benign and 24 (39.35%) were malignant thyroid lesions. The mean TSH level in benign group was 1.92 ± 0.94 mIU/liter and malignant group was 2.73 ± 1.74 mIU/liter which was statistically significant (P = 0.023). VEGF expression was strongly positive (3+) in 26 (42.62%) patients and negative/equivocal (1+ & 2+) in 35 (57.38%) patients. In benign group, 10 (27.0%) patients were strongly positive for VEGF whereas in malignant group, 16 (66.7%) patients were strongly positive for VEGF showed significant association (P = 0.002). On comparing TSH level of benign, malignant and total patients separately with VEGF expression, significant association were also observed (P < 0.001, P = 0.004 and P < 0.001, respectively).Conclusion:VEGF was strongly expressed in malignant thyroid lesions which are having high serum concentration of serum TSH level. Serum TSH levels reveal a significant correlation with VEGF expression.

A Rare Finding of Abundant Crystals in Thyroid FNAC

Thyroid is a versatile endocrine organ. Fine needle aspiration cytology is the famous technique which is safe, easy to perform, cost effective and more accurate in diagnosing benign and malignant thyroid lesions. Our case shows a rare presentation of numerous calcium oxalate crystals within the colloid in thyroid smear which indicates degenerative and atrophic changes in the follicles, and can also be seen in numerous other benign and systemic conditions which roots the underlying pathology and helps in treatment as well as stays as a unique rare finding.

Віддалені результати хірургічного лікування доброякісної вогнищевої патології щитоподібної залози

Проведено аналіз віддалених результатів органозберігаючих операцій на щитоподібній залозі з приводу доброякісної вогнищевої патології. Виявлені закономірності виникнення рецидивів залежно від обсягу операції, морфологічного типу вузлів, їх множинності. Також вивчений вплив радіаційного опромінення, отриманого в 1986 р. внаслідок аварії на ЧАЕС, на розвиток рецидивів доброякісної вогнищевої патології щитоподібної залози.

High-performance sonographical multimodal imaging of non cystic thyroid lesions: Chances of the preoperative diagnostics in relation to histopathology.

AIM:To improve preoperative diagnostics of solid non-cystic thyroid lesions by using new high-performance ultrasound techniques: optimized B-mode morphology, elastography, Color-Coded Doppler-Sonography (CCDS) and contrast enhanced ultrasound (CEUS)MATERIALS AND METHODS:In 33 cases solid, non-cystic thyroid lesions were rated as TIRADS 3 and up from conventional B-mode examinations. Additional high resolution Power Doppler including HR- and Glazing-Flow as optimized macrovascularization techniques, shear wave elastography and CEUS were performed on these patients by one experienced examiner. For CEUS a bolus of 1–2.4 ml Sulfurhexafluorid microbubbles (SonoVue®, Bracco, Milan, Italy) was injected into a cubital vein and then the distribution kinetics of the contrast agent were documented from the early arterial phase (10 to 15 seconds after injection) to the late venous phase (5 minutes after injection). Postoperative histopathology was the diagnostic gold standard as it provides the most reliable proof.RESULTS:33 patients (13 males, 20 females; age 29 –77 years; mean 55 years; SD 13 years) were included in this study. 28 of them had benign regressive thyroid nodules, 3 had adenomas and 4 were diagnosed with carcinomas (3 were histologically identified as papillary thyroid carcinomas, one as a medullary thyroid carcinoma). The volume of the thyroid gland ranged from 6.6 to 401.3 cm2 (mean 72.6±92.0 cm2).The adenoma diameters ranged from 9 to 40 mm (mean 22±16 mm) and the carcinoma diameters ranged from 19 to 33 mm (mean 26±6 mm). The 3 adenomas had different echogenicities: One was completely echofree, one was hypoechoic and one isoechoic. The 4 carcinomas however were equally characterized as hypoechoic and echofree. Two of three adenomas and all of the carcinomas showed an incomplete or diffuse margin. Micro-calcifications were found in one adenoma and in every carcinoma. However, no micro-calcifications were observed in cases of benign regressive nodules.Performing shear-wave elastography the adenomas showed lower values than the carcinomas: The tissue velocity of the adenomas ranged from 2.86 m/s to 3.85 m/s (mean 3.32±0.5 m/s) and in carcinomas from 3.89 m/s to 5.66 m/s (mean 4.18±0.3 m/s).Marginal hypervascularization was detected in two adenomas after applying CCDS. One adenoma was hypovascularized. The four carcinomas showed an irregular extreme hypervascularization along their margins as well as an irregular central normo- or hypervascularization in CCDS. The additional HR-Flow helped reducing artefacts.In CEUS the dynamic capillary microvascularization of all carcinomas was very irregular with early enhancement and followed by partial or complete wash-out. In CEUS two adenomas had no wash-out and the other one showed a partial wash-out.CONCLUSION:Using modern multimodal imaging offers new possibilities for the differentiation between benign and malignant thyroid lesions. It is a very important diagnostic tool in addition to the B-Mode TIRADS classification and eases the decision between TIRADS 3, 4 and 5. However, additional multicenter studies are required for more detailed evaluations.

Discrimination between malignant and benign thyroid tumors by diffusion-weighted imaging – A systematic review and meta analysis

PurposeMagnetic resonance imaging is used to stage thyroid tumors. Diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) can be used to reflect tumor microstructure. Our aim was to compare ADC values of malignant and benign thyroid lesions based on a large sample. MethodsMEDLINE library, EMBASE and SCOPUS databases were screened for the associations between ADC values and thyroid lesions up to August 2021. The primary endpoint of the systematic review were ADC values of benign and malignant thyroid lesions. In total, 29 studies were suitable for the analysis and were included into the present study. ResultsThe included studies comprised a total of 2137 lesions, 1118 (52.3%) benign and 1019 (47.7%) malignant lesions. The pooled mean ADC value of the benign thyroid lesions was 1.88 × 10−3 mm2/s [95% CI 1.77–2.0] and the pooled mean ADC value of malignant thyroid lesions was 1.15 × 10−3 mm2/s [95% CI 1.04–1.25]. ConclusionsADC can well discriminate benign and malignant thyroid tumors. Therefore, DWI should be implemented into the presurgical diagnostic work-up in clinical routine.

Можливості передопераційних та інтраопераційних методів діагностики вузлової патології щитоподібної залози

При вузловій патології щитоподібної залози (ЩЗ) важливо своєчасно встановити характер патологічного процесу, оскільки від цього залежить алгоритм лікування пацієнта. Основним та ефективним методом передопераційної діагностики залишається тонкоголкова аспіраційна пункційна біопсія (ТАПБ). Однак на цьому етапі не завжди вдається отримати інформативні результати, а також запобігти зайвих операцій або чітко виявити/виключити злоякісний процес. Зменшити частку неінформативних результатів у деяких випадках допомагає стрижнева біопсія голкою, яку пропонують виконувати як альтернативу повторної ТАПБ. Ще один підхід, який достатньо широко використовують для поліпшення перед­операційної діагностики вузлової патології ЩЗ, полягає у додатковому дослідженні з використанням специфічних молекулярних маркерів і тестів. Для ідентифікації доброякісних утворень найчастіше застосовують класифікатор експресії генів, а для виявлення злоякісного процесу — тест на наявність мутацій і генетичних перебудов. Оскільки навіть такий комплексний підхід не завжди дозволяє розмежувати доброякісні та злоякісні пухлини, актуальними залишаються інтраопераційні експрес-гістологічні дослідження (ЕГД). При цьому паралельне виконання ЕГД та інтраопераційної цитології підвищує ефективність інтраопераційної діагностики. Отже, спектр наданих методів широкий, тому в даному огляді були розглянуті особливості кожного підходу, зокрема, ефективність, можливості та обмеження, а також було показано, в яких ситуаціях доцільно проводити ті чи інші дослідження або їх комплекс.

Correlation between Ultrasonography and Fine Needle Aspiration Cytology (FNAC) Findings in Patients with Thyroid Lesions

Background:Thyroid nodules are common presentation in patients having thyroid disorders. There is approximately 4-5% incidence of clinically apparent thyroid lesions in general populations.Thyroid nodules are about four times more common in females than in males. The present study aims to diagnose the thyroid lesions and evaluate to relation and diagnostic test of ultrasonography (USG) and Fine Needle Aspiration Cytology (FNAC) report. To determine the sensitivity of ultrasonography in detecting thyroid lesions.Method:This was hospital based prospective study carried in 94 patients who came to radiology department for USG neck, after clinical examination frommedicine, surgery and ENT department.Those patients with thyroid lesions were followed and advised for USG guided FNAC of thyroid swelling. The patients who were advised for FNAC, and gave consent for procedure were included in the study. The USG guided FNAC was done and wasfurther evaluated by pathologist. Results:Out of 94 cases, 85 were benign nodules and 9 were malignant nodules by USG which were further confirmed by FNAC with results of 87 benign and 7 malignant.The USG diagnosed the benign thyroid nodule with sensitivity of 96.55% and specificity of 85.71%, positive predictive value 98.82%, negative predictive value 66.67%, accuracy 95.74%. The result revealed that there is a strong relation between diagnoses of benign thyroid lesions by USG and final diagnosis by FNAC (P=0.001).Conclusion:High resolution grey scale imaging features can differentiate benign and malignant lesions. USG is very helpful for FNAC, characterization of nodules and provides differential diagnosis in those patients affecting with thyroid disorders.

Application of Pet-CT Fusion Deep Learning Imaging in Precise Radiotherapy of Thyroid Cancer.

This article explores the value of wall F-FDG PET/Cr imaging in the diagnosis of thyroid cancer, studies its ability to distinguish benign and malignant thyroid lesions, and seeks ways to improve the accuracy of diagnosis. The normal control group selected 40 patients who came to our center for physical examination. In the normal control group, the average value of the standard uptake value of both sides of the thyroid was used as the SUV of the thyroid gland and the highest SUV value of the patient's lesion (SUV max) represented the SUV of the lesion. After injection of imaging agent 18F-FD1G, routine imaging was performed at 1h, time-lapse imaging was performed at 2.5 h, and the changes with conventional imaging were compared to infer the benign and malignant lesions. We used SPSS software to carry out statistical analysis, respectively, carrying out analysis of variance, paired t-test, independent sample t-test, and linear correlation analysis. In the thyroid cancer group, 87.5% of the delayed imaging SUV was higher than the conventional imaging SUV, while 83.33% of the benign disease group had a lower SUV than the conventional imaging SUV. 18F-FDG PET/CT imaging has higher sensitivity and specificity for the diagnosis of recurrence or metastasis in patients with Tg positive. However, it has lower sensitivity and specificity for the diagnosis of 131I-Dx-WBS negative DTC and 18F-FDG PET/CT. The specificity increases with the increase of serum Tg level. The above results confirm that 18F-FDG PET/CT imaging is of great significance for the diagnosis of recurrence or metastasis in patients; with PET/CT imaging, the results changed 16.13% of the Tg-positive and 131I-Dx-WBS negative DTC patients' later treatment decision. The decision-making and curative effect evaluation have certain value.

NRAS Q61R immunohistochemical staining in thyroid pathology: sensitivity, specificity and utility.

The diagnosis of thyroid neoplasms relies upon the demonstration of histological parameters that can be focal and prone to subjective interpretation. We evaluated the utility of NRAS Q61R immunohistochemistry (IHC) in the diagnosis of thyroid lesions after determining its specificity and sensitivity as a surrogate marker for RAS Q61R mutation. NRAS Q61R IHC was performed on 282 primary or metastatic thyroid lesions from 256 patients. RAS mutation status was collected from patients' charts. Sensitivity and specificity of NRAS Q61R IHC for detecting a RAS Q61R mutation was calculated. IHC-positive cases were reviewed to determine the diagnostic utility of NRAS Q61R IHC. NRAS Q61R immunopositivity was seen in non-neoplastic, benign and malignant thyroid lesions. NRAS Q61R antibody cross-reactivity led to the detection of NRAS Q61R, KRAS Q61R and HRAS Q61R proteins. Among primary thyroid carcinomas, immunopositivity was most frequent in papillary thyroid carcinomas, follicular variant (48.0%). The sensitivity and specificity of NRAS Q61R IHC in detecting RAS Q61R mutation was 90.6% and 92.3%, respectively. When positive, the NRAS Q61R stain was determined to be helpful in demonstrating infiltration, tumour size, capsular and/or vascular invasion and multifocality. NRAS Q61R IHC is highly sensitive and specific for the detection of RAS Q61R mutations in thyroid pathology and is particularly relevant in follicular-patterned neoplasms. When evaluated alongside histological features, NRAS Q61R immunoreactivity can be instrumental in the diagnosis and classification of thyroid nodules.

Diagnostic Performance of ACR-TIRADS in Differentiating Benign From Malignant Thyroid Nodules in Patients Undergoing Fine-Needle Aspiration Biopsy: Comparative Study Based on Five International Guidelines for Management of Thyroid Nodules

Background: The purpose of this study was to retrospectively analyze the diagnostic performance of different international guidelines to detect benign from malignant nodules using fine-needle aspiration biopsy as a reference test. Methods: This study is a multi-institution, IRB-approved, retrospective study conducted from 2016 to 2020 that evaluated 200 consecutive biopsied thyroid nodules. The nodules were reclassified according to American College of Radiology Thyroid Imaging and Reporting Data System (ACR-TIRADS), Kwak-TIRADS (K-TIRADS), Korean Society of Thyroid Radiology (KSThR), European Thyroid Imaging and Reporting Data System (EU-TIRADS), and American Thyroid Association (ATA) guidelines. A Chi-squared test and receiver operating curve (ROC) with 95% confidence intervals and P-value &lt; 0.05 were performed to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative and unnecessary biopsy rate. The unnecessary biopsy rate was defined as the percentage of benign nodules among total biopsy-required nodules. Results: A total of 200 patients were included in this study. Patients aged from 23 to 74 years including 36 males and 164 females. The female/male ratio was 4.5:1. Female predominance was seen among most of the age groups. The cohort showed 26 (13%) malignant nodules and 174 (87%) benign nodules. A solid component was observed in the majority of malignant nodules (61.6%, P = 0.0376) and mixed component was observed in the majority of benign nodules (51.7%, P = 0.0376). There was no statistically significant difference in differentiating benign from malignant nodule with the echogenicity or orientation of the nodule. The statistically significant features of a benign nodule were spongiform appearance, no echogenic foci or comet tail and absence of peripheral halo (P &lt; 0.03). The statistically significant features of a malignant nodule were a solid, peripheral halo, peripheral or punctate echogenic foci, microcalcification, and macrocalcification (P &lt; 0.001). The ACR-TIRADS showed the highest specificity (40.23% (95% confidence interval (CI) 32 - 47)), PPV (18.75 (95% CI 0.12 - 0.26)), NPV (97.22 (95% CI 0.90 - 0.99)) and area under the curve (AUC) (0.6627 (95% CI 0.59 - 0.72)). This was closely followed by ATA which demonstrated the PPV of 17.39 (95% CI 0.11 - 0.24), NPV of 96.77 (95% CI 0.89 - 0.99) and AUC of 0.6340 (95% CI 0.57 - 0.69). The K-TIRADS has the highest sensitivity (96.15% (95% CI 80 - 99)). Lowest unnecessary biopsy rates were found with ACR-TIRADS (104 (52%) (P = 0.0013)) and KSThR guidelines (114 (57%) (P = 0.0059)) and highest with K-TIRADS (160 (80%) (P = 0.4482)). Conclusion: We found that diagnostic performance of ACR and ATA guidelines is higher and is a practical method for assessing thyroid nodules in routine practice. Both these guidelines can avoid unnecessary biopsies in a significant proportion of benign thyroid lesions. ACR-TIRADS is also very specific in identifying malignant lesions. The increased sensitivity of K-TIRADS is likely due to their lower size threshold. J Endocrinol Metab. 2021;11(3-4):69-75 doi: https://doi.org/10.14740/jem735

Role of Claudin-1 on diagnostic cut-off value and multiple tests in patients with papillary thyroid carcinoma

Objective: To explore the diagnostic cut-off value of Claudin-1 (Cla-1) in papillary thyroid carcinoma (PTC) and the efficacy of the multiple test. Methods: Clinical and pathological data were collected from 295 patients with PTC and 137 patients with benign thyroid lesions (BTL) admitted to two hospitals in Pingdingshan City, Henan Province from January 2015 to June 2020. The expression index of Cla-1, the positive expression rate of high molecular weight cytokeratin (HMW-CK) and the negative expression rate of leukocyte differentiation antigen 56 (CD56) were calculated according to the results of immunohistochemistry. Receiver operating characteristic (ROC) curve was used to determine the cut-off value of Cla-1 for diagnosing PTC. Cla-1+HMW-CK, Cla-1+CD56, HMW-CK+CD56 and Cla-1+HMW-CK+CD56 were tested in series, and the diagnostic efficacy was evaluated by sensitivity, specificity and accuracy. Results: The age of PTC patients M (P25, P75) was 48.0 (41.0, 55.0) years old, among which 230 cases were male (78.0%). The age of BTL patients M (P25, P75) was 53.0 (46.0, 61.0) years old, including 34 males (24.8%). Cla-1 detection was conducted in all PTC and BTL patients, whereas only 198 and 97 cases conducted HMW-CK detection, 242 and 136 cases conducted CD56 detection, respectively. The M (P25, P75) of Cla-1 expression index in PTC was 80.0% (45.0%, 90.0%), which was higher than that in BTL [0.0 (0.0, 2.0%)] (P<0.001). The positive expression rate of HMW-CK was 93.9% (186/198) in PTC, and was negative in all BTL. The negative expression rate of D56 was 89.7% (217/242) in PTC, higher than that of BTL [1.5% (2/136)] (P<0.001). When expression index 19.0% was set as the cut-off value of Cla-1 for diagnosing PTC, the area under the ROC curve (AUC) was the maximum [AUC (95%CI): 0.981 (0.969, 0.994)], and the sensitivity, specificity and accuracy were 92.2% (272/295), 98.5% (135/137) and 94.2% (407/432), respectively. In multiple tests for diagnosis of PTC, the sensitivity ranged from 89.3% to 94.7%, specificity were all 100.0% and accuracy ranged from 93.1% to 96.9%. Conclusion: Cla-1 expression index ≥19.0% could be set as a cut-off value for the diagnosis of PTC and serial test of Cla-1 combined with HMW-CK(CD56) improves diagnostic specificity.

Diagnostic performance of acr-tirads in differentiating benign from malignant thyroid nodules in patients undergoing fine-needle aspiration biopsy: Comparative study based on five international guidelines for management of thyroid nodules

Background: The purpose of this study was to retrospectively analyze the diagnostic performance of different international guidelines to detect benign from malignant nodules using fine-needle aspiration biopsy as a reference test. Methods: This study is a multi-institution, IRB-approved, retrospective study conducted from 2016 to 2020 that evaluated 200 consecutive biopsied thyroid nodules. The nodules were reclassified according to American College of Radiology Thyroid Imaging and Reporting Data System (ACR-TIRADS), Kwak-TIRADS (K-TIRADS), Korean Society of Thyroid Radiology (KSThR), European Thyroid Imaging and Reporting Data System (EU-TIRADS), and American Thyroid Association (ATA) guidelines. A Chi-squared test and receiver operating curve (ROC) with 95% confidence intervals and P-value < 0.05 were performed to calculate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative and unnecessary biopsy rate. The unnecessary biopsy rate was defined as the percentage of benign nodules among total biopsy-required nodules. Results: A total of 200 patients were included in this study. Patients aged from 23 to 74 years including 36 males and 164 females. The female/male ratio was 4.5:1. Female predominance was seen among most of the age groups. The cohort showed 26 (13%) malignant nodules and 174 (87%) benign nodules. A solid component was observed in the majority of malignant nodules (61.6%, P = 0.0376) and mixed component was observed in the majority of benign nodules (51.7%, P = 0.0376). There was no statistically significant difference in differentiating benign from malignant nodule with the echogenicity or orientation of the nodule. The statistically significant features of a benign nodule were spongiform appearance, no echogenic foci or comet tail and absence of peripheral halo (P < 0.03). The statistically significant features of a malignant nodule were a solid, peripheral halo, peripheral or punctate echogenic foci, microcalcification, and macrocalcification (P < 0.001). The ACR-TIRADS showed the highest specificity (40.23% (95% confidence interval (CI) 32 - 47)), PPV (18.75 (95% CI 0.12 - 0.26)), NPV (97.22 (95% CI 0.90 - 0.99)) and area under the curve (AUC) (0.6627 (95% CI 0.59 - 0.72)). This was closely followed by ATA which demonstrated the PPV of 17.39 (95% CI 0.11 - 0.24), NPV of 96.77 (95% CI 0.89 - 0.99) and AUC of 0.6340 (95% CI 0.57 - 0.69). The K-TIRADS has the highest sensitivity (96.15% (95% CI 80 - 99)). Lowest unnecessary biopsy rates were found with ACR-TIRADS (104 (52%) (P = 0.0013)) and KSThR guidelines (114 (57%) (P = 0.0059)) and highest with K-TIRADS (160 (80%) (P = 0.4482)). Conclusion: We found that diagnostic performance of ACR and ATA guidelines is higher and is a practical method for assessing thyroid nodules in routine practice. Both these guidelines can avoid unnecessary biopsies in a significant proportion of benign thyroid lesions. ACR-TIRADS is also very specific in identifying malignant lesions. The increased sensitivity of K-TIRADS is likely due to their lower size threshold. J Endocrinol Metab. 2021;11(3-4):69-75 doi: https://doi.org/10.14740/jem735

Cytomorphological Profile of Thyroid Lesions on Fine Needle Aspiration Cytology

Background and Objectives: Fine needle aspiration cytology (FNAC) of thyroid offers an alternative, as an immediate, preliminary procedure associated with low cost, little trauma and complications. Being superficial and easily accessible it is an ideal organ for FNAC. It is useful in diagnosis of inflammatory, infectious and neoplastic conditions. The aim of this study was to evaluate the cytomorphological profile of thyroid lesions on FNAC with application of Bethesda system for reporting and perform cyto-histopathology correlation whenever possible with regards to age and sex distribution. Methodology: This two-year prospective study was conducted in the Cytology section of Pathology Department &amp; included 243 cases of thyroid gland enlargement. The detailed history of the patient including age, sex, presenting symptoms and duration of thyroid gland enlargement along with any other significant findings was note. FNAC was performed as per the protocol using a 23-gauge needle and smears stained using Haematoxylin &amp; Eosin (H&amp;E) and Papanicolaou stain, while air-dried smears were stained with Giemsa stain. Results: The study period included a total of 243 FNACs of thyroid enlargement. The age of patients ranged from 10 to 80 years with male to female ratio of 1.4. The diagnosis on FNAC was as follows Colloid Goitre (54.7 %), Lymphocytic Thyroiditis (9.54%), Follicular Neoplasm (7.05%), Hashimoto Thyroiditis (5.80 %), Benign Thyroid Lesions (3.31%) and Multinodular Goitre (2.90%). Conclusion: Thyroid fine needle aspiration cytology has proven to be a first line tool to evaluate the thyroid lesions because of its cost effectiveness and high patient acceptance. Fine needle aspiration cytology is highly successful in triaging patients with thyroid nodules into operative and non-operative groups and enables surgeons to take an early decision regarding mode of treatment. The Bethesda system for reporting of thyroid lesions aims at standardization of reports. It makes the cytology report unambiguous and clinically relevant. Keywords: Fine needle aspiration cytology, thyroid lesions.

English

BACKGROUND Thyroid carcinoma is the most common endocrine malignancy. Galectin-3 has been implicated in malignant transformation and metastasis of cancer cells and it has received notable recognition for its usefulness as a diagnostic marker for thyroid cancer. We wanted to evaluate the expression of Galectin-3 on thyroid neoplasms, establish its diagnostic accuracy and also differentiate between benign and malignant thyroid lesions. METHODS A total of 54 thyroidectomy specimens were studied over a period of 3 years (2016 - 2019) which included 20 benign and 34 malignant thyroid neoplasms. Histopathologic evaluation of H &amp; E stained sections was done and immunohistochemistry (IHC) staining for Galectin-3 was performed for all neoplasms with the polymeric method using lyophilized mouse monoclonal antibody. (Path n Situ) and grading based on intensity of Galectin-3 expression were noted. RESULTS Galectin-3 expression was significantly higher (P &lt; 0.001) in malignant thyroid neoplasms in comparison to the benign neoplasms. Galectin-3 expression for malignant neoplasms showed sensitivity of 88.23 %, specificity of 95.0 %, positive predictive value (PPV) of 96.8 % and negative predictive value (NPV) of 82.6 %. Galectin-3 expression in Papillary thyroid carcinoma showed a sensitivity of 95.83 % and PPV of 88.2 %. While comparing the neoplasms showing follicular pattern, Galectin-3 expression was more in the malignant neoplasms (follicular carcinoma and follicular variant of papillary carcinoma thyroid) than benign neoplasms (follicular adenoma). CONCLUSIONS Galectin-3 is a useful marker in differentiating benign and malignant thyroid neoplasms. Galectin-3 is sensitive for Papillary thyroid carcinoma (PTC) and among the follicular patterned lesions, Galectin-3 is sensitive for follicular variant of papillary carcinoma and follicular carcinoma. Thus Galectin-3 protein expression evaluated using immunohistochemistry technique acts as an adjunctive ancillary technique in thyroid cancer diagnosis. KEYWORDS Galectin-3, Immunohistochemistry, Thyroid Carcinoma, Papillary Thyroid Carcinoma

Diagnostic Value of Ultrasonography in Benign and Malignant Thyroid Lesions

Diagnostic Value of Ultrasonography in Benign and Malignant Thyroid Lesions

Inherited Thyroid Tumors With Oncocytic Change.

Familial non-medullary thyroid carcinoma (FNMTC) corresponds to 5-10% of all follicular cell-derived carcinoma (FCDTC). Oncocytic thyroid tumors have an increased incidence in the familial context in comparison with sporadic FCDTC, encompassing benign and malignant tumors in the same family presenting with some extent of cell oxyphilia. This has triggered the interest of our and other groups to clarify the oncocytic change, looking for genetic markers that could explain the emergence of this phenotype in thyroid benign and malignant lesions, focusing on familial aggregation. Despite some advances regarding the identification of the gene associated with retinoic and interferon-induced mortality 19 (GRIM-19), as one of the key candidate genes affected in the “Tumor with Cell Oxyphilia” (TCO) locus, most of the mutations follow a pattern of “private mutations”, almost exclusive to one family. Moreover, no causative genetic alterations were identified so far in most families. The incomplete penetrance of the disease, the diverse benign and malignant phenotypes in the affected familial members and the variable syndromic associations create an additional layer of complexity for studying the genetic alterations in oncocytic tumors. In the present review, we summarized the available evidence supporting genomic-based mechanisms for the oncocytic change, particularly in the context of FNMTC. We have also addressed the challenges and gaps in the aforementioned mechanisms, as well as molecular clues that can explain, at least partially, the phenotype of oncocytic tumors and the respective clinico-pathological behavior. Finally, we pointed to areas of further investigation in the field of oncocytic (F)NMTC with translational potential in terms of therapy.