Diagnosis Of Papillary Thyroid Carcinoma Research Articles

Significance of FNAC, BRAF mutation, and intraoperative frozen section in surgical decision‐making of thyroid nodules

A preoperative method is desired to discriminate benign from malignant thyroid nodules. This retrospective study evaluated the diagnostic performance of BRAF (B-Raf proto-oncogene) mutation (BRAFV600E ) positivity and fine-needle aspiration cytology (FNAC) relative to intraoperative frozen section pathology. Patients underwent preoperative FNAC of thyroid nodules. Cytology specimens were classified according to the Bethesda System for Reporting Thyroid Cytopathology (BSRTC), and analyzed for BRAFV600E using an amplification-refractory mutation system (ARMS). Thyroid tissue was surgically removed and frozen sections processed for histology. The sensitivities and specificities of each analysis were compared, alone and in combination. Among 346 patients, 333/358 FNACs (93%) showed malignant nodules; 322 (93%) patients received a pathological diagnosis of papillary thyroid carcinoma (PTC). The sensitivity and specificity of BSRTC VI for malignancy was the highest among the BSRTC categories. Compared with FNAC, the BRAFV600E analysis had significantly higher sensitivity and specificity. The diagnostic efficacy of frozen section pathology was significantly higher than that of either BSRTC category or BRAFV600E analysis alone. Combining methods variably improved diagnostic performance. BRAFV600E was not associated with capsule infiltration, neurovascular infiltration, mono- or multifocal PTC, lymph node metastasis, or clinical stage. The diagnostic performance of preoperative BRAFV600E determination was better than that of the BSRTC-FNAC category; combining both improved sensitivity and specificity. Patients with positive malignancy scores from both should be recommended for surgery; those with negative scores require close monitoring. Surgical treatment should include comprehensive intraoperative frozen section assessment. BRAF mutations cannot indicate aggressive treatment.

Cell-free DNA methylation biomarker for the diagnosis of papillary thyroid carcinoma.

Cell-free DNA (cfDNA) is being explored as biomarker for non-invasive diagnosis of cancer. We aimed to establish a cfDNA-based DNA methylation marker panel to differentially diagnose papillary thyroid carcinoma (PTC) from benign thyroid nodule (BTN). 220 PTC- and 188 BTN patients were enrolled. Methylation markers of PTC were identified from patients' tissue and plasma by reduced representation bisulfite sequencing and methylation haplotype analyses. They were combined with PTC markers from literatures and were tested on additional PTC and BTN samples to verify PTC-detecting ability using targeted methylation sequencing. Top markers were developed into ThyMet and were tested in 113 PTC and 88 BTN cases to train and validate a PTC-plasma classifier. Integration of ThyMet and thyroid ultrasonography was explored to improve accuracy. From 859 potential PTC plasma-discriminating markers that include 81 markers identified by us, the top 98 most PTC plasma-discriminating markers were selected for ThyMet. A 6-marker ThyMet classifier for PTC plasma was trained. In validation it achieved an Area Under the Curve (AUC) of 0.828, similar to thyroid ultrasonography (0.833) but at higher specificity (0.722 and 0.625 for ThyMet and ultrasonography, respectively). A combinatorial classifier by them, ThyMet-US, improved AUC to 0.923 (sensitivity=0.957, specificity=0.708). The ThyMet classifier improved the specificity of differentiating PTC from BTN over ultrasonography. The combinatorial ThyMet-US classifier may be effective in preoperative diagnosis of PTC. This work was supported by the grants from National Natural Science Foundation of China (82072956 and 81772850).

Scoring System and Diagnosis of Papillary Thyroid Carcinoma Using Human Bone Marrow Endothelium Marker-1, Cytokeratin 19, and Galectin-3.

The increasing incidence of papillary thyroid carcinoma (PTC) and the inadequacy of routine histologic examination in its diagnosis necessitate the application of ancillary studies like immunohistochemistry. This research aimed to investigate the scoring system and diagnosis of PTC with cytokeratin 19 (CK19), human bone marrow endothelium marker-1 (HBME-1), and galectin-3. This experimental laboratory study was performed at Babol University of Medical Sciences, Mazandaran, Iran from April 2017 to March 2019. Neoplastic and nonneoplastic tissue samples of 100 cases with a diagnosis of PTC were selected by convenience sampling. CK19, HBME-1, and galectin-3 immunohistochemistry markers were used on tissue samples. Analysis was performed using the t test and the chi-square test, as well as the receiver operator characteristic (ROC) curve (significance level P < 0.05). The CK19 staining was observed in all 100 (100%) non-neoplastic tissues, but HBME-1 and galectin-3 were positive in 36 (36%) and 14 (14%) of non-neoplastic tissues, respectively. The intensity scores of all the markers and their total had significantly different means in PTC and non-neoplastic tissues (P < 0.001). A significant difference was observed between the total score of each marker and the total score of their combination (P < 0.001). The combination of all 3 markers with an 11.5 0 cut-off for the total score showed the most sensitive (0.99) and specific (1.00) results. Interpreting CK19, HBME-1, and galectin-3 with the aid of the proposed scoring system was fruitful. HBME-1 and galectin-3 can be used individually or in combination for the diagnosis of PTC.

Nrf2 as a novel diagnostic biomarker for papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. However, it is very difficult to distinguish PTC from benign carcinoma. Thus, specific diagnostic biomarkers are actively pursued. Previous studies observed that Nrf2 was highly expressed in PTC. Based on this research, we hypothesized that Nrf2 may serve as a novel specific diagnostic biomarker. A single-center retrospective study, including 60 patients with PTC and 60 patients with nodular goiter, who underwent thyroidectomy at the Central Theater General Hospital from 2018 to July 2020, was conducted. The clinical data of the patients were collected. Nrf2, BRAF V600E, CK-19, and Gal-3 proteins were compared from paraffin samples of the patients. Through this study, we obtained the following results: i) Nrf2 exhibits high abundance expression in PTC, but not in adjacent to PTC and nodular goiter; increased Nrf2 expression could serve as a valuable biomarker for PTC diagnosis; the sensitivity and specificity for the diagnosis of PTC were 96.70% and 89.40%, respectively. ii) Nrf2 also shows higher expression in PTC with lymph node metastasis, but not adjacent to PTC and nodular goiter, thus the increased Nrf2 expression might serve as a valuable predictor for lymph node metastasis in PTC patients; the sensitivity and specificity for the prediction in lymph node metastasis were 96.00% and 88.57%, respectively; excellent diagnostic agreements were found between Nrf2 and other routine parameters including HO-1, NQO1 and BRAF V600E. iii) The downstream molecular expression of Nrf2 including HO-1 and NQO1 consistently increased. In conclusion, Nrf2 displays a high abundance expression in human PTC, which leads to the higher expression of downstream transcriptional proteins: HO-1 and NQO1. Moreover, Nrf2 can be used as an extra biomarker for differential diagnosis of PTC and a predictive biomarker for lymph node metastasis of PTC.

Accuracy of different cytoarchitectural features in the diagnosis of papillary thyroid carcinoma by fine needle aspiration

Fine needle aspiration (FNA) has about 90% diagnostic accuracy for papillary thyroid carcinoma (PTC) in an adequate sample. Ignorance of relative significance of individual cytologic features may lead to misdiagnosis due to reliance on a single or few features. Our objective was to determine the usefulness of individual and most appropriate combined cytologic features, for diagnosis of PTC. H&amp;E stained FNA smears of fifty cases each, of consecutive histologically confirmed PTC and benign thyroid cases (controls), reported over 3 years, were retrieved from the files. A total of 31 architectural, cytological and background features were assessed, blind to the final diagnosis and compared amongst the two groups. The statistical significance (p&amp;#60;0.05) of each parameter was determined by chi-square and odds ratio and combinations quality assessed by ROC curves.: Twenty features were found to be statistically significant. Fourteen highly significant (p&amp;#60;0.000) features included flat syncytial sheets, anatomical borders, true papillae, cellular swirls, individually dispersed cells with eosinophilic cytoplasm, anisonucleosis, elongated oval nuclei, powdery chromatin, nuclear outline irregularity, thickened nuclear membranes, crescent shaped nuclei, intranuclear inclusions, histocytoid cells and soap bubble cytoplasmic vacuolation. The six statistically significant features (p&amp;#60;0.05) included micro-acinar structures, cellular crowding, nuclear overlapping, nuclear grooves, squamoid cells and bubble gum colloid. The control group also showed some of these single cytologic features. All the combinations of ≥ 4 features had a statistical significance of p=0.000 and specificity and PPV of 100% with ROC showing excellent results. Using correct combination of cytologic features will increase accuracy of FNA diagnosis of PTC.

HASHIMOTO'S THYROIDITIS MIMICKING PAPILLARY THYROID CARCINOMA – FALSE POSITIVE CYTOLOGY WITH HISTOPATHOLOGICAL CORRELATION- A RARE CASE REPORT

Background:- It is very rare that cytological diagnosis of papillary thyroid carcinoma by FNAC could not be conrmed by histological evaluation. One of the reasons for positive cytological nding and negative histological nding of papillary thyroid carcinoma is false positive diagnosis. Hashimoto's thyroiditis an autoimmune disease can be so extensive may mimic as papillary thyroid carcinoma because it may cause massive destruction of thyroid gland and may show similar nuclear features like Ptc. A Case Report:- 35-year old female, with a midline neck swelling of size (4x3)cm2 for one year. On FNAC the thyroid swelling was diagnosed as suspicious for papillary thyroid carcinoma. (Bethesda category v). However post operative diagnosis was conrmed as Hashimoto's thyroiditis. Hi Conclusion:- stomorphology in conjunction with biochemical ndings are necessary to conrm diagnosis of Hashimoto's Thyroiditis. False positive FNAC result is a pitfall of FNAC. Awareness of cytopathologist about pitfall of FNACS and strict adherence to adequacy criteria can reduce false positive rates.

Socioeconomic disparity in the association between fine particulate matter exposure and papillary thyroid cancer

BackgroundLimited data exists suggesting that cumulative exposure to air pollution in the form of fine particulate matter (aerodynamic diameter ≤ 2.5 μm [PM2.5]) may be associated with papillary thyroid carcinoma (PTC), although this relationship has not been widely established. This study aims to evaluate the association between PM2.5 and PTC and determine the subgroups of patients who are at the highest risk of PTC diagnosis.MethodsUnder IRB approval, we conducted a case-control study of adult patients (age ≥ 18) newly diagnosed with PTC between 1/2013–12/2016 across a single health care system were identified using electronic medical records. These patients were compared to a control group of patients without any evidence of thyroid disease. Cumulative PM2.5 exposure was calculated for each patient using a deep learning neural networks model, which incorporated meteorological and satellite-based measurements at the patients’ residential zip code. Adjusted multivariate logistic regression was used to quantify the association between cumulative PM2.5 exposure and PTC diagnosis. We tested whether this association differed by gender, race, BMI, smoking history, current alcohol use, and median household income.ResultsA cohort of 1990 patients with PTC and a control group of 6919 patients without thyroid disease were identified. Compared to the control group, patients with PTC were more likely to be older (51.2 vs. 48.8 years), female (75.5% vs 46.8%), White (75.2% vs. 61.6%), and never smokers (71.1% vs. 58.4%) (p < 0.001). After adjusting for age, sex, race, BMI, current alcohol use, median household income, current smoking status, hypertension, diabetes, COPD, and asthma, 3-year cumulative PM2.5 exposure was associated with a 1.41-fold increased odds of PTC diagnosis (95%CI: 1.23–1.62). This association varied by median household income (p-interaction =0.03). Compared to those with a median annual household income <$50,000, patients with a median annual household income between $50,000 and < $100,000 had a 43% increased risk of PTC diagnosis (aOR = 1.43, 95%CI: 1.19–1.72), and patients with median household income ≥$100,000 had a 77% increased risk of PTC diagnosis (aOR = 1.77, 95%CI: 1.37–2.29).ConclusionsCumulative exposure to PM2.5 over 3 years was significantly associated with the diagnosis of PTC. This association was most pronounced in those with a high median household income, suggesting a difference in access to care among socioeconomic groups.

Prognostic factors for recurrence in patients with papillary thyroid carcinoma.

The prognostic factors for tumor recurrence and mortality of patients diagnosed with Papillary Thyroid Carcinoma (PTC) with immediate surgery in Colombia has not been reported. To retrospectively evaluate the risk factors for recurrence and survival at 10years in patients with the diagnosis of PTC treated at Fundación Santa Fe deBogota (FSFB). A total of 486 patients with thyroid surgery accompanied by medical follow-up were recruited. Demographic, clinical, and pathological variables were followed-up for a median period of 10years. The most significant variables for recurrence were tumors with > 4cm of size (hazard ratio [HR] = 8.1; 95% confidence interval [CI] = 1.7-55) and extrathyroidal spread (HR = 26.7; 95% CI = 3.1-228). PTC in our population has low rates of mortality (0.6%) and recurrence (9.6%), with an average time of recurrence of 3years. Size of the lesion, positive surgical margins, extrathyroidal spread, and high postoperative serum thyroglobulin (Tg) level act as prognostic factors that determine the likelihood of recurrence. Unlike other studies, the influence of age and gender does not act as a prognostic factor.

The Preferred Route for the Diagnosis and Management of Thyroid Carcinoma Among the General Population in Saudi Arabia.

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Papillary thyroid microcarcinoma (PTMC) is a specific subgroup of PTC. Given their small size, PTMCs are often asymptomatic and behave benignly. This puts physicians in a challenging situation about how to prevent overdiagnosis and overtreatment of PTMC. This study aimed to assess the preferences regarding the route of PTMC diagnosis and treatment among Saudi Arabia's general population. This is a cross-sectional questionnaire-based-study conducted among the general population in Saudi Arabia. The target subjects werethe general population of Saudi Arabia both genders and different age groups from various regionsof Saudi Arabia(Western, Central, Eastern, Southern, and North). Participants who did not complete the questionnaire or did not agree to participate were excluded. A self-administered questionnaire was distributed on different social media platforms to collect data from different regions. Data analysis was conducted by using Statistical Package for the Social Sciences (SPSS) 24.0 version (IBM Inc., Chicago, USA) statistical software. AChi-square test was used to compare categorical variables. A total of 1,428 participants were included. The majority of them were females (64.4%), and most of them were aged between 19 and 25 years. Moreover, we found that 4.8% of the study population had a medical history of thyroid cancer. Our results revealed that more than half of respondents (54.6%) would select surgical operation immediately if they have a thyroid nodule less than 1 cm in maximal diameter, which turns out to be a PTC. The vast majority of participants (90.1%) would prefer to do cytologic confirmation immediately if they have a thyroid nodule less than 1 cm in maximal diameter, which has suspicious characteristics of PTC in neck ultrasound examination. Regarding PTMC operation, 59.8% of responders were more concerned about complications than recurrences. We found that neither age nor gender significantly affects decision-making for management or operative extent for PTC. There was a significant difference between age and decision-making for the diagnosis of suspicious thyroid nodules (p value = 0.041). Our results concluded that most of the participants preferred to select immediate surgery and cytologic confirmation regarding the management and diagnosis of PTC. More research is advised. The need to inform patients about their disease state and treatment options should be highlighted more.

Score system for cytological evaluation of fine-needle aspiration specimens to predict the diagnosis of papillary thyroid carcinomas

IntroductionAccording to the World Health Organization's classification of endocrine tumors, papillary thyroid carcinoma (PTC) accounts for almost 90 % of malignant thyroid neoplasms. This study aimed to create a point system based on cytomorphological criteria for evaluating FNA products from thyroid nodules to predict the risk of papillary thyroid carcinomas. MethodsThis was an analytical observational study based on a retrospective analysis of cytological reports and surgical specimens from January 1, 2016, to December 31, 2021. Cytological slides were analyzed using the following ten variables: Nuclear Grooves; Intranuclear Pseudoinclusion; Cellularity; Colloid (Quantity); Clarified Chromatin; Overlapping nuclei; Irregular Nuclear Membrane; Multinucleated Giant Cells; Psamoma bodies; and Papillae. We categorized these variables quantitatively from zero to three points as follows: zero (absent), one (mild), two (moderate), and three (intense). ResultsCytologies of 254 (4.9 %) cases were analyzed. The cut-off point was defined in this study as 6 ± 1 points. For the prediction of cases in benign, values < 5 points, malignant, values > 7 points and indeterminate, 5–7 points. Among the benign, there were 64 (69.5 %) cases <5 points, 17 (18.4 %) from 5 to 7 points and 11 (11.9 %) >7 points. Among the malignant ones, there were 12 (8.6 %) cases <5 points, 19 (13.6 %) from 5 to 7 points and 108 (77.6) >7 points. ConclusionIn this context, through the quantitative analysis of the ten suggested cytological variables, scored from 0 to 3, a final score > 7 is suspicious for malignancy, while a score < 5 is related to benign lesions.

Papillary Carcinoma in a Patient with a Thyroid Nodule: Role of Ultrasonography and its Diagnostic Accuracy

Introduction: While it can be difficult to categorize thyroid lesions, employing ultrasound may enable correct diagnosis, classification, and therapy of thyroid nodules, particularly papillary carcinoma of the thyroid, and assist save unneeded biopsy. Objective: Taking histopathology as the gold standard, assessing the diagnostic precision of ultrasound in the identification of papillary cancer in thyroid nodule patients. Study design: Cross sectional study Study Settings: Department of ENT &amp; Surgery, Jinnah Teaching Hospital, Peshawar Study Duration: This study was conducted from 1st August 2021 till 30th June 2022. Materials and Methods: Patients of both gender who sought assessment for a thyroid nodule were included. On ultrasonography, papillary carcinoma was detected. The gold standard for diagnosing cancers, histology, was used to confirm papillary carcinoma. Using a 2×2 table, diagnostic accuracy was assessed in terms of sensitivity, specificity, PPV, and NPV. Results: Overall 241 participants recruited. The patients were between the ages of 18 and 75. The patients' mean age was 57.80 + 9.245 years. The ratio of men to women was 1.2:1. The ultrasound's sensitivity, specificity, PPV, NPV, and diagnostic accuracy for the diagnosis of papillary thyroid cancer were, respectively, 85.1%, 97.5%, 88.8%, 96.5%, and 95.1%. Conclusion: With clinically significant diagnostic accuracy for the early diagnosis of thyroid papillary carcinoma, ultrasound is a cost-effective, non-invasive diagnostic method that may lessen the need for invasive diagnostic methods like thyroid biopsy. Keywords: Papillary Carcinoma of Thyroid, Ultrasound, Diagnostic Accuracy

Identification of potential biomarkers for papillary thyroid carcinoma by comprehensive bioinformatics analysis.

To perform bioinformatics analysis on the papillary thyroid carcinoma (PTC) gene chip dataset to explore new biological markers for PTC. The gene expression profiles of GSE3467 and GSE6004 chip data were collected by GEO2R, and the differentially expressed genes (DEGs) were selected for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Protein-protein interaction (PPI) relationship analysis was achieved using STRING, and the hub genes were obtained using the Cytoscape software. GEPIA was used to validate the expressions of the hub genes in the normal and tumor tissues and to conduct survival analyses. Pertinent genetic pathology results were fetched using the HPA database. Finally, the key genes were clinically verified by reverse transcription-polymerase chain reaction. 97 genes were jointly up-regulated and 107 genes were jointly down-regulated in GSE3467 and GSE6004. GO function enrichment analysis revealed that the DEGs were involved in the regulation of calcium ion transport into cytosol, integrin binding, and cell adhesion molecule binding. KEGG pathway enrichment analysis indicated that the DEGs were chiefly associated with thyroid cancer and non-small cell lung cancer. According to the PPI network, 30 key target genes were identified. Only the expressions of ANK2, TLE1, and TCF4 matched between the normal and tumor tissues, and were associated with disease prognosis. When compared with the normal thyroid tissues, the protein and mRNA expressions of ANK2, TLE1, and TCF4 were down-regulated in PTC. Significant differences exist in overall gene expression between the thyroid tissues of patients with PTC and those of healthy people. Furthermore, the differential genes ANK2, TLE1, and TCF4 are expected to be reliable molecular markers for the mechanism study and diagnosis of PTC.

Preoperative Diagnostics of Papillary Thyroid Carcinoma by Molecular Analysis of FNAB Materials

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Molecular markers of papillary thyroid carcinoma (PTC) including the BRAFT1799A mutation, RET/PTC1,3 rearrangements, and differentially expressed SFTPB (up-regulated) and TFF3 (down-regulated) genes were prospectively assessed in FNAB (fine needle aspiration biopsy) material from thyroid nodules. We examined 73 cases, of them 59 PTC (papillary thyroid carcinoma), five nodular goiters, and nine follicular adenomas. Concordantly with cytology, molecular diagnosis of PTC by SFTPB and TFF3 expression levels was confirmed in 38/41 cases (92.7%); in them, 22/41 (53.6%) had BRAFT1799A mutation and 7/41 (17.1%) had RET/PTC rearrangements. For benign nodules, concordance was observed in 10/12 (83.3%) cases. Among 20 cases, including 19 suspicious for malignancy and one inadequate sample, 17 were positive for SFTPB/TFF3 test (85.0%). Of these, four were also positive for RET/PTC rearrangements, five were positive for BRAFT1799A and all resulted in PTC at histology. The remaining 3 cases were negative for three molecular markers. These nodules showed benign lesions in histology. Our results demonstrated that specific molecular tests improve the efficacy of preoperative diagnostics of PTC.

Relationship between serum NDRG3 and papillary thyroid carcinoma.

In recent years, papillary thyroid carcinoma is considered to be one of the fastest increaseing cancer. NDRG family member 3 (NDRG3) has been proposed as a molecular marker of tumor, and is expected to be used in clinic. Enzyme-linked immunosorbent assay was used to detect the serum NDRG3 expression in 81 papillary thyroid carcinoma cases, 75 benign thyroid nodules cases and 77 healthy control cases, respectively. Electrochemiluminescence method was applied to measure the levels of triiodothyronine, tetraiodothyronine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody. Immunohistochemical staining was used to detect the expression of NDRG3 in papillary thyroid carcinoma, benign thyroid nodules and normal tissues adjacent to cancer. The expression of serum triiodothyronine, tetraiodothyronine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody and NDRG3 were significantly different among benign thyroid nodules, papillary thyroid carcinoma cases and healthy control groups (P <0.001). Only the expression of serum NDRG3 was significantly different between benign thyroid nodules and papillary thyroid carcinoma groups (P <0.001). Immunohistochemistry showed that NDRG3 was expressed in all three groups, the lowest in papillary thyroid carcinoma, the second in benign thyroid nodules, and the highest in normal tissues adjacent to cancer. Logistic regression analysis showed that serum NDRG3 was an independent protective factor for papillary thyroid carcinoma (OR =0.964, 95%CI =0.953 to 0.974, P <0.001). The ROC curve of non-papillary thyroid carcinoma diagnosed by serum NDRG3 showed the optimal cut-off value of 481.38 pg/ml, sensitivity of 72.4%, specificity of 90.1%, and the maximum area under the curve (AUC =0.902, 95%CI =0.863 to 0.940, P <0.001). The ROC curve of benign thyroid nodules diagnosed by serum NDRG3 showed the optimal critical value of 459.28 pg/ml, sensitivity of 81.3%, and specificity of 74.1% (AUC =0.863, 95%CI =0.808 to 0.919, P <0.001). The expression level of serum NDRG3 was significantly correlated with extrathyroid extensionand (P =0.007) and lymphatic metastasis of papillary thyroid carcinoma (P =0.019). The decrease of NDRG3 expression can not only differential diagnosis benign thyroid nodules and papillary thyroid carcinoma, but also serve as a molecular marker for the diagnosis of papillary thyroid carcinoma.

The impact of the initial operation of PTC in children on recurrence: 9-year experience in a single center

PurposeTo summarize the treatment experience of single-center children with PTC and to explore the influence of initial surgery on the recurrence/metastasis of papillary thyroid carcinoma (PTC) in children.MethodsA retrospective analysis of PTC case data of children (≤ 18 years old) who were admitted to and received surgical treatment in the First Affiliated Hospital of Kunming Medical University from January 2012 to December 2020.ResultsA total of 64 children with PTC were included, including 45 cases (70.31%) with a single lesion, and 19 cases (29.69%) with multiple lesions (≥ 2 lesions). Fifteen patients relapsed. Univariate analysis found that gender, thyroidectomy scope, central lymph node dissection, and lateral lymph node dissection were risk factors affecting reoperation; multi-factor analysis showed that central lymph node dissection was an independent risk factor affecting reoperation. According to Kaplan–Meier analysis, central lymph node dissection, total thyroidectomy (TT), lobectomy (LT), and disease-free survival (DFS) were statistically significant (p = 0.000, p = 0.000).ConclusionAt the time of diagnosis of PTC in children, the rate of lymph node metastasis in the central and lateral cervical regions is high. The vast majority of children with PTC should be treated with TT, and LT is chosen for a small number of patients. CND should be routinely lined.

Advantages and clinical significance of enhanced CT combined with BRAF V600E gene detection in the diagnosis of papillary thyroid carcinoma

The diagnosis of papillary thyroid carcinoma (PTC) remains the focus of clinical research. Studies have shown that the BRAFV600E gene mutation is closely related to the development of PTC. In this study, we used the advantages and clinical significance of enhanced CT combined with BRAFV600E gene testing in the diagnosis of PTC. A total of 170 PTC patients who received treatment in our hospital between January 2020 and December 2020 were collected and divided into group A (enhanced CT combined with BRAFV600E gene detection) and group B (fine needle aspiration cytology, FNAC) according to different diagnostic methods. We recorded the general information of the patients and measured the levels of serum tumor markers including carcinoembryonic antigen (CEA), cytokeratin fragment 19 (CYFRA21-1), neuron-specific enolase (NSE) and carbohydrate antigen 125 (CA125). After pathological diagnosis, the specificity, sensitivity, accuracy, positive predictive value, and negative predictive value of the two diagnostic methods were contrasted. The accuracy of the two methods and the pathological test in identifying benign lesions, malignant tumors, was also compared. All patients' serum tumor markers CEA, CYFRA21-1, NSE and CA125 levels were above normal. The detection rate of specificity, sensitivity, accuracy, positive predictive value and negative predictive value of enhanced CT combined with BRAF V600E gene detection were superior to those of FNAC. And the accuracy of enhanced CT combined with BRAF V600E gene detection, which was confirmed by corresponding pathological detection results, was significantly increased (P<0.05). Enhanced CT combined with BRAF V600E gene detection can improve the diagnostic accuracy of PTC, and its clinical indicators and safety are superior to FNAC.

Distinct molecular subtypes of papillary thyroid carcinoma and gene signature with diagnostic capability

Papillary thyroid carcinoma (PTC) is heterogeneous and its molecular characteristics remain elusive. We integrated transcriptomic sequencing, genomic analysis and clinicopathologic information from 582 tissue samples of 216 PTC and 75 benign thyroid nodule (BTN) patients. We discovered four subtypes of PTC including Immune-enriched Subtype, BRAF-enriched Subtype, Stromal Subtype and CNV-enriched Subtype. Molecular subtypes were validated in an external cohort of 497 PTC cases from the TCGA. Tumors in the Immune-enriched Subtype showed higher immune infiltration and overexpression of immune checkpoints, whilst BRAF-enriched Subtype showed a higher tendency for extrathyroidal extension and more advanced TNM stage. Key oncogenes including LRRK2, SLC34A2, MUC1, FOXQ1 and KRT19 were overexpressed and enriched in oncogenic MAPK and PI3K/AKT signaling pathways in BRAF-enriched subtype. Further analysis of BRAF-enriched Subtype identified three subclasses with different degrees of malignancies. We also uncovered the molecular link of the initiation and progression from BTN to subtypes of PTC using trajectory analysis. Moreover, a 20-gene expression signature was generated for differential diagnosis of PTC from BTN patients. Together, our work identified previously unreported molecular subtypes of PTC, offering opportunities to stratify patients into optimal treatment plans based on molecular subtyping.

Tiroidite cronica linfocitaria e carcinoma papillare della tiroide: quale relazione?

Papillary thyroid carcinoma (PTC) is the most common form of thyroid tumour in childhood. Different studies reported higher risk of developing a PTC in Hashimoto’s thyroiditis patients (HT) even in paediatric-adolescent age, although real incidence and risk factors are unknown. The paper describes the case of a girl, diagnosed with HT and hypothyroidism at the age of 11, who developed thyroid ultrasound alterations after two years. The histological examination of the satellite lymph node confirmed the diagnosis of PTC. A total thyroidectomy was performed. The follow up scintigraphy did not show disease residues, so no indication was given to radioiodine therapy. The case report underlines the importance of an accurate thyroid and lymph nodes ultrasound monitoring in children with autoimmune thyroiditis, in order to highlight possible malignancy development.

BRAF gene mutation and papillary thyroid carcinoma

Nowadays, Thyroid carcinoma (TC) is the most common malignant tumor of endocrine system, accounting for about 1% of the malignant tumors in the whole body, ranking first in the head and neck malignant tumors. Papillary thyroid carcinoma (PTC) is a malignant tumor originated from thyroid follicular epithelial cells, which is the most common pathological type in TC. V-RAF murine sarcoma viral oncogene homolog B1 (BRAF) is a molecular biological marker for the diagnosis and prognosis of PTC and a target gene for the treatment of PTC. Its gene mutation is a hot point in the TC research field. The most common gene mutation is BRAF V600E mutation and it is a molecular marker in PTC. With the deep-going of its research, contradictions and controversies about the relationship between BRAF V600E and PTC gradually emerge. Many molecular targeted drugs targeting BRAF gene are also being continuously researched and some achievements have been made. This review mainly expounds the relationship between BRAF V600E and clinicopathological features, analyzes and expounds the controversial parts currently as well as show the research status of molecular targeted drugs.

Correlation between Pro-inflammatory biomarkers and papillary thyroid cancer: A case control Study

Abstract Introduction: Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. Apart from genetics, autoimmunity has been implicated in its pathogenesis. In this context, we set out to study the role of Pro- inflammatory cytokines in PTC in South Indian population. Material and methods: This pilot prospective case-control study was conducted on surgically managed PTC patients. Institutional ethical committee approval was obtained. Diagnosis of PTC was based on imaging, fine needle aspiration cytology and later confirmed by histopathology. Exclusion criteria were subjects with any disease or medication interfering with the hypothalamic-pituitary-gonadal axis. Serum samples were collected from 46 PTC subjects and 44 age matched healthy controls. Interleukin-6 (IL-6), Tumour necrosis factor-alpha (TNF-α) and high sensitive C reactive protein (hsCRP), leptin levels were measured in all serum samples. Statistical analysis was performed by one way ANOVA with Dunnet’s test and Pearson correlation tests. Results: The mean hSCRP level in PTC and controls were 18.3 ± 3.1 mg/mL and 5.5 ± 1.2 mg/mL respectively. The mean TNF-α level, IL-6 level and Leptin levels were 295 ± 28 pg/mL, 13.6 ± 4.4 pg/mL and 1.93 ± 0.8 ng/mL respectively. Serum leptin level in controls was 3.6 ±1.8 ng/mL. There was statistically significant difference of all the pro-inflammatory cytokines compared to controls (P value &lt;0.05) with negative correlation for leptin levels. Conclusions: Our study shows raised titers of pro-inflammatory markers – IL-6, TNFα and hsCRP, while reduced leptin levels correlated with PTC suggesting a contributory role. But, the exact immuno-modulatory mechanism needs more research.