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Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (28 February 2021) | Viewed by 36024

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Special Issue Editors

Prof. Dr. Marek Ruchala

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Guest Editor

Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
Interests: thyroid imaging; thyroid developmental anomalies; thyroid nodules; thyroid cancer; thyroiditis; acromegaly

Prof. Dr. Ewelina Szczepanek-Parulska

E-Mail Website
Guest Editor

Department of Metabolism Endocrinology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
Interests: thyroid imaging; thyroid developmental anomalies; thyroid nodules; thyroid cancer; thyroiditis

Special Issue Information

Dear Colleagues,

The diagnostics of thyroid nodular disease constitute an everyday challenge for endocrinologists. Due to the high incidence of this pathology, estimated at 10%–70% of adults, it is a source of major socioeconomic burden. However, only 18% of thyroid nodules are diagnosed as malignant. Thyroid nodular disease is the most frequently diagnosed endocrine pathology, while thyroid cancer constitues the most common endocrine malignancy and is reponsible for about 67% of deaths due to neoplasms derived from endocrine organs. The incidence of thyroid cancer has risen by about 240% in the last three decades. Due to the increased availability of imaging techniques, recently, a rise in the detectability of thyroid cancer at the stage of microcarcinoma has been observed. Diagnostic and therapeutic decisions in patients with thyroid nodules require an interdisciplinary consensus between endocrinologists and physicians of other specialities (radiologists, pathologists, surgeons, oncologists).

The well-established gold standard of diagnostics in thyroid nodular disease is fine-needle aspiration biopsy (FNAB). However, due to its invasiveness and significant percentage of inconclusive results, novel imaging techniques or molecular markers are being researched and developed, with the aim of increasing diagnostic performance and making the preoperative estimation of malignancy risk more effective.

In recent years, sonoelastography has been demonstrated to be a promising tool to achieve this goal, improving the diagnostic capability of conventional ultrasonography in estimating malignancy risk and selecting thyroid lesions for biopsy. Moreover, different modes of sonoeastography are available (i.e., strain, shear wave). There is still a need to evaluate and compare the usefulness and roles of different modes of sonoelastography in the current management of thyroid nodules. Furthermore, ultrasonographs are currently being equiped with other modalities and new software, which aim to facilitate the diagnostics of thyroid focal lesions (different modes of vascularisation assesment, i.e., visualizing slow flow microvascularized structures or contrast-enhanced ultrasonography, 3D ultrasound). Recently, algorithms based on the application of artificial intelligence and deep learning have been introduced. Advanced and automated analysis of ultrasound pictures allows for quick and objective computer-based assesment of the malignancy risk of thyroid lesions. However, literature data regarding the reliable estimation of the roles and clinical usefulness of these techniques in the assessment of thyroid lesions are scarce. Furthermore, the target group of physicians who would benefit the most from application of these algorithms needs to be defined (e.g., experienced endocrinologists/radiologists, in-training physicians, general practitioners performing screening examinations).

Due to lowered cost and increased accesibility, more sophisticated imaging techniques in thyroid nodules diagnostics, like MRI or 18F-FDG-PET/CT, which were previously not considered to be cost-effective, are being employed. In addition, due to the rapid development of molecular diagnostics, many ongoing research programs are being performed to detect novel molecular markers and establish the true clinical utility and cost-effectiveness of those markers in pre-surgical differentiation of benign and malignant thyroid lesions, especially when conventional techniques (ultrasonograhy, FNAB) do not bring conclusive results. Further reseach is needed to identify the limitations of these proecedures and improve these techniques.

The goal of this Special Issue of JCM is to provide a platform to present current trends in novel techniques of thyroid nodule diagnostics before they are implemented in the current guidelines on the management of thyroid nodular disease.

Prof. Dr. Marek Ruchala
Prof. Dr. Ewelina Szczepanek-Parulska
Guest Editors

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Keywords

thyroid ultrasound examination
sonoelastography
artificial intelligence
computer-aided diagnosis
molecular malignancy markers
next generation sequencing
MRI
PET/CT
thyroid nodules
thyroid cancer

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Editorial

Jump to: Research

5 pages, 188 KiB

Open AccessEditorial

Editorial on the Special Issue “Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions”

by Ewelina Szczepanek-Parulska and Marek Ruchala

J. Clin. Med. 2022, 11(4), 932; https://doi.org/10.3390/jcm11040932 - 11 Feb 2022

Cited by 1 | Viewed by 1219

Abstract

Thyroid nodular disease is one of the most frequent endocrine diseases [...] Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

Research

Jump to: Editorial

9 pages, 455 KiB

Open AccessArticle

Evaluation of the Performance of ACR TI-RADS Also Considering Those Nodules with No Indication of FNAC: A Single-Center Experience

by Stefano Amendola, Sium Wolde Sellasie, Francesco Pedicini, Massimo Carlini, Giulia Russo, Nicola Ossola, Andrea Leoncini, Flavia Botti, Elena Bonanno, Pierpaolo Trimboli and Luigi Uccioli

J. Clin. Med. 2023, 12(2), 398; https://doi.org/10.3390/jcm12020398 - 4 Jan 2023

Cited by 3 | Viewed by 1854

Abstract

Background: Several US risk stratification score systems (RSSs) have been developed to standardize a thyroid nodule risk of malignancy. It is still a matter of debate which RSS is the most reliable. The purpose of this study is to evaluate: (1) the concordance between the American College of Radiology TI-RADS (ACR TI-RADS) and fine needle aspiration cytology (FNAC), (2) the cancer rate in the ACR TI-RADS categories, (3) the characteristics of nodules evaluated by FNAC even if not formally indicated according to ACR TI-RADS (‘not indicated FNACs”). Methods: From January 2021 to September 2022, patients attending the Endocrinology Unit of the CTO Hospital of Rome for evaluation of thyroid nodules were included. Results: 830 nodules had negative cytology, belonging to TIR2 and TIR1C. One hundred and thirteen nodules were determined to be suspicious for or consistent with malignancy belonging to TIR3B/TIR4/TIR5. Of this last group, 94% were classified as TR4/TR5 nodules. In total, 87/113 underwent surgery. Among these, 73 had histologically proven cancer, 14 turned out to be benign. “Not indicated FNACs” was 623. Among these, 42 cancers were present. Conclusions: This study confirmed the diagnostic power of ACR TI-RADS. In addition, these data suggest revising the ACR TI-RADS indication to FNAC, especially for TR4. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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13 pages, 1072 KiB

Open AccessArticle

How Long Does It Take to Regain Normocalcaemia in the Event of Postsurgical Hypoparathyroidism? A Detailed Time Course Analysis

by Laura Guglielmetti, Sina Schmidt, Mirjam Busch, Joachim Wagner, Ali Naddaf, Barbara Leitner, Simone Harsch, Andreas Zielke and Constantin Smaxwil

J. Clin. Med. 2022, 11(11), 3202; https://doi.org/10.3390/jcm11113202 - 3 Jun 2022

Cited by 1 | Viewed by 1941

Abstract

Background: Postsurgical hypoparathyroidism (PH) is the most common side effect of bilateral thyroid resections. Data regarding the time course of recovery from PH are currently unavailable. Therefore, a detailed analysis of the time course of PH recovery and conditions associated with rapid recovery was conducted. Methods: This is a retrospective analysis of prospectively documented data. Patients with biochemical signs of PH or need for calcium supplementation were followed-up for 12 months. Logistic regression analyses were used to identify covariates of early as opposed to late recovery from PH. Results: There were 1097 thyroid resections performed from 06/2015 to 07/2016 with n = 143 PH. Median recovery time was 8 weeks and six patients (1.1% of total thyroid resections) required calcium supplementation > 12 months. Recovery of PH within 4 and 12 weeks was characterized by high PTH levels on the first postoperative day (4 weeks: OR 1.13, 95% CI 1.06–1.20; 12 weeks: OR 1.08, 95%CI 1.01–1.16). Visualization of all PTGs emerged as an independent predictor of recovery within 12 months (OR 2.32, 95% CI 1.01–4.93) and 24 weeks (OR 2.69, 95% CI 1.08–6.69). Conclusion: In the setting of specialized high-volume endocrine surgery, permanent PH is rare. However, every second patient will require more than 2 months of continued medical surveillance. Early recovery was associated with only moderately decreased postsurgical PTH-levels. Successful late recovery appeared to be associated with the number of parathyroid glands visualized during surgery. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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12 pages, 615 KiB

Open AccessArticle

[¹⁸F]fluoro-ethylcholine-PET Plus 4D-CT (FEC-PET-CT): A Break-Through Tool to Localize the “Negative” Parathyroid Adenoma. One Year Follow Up Results Involving 170 Patients

by Constantin Smaxwil, Philip Aschoff, Gerald Reischl, Mirjam Busch, Joachim Wagner, Julia Altmeier, Oswald Ploner and Andreas Zielke

J. Clin. Med. 2021, 10(8), 1648; https://doi.org/10.3390/jcm10081648 - 13 Apr 2021

Cited by 7 | Viewed by 2158

Abstract

Background: The diagnostic performance of [¹⁸F]fluoro-ethylcholine-PET-CT&4D-CT (FEC-PET&4D-CT) to identify parathyroid adenomas (PA) was analyzed when ultrasound (US) or MIBI-Scan (MS) failed to localize. Postsurgical one year follow-up data are presented. Methods: Patients in whom US and MS delivered either incongruent or entirely negative findings were subjected to FEC-PET&4D-CT and cases from July 2017 to June 2020 were analyzed, retrospectively. Cervical exploration with intraoperative PTH-monitoring (IO-PTH) was performed. Imaging results were correlated to intraoperative findings, and short term and one year postoperative follow-up data. Results: From July 2017 to June 2020 in 171 FEC-PET&4D-CTs 159 (92.9%) PAs were suggested. 147 patients already had surgery, FEC-PET&4D-CT accurately localized in 141; false neg. 4, false pos. 2, global sensitivity 0.97; accuracy 0.96, PPV 0.99. All of the 117 patients that already have completed their 12-month postoperative follow up had normal biochemical parameter, i.e., no signs of persisting disease. However, two cases may have a potential for recurrent disease, for a cure rate of at least 98.3%. Conclusion: FEC-PET&4D-CT shows unprecedented results regarding the accuracy localizing PAs. The one-year-follow-up data demonstrate a high cure rate. We, therefore, suggest FEC-PET-CT as the relevant diagnostic tool for the localization of PAs when US fails to localize PA, especially after previous surgery to the neck. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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10 pages, 651 KiB

Open AccessArticle

Neuromonitoring of the Recurrent Laryngeal Nerve Reduces the Rate of Bilateral Vocal Cord Dysfunction in Planned Bilateral Thyroid Procedures

by Constantin Smaxwil, Miriam Aleker, Julia Altmeier, Ali Naddaf, Mirjam Busch, Joachim Wagner, Simone Harsch, Oswald Ploner and Andreas Zielke

J. Clin. Med. 2021, 10(4), 740; https://doi.org/10.3390/jcm10040740 - 12 Feb 2021

Cited by 4 | Viewed by 2079

Abstract

Purpose: Bilateral vocal cord dysfunction (bVCD) is a rare but feared complication of thyroid surgery. This long term retrospective study determined the effect of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgeries with regard to the rate of bVCD and evaluated the frequency as well as the outcome of staged operations. Methods: Retrospective analysis of prospectively documented data (2000–2019) of a tertiary referral centers’ database. IONM started in 2000 and, since 2010, discontinuation of surgery was encouraged in planned bilateral surgeries to prevent bVCD, if non-transient loss of signal (ntLOS) occurred on the first side. Datasets of the most recent 40-month-period were assessed in detail to determine the clinical outcome of unilateral ntLOS in planned bilateral thyroid procedures. Results: Of 22,573 patients, 65 had bVCD (0.288%). The rate of bVCD decreased from 0.44 prior to 2010 to 0.09% after 2010 (p < 0.001, Chi2). Case reviews of the most recent 40 months period identified ntLOS in 113/3115 patients (3.6%, 2.2% NAR), of which 40 ntLOS were recorded during a planned bilateral procedure (n = 952, 2.1% NAR). Of 21 ntLOS occurring on the first side of the bilateral procedure, 15 procedures were stopped, subtotal contralateral resections were performed, and thyroidectomy was continued in 3 patients respectively, with the use of continuous vagal IONM. Eighteen cases of VCD were documented postop, and all but one patient had a full recovery. Seven patients had staged resections after 1 to 18 months (median 4) after the first procedure. Conclusion: IONM facilitates reduced postoperative bVCD rates. IONM is, therefore, recommendable in planned bilateral procedures. The rate of non-complete bilateral surgery after intraoperative non-transient LOS was 2%. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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9 pages, 759 KiB

Open AccessArticle

Application of Tissue Aspirate Parathyroid Hormone Assay for Imaging Suspicious Neck Lesions in Patients with Complicated Recurrent or Persistent Renal Hyperparathyroidism

by Chien-Ling Hung, Yu-Chen Hsu, Shih-Ming Huang and Chung-Jye Hung

J. Clin. Med. 2021, 10(2), 329; https://doi.org/10.3390/jcm10020329 - 18 Jan 2021

Cited by 6 | Viewed by 2698

Abstract

Background: Comprehensive pre-reoperative localization is essential in complicated persistent or recurrent renal hyperparathyroidism. The widely used imaging studies sometimes lead to ambiguous results. Our study aimed to clarify the role of tissue aspirate parathyroid hormone (PTH) assay with a new positive assay definition for imaging suspicious neck lesions in these challenging scenarios. Methods: All patients with complicated recurrent or persistent renal hyperparathyroidism underwent parathyroid sonography and scintigraphy. Echo-guided tissue aspirate PTH assay was performed in suspicious lesions revealed by localization imaging studies. The tissue aspirate PTH level was determined by an immunoradiometric assay. We proposed a newly-developed definition for positive assay as a washout level higher than one-thirtieth of the serum PTH level obtained at the same time. The final diagnosis after re-operation was confirmed by the pathologists. Results: In total, 50 tissue aspirate PTH assays were performed in 32 patients with imaging suspicious neck lesions, including discrepant results between scintigraphy and sonography in 47 lesions (94%), unusual locations in 19 lesions (38%), multiple foci in 28 lesions (56%), and locations over previously explored areas in 31 lesions (62%). Among 39 assay-positive lesions, 13 lesions (33.3%) were not identified by parathyroid scintigraphy, and 28 lesions (71.8%) had uncertain parathyroid sonography findings. The final pathology in patients who underwent re-operative surgery proved the tissue aspirate PTH assays had a 100% positive predictive value. Conclusions: Our findings suggest tissue aspirate PTH assay with this new positive assay definition is beneficial to clarify the nature of imaging suspicious lesions in patients with complicated persistent or recurrent renal hyperparathyroidism. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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11 pages, 4111 KiB

Open AccessArticle

Interobserver Agreement and Plane-Dependent Intraobserver Variability of Shear Wave Sonoelastography in the Differential Diagnosis of Ectopic Thymus Tissue

by Zbigniew Adamczewski, Magdalena Stasiak, Bartłomiej Stasiak, Magdalena Adamczewska and Andrzej Lewiński

J. Clin. Med. 2021, 10(2), 214; https://doi.org/10.3390/jcm10020214 - 9 Jan 2021

Cited by 2 | Viewed by 1834

Abstract

Shear wave elastography (SWE) has been demonstrated to be a useful tool in the differential diagnosis of ectopic thymus tissues (ETs), providing quantitative values of the shear wave stiffness (SWS) of both ETs and adjacent thyroid tissue. However, no data are available on the potential influence of the imaging plane (transverse vs. longitudinal) on the obtained SWS and shear wave ratio (SWR) values in SWE of these tissues. Moreover, no reports on the interobserver repeatability of SWE were published in regard to ETs. The aim of this study has been to evaluate the potential influence of the examination plane—transverse vs. longitudinal—on the SWS and SWR results, as well as to determine whether SWE of ETs is subjected to interobserver variability. SWE was demonstrated to have high inter- and intraobserver agreement in the evaluation of ETs and adjacent thyroid tissue. Significant differences between SWS values, but not SWR values, obtained in the transverse and longitudinal planes were observed. This phenomenon is probably a result of anisotropy-related artifacts and does not reduce the reliability of the method. SWE operators should be aware of the presence of plane-dependent artifacts to properly interpret the obtained results. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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12 pages, 1300 KiB

Open AccessArticle

Application of Shear Wave Sonoelastography in the Differential Diagnosis of Extra- and Intra-Thyroidal Ectopic Thymic Tissue

by Magdalena Stasiak, Zbigniew Adamczewski, Renata Stawerska, Bartłomiej Stasiak and Andrzej Lewiński

J. Clin. Med. 2020, 9(12), 3816; https://doi.org/10.3390/jcm9123816 - 25 Nov 2020

Cited by 4 | Viewed by 1935

Abstract

The ultrasound (US) pattern of intrathyroidal ectopic thymus (IET) can resemble papillary thyroid carcinoma (PTC) while the extrathyroidal ectopic thymus (EET) can mimic pathological lymph nodes. Recently, the usefulness of strain elastography (SE) was demonstrated in the differential diagnosis, however this method has several limitations. The aim of the current study was to assess the usefulness of shear wave elastography (SWE) in this field. The US, SE, and SWE were performed in 31 children with 53 ectopic thymuses (ETs) and quantitative values of SWE parameters were calculated, so as to generate potential normative values of ET elasticity and of the shear wave ratio (SWR). The mean SWR_IET was 0.89 ± 0.21 and the mean shear wave stiffness (SWS) was 7.47 ± 1.93 kPa. The mean SWR_EET was 0.84 ± 0.15 and the mean SWS_EET was 11.28 ± 2.58 kPa. The results have proven that the stiffness of ETs is lower or equal to the thyroid’s. SWE was demonstrated to be a useful diagnostic method for ET evaluation. Therefore, the application of SWE in ET diagnosis allows more accurate evaluation of ET-like lesions and, in many cases, allows one to avoid invasive procedures, simultaneously providing a precise monitoring method based on combined US and SWE evaluation. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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10 pages, 1064 KiB

Open AccessArticle

Surgical Management of Primary Hyperparathyroidism—Clinicopathologic Study of 1019 Cases from a Single Institution

by Jacek Gawrychowski, Grzegorz J. Kowalski, Grzegorz Buła, Adam Bednarczyk, Dominika Żądło, Zbigniew Niedzielski, Agata Gawrychowska and Henryk Koziołek

J. Clin. Med. 2020, 9(11), 3540; https://doi.org/10.3390/jcm9113540 - 2 Nov 2020

Cited by 6 | Viewed by 2019

Abstract

Background: Primary hyperparathyroidism (pHPT) is an endocrine disorder characterized by hypercalcemia and caused by the presence of disordered parathyroid glands. Parathyroidectomy is the only curative therapy for pHPT, but despite its high cure rate of 95–98%, there are still cases where hypercalcemia persists after this surgical procedure. The aim of this study was to present the results of a surgical treatment of patients due to primary hyperparathyroidism and failures related to the thoracic location of the affected glands. Methods: We present a retrospective analysis of 1019 patients who underwent parathyroidectomy in our department in the period 1983–2018. Results: Among the group of 1019 operated-on patients, treatment failed in 19 cases (1.9%). In 16 (84.2%) of them, the repeated operation was successful. In total, 1016 patients returned to normocalcemia. Conclusions: Our results confirm that parathyreoidectomy is the treatment of choice for patients with primary hyperparathyroidism. The ectopic position of the parathyroid gland in the mediastinum is associated with an increased risk of surgical failure. Most parathyroid lesions in the mediastinum can be safely removed from the cervical access. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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11 pages, 1505 KiB

Open AccessArticle

Snail-1 Overexpression Correlates with Metastatic Phenotype in BRAF^V600E Positive Papillary Thyroid Carcinoma

by Katarzyna Wieczorek-Szukala, Janusz Kopczynski, Aldona Kowalska and Andrzej Lewinski

J. Clin. Med. 2020, 9(9), 2701; https://doi.org/10.3390/jcm9092701 - 21 Aug 2020

Cited by 9 | Viewed by 2280

Abstract

The ability of cancer to metastasize is regulated by various signaling pathways, including transforming growth factor β (TGFβ), also implicated in the upregulation of Snail-1 transcription factor in malignant neoplasms. B-type Raf kinase gene (BRAF)^V600E, the most common driving mutation in papillary thyroid carcinoma (PTC), induces epithelial to mesenchymal transition (EMT) in thyroid cancer cells through changes in the Snail-1 level, increasing cell migration and invasion. However, little is known about the mechanism of Snail-1 and BRAF^V600E relations in humans. Our study included 61 PTC patients with evaluated BRAF^V600E mutation status. A total of 18 of those patients had lymph node metastases—of whom 10 were BRAF^V600E positive, and 8 negative. Our findings indicate that the expression of Snail-1, but not TGFβ1, correlates with the metastatic phenotype in PTC. This is the first piece of evidence that the upregulation of Snail-1 corresponds with the presence of BRAF^V600E mutation and increased expression of Snail-1 in metastatic PTC samples is dependent on BRAF^V600E mutation status. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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14 pages, 755 KiB

Open AccessArticle

S-Detect Software vs. EU-TIRADS Classification: A Dual-Center Validation of Diagnostic Performance in Differentiation of Thyroid Nodules

by Ewelina Szczepanek-Parulska, Kosma Wolinski, Katarzyna Dobruch-Sobczak, Patrycja Antosik, Anna Ostalowska, Agnieszka Krauze, Bartosz Migda, Agnieszka Zylka, Malgorzata Lange-Ratajczak, Tomasz Banasiewicz, Marek Dedecjus, Zbigniew Adamczewski, Rafal Z. Slapa, Robert K. Mlosek, Andrzej Lewinski and Marek Ruchala

J. Clin. Med. 2020, 9(8), 2495; https://doi.org/10.3390/jcm9082495 - 3 Aug 2020

Cited by 20 | Viewed by 9101

Abstract

Computer-aided diagnosis (CAD) and other risk stratification systems may improve ultrasound image interpretation. This prospective study aimed to compare the diagnostic performance of CAD and the European Thyroid Imaging Reporting and Data System (EU-TIRADS) classification applied by physicians with S-Detect 2 software CAD based on Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and combinations of both methods (MODELs 1 to 5). In all, 133 nodules from 88 patients referred to thyroidectomy with available histopathology or with unambiguous results of cytology were included. The S-Detect system, EU-TIRADS, and mixed MODELs 1–5 for the diagnosis of thyroid cancer showed a sensitivity of 89.4%, 90.9%, 84.9%, 95.5%, 93.9%, 78.9% and 93.9%; a specificity of 80.6%, 61.2%, 88.1%, 53.7%, 73.1%, 89.6% and 80.6%; a positive predictive value of 81.9%, 69.8%, 87.5%, 67%, 77.5%, 88.1% and 82.7%; a negative predictive value of 88.5%, 87.2%, 85.5%, 92.3%, 92.5%, 81.1% and 93.1%; and an accuracy of 85%, 75.9%, 86.5%, 74.4%, 83.5%, 84.2%, and 87.2%, respectively. Comparison showed superiority of the similar MODELs 1 and 5 over other mixed models as well as EU-TIRADS and S-Detect used alone (p-value < 0.05). S-Detect software is characterized with high sensitivity and good specificity, whereas EU-TIRADS has high sensitivity, but rather low specificity. The best diagnostic performance in malignant thyroid nodule (TN) risk stratification was obtained for the combined model of S-Detect (“possibly malignant” nodule) and simultaneously obtaining 4 or 5 points (MODEL 1) or exactly 5 points (MODEL 5) on the EU-TIRADS scale. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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12 pages, 1390 KiB

Open AccessArticle

Detection of BRAFV600E in Liquid Biopsy from Patients with Papillary Thyroid Cancer Is Associated with Tumor Aggressiveness and Response to Therapy

by Kirk Jensen, Shilpa Thakur, Aneeta Patel, Maria Cecilia Mendonca-Torres, John Costello, Cristiane Jeyce Gomes-Lima, Mary Walter, Leonard Wartofsky, Kenneth Dale Burman, Athanasios Bikas, Dorina Ylli, Vasyl V. Vasko and Joanna Klubo-Gwiezdzinska

J. Clin. Med. 2020, 9(8), 2481; https://doi.org/10.3390/jcm9082481 - 2 Aug 2020

Cited by 23 | Viewed by 3541

Abstract

The detection of rare mutational targets in plasma (liquid biopsy) has emerged as a promising tool for the assessment of patients with cancer. We determined the presence of cell-free DNA containing the BRAFV600E mutations (cfBRAFV600E) in plasma samples from 57 patients with papillary thyroid cancer (PTC) with somatic BRAFV600E mutation-positive primary tumors using microfluidic digital PCR, and co-amplification at lower denaturation temperature (COLD) PCR. Mutant cfBRAFV600E alleles were detected in 24/57 (42.1%) of the examined patients. The presence of cfBRAFV600E was significantly associated with tumor size (p = 0.03), multifocal patterns of growth (p = 0.03), the presence of extrathyroidal gross extension (p = 0.02) and the presence of pulmonary micrometastases (p = 0.04). In patients with low-, intermediate- and high-risk PTCs, cfBRAFV600E was detected in 4/19 (21.0%), 8/22 (36.3%) and 12/16 (75.0%) of cases, respectively. Patients with detectable cfBRAFV600E were characterized by a 4.68 times higher likelihood of non-excellent response to therapy, as compared to patients without detectable cfBRAFV600E (OR (odds ratios), 4.68; 95% CI (confidence intervals)) 1.26–17.32; p = 0.02). In summary, the combination of digital polymerase chain reaction (dPCR) with COLD-PCR enables the detection of BRAFV600E in the liquid biopsy from patients with PTCs and could prove useful for the identification of patients with PTC at an increased risk for a structurally or biochemically incomplete or indeterminate response to treatment. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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12 pages, 1011 KiB

Open AccessArticle

Influence of Care Pathway on Thyroid Nodule Surgery Relevance: A Historical Cohort Study

by Solène Castellnou, Jean-Christophe Lifante, Stéphanie Polazzi, Léa Pascal, Françoise Borson-Chazot and Antoine Duclos

J. Clin. Med. 2020, 9(7), 2271; https://doi.org/10.3390/jcm9072271 - 17 Jul 2020

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Abstract

Background: Guidelines recommend using fine-needle aspiration cytology (FNAC) to guide thyroid nodule surgical indication. However, the extent to which these guidelines are followed remains unclear. This study aimed to analyze the quality of the preoperative care pathway and to evaluate whether compliance with the recommended care pathway influenced the relevance of surgical indications. Methods: Nationwide historical cohort study based on data from a sample (1/97th) of French health insurance beneficiaries. Evaluation of the care pathway of adult patients operated on between 2012 and 2015 during the year preceding thyroid nodule surgery. The pathway containing only FNAC was called “FNAC”, the pathway including an endocrinology consultation (ENDO) with FNAC was called “FNAC+ENDO”, whereas the no FNAC pathway was called “NO FNAC”. The main outcome was the malignant nature of the nodule. Results: Among the 1080 patients included in the study, “FNAC+ENDO” was found in 197 (18.2%), “FNAC” in 207 (19.2%), and “NO FNAC” in 676 (62.6%) patients. Cancer diagnosis was recorded in 72 (36.5%) “FNAC+ENDO” patients and 66 (31.9%) “FNAC” patients, against 119 (17.6%) “NO FNAC” patients. As compared to “NO FNAC”, the “FNAC+ENDO” care pathway was associated with thyroid cancer diagnosis (OR 2.67, 1.88–3.81), as was “FNAC” (OR 2.09, 1.46–2.98). Surgeries performed in university hospitals were also associated with thyroid cancer diagnosis (OR 1.61, 1.19–2.17). Increasing the year for surgery was associated with optimal care pathway (2015 vs. 2012, OR 1.52, 1.06–2.18). Conclusions: The recommended care pathway was associated with more relevant surgical indications. While clinical guidelines were insufficiently followed, compliance improved over the years. Full article

(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)

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