scholarly journals Postoperatively determined high-risk histopathologic features in papillary thyroid carcinoma initially eligible for thyroid lobectomy: a game changer

Endocrine ◽  
2021 ◽  
Author(s):  
Sohail Bakkar ◽  
Khaled Al-Omar ◽  
Gianluca Donatini ◽  
Qusai Aljarrah ◽  
Theodosios S. Papavramidis ◽  
...  
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Papillary Thyroid ◽  
Thyroid Lobectomy ◽  
Histopathologic Features ◽  
Game Changer

scholarly journals Postoperatively Determined High-Risk Histopathologic Features in Papillary Thyroid Carcinoma Initially Eligible for Thyroid Lobectomy: A Game Changer

2021 ◽  
Author(s):  
Sohail Bakkar ◽  
Khaled Al-Omar ◽  
Gianluca Donatini ◽  
Qusai Aljarrah ◽  
Theodosios S Papavramidis ◽  
...  
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Vascular Invasion ◽  
Considerable Proportion ◽  
Completion Thyroidectomy ◽  
Papillary Thyroid ◽  
Thyroid Lobectomy ◽  
Aggressive Histology ◽  
Histopathologic Features

Abstract Purpose. Recent clinical practice guidelines consider thyroid lobectomy a viable alternative for low-risk papillary thyroid carcinoma PTC measuring 1–4 cm in size. We aimed to assess the likelihood of finding postoperatively determined high-risk histopathologic features that would lead to the recommendation of completion thyroidectomy. Methods. A retrospective review of patients who underwent total thyroidectomy for PTC measuring 1–4 cm in size between Jan 2012-Jan 2018 was conducted. Patients with pre-operative high-risk characteristics were excluded; history of radiation exposure, positive family history, clinically suspicious cervical lymphadenopathy, and gross extrathyroidal extension (ETE). A hypothetical group of 245 patients remained eligible for lobectomy. The pathology specimens from the cancer-containing lobes were evaluated for high-risk features: aggressive histology, capsular and/or vascular invasion, microscopic ETE, and multifocality. A subgroup analysis was performed with 2 cm being the cut-off size. Results. The average age was 39 years with 73% being females. Mean cancer size was 16 mm. Evaluation of the cancer-containing lobe for high-risk features revealed: aggressive histology (33%), ETE (12%), capsular invasion (33%), vascular invasion (17%), and ipsilateral multifocality (30%). The cumulative risk of having ≥ 1 high-risk feature mandating completion thyroidectomy was 59%. The risk was considerably higher for lesions ≤ 2 cm compared to larger lesions (64% vs.48%; p = 0.049; RR = 1.3). Conclusion. A considerable proportion of patients initially eligible for lobectomy have high-risk features that only become evident at pathology. Therefore, a comprehensive approach is advocated to determine the extent of surgery for PTC incorporating patient preferences regarding risks and benefits.

Papillary Thyroid Carcinoma: How Radical Lymphadenectomy Should be Performed?

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 63-68
Author(s):  
Schweizer ◽  
Seifert ◽  
Gemsenjäger
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Low Risk ◽  
Papillary Thyroid ◽  
Sentinel Nodes ◽  
Fand Sich ◽  
Radical Lymphadenectomy ◽  
N Status

Fragestellung: Die Bedeutung von Lymphknotenbefall bei papillärem Schilddrüsenkarzinom und die optimale Lymphknotenchirurgie werden kontrovers beurteilt. Methodik: Retrospektive Langzeitstudie eines Operateurs (n = 159), prospektive Dokumentation, Nachkontrolle 1-27 (x = 8) Jahre, Untersuchung mit Bezug auf Lymphknotenbefall. Resultate: Staging. Bei 42 Patienten wurde wegen makroskopischem Lymphknotenbefall (cN1) eine therapeutische Lymphadenektomie durchgeführt, mit pN1 Status bei 41 (98%) Patienten. Unter 117 Patienten ohne Anhalt für Lymphknotenbefall (cN0) fand sich okkulter Befall bei 5/29 (17%) Patienten mit elektiver (prophylaktischer) Lymphadenektomie, und bei 2/88 (2.3%) Patienten ohne Lymphadenektomie (metachroner Befall) (p < 0.005). Lymphknotenrezidive traten (1-5 Jahre nach kurativer Primärtherapie) bei 5/42 (12%) pN1 und bei 3/114 (2.6%) cN0, pN0 Tumoren auf (p = 0009). Das 20-Jahres-Überleben war bei TNM I + II (low risk) Patienten 100%, d.h. unabhängig vom N Status; pN1 vs. pN0, cN0 beeinflusste das Überleben ungünstig bei high risk (>= 45-jährige) Patienten (50% vs. 86%; p = 0.03). Diskussion: Der makroskopische intraoperative Lymphknotenbefund (cN) hat Bedeutung: - Befall ist meistens richtig positiv (pN1) und erfordert eine ausreichend radikale, d.h. systematische, kompartiment-orientierte Lymphadenektomie (Mikrodissektion) zur Verhütung von - kurablem oder gefährlichem - Rezidiv. - Okkulter Befall bei unauffälligen Lymphknoten führt selten zum klinischen Rezidiv und beeinflusst das Überleben nicht. Wir empfehlen eine weniger radikale (sampling), nur zentrale prophylaktische Lymphadenektomie, ohne Risiko von chirurgischer Morbidität. Ein empfindlicherer Nachweis von okkultem Befund (Immunhistochemie, Schnellschnitt von sampling Gewebe oder sentinel nodes) erscheint nicht rational. Bei pN0, cN0 Befund kommen Verzicht auf 131I Prophylaxe und eine weniger intensive Nachsorge in Frage.

High expression and localization of β-catenin and epidermal growth factor receptor identify high risk papillary thyroid carcinoma patients

2018 ◽  
Vol 105 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Tijana Išić Denčić ◽  
Aleksandar Bartolome ◽  
Sonja Šelemetjev ◽  
Ilona Đorić ◽  
Svetislav Tatić ◽  
...  
Keyword(s):  
Epidermal Growth Factor Receptor ◽  
Growth Factor ◽  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Epidermal Growth Factor ◽  
Thyroid Carcinoma ◽  
Growth Factor Receptor ◽  
High Expression ◽  
Papillary Thyroid ◽  
Epidermal Growth

scholarly journals Incidental Papillary Thyroid Cancer Identified During Parathyroidectomy

2020 ◽  
pp. 014556132098269
Author(s):  
Megan L. Crenshaw ◽  
Dana Goldenberg ◽  
Darrin V. Bann
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Treatment Guidelines ◽  
Surgical Excision ◽  
Current Treatment ◽  
Papillary Thyroid ◽  
Disease Extent ◽  
Lack Of Information ◽  
Thyroid Lobectomy ◽  
Short And Long Term

Current treatment guidelines recommend surgical excision of papillary thyroid carcinoma. However, the precise surgical treatment, including thyroid lobectomy, total thyroidectomy, and the need for neck dissection, is dictated by disease extent and tumor cytology. Incidental papillary thyroid carcinoma discovered during another surgery therefore presents a surgical conundrum due to lack of information. Surgeons must consider short- and long-term surgical morbidities, as well as individual patient factors, when deciding how to treat an unexpected thyroid carcinoma.

scholarly journals The oncogene BRAFV600E is associated with a high risk of recurrence and less differentiated papillary thyroid carcinoma due to the impairment of Na+/I− targeting to the membrane

2006 ◽  
Vol 13 (1) ◽  
pp. 257-269 ◽  
Author(s):  
G Riesco-Eizaguirre ◽  
P Gutiérrez-Martínez ◽  
M A García-Cabezas ◽  
M Nistal ◽  
P Santisteban
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Prognostic Impact ◽  
Erk Pathway ◽  
Papillary Thyroid ◽  
Thyroid Cells ◽  
Genetic Event ◽  
Total Body

The oncogene BRAFV600E is the most frequent genetic event in papillary thyroid carcinoma (PTC) but its prognostic impact still remains to be elucidated. We evaluated a representative series of 67 individuals with PTC who underwent total thyroidectomy. BRAF-positive tumours correlated with early recurrences (32% vs 7.6%; P=0.02) during a median postoperative follow-up period of 3 years. Interestingly, within the recurrences, a significant majority had negative radioiodine (131I) total body scans, predicting a poorer outcome as treatment with 131I is not effective. This last observation led us to investigate the role of BRAFV600E and the MEK-ERK pathway in thyroid dedifferentiation, particularly in Na+/I− symporter (NIS) impairment, as this thyroid-specific plasma membrane glycoprotein mediates active transport of I− into the thyroid follicular cells. A subset of 60 PTC samples was evaluated for NIS immunoreactivity and, accordingly, we confirmed a significant low NIS expression and impaired targeting to membranes in BRAF-positive samples (3.5% vs 30%; P=0.005). Furthermore, experiments with differentiated PCCl3 thyroid cells demonstrated that transient expression of BRAFV600E sharply impaired both NIS expression and targeting to membrane and, surprisingly, this impairment was not totally dependent on the MEK-ERK pathway. We have concluded that BRAFV600E is a new prognostic factor in PTC that correlates with a high risk of recurrences and less differentiated tumours due to the loss of NIS-mediated 131I uptake.

Thyroid Lobectomy for T1 Papillary Thyroid Carcinoma in Pediatric Patients

2021 ◽  
Author(s):  
Chad K. Sudoko ◽  
Carolyn M. Jenks ◽  
Andrew J. Bauer ◽  
Amber Isaza ◽  
Sogol Mostoufi-Moab ◽  
...  
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Pediatric Patients ◽  
Papillary Thyroid ◽  
Thyroid Lobectomy

scholarly journals Microcalcifications without a thyroid nodule as the sole sign of papillary thyroid carcinoma

2021 ◽  
Vol 2021 ◽  
Author(s):  
Stamatina Ioakim ◽  
Vasilis Constantinides ◽  
Meropi Toumba ◽  
Theodoros Lyssiotis ◽  
Angelos Kyriacou
Keyword(s):  
High Risk ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Gland ◽  
Thyroid Carcinoma ◽  
Histopathological Examination ◽  
Needle Aspiration ◽  
List Type ◽  
Papillary Thyroid ◽  
Resected Tissue ◽  
Current Guidelines

Summary Our objective is to demonstrate the importance of considering microcalcifications even without evidence of nodules as a potential sign of malignancy. Current guidelines, such as those of the British Thyroid Association, acknowledge the clinical significance of microcalcifications only when found within nodules. In this case, they are considered a suspicious feature, classifying the nodules as U5 (i.e. high risk) where fine-needle aspiration biopsy (FNAB) is warranted, following the high likelihood of cancer in these nodules. In addition, there is a dearth of evidence of ultrasound scan (USS) detection of microcalcifications in the thyroid gland outside of nodules, along with their associated clinical implications. Yet, this clinical manifestation is not so infrequent considering that we do encounter patients in the clinic showing these findings upon ultrasound examination. Three patients who presented to our clinic with thyroid-related symptoms were shown to have areas of microcalcifications without a nodule upon sonographic evaluation of their thyroid gland. These incidentally detected hyperechoic foci were later confirmed to correspond to areas of papillary thyroid carcinoma (PTC) on histopathological examination of resected tissue following thyroidectomy. Four more cases were identified with sonographic evidence of microcalcifications without nodules and given their clinical and other sonographic characteristics were managed with active surveillance instead. Learning points Echogenic foci known as microcalcifications may be visible without apparent association to nodular structures. Microcalcifications without nodules may not be an infrequent finding. Microcalcifications are frequently indicative of malignancy within the thyroid gland even without a clearly delineated nodule. Empirically, the usual guidelines for the management of thyroid nodules can be applied to the management of microcalcifications not confined to a nodule, but such a finding per se should be classified as a ‘high-risk’ sign.

Sign in / Sign up

Export Citation Format

Share Document