Serum MicroRNA-222 Expression for Malignancy Prediction in Euthyroid Patients with Indeterminate Thyroid Nodule

Abstract Background The Prevalence of thyroid nodules is rising nowadays, luckily most of them are benign. The risk of malignancy 5-15%, which necessitates the ultimate need to accurately distinguish benign from malignant nodule to avoid unnecessary thyroidectomy with risk of recurrent laryngeal nerve injury, postoperative hypothyroidism and lifetime thyroid replacement therapy, and other complications related to surgery and anaesthesia. Recent evidence suggests that circulating miRNA might have probable advantage as diagnostic or prognostic markers for numerous cancers. Given their reproducible and constant presence in sera, miRNA profiles have emerged as a non-invasive method to categorise a wide variety of human cancers. Aim of the study To evaluate a possible relationship between the expression level of circulating miRNA-222 and the histological outcome of euthyroid patients undergoing thyroidectomy for thyroid nodules with indeterminate FNAB cytology. Patients and Methods 45 patients of both genders, of age ranging from 19-70 years old visiting endocrine clinic or admitted to the endocrine surgical department with indeterminate thyroid nodules planned for thyroidectomy were included. All pateints were subjected to full medical history taking, general and local clinical examination, laboratory investigations (thyroid function tests), quantitative assay of serum micro RNA-222 expression by quantitative Real-Time polymerase chain reaction (qRT-PCR), ultrasonography imaging of thyroid gland, fine needle aspiration biopsy and cytology of the thyroid nodule, histopathological examination after thyroidectomy. Results The incidence of thyroid nodules was predominant in female gender in benign group and malignant group. Risk of malignancy increases as TI-RADS and Bethesda scores increases. Also, larger nodule in size has a more risk of malignancy (p = 0.034). Expression level of circulating miRNA222 in serum can’t differentiate between healthy, benign and malignant patients where there was no significant difference between them statistically (p = 0.867). Circulating miRNA-222 is a poor predicator for malignant nodules with sensitivity of 50%, specificity of 32.43%, with high negative predictive value (NPV=75%). Conclusion Expression level of circulating miRNA-222 is a poor predictor of malignant nodules in our studied group. The larger the nodule size the more risk of malignancy. Also, as TI-RADS and Bethesda scores increases the more risk of malignancy.

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MULTI NODULAR GOITER

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.01.1976 ◽

2010 ◽

Vol 17 (01) ◽

pp. 40-43

Author(s):

SYED ALI AKBAR ◽

Mohammad Qasim ◽

NAZIR AHMED ◽

Zar Khan ◽

JOHAR ALI ◽

...

Keyword(s):

Histopathological Examination ◽

Cervical Lymphadenopathy ◽

Nodular Goiter ◽

Follicular Carcinoma ◽

Study Patient ◽

Surgical Department ◽

Medical College ◽

Risk Of Malignancy ◽

Azad Kashmir ◽

A Prospective Study

Objective: I. To determine the frequency of malignancy in multi nodular goiter. II. To determine the histopathological types.Design: This is a prospective study. Setting: Surgical department of Foundation Hospital Rawalpindi and associated Teaching Hospital ofFrontier Medical College Abbottabad. Period: Aug. 2002 to Aug. 2007. Patients and Methods. One hundred patients with Multi nodular wereincluded in this study. Patient with diffuse goiter, solitary nodules, patient operated somewhere else and suspected cases of malignancy wereexcluded from the study. Tissue were sent to Armed Force Institute for histopathological examination. Patients were followed for 2 weeks aftersurgery with histopathological report, all the preoperative and postoperative findings were recorded in detail. Data was analyzed byusingSPSS 14. Results. Majority of patients studied, belonged to Azad Kashmir and Gilgit which are among the known endemic regions for goitrein Pakistan and other from Chakwal and Jhelum. Histopathology revealed 96 (96%) patients with multi nodular goiter, 3 (3%) papillary carcinomaand 1 (1 %) Follicular carcinoma. Conclusions: Multinodularity of the goitre should not be considered as low risk of malignancy and delay forsurgical intervention. Changes in the size of gland, the appearance of new and hard nodules or cervical lymphadenopathy may indicatemalignant change and prompt indication for surgery.

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THYROID NODULE GROWTH AS A PREDICTOR OF MALIGNANCY

Endocrine Practice ◽

10.4158/ep-2019-0049 ◽

2019 ◽

Vol 25 (10) ◽

pp. 1029-1034 ◽

Cited By ~ 2

Author(s):

Kathleen O'Connell ◽

Alexa Clark ◽

Wilma Hopman ◽

Joshua Lakoff

Keyword(s):

Confidence Interval ◽

Thyroid Nodule ◽

Odds Ratio ◽

Doubling Time ◽

Thyroid Nodules ◽

Volume Growth ◽

Needle Aspiration ◽

Health Science ◽

Significant Difference ◽

Nodule Growth

Objective: To assess which measure of thyroid nodule growth on serial neck ultrasound, if any, is associated with malignancy. Methods: Retrospective exploratory chart review of malignant thyroid nodules assessed at Kingston Health Sciences Centre (2006–2016) and benign thyroid nodules (2016), at least 1 cm in diameter and with 2 ultrasounds completed at least 30 days apart. Groups were compared using independent samples Student's t test, chi-square test, or Mann-Whitney U test as appropriate, as well as multivariable logistic and linear regression modelling to adjust for age and baseline volume. Results: One hundred and seventy-eight nodules were included in the study. When growth was defined as >20% increase in 2 dimensions (minimum 2 mm), malignant nodules (MNs) underwent significantly more growth than benign nodules (BNs) (16.8% BN versus 29.8% MN [ P = .026]; odds ratio = 2.49; 95% confidence interval = 1.12 to 5.56). There was no significant difference between the groups when growth was defined as >2 mm/year or ≥50% volume growth. Nodules shrank >2 mm/year in each group and the difference was not statistically significant (24.2% BN versus 20.7% MN [ P = .449]). The median doubling time for the nodules that grew was 1022.1 days in the BN group and 463.2 days in the MN group ( P = .036). The median doubling time for all nodules was 456.5 days in the BN group and 244.2 days in the MN group ( P = .015). Conclusion: Thyroid nodule growth defined as >20% increase in 2 dimensions (minimum 2 mm) is associated with risk of malignancy. Nodule shrinkage did not distinguish between BNs and MNs. Abbreviations: BN = benign nodule; CI = confidence interval; FNA = fine needle aspiration; KHSC = Kingston Health Science Centre; MN = malignant nodule; OR = odds ratio; ROC = receiver operating characteristic

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The Risk For Malignancy of the Thyroid Nodule is Modulated by Gender, Echotexture, and Intranodular Lymphocytic Thyroiditis

Hormone and Metabolic Research ◽

10.1055/a-0994-0489 ◽

2019 ◽

Vol 51 (09) ◽

pp. 559-567 ◽

Cited By ~ 1

Author(s):

Salvatore Arena ◽

Salvatore Benvenga

Keyword(s):

At Risk ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

Chronic Lymphocytic Thyroiditis ◽

Lymphocytic Thyroiditis ◽

Malignancy Rate ◽

Risk Of Malignancy

AbstractBased on the American (Bethesda, 2017) or Italian (SIAPEC 2014) cytological categories of thyroid nodules, the risk of malignancy and management vary. This risk is 5–10% or<3% (benign or TIR2), 6–18% or<10% (AUS/FLUS or TIR3A), 10–40% or 15–30% (FN/SFN or TIR3B), 45–60% or 60–80% (suspicious or TIR4), 94–96% or 95% (malignant or TIR5). In 408 thyroid nodules evaluated cytologically, we computed the malignancy rate in each category considering gender (325 females, 83 males), echotexture (268 isoechoic, 140 hypoechoic), intranodular chronic lymphocytic thyroiditis (ICLT: 113 with and 295 without); histology (263 benign, 145 malignant). It was 0–1.7% for the benign categories, except hypoechoic/ICLT+ve nodules of females (25%); 0–2.3% for the AUS/FLUS category, except isoechoic/ICLT–ve nodules of males (11.1%) and hypoechoic/ICLT–ve nodules of females (22.2%). For the FN/SFN category, rate was the most variable (from 0% in isoechoic/ICLT+ve nodules of males to 100% in hypoechoic/ICLT–ve nodules of males). The 30% threshold for risk was passed in four subgroups, and the 40% threshold in two subgroups (45% in isoechoic/ICLT–ve nodules of males, 80% in hypoechoic/ICLT+ve nodules of females). For the suspicious category, rate was 100% in males, except those with isoechoic/ICLT–ve nodules (75%), and>80% in females with hypoechoic nodules. For the malignant category, rate was always 100%. In conclusion, particular groups of nodules (based on gender, echotexture, and ICLT) within the cytologically benign through the suspiciously malignant category are at risk of malignancy substantially greater (even 100%) than the standard one. Accordingly, the suggested management cannot be standardized.

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1629 The Risk of Malignancy in Cytologically Indeterminate Thyroid Nodules

British Journal of Surgery ◽

10.1093/bjs/znab259.577 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

O Jones ◽

V Blackabey ◽

N Bhat

Keyword(s):

Thyroid Nodules ◽

Clinical Decision Making ◽

Clinical Decision ◽

Needle Aspiration ◽

Diagnostic Assessment ◽

Patient Counselling ◽

Conversion Rates ◽

Significant Difference ◽

Risk Of Malignancy ◽

Malignant Conversion

Abstract Introduction Fine needle aspiration (FNA) is the gold standard for the diagnostic assessment of thyroid nodules, with cytology stratified using the Thy classification (Thy 1-5). The management of cases where cytology is indeterminate (Thy-3) is challenging and subject to controversy. The current British Thyroid Association guidelines subclassify Thy-3 lesions into Thy-3a (atypia) and Thy-3f (follicular). Repeat FNA is generally recommended for Thy-3a specimens, whilst Thy-3f lesions should proceed to diagnostic hemithyroidectomy. The aim of this study was to determine the risk of malignancy in Thy-3a and Thy-3f lesions. Method This was a retrospective study of all patients who underwent FNA of a thyroid nodule from 01/01/2018 – 31/12/19. Those with Thy-3 cytology were identified and results correlated with final surgical histology. Results In total, there were 179 patients with Thy-3 cytology: 37 Thy-3a and 142 Thy-3f. The rate of malignancy was 21.6% (n = 8) for Thy-3a lesions and 20.4% (n = 29) for Thy-3f. When excluding microcarcinoma, the rates fell to 20.4% (n = 7) and 12.7% (n = 18) respectively. There was no statistically significant difference in malignant conversion between the two groups (p = 0.20). Conclusions This study does not demonstrate any statistically significant difference in the risk of malignancy between the Thy-3a and Thy-3f groups, suggesting that this subclassification does not add any additional utility to clinical decision making. Consideration should be given to the use of local malignant conversion rates to guide further management and pre-operative patient counselling in the Thy3 group.

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Diagnostic Accuracy of the Bethesda System of Reporting Thyroid Cytopathology in the Evaluation of Thyroid Nodule in a Tertiary Care Hospital of Kolkata

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/46 ◽

2021 ◽

Vol 8 (05) ◽

pp. 241-245

Author(s):

Sweta Verma ◽

Mita Saha Dutta Chowdhury ◽

Souradeep Ray ◽

Ruma Guha

Keyword(s):

Diagnostic Accuracy ◽

Thyroid Nodule ◽

Thyroid Nodules ◽

Tertiary Care ◽

Needle Aspiration ◽

Care Hospital ◽

Risk Of Malignancy ◽

Needle Aspiration Cytology ◽

Thyroid Cytopathology ◽

The Bethesda System

BACKGROUND Thyroid cancer has the most rapidly increasing incidence of all major cancers in India. The overall prevalence of thyroid malignancy is approximately 1 - 5 % of all cancers in women and less than 2 % in men. Thyroid nodules are a common clinical finding and have a reported prevalence of 4 – 7 % in the general population. The vast majority of these nodules are non-neoplastic or benign and the risk of malignancy varies from 5 to 10 %. Fine needle aspiration cytology (FNAC) is an efficient and reliable means for the evaluation of thyroid nodules. A key challenge for clinicians is to choose which thyroid nodule is to be investigated further and treated. Early detection and treatment of malignant thyroid nodules is associated with excellent outcomes. The aim of our study is to compare and correlate between fine needle aspiration cytology and histopathology of resected specimen and to determine the diagnostic accuracy of TBSRTC (The Bethesda System for Reporting Thyroid Cytopathology) in thyroid nodule. METHODS This is a cross sectional validation study conducted in a tertiary care hospital (R.G. Kar Medical College) of Kolkata to find the sensitivity, specificity and diagnostic accuracy of TBSRTC in evaluation of thyroid nodule. RESULTS We have observed that TBSRTC is highly sensitive and specific in stratifying the malignancy risk of thyroid nodule. CONCLUSIONS It aids the clinician to choose the thyroid nodules which require further evaluation and intervention. It also guides the clinician to decide the operability of thyroid nodule. TBSRTC is highly accurate and is highly specific in stratifying the risk of malignancy of thyroid nodule. KEYWORDS TBSRTC, FNAC, Thyroid Nodules, Thyroid Cancer

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Case Report of Postpartum Thyroid Nodule Size Reduction

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1886 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A923-A923

Author(s):

Jana Havranova ◽

Thomas Gallagher ◽

Mohammad Ishaq Arastu

Keyword(s):

Thyroid Gland ◽

Thyroid Nodule ◽

Thyroid Function ◽

Thyroid Nodules ◽

Late Pregnancy ◽

Needle Aspiration ◽

White Coat Hypertension ◽

Thyroid Function Tests ◽

Function Tests ◽

True Association

Abstract Introduction: Thyroid nodules are very common. They occur more commonly in women with an increased prevalence of thyroid nodules reported in pregnancy. Most thyroid nodules diagnosed during pregnancy are benign. Pregnancy causes major physiological changes including changes in the levels of thyroid hormones and the elevation of thyroid binding globulin. Thyroid nodules may also occur in people with abnormal thyroid function tests manifesting as hyperthyroidism or hypothyroidism. We present a unique case of a new diagnosis of a large thyroid nodule that has significantly decreased in size after 20 months postpartum. Case description: Patient is a 31 year old female with past medical history of anxiety and white coat hypertension who was diagnosed with a 3.3 x 2.3 x 2.1 cm thyroid nodule a month following delivery. Patient did not have any abnormalities in her thyroid function tests before, during, or after pregnancy. She remained euthyroid throughout the pregnancy and in the postpartum period. Fine needle aspiration biopsy of the nodule showed atypia of undetermined significance (Bethesda Category III). The specimen was further analyzed by afirma testing that confirmed benign pathology. Twenty months postpartum, the thyroid nodule significantly decreased in size to 1.9 x 1.4 x 1.2 cm. Conclusion: Thyroid hormone levels physiologically change during pregnancy and this may affect the growth of thyroid nodules. We just presented a patient who exhibited a significant decrease in the size of her thyroid nodule. Sahin et al. showed that while the size of the thyroid nodule increases during pregnancy the number of nodules remains unaffected. Kung et al. showed that pregnancy is associated with an increase in the size of preexisting thyroid nodules as well as the number of newly developed thyroid nodules. Vanucchi et al. showed that although the thyroid gland becomes larger, particularly in late pregnancy, the sizes of any preexisting thyroid nodules remained unchanged and patients’ thyroid gland size returned to normal after delivery. The current literature provides conflicting data on this topic. The true association between pregnancy and thyroid nodules is unknown. Contemporary literature is ambiguous on this topic and more scientific studies are required to find the true association between pregnancy, the formation of thyroid nodules, and increase in the size or number of thyroid nodules.

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Triple diagnostic test in the evaluation of thyroid nodules

International Surgery Journal ◽

10.18203/2349-2902.isj20211309 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1264

Author(s):

Snigdha Kamini ◽

Jainendra K. Arora ◽

Sunil Kumar Jain

Keyword(s):

Thyroid Nodule ◽

Sensitivity And Specificity ◽

Thyroid Nodules ◽

Histopathological Examination ◽

Clinical Score ◽

Triple Test ◽

Follicular Lesions ◽

Unnecessary Procedures ◽

Sensitivity Specificity ◽

The Bethesda System

Background: Thyroid nodules are a common endocrine disease whose prevalence in India is approximately 12.2%. Although most patients with suspected nodules have benign conditions, the overestimation of malignancy leads to the performance of unnecessary procedures. No clinical, radiological and cytological parameters has singularly shown significant impact on clinical practice and post-operative histopathological examination remains the gold standard in the diagnosis of malignancy.Methods: 55 patients with thyroid nodules were evaluated and the Clinical assessment findings were recorded by McGill thyroid nodule score, ultrasonography findings using TIRADS and FNAC findings by the Bethesda system. The triple test was then used to classify them and these results were compared with the HPE of the post-operative specimen.Results: The sensitivity and specificity of TIRADS, FNAC were higher as compared to clinical score; clinical score had lowest sensitivity of 72.73%. The sensitivity, specificity, PPV, NPV and accuracy of triple test was 100%. Triple test had higher sensitivity, specificity and accuracy in differentiating thyroid nodules as compared to any of the three parameters used individually.Conclusions: Triple test has higher accuracy, sensitivity and specificity in determining the nature of thyroid nodule than each of the parameters used individually and it is especially useful in follicular lesions. On the basis of the results of this study, we conclude that the triple test can reliably be used to differentiate benign and malignant nodules preoperatively.

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Papillary thyroid cancer in an adolescent with a toxic single nodular goiter

Problems of Endocrinology ◽

10.14341/probl2017632114-116 ◽

2017 ◽

Vol 63 (2) ◽

pp. 114-116 ◽

Cited By ~ 1

Author(s):

Olga S. Rogova ◽

Goar F. Okminyan ◽

Lubov N. Samsonova ◽

Elena V. Kiseleva ◽

Oleg Yu. Latyshev ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Nodule ◽

Papillary Thyroid Cancer ◽

Thyroid Nodules ◽

Fine Needle Aspiration Biopsy ◽

Nodular Goiter ◽

Needle Aspiration ◽

Papillary Thyroid ◽

Risk Of Malignancy ◽

Functional Autonomy

The rate of nodular goiter in children ranges from 0.05 to 5.1%; in this case, the risk of thyroid cancer in childhood amounts to 3―70% of all cases of thyroid pathology. Therefore, the main issue is the differential diagnosis of a nosological variant of a thyroid nodule, which defines the optimal therapeutic tactics for a particular patient. The risk of malignancy is traditionally believed to be low in the case of decompensated functional autonomy of a thyroid nodule; therefore, the need for fine needle aspiration biopsy (FNAB) followed by cytomorphological analysis of the aspirate is avoided in most cases. The presented clinical case demonstrates papillary cancer in an adolescent with a toxic single nodular goiter. A thyroid ultrasound examination revealed a nodular lesion in the boy. An increase in the thyroid size and thyrotoxicosis manifestation occurred 3 years later. A cytomorphological study identified follicular neoplasia; scintigraphy revealed a hot nodule. Surgical treatment was planned. Antithyroid therapy was prescribed to prepare for surgery. After compensation of thyrotoxicosis, hemithyroidectomy was performed. A histological examination diagnosed papillary thyroid cancer, which required repeated thyroidectomy followed by radioiodine I131 ablation. The postoperative period was uneventful; the patient well tolerated suppressive levothyroxine therapy. Therefore, the presence of a toxic single nodular goiter does not exclude thyroid cancer, which defines the need to discuss the indications for FNAB of thyroid nodules in children.

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Study of serum Micro-RNA 221 Expression in Patients with Thyroid Nodules and Its Relation to Outcome

QJM ◽

10.1093/qjmed/hcab100.108 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Sherief Samy Bayomy ◽

Raef Malak Botros ◽

Alyaa Ahmed Elsherbini ◽

Hanan Mohamed Ali

Keyword(s):

Thyroid Nodules ◽

Malignant Lesion ◽

Needle Aspiration ◽

Micro Rna ◽

Rna Sequences ◽

Expression Of Genes ◽

Indeterminate Nodules ◽

Diagnostic Management ◽

Risk Of Malignancy ◽

Rule Out

Abstract A major dilemma in the diagnostic management of thyroid nodules is to determine whether it is a benign or malignant lesion and hence to determine decision for surgery. The majority of individuals with thyroid nodules are asymptomatic. The current first line of evaluation of thyroid nodules encompasses thyroid hormone laboratory tests, and ultrasonography of the thyroid gland, fine-needle aspiration (FNA) biopsy is often used to rule out cancer in thyroid nodules, in 20–30% of cases, however, FNAB yields indeterminate cytological results and suspicious for malignancy. Surgery was classically recommended for such indeterminate nodules for their risk of malignancy, which, overall, is about 25% when confirmed histopathologically upon thyroidectomy. As a result, about 75% of patients with cytologically indeterminate thyroid nodules would undergo unnecessary thyroid surgeries for nodules that prove to be benign only after surgery. Recent advances in research on thyroid carcinogenesis have yielded applications of diagnostic molecular biomarkers and profiling panels in the management of thyroid nodules. Among these markers are MicroRNAs (miRs) are small RNA sequences (19–25 nucleotides) that function to regulate the expression of genes. In this paper we aim to detect a possible of Micro-RNA 221 expression in sera of Patients With thyroid nodules and its relation to outcome after surgery.

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