Journal of Clinical Medicine

Editorial

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Open AccessEditorial

Thyroid Cancer: Toward Surgical Evolution

by Annamaria D’Amore, Renato Patrone, Ludovico Docimo, Giovanni Conzo and Celestino Pio Lombardi

J. Clin. Med. 2021, 10(16), 3582; https://doi.org/10.3390/jcm10163582 - 14 Aug 2021

Cited by 2 | Viewed by 1176

Abstract

It has been more than five years since the American Thyroid Association (ATA) and the Italian consensus on thyroid cancer was published [...] Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

Research

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8 pages, 534 KiB

Open AccessArticle

Laser Ablation Treatment of Recurrent Lymph Node Metastases from Papillary Thyroid Carcinoma

by Chiara Offi, Claudia Misso, Giovanni Antonelli, Maria Grazia Esposito, Umberto Brancaccio and Stefano Spiezia

J. Clin. Med. 2021, 10(22), 5295; https://doi.org/10.3390/jcm10225295 - 14 Nov 2021

Cited by 5 | Viewed by 1935

Abstract

(1) Background: The incidence of papillary thyroid cancers is increasing. Papillary neoplasm metastasizes to the central and lateral lymph nodes of the neck. The recurrence rate is less than 30%. The gold standard of treatment for lymph node recurrences is surgery, but surgery [...] Read more.

(1) Background: The incidence of papillary thyroid cancers is increasing. Papillary neoplasm metastasizes to the central and lateral lymph nodes of the neck. The recurrence rate is less than 30%. The gold standard of treatment for lymph node recurrences is surgery, but surgery is burdened by a high rate of complications. Therefore, laser ablation of recurrent lymph nodes has been recognized as an alternative treatment with minimal invasiveness, a low complication rate and a curative effect. (2) Methods: We analyzed 10 patients who underwent a total thyroidectomy and metabolic radiotherapy and who developed a lymph node recurrence in the laterocervical compartment in the following 12–18 months. (3) Results: Patients developed lymph node recurrence at IV and Vb levels in 70% and 30% of cases, respectively. All patients were treated with a single laser ablative session. Hydrodissection was performed in all patients. The energy delivered was 1120 ± 159.3 Joules and 3–4 Watts in 362 ± 45.7 s. No complications were reported. All patients underwent a 6-month follow-up. A volumetric reduction of 40.12 ± 2.2%, 49.1 ± 2.13% and 59.8 ± 3.05%, respectively at 1-, 3- and 6-months of follow-up was reported. (4) Conclusions: At 6 months, a fine needle aspiration was performed, which was negative for malignant cells and negative for a dosage of Thyroglobulin in eluate. The laser ablation is an effective alternative to surgical treatment. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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8 pages, 240 KiB

Open AccessArticle

Preoperative Ultrasonography in the Evaluation of Suspected Familial Non-Medullary Thyroid Cancer: Are We Able to Predict Multifocality and Extrathyroidal Extension?

by Giorgio Grani, Gianluca Cera, Giovanni Conzo, Valeria Del Gatto, Cira Rosaria Tiziana di Gioia, Marianna Maranghi, Piernatale Lucia, Vito Cantisani, Alessio Metere, Rossella Melcarne, Maria Carola Borcea, Chiara Scorziello, Rosa Menditto, Marco Summa, Marco Biffoni, Cosimo Durante and Laura Giacomelli

J. Clin. Med. 2021, 10(22), 5277; https://doi.org/10.3390/jcm10225277 - 13 Nov 2021

Cited by 6 | Viewed by 1506

Abstract

Family history of thyroid cancer increases the risk of harboring thyroid malignancies that end up having extrathyroidal extension (ETE) and multifocality on histology; some authors suggest a more aggressive surgical approach. Their pre-operative identification could allow more conservative surgical procedures if none of [...] Read more.

Family history of thyroid cancer increases the risk of harboring thyroid malignancies that end up having extrathyroidal extension (ETE) and multifocality on histology; some authors suggest a more aggressive surgical approach. Their pre-operative identification could allow more conservative surgical procedures if none of these features are suspected. Our aim was to assess if neck ultrasonography could identify or exclude multifocality or ETE in these patients to tailor the extent of surgery. This retrospective study included patients with previous thyroid surgery, ≥1 first-grade relative with thyroid cancer, and who had undergone pre-surgical ultrasound. ETE was suspected in the case of thyroid border interruption or gross invasion of perithyroidal tissues. Multiple suspicious nodules were defined as suspicion of multifocal cancer. The cohort consisted of 45 patients (median age 49 years, 40 with thyroid cancer, 30 females). The positive predictive value of ultrasonography in predicting multifocality and ETE was 57.14% (25.25–84.03) and 41.67% (21.5–65.1%), respectively, while the negative predictive values were 63.2% (56.4–69.4%) and 72.7% (63.3–80.5%). Pre-operative ultrasound examination is unable to reliably identify or exclude multifocal disease or extrathyroidal extension. In patients scheduled for surgery and with a first-degree relative affected by DTC, a “negative” pre-operative US report does not exclude the potential finding of multifocality and ETE at final histopathology. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

8 pages, 571 KiB

Open AccessArticle

Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma

by Joohyun Woo, Hyeonkyeong Kim and Hyungju Kwon

J. Clin. Med. 2021, 10(21), 5144; https://doi.org/10.3390/jcm10215144 - 02 Nov 2021

Cited by 17 | Viewed by 1954

Abstract

The incidence of thyroid cancer has dramatically increased over the last few decades, and up to 60% of patients have multifocal tumors. However, the prognostic impact of multifocality in patients with papillary thyroid carcinoma (PTC) remains unestablished and controversial. We evaluate whether multifocality [...] Read more.

The incidence of thyroid cancer has dramatically increased over the last few decades, and up to 60% of patients have multifocal tumors. However, the prognostic impact of multifocality in patients with papillary thyroid carcinoma (PTC) remains unestablished and controversial. We evaluate whether multifocality can predict the recurrence of PTC. A total of 1249 patients who underwent total thyroidectomy for PTC at the Ewha Medical Center between March 2012 and December 2019 were reviewed. In this study, multifocality was found in 487 patients (39.0%) and the mean follow-up period was 5.5 ± 2.7 years. Multifocality was associated with high-risk features for recurrence, including extrathyroidal extension, lymph node metastasis, and margin involvement. After adjustment of those clinicopathological features, 10-year disease-free survival was 93.3% in patients with multifocal tumors, whereas those with unifocal disease showed 97.6% (p = 0.011). Multivariate Cox regression analysis indicated that male sex (HR 2.185, 95% CI 1.047–4.559), tumor size (HR 1.806, 95% CI 1.337–2.441), N1b LN metastasis (HR 3.603, 95% CI 1.207–10.757), and multifocality (HR 1.986, 95% CI 1.015–3.888) were independent predictors of recurrence. In conclusion, multifocality increased the risk of recurrence in patients with PTC. Patients with multifocal PTCs may need judicious treatment and follow-up approaches. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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12 pages, 1280 KiB

Open AccessArticle

Impact of Epithelial–Mesenchymal Immunophenotype on Local Aggressiveness in Papillary Thyroid Carcinoma Invading the Airway

by Martina Mandarano, Marco Andolfi, Renato Colella, Massimo Monacelli, Andrea Polistena, Sonia Moretti, Guido Bellezza, Efisio Puxeddu, Alessandro Sanguinetti, Angelo Sidoni, Nicola Avenia, Francesco Puma and Jacopo Vannucci

J. Clin. Med. 2021, 10(19), 4351; https://doi.org/10.3390/jcm10194351 - 24 Sep 2021

Viewed by 1322

Abstract

Primary thyroid tumours show different levels of aggressiveness, from indolent to rapidly growing infiltrating malignancies. The most effective therapeutic option is surgery when radical resection is feasible. Biomarkers of aggressiveness may help in scheduling extended resections such as airway infiltration, avoiding a non-radical [...] Read more.

Primary thyroid tumours show different levels of aggressiveness, from indolent to rapidly growing infiltrating malignancies. The most effective therapeutic option is surgery when radical resection is feasible. Biomarkers of aggressiveness may help in scheduling extended resections such as airway infiltration, avoiding a non-radical approach. The aim of the study is to evaluate the prognostic role of E-cadherin, N-cadherin, Aryl hydrocarbon receptor (AhR), and CD147 in different biological behaviours. Fifty-five samples from three groups of thyroid carcinomas were stained: papillary thyroid carcinomas (PTCs) infiltrating the airway (PTC-A), papillary intra-thyroid carcinomas (PTC-B) and poorly differentiated or anaplastic thyroid carcinomas (PDTC/ATC). High expressions of N-cadherin and AhR were associated with higher locoregional tumour aggressiveness (p = 0.005 and p < 0.001 respectively); PDTC/ATC more frequently showed a high expression of CD147 (p = 0.011), and a trend of lower expression of E-cadherin was registered in more aggressive neoplasms. Moreover, high levels of AhR were found with recurrent/persistent diseases (p = 0.031), particularly when tumours showed a concomitant high N-cadherin expression (p = 0.043). The study suggests that knowing in advance onco-biological factors with a potential role to discriminate between different subsets of patients could help the decision-making process, providing a more solid therapeutic indication and an increased expectation for radical surgery. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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12 pages, 765 KiB

Open AccessArticle

Thyroidectomy for Cancer: The Surgeon and the Parathyroid Glands Sparing

by Giuliano Perigli, Fabio Cianchi, Francesco Giudici, Edda Russo, Giulia Fiorenza, Luisa Petrone, Clotilde Sparano, Fabio Staderini, Benedetta Badii and Alessio Morandi

J. Clin. Med. 2021, 10(19), 4323; https://doi.org/10.3390/jcm10194323 - 23 Sep 2021

Cited by 4 | Viewed by 1584

Abstract

Background: The diagnosis of thyroid cancer is continuously increasing and consequently the amount of thyroidectomy. Notwithstanding the actual surgical skill, postoperative hypoparathyroidism still represents its most frequent complication. The aims of the present study are to analyze the rate of postoperative hypoparathyroidism after [...] Read more.

Background: The diagnosis of thyroid cancer is continuously increasing and consequently the amount of thyroidectomy. Notwithstanding the actual surgical skill, postoperative hypoparathyroidism still represents its most frequent complication. The aims of the present study are to analyze the rate of postoperative hypoparathyroidism after thyroidectomy, performed for cancer by a single first operator, without any technological aid, and to compare the data to those obtained adopting the most recent technological adjuncts developed to reduce the postoperative hypoparathyroidism. Methods: During the period 1997–2020 at the Endocrine Surgery Unit of the Department of Clinical and Experimental Medicine of the University of Florence, 1648 consecutive extracapsular thyroidectomies for cancer (401 with central compartment node dissection) were performed. The percentage of hypoparathyroidism, temporary or permanent, was recorded both in the first period (Group A) and in the second, most recent period (Group B). Total thyroidectomies were compared either with those with central compartment dissection and lobectomies. Minimally invasive procedures (MIT, MIVAT, some transoral) were also compared with conventional. Fisher’s exact and Chi-square tests were used for comparison of categorical variables. p < 0.01 was considered statistically significant. Furthermore, a literature research from PubMed^® has been performed, considering the most available tools to better identify parathyroid glands during thyroidectomy, in order to reduce the postoperative hypoparathyroidism. We grouped and analyzed them by technological affinity. Results: On the 1648 thyroidectomies enrolled for the study, the histotype was differentiated in 93.93 % of cases, medullary in 4% and poorly differentiated in the remaining 2.06%. Total extracapsular thyroidectomy and lobectomy were performed respectively in 95.45% and 4.55%. We recorded a total of 318 (19.29%) cases of hypocalcemia, with permanent hypoparathyroidism in 11 (0.66%). In regard to the literature, four categories of tools to facilitate the identification of the parathyroids were identified: (a) vital dye; (b) optical devices; (c) autofluorescence of parathyroids; and (d) autofluorescence enhanced by contrast media. Postoperative hypoparathyroidism had a variable range in the different groups. Conclusions: Our data confirm that the incidence of post-surgical hypoparathyroidism is extremely low in the high volume centers. Its potential reduction adopting technological adjuncts is difficult to estimate, and their cost, together with complexity of application, do not allow immediate routine use. The trend towards increasingly unilateral surgery in thyroid carcinoma, as confirmed by our results in case of lobectomy, is expected to really contribute to a further reduction of postsurgical hypoparathyroidism. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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13 pages, 746 KiB

Open AccessArticle

The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer

by Andrea Polistena, Monia Ranalli, Stefano Avenia, Roberta Lucchini, Alessandro Sanguinetti, Sergio Galasse, Fabio Rondelli, Jacopo Vannucci, Renato Patrone, Nunzio Velotti, Giovanni Conzo and Nicola Avenia

J. Clin. Med. 2021, 10(18), 4246; https://doi.org/10.3390/jcm10184246 - 18 Sep 2021

Cited by 3 | Viewed by 1657

Abstract

Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention [...] Read more.

Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention of shoulder syndrome has not yet been defined in comparison to nerve visualization only. We retrospectively analyzed 56 thyroid cancer patients who underwent MRND over a period of six years (2015–2020) in a high-volume institution. Demographic variables, type of surgical procedure, removed lymph nodes and the metastatic node ratio, pathology, adoption of IONM and shoulder functional outcome were investigated. The mean number of lymph nodes removed was 15.61, with a metastatic node ratio of 0.2745. IONM was used in 41.07% of patients, with a prevalence of 68% in the period 2017–2020. IONM adoption showed an effect on post-operative shoulder function. There were no effects in 89.29% of cases, and temporary and permanent effects in 8.93% and 1.79%, respectively. Confidence intervals and two-sample tests for equality of proportions were used when applicable. Expertise in high-volume centres and IONM during MRND seem to be correlated with a reduced prevalence of accessory nerve lesions and limited functional impairments. These results need to be confirmed by larger prospective randomized controlled trials. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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11 pages, 263 KiB

Open AccessArticle

Risk Factors for Low Levels of Parathyroid Hormone after Surgery for Thyroid Cancer: A Single Center Study

by Francesca Privitera, Rossella Gioco, Ileana Fazio, Alessio Volpicelli, Maria Teresa Cannizzaro, Salvatore Costa, Matteo Angelo Cannizzaro and Massimiliano Veroux

J. Clin. Med. 2021, 10(18), 4113; https://doi.org/10.3390/jcm10184113 - 12 Sep 2021

Cited by 5 | Viewed by 1706

Abstract

Background: Thyroidectomy is the definitive treatment for most patients with thyroid cancer. Hypoparathyroidism is the most frequent complication of thyroidectomy, and its pathogenesis is multifactorial. The aim of this study is to evaluate the patient- and surgical-related risk factors for hypoparathyroidism after surgery [...] Read more.

Background: Thyroidectomy is the definitive treatment for most patients with thyroid cancer. Hypoparathyroidism is the most frequent complication of thyroidectomy, and its pathogenesis is multifactorial. The aim of this study is to evaluate the patient- and surgical-related risk factors for hypoparathyroidism after surgery for thyroid cancer. Methods: In this retrospective study, patients referred to surgery for thyroid cancer from 2016 to 2019 were enrolled. Preoperative serum calcium and parathyroid hormone (PTH) and postoperative 24 h PTH and calcium levels were evaluated. Demographic data, type of surgery, incidence of hypoparathyroidism and hypocalcemia were recorded for all the patients. Patients were divided into two groups based on post-operative PTH levels (≤12 and >12 pg/mL). Results: A total of 189 patients were enrolled in this study. There were 146 women (87.3%) and 43 men (22.7%), with a mean age of 51.3 years. A total of 79 patients (41.7%) underwent a neck dissection. A total of 59 patients (31.1%) had a postoperative PTH level < 12 pg/mL. Female sex, neck dissection, the yield of lymph node dissection and incidental parathyroidectomy were significantly associated with postoperative hypoparathyroidism. Incidental parathyroidectomy was reported in 44 (23.2%) patients and was correlated with younger age (<40 years) and neck dissection. There was no difference in the rate of post-operative hypocalcemia between patients with incidental parathyroidectomy and those without. Conclusions: Young patients undergoing neck dissection and with incidental parathyroidectomy have the highest risk of postoperative hypoparathyroidism after surgery for thyroid cancer. However, a large proportion of patients without incidental parathyroidectomy may have temporary hypocalcemia, suggesting that impaired blood supply of parathyroid glands during their identification and dissection may play a relevant role. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

19 pages, 1591 KiB

Open AccessArticle

Expression and Clinical Utility of Transcription Factors Involved in Epithelial–Mesenchymal Transition during Thyroid Cancer Progression

by Enke Baldini, Chiara Tuccilli, Daniele Pironi, Antonio Catania, Francesco Tartaglia, Filippo Maria Di Matteo, Piergaspare Palumbo, Stefano Arcieri, Domenico Mascagni, Giorgio Palazzini, Domenico Tripodi, Alessandro Maturo, Massimo Vergine, Danilo Tarroni, Eleonora Lori, Iulia Catalina Ferent, Corrado De Vito, Poupak Fallahi, Alessandro Antonelli, Simona Censi, Matteo D’Armiento, Susy Barollo, Caterina Mian, Aldo Morrone, Vito D’Andrea, Salvatore Sorrenti and Salvatore Ulisse Show full author list Hide full author list

J. Clin. Med. 2021, 10(18), 4076; https://doi.org/10.3390/jcm10184076 - 09 Sep 2021

Cited by 20 | Viewed by 2034

Abstract

The transcription factors involved in epithelial–mesenchymal transition (EMT-TFs) silence the genes expressed in epithelial cells (e.g., E-cadherin) while inducing those typical of mesenchymal cells (e.g., vimentin). The core set of EMT-TFs comprises Zeb1, Zeb2, Snail1, Snail2, and Twist1. To date, information concerning their [...] Read more.

The transcription factors involved in epithelial–mesenchymal transition (EMT-TFs) silence the genes expressed in epithelial cells (e.g., E-cadherin) while inducing those typical of mesenchymal cells (e.g., vimentin). The core set of EMT-TFs comprises Zeb1, Zeb2, Snail1, Snail2, and Twist1. To date, information concerning their expression profile and clinical utility during thyroid cancer (TC) progression is still incomplete. We evaluated the EMT-TF, E-cadherin, and vimentin mRNA levels in 95 papillary TC (PTC) and 12 anaplastic TC (ATC) tissues and correlated them with patients’ clinicopathological parameters. Afterwards, we corroborated our findings by analyzing the data provided by a case study of the TGCA network. Compared with normal tissues, the expression of E-cadherin was found reduced in PTC and more strongly in ATC, while the vimentin expression did not vary. Among the EMT-TFs analyzed, Twist1 seems to exert a prominent role in EMT, being significantly associated with a number of PTC high-risk clinicopathological features and upregulated in ATC. Nonetheless, in the multivariate analysis, none of the EMT-TFs displayed a prognostic value. These data suggest that TC progression is characterized by an incomplete EMT and that Twist1 may represent a valuable therapeutic target warranting further investigation for the treatment of more aggressive thyroid cancers. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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7 pages, 211 KiB

Open AccessArticle

Perioperative Management of Pheochromocytoma: From a Dogmatic to a Tailored Approach

by Salvatore Buscemi, Giuseppe Di Buono, Rocco D’Andrea, Claudio Ricci, Laura Alberici, Lorenzo Querci, Saverio Selva, Francesco Minni, Roberto Citarrella, Giorgio Romano and Antonino Agrusa

J. Clin. Med. 2021, 10(16), 3759; https://doi.org/10.3390/jcm10163759 - 23 Aug 2021

Cited by 2 | Viewed by 3396

Abstract

Background: Perioperative management of pheochromocytoma (PCC) remains under debate. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. Patients were divided into two groups: Group 1 treated with alpha-blockade, and Group 2, [...] Read more.

Background: Perioperative management of pheochromocytoma (PCC) remains under debate. Methods: A bicentric retrospective study was conducted, including all patients who underwent laparoscopic adrenalectomy for PCC from 2000 to 2017. Patients were divided into two groups: Group 1 treated with alpha-blockade, and Group 2, without alfa-blockers. The primary end point was the major complication rate. The secondary end points were: the need for advanced intra-operative hemostasis, the admission to the intensive care unit (ICU), the length of stay (LOS), systolic (SBP), and diastolic blood pressure (DBP). Univariate and multivariate analysis was conducted. A p-value < 0.05 was considered statistically significant. Results: Major postoperative complications were similar (p = 0.49). Advanced hemostatic agents were 44.9% in Group 1 and 100% in Group 2 (p < 0.001). In Group 2, no patients were admitted to the ICU, while only 73.5% of Group 1 (p < 0.001) were admitted. The median length of stay was larger in Group 1 than in Group 2 (p = 0.026). At the induction, SBP was 130 mmHg in Group 1, and 115 mmHg (p < 0.001). The pre-surgery treatment was the only almost statistically significant variable at the multivariate analysis of DBP at the end of surgery. Conclusion: The preoperative use of alfa-blockers should be considered not a dogma in PCC. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

10 pages, 600 KiB

Open AccessArticle

Total Tumor Diameter and Unilateral Multifocality as Independent Predictor Factors for Metastatic Papillary Thyroid Microcarcinoma

by Liviu Hîțu, Paul-Andrei Ștefan and Doina Piciu

J. Clin. Med. 2021, 10(16), 3707; https://doi.org/10.3390/jcm10163707 - 20 Aug 2021

Cited by 7 | Viewed by 1497

Abstract

The purpose of this study was to assess whether total tumor diameter (TTD) and multifocality are predictors for metastatic disease in papillary thyroid microcarcinomas (PTMC). Eighty-two patients with histologically proven PTMC were retrospectively included. Patients were divided according to the presence of metastatic [...] Read more.

The purpose of this study was to assess whether total tumor diameter (TTD) and multifocality are predictors for metastatic disease in papillary thyroid microcarcinomas (PTMC). Eighty-two patients with histologically proven PTMC were retrospectively included. Patients were divided according to the presence of metastatic disease in the metastatic (n = 41) and non-metastatic (n = 41) demographic-matched group. The morphological features of PTMCs (primary tumor diameter, multifocality, TTD, number of foci, and tumor site) were compared between groups using univariate, multivariate, and receiver operating characteristic analyses. TTD (p = 0.026), TTD > 10 mm (p = 0.036), and Unilateral Multifocality (UM) (p = 0.019) statistically differed between the groups. The combination of the two independent predictors (TTD and UM) was able to assess metastatic risk with 60.98% sensitivity and 75.61% specificity. TTD and UM can be used to predict metastatic disease in PTMC, which may help to better adapt the RAI therapy decision. We believe that TTD and multifocality are tumor features that should be considered in future guidelines. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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10 pages, 705 KiB

Open AccessArticle

Predictors of Central Compartment Involvement in Patients with Positive Lateral Cervical Lymph Nodes According to Clinical and/or Ultrasound Evaluation

by Giuseppa Graceffa, Giuseppina Orlando, Gianfranco Cocorullo, Sergio Mazzola, Irene Vitale, Maria Pia Proclamà, Calogera Amato, Federica Saputo, Enza Maria Rollo, Alessandro Corigliano, Giuseppina Melfa, Calogero Cipolla and Gregorio Scerrino

J. Clin. Med. 2021, 10(15), 3407; https://doi.org/10.3390/jcm10153407 - 30 Jul 2021

Cited by 6 | Viewed by 1672

Abstract

Lymph node neck metastases are frequent in papillary thyroid carcinoma (PTC). Current guidelines state, on a weak level of evidence, that level VI dissection is mandatory in the presence of latero-cervical metastases. The aim of our study is to evaluate predictive factors for [...] Read more.

Lymph node neck metastases are frequent in papillary thyroid carcinoma (PTC). Current guidelines state, on a weak level of evidence, that level VI dissection is mandatory in the presence of latero-cervical metastases. The aim of our study is to evaluate predictive factors for the absence of level VI involvement despite the presence of metastases to the lateral cervical stations in PTC. Eighty-eight patients operated for PTC with level II–V metastases were retrospectively enrolled in the study. Demographics, thyroid function, autoimmunity, nodule size and site, cancer variant, multifocality, Bethesda and EU-TIRADS, number of central and lateral lymph nodes removed, number of positive lymph nodes and outcome were recorded. At univariate analysis, PTC location and number of positive lateral lymph nodes were risk criteria for failure to cure. ROC curves demonstrated the association of the number of positive lateral lymph nodes and failure to cure. On multivariate analysis, the protective factors were PTC located in lobe center and number of positive lateral lymph nodes < 4. Kaplan–Meier curves confirmed the absence of central lymph nodes as a positive prognostic factor. In the selected cases, Central Neck Dissection (CND) could be avoided even in the presence of positive Lateralcervical Lymph Nodes (LLN+). Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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9 pages, 397 KiB

Open AccessArticle

Tall Cell Variant versus Conventional Papillary Thyroid Carcinoma: A Retrospective Analysis in 351 Consecutive Patients

by Alessandro Longheu, Gian Luigi Canu, Federico Cappellacci, Enrico Erdas, Fabio Medas and Pietro Giorgio Calò

J. Clin. Med. 2021, 10(1), 70; https://doi.org/10.3390/jcm10010070 - 28 Dec 2020

Cited by 11 | Viewed by 2704

Abstract

Background: The aim of this retrospective study was to investigate clinical and pathological characteristics of the tall cell variant of papillary thyroid carcinoma compared to conventional variants. Methods: The clinical records of patients who underwent surgical treatment between 2009 and 2015 were analyzed. [...] Read more.

Background: The aim of this retrospective study was to investigate clinical and pathological characteristics of the tall cell variant of papillary thyroid carcinoma compared to conventional variants. Methods: The clinical records of patients who underwent surgical treatment between 2009 and 2015 were analyzed. The patients were divided into two groups: those with a histopathological diagnosis of tall cell papillary carcinoma were included in Group A, and those with a diagnosis of conventional variants in Group B. Results: A total of 35 patients were included in Group A and 316 in Group B. All patients underwent total thyroidectomy. Central compartment and lateral cervical lymph node dissection were performed more frequently in Group A (42.8% vs. 18%, p = 0.001, and 17.1% vs. 6.9%, p = 0.04). Angiolymphatic invasion, parenchymal invasion, extrathyroidal extension, and lymph node metastases were more frequent in Group A, and the data reached statistical significance. Local recurrence was more frequent in Group A (17.1% vs. 6.3%, p = 0.02), with two patients (5.7%) in Group A showing visceral metastases, whereas no patient in Group B developed metastatic cancer (p = 0.009). Conclusions: Tall cell papillary carcinoma is the most frequent aggressive variant of papillary thyroid cancer. Tall cell histology represents an independent poor prognostic factor compared to conventional variants. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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Review

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8 pages, 239 KiB

Open AccessReview

Poorly Differentiated Thyroid Carcinoma: Single Centre Experience and Review of the Literature

by Maria Irene Bellini, Marco Biffoni, Renato Patrone, Maria Carola Borcea, Maria Ludovica Costanzo, Tiziana Garritano, Rossella Melcarne, Rosa Menditto, Alessio Metere, Chiara Scorziello, Marco Summa, Luca Ventrone, Vito D’Andrea and Laura Giacomelli

J. Clin. Med. 2021, 10(22), 5258; https://doi.org/10.3390/jcm10225258 - 12 Nov 2021

Cited by 9 | Viewed by 2512

Abstract

There is controversy in the literature regarding a distinct subset of thyroid carcinoma whose histologically classification falls between well-differentiated and anaplastic carcinomas, previously identified as ‘poorly differentiated thyroid carcinoma’ (PDTC), or ‘insular carcinoma’, in view of the peculiar morphological characteristics of the cell [...] Read more.

There is controversy in the literature regarding a distinct subset of thyroid carcinoma whose histologically classification falls between well-differentiated and anaplastic carcinomas, previously identified as ‘poorly differentiated thyroid carcinoma’ (PDTC), or ‘insular carcinoma’, in view of the peculiar morphological characteristics of the cell groupings. The correct diagnosis and treatment of this entity have important prognostic and therapeutic significance. In this review, we describe the epidemiology, diagnosis, and management of PDTC and report our single centre experience to add to the limited evidence existing in the literature. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

13 pages, 3972 KiB

Open AccessReview

The Role of CEUS in the Evaluation of Thyroid Cancer: From Diagnosis to Local Staging

by Salvatore Sorrenti, Vincenzo Dolcetti, Daniele Fresilli, Giovanni Del Gaudio, Patrizia Pacini, Pintong Huang, Chiara Camponovo, Andrea Leoncini, Vito D’Andrea, Daniele Pironi, Fabrizio Frattaroli, Pierpaolo Trimboli, Maija Radzina and Vito Cantisani

J. Clin. Med. 2021, 10(19), 4559; https://doi.org/10.3390/jcm10194559 - 30 Sep 2021

Cited by 38 | Viewed by 3159

Abstract

Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate [...] Read more.

Ultrasound often represents the first diagnostic step for thyroid nodule evaluation in clinical practice, but baseline US alone is not always effective enough to achieve thyroid nodule characterization. In the last decades new ultrasound techniques, such as CEUS, have been introduced to evaluate thyroid parenchyma as recommended by EFSUMB guidelines, for use in clinical research field, although its role is not yet clear. Several papers show the potential utility of CEUS in the differential diagnosis of benign and malignant thyroid nodules and in the analysis of lymph node involvement in neoplastic pathology. Therefore, we carried out an evaluation of the literature concerning the role of CEUS in three specific areas: the characterization of the thyroid nodule, the evaluation of minimally invasive treatment and loco-regional staging of the lymph node in proven thyroid cancer. According to evidence reported, CEUS can also play an operative role in nodular thyroid pathology as it is able to guide ablation procedures on thyroid nodule and metastatic lymph nodes, to assess the radicality of surgery, to evaluate disease relapse at the level of the margins of ablated regions and to monitor the clinical evolution of necrotic areas in immediate post-treatment setting. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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8 pages, 391 KiB

Open AccessReview

Management of Low-Risk Thyroid Cancers: Is Active Surveillance a Valid Option? A Systematic Review of the Literature

by Renato Patrone, Nunzio Velotti, Stefania Masone, Alessandra Conzo, Luigi Flagiello, Chiara Cacciatore, Marco Filardo, Vincenza Granata, Francesco Izzo, Domenico Testa, Stefano Avenia, Alessandro Sanguinetti, Andrea Polistena and Giovanni Conzo

J. Clin. Med. 2021, 10(16), 3569; https://doi.org/10.3390/jcm10163569 - 13 Aug 2021

Cited by 4 | Viewed by 2110

Abstract

Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States. It has an excellent prognosis, with a five-year relative survival rate of 98.3%.Differentiated Thyroid Carcinomas (DTCs) are the most diagnosed thyroid tumors and are characterized [...] Read more.

Thyroid cancer is the most common endocrine malignancy, representing 2.9% of all new cancers in the United States. It has an excellent prognosis, with a five-year relative survival rate of 98.3%.Differentiated Thyroid Carcinomas (DTCs) are the most diagnosed thyroid tumors and are characterized by a slow growth rate and indolent course. For years, the only approach to treatment was thyroidectomy. Active surveillance (AS) has recently emerged as an alternative approach; it involves regular observation aimed at recognizing the minority of patients who will clinically progress and would likely benefit from rescue surgery. To better clarify the indications for active surveillance for low-risk thyroid cancers, we reviewed the current management of low-risk DTCs with a systematic search performed according to a PRISMA flowchart in electronic databases (PubMed, Web of Science, Scopus, and EMBASE) for studies published before May 2021. Fourteen publications were included for final analysis, with a total number of 4830 patients under AS. A total of 451/4830 (9.4%) patients experienced an increase in maximum diameter by >3 mm; 609/4830 (12.6%) patients underwent delayed surgery after AS; metastatic spread to cervical lymph nodes was present in 88/4213 (2.1%) patients; 4/3589 (0.1%) patients had metastatic disease outside of cervical lymph nodes. Finally, no subject had a documented mortality due to thyroid cancer during AS. Currently, the American Thyroid Association guidelines do not support AS as the first-line treatment in patients with PMC; however, they consider AS to be an effective alternative, particularly in patients with high surgical risk or poor life expectancy due to comorbid conditions. Thus, AS could be an alternative to immediate surgery for patients with very-low-risk tumors showing no cytologic evidence of aggressive disease, for high-risk surgical candidates, for those with concurrent comorbidities requiring urgent intervention, and for patients with a relatively short life expectancy. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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9 pages, 523 KiB

Open AccessReview

Morbid Obesity and Thyroid Cancer Rate. A Review of Literature

by Stefania Masone, Nunzio Velotti, Silvia Savastano, Emanuele Filice, Rossana Serao, Antonio Vitiello, Giovanna Berardi, Vincenzo Schiavone and Mario Musella

J. Clin. Med. 2021, 10(9), 1894; https://doi.org/10.3390/jcm10091894 - 27 Apr 2021

Cited by 18 | Viewed by 2421

Abstract

In the past three decades, several recent studies have analyzed the alarming increase of obesity worldwide, and it has been well established that the risk of many types of malignancies is increased in obese individuals; in the same period, thyroid cancer has become [...] Read more.

In the past three decades, several recent studies have analyzed the alarming increase of obesity worldwide, and it has been well established that the risk of many types of malignancies is increased in obese individuals; in the same period, thyroid cancer has become the fastest growing cancer of all malignancies. We investigated the current literature to underline the presence of a connection between excess body weight or Body Mass Index (BMI) and risk of thyroid cancer. Previous studies stated that the contraposition between adipocytes and adipose-resident immune cells enhances immune cell production of multiple pro-inflammatory factors with subsequent induction of hyperlipidemia and vascular injury; these factors are all associated with oxidative stress and cancer development and/or progression. Moreover, recent studies made clear the mitogenic and tumorigenic action of insulin, carried out through the stimulation of mitogen-activated protein kinase (MAPK) and phosphoinositide-3 kinase/AKT (PI3K/AKT) pathways, which is correlated to the hyperinsulinemia and hyperglycemia found in obese population. Our findings suggest that obesity and excess body weight are related to an increased risk of thyroid cancer and that the mechanisms that combine overweight with this cancer should be searched for in the adipokine pathways and chronic inflammation onset. Full article

(This article belongs to the Special Issue Outcomes and Therapeutic Management of Thyroid Carcinoma)

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