Preoperative Factors Associated with Extrathyroidal Extension in Papillary Thyroid Cancer

Objective The presence of extrathyroidal extension (ETE) is generally considered as an indication for total thyroidectomy for differentiated thyroid cancer. The accuracy of neck ultrasound for the diagnosis of ETE is controversial. The aim of this study was to assess the diagnostic accuracy of preoperative ultrasound evaluation of ETE. Methods The retrospective and observational study of consecutive patients operated between 2016 and 2019 for cytologically suspicious or indeterminate thyroid nodules were analyzed. US images obtained preoperatively were retrospectively reviewed to identify signs of minimal or gross ETE. Histology was considered as the golden standard for diagnosis of ETE. The sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of US were evaluated. Results A cohort of 305 patients (75% females, median age 48 years) with 378 nodules (median size 18 mm) was studied. Seventy-five percent of the nodules (n = 228) were malignant on histology and ETE was present in 106 cases (28%): 83 minimal ETE and 23 gross ETE. Suspicion of minimal ETE on preoperative ultrasound was found in 50 (13%) with a sensitivity of 30%, a specificity of 93%, a PPV of 62% and an NPV of 78%, with an accuracy of 76%. Gross ETE on ultrasound was found in 19 (5%) nodules with a sensitivity of 78%, a specificity of 99.7% a PPV of 94.7% an NPV of 98.6% and an accuracy of 98%. Conclusions Preoperative US is very specific and accurate in diagnosing gross ETE which impacts the extent of initial surgery for thyroid cancers.

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“…Other clinical factors, such as older age and tumor size, are associated to the presence of ETE (41) and may assist clinical decision.…”

Section: Discussionmentioning

confidence: 99%

Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

Lamartina¹,

Bidault²,

Hadoux³

et al. 2021

European Journal of Endocrinology

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“…Differences between categorical variables were assessed using Fisher's exact probability test. For ordered groups, comparisons were done using the Cochran-Armitage trend test for categorical variables and the Jonckheere-Terpstra test for continuous variables [16]. Cohen's κ coefficient was used to measure the inter-rater agreement [17].…”

Section: Discussionmentioning

confidence: 99%

Loss of Integrase Interactor 1 (INI1) Expression in a Subset of Differentiated Thyroid Cancer

Lee

Lin

et al. 2020

Diagnostics

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Alterations in the switching defective/sucrose non-fermenting (SWI/SNF) chromatin-remodeling complex are enriched in advanced thyroid cancer. Integrase interactor 1 (INI1), encoded by the SMARCB1 gene on the long arm of chromosome 22, is one of the core subunits of the SWI/SNF complex. INI1 immunohistochemistry is frequently used for the diagnosis of malignant rhabdoid neoplasms. In the present study, we found normal and benign thyroid tissues generally had diffusely intense nuclear immunostaining. Loss of INI1 immunohistochemical expression was observed in 8% of papillary thyroid cancer and 30% of follicular thyroid cancer. Furthermore, loss of INI1 expression was associated with extrathyroidal extension (p < 0.001) and lymph node metastasis (p = 0.038). Analysis of The Cancer Genome Atlas database revealed that SMARCB1 underexpression was associated with the follicular variant subtype and aneuploidy in papillary thyroid cancer. We speculate that SMARCB1 is an important effector in addition to NF2 and CHEK2 inactivation among thyroid cancers with chromosome 22q loss.

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“…Preoperative assessment of TC aggressiveness can be performed prior to surgical planning. TC aggressiveness is positively correlated with older age, a higher BMI, a larger tumor size and the presence of the BRAF V600E mutation in papillary TC 84 . These risk predictors of extrathyroidal extension should be taken into consideration during decision making before surgery, and the surgical regimen should minimize postoperative recurrence and complications.…”

Section: Introductionmentioning

confidence: 99%

The association of obesity with thyroid carcinoma risk

Hou

et al. 2022

Cancer Medicine

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Background The prevalence of obesity and an increased incidence of thyroid carcinoma (TC) threaten public health in parallel on a global scale. Sufficient evidence supports excess body fatness in thyroid carcinogenesis, and the role and anthropometric markers of obesity have been causally associated with the rising risk of TC. Methods A literature search was conducted in PubMed. Studies focused on the effect of obesity in TC. Results This review mainly discusses the global incidence and prevalence of obesity‐related TC. We also review the role of obesity in TC and potential clinical strategies for obesity‐related TC. Conclusions Excess body fatness in early life and TC survival initiate adverse effects later in life.

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Preoperative Factors Associated with Extrathyroidal Extension in Papillary Thyroid Cancer

Cited by 11 publications

References 40 publications

Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

Can preoperative ultrasound predict extrathyroidal extension of differentiated thyroid cancer?

Loss of Integrase Interactor 1 (INI1) Expression in a Subset of Differentiated Thyroid Cancer

The association of obesity with thyroid carcinoma risk

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