1,721,001 research outputs found
Nuove frontiere nel carcinoma midollare della tiroide: identificazione di nuovi biomarkers diagnostici
Full text linkBackground: medullary thyroid carcinoma (MTC) is rare thyroid cancer. The difficulty in management and the unfavorable outcome are mainly due to the absence of tools for early diagnosis. Recent studies have demonstrated the deregulation of microRNAs (miRNAs) in tumor samples from MTC patients. Extracellular plasma vesicles (pEVs) containing miRNA represent an emerging source of tumor biomarkers. There are no data from the circulating pEV-miRNAs in patients with MTC.
Aim: to identify new circulating diagnostic biomarkers in MTC.
Study design: multicenter, prospective, observational study enrolling adult patients with stage I-IV MTC (Group 1, n=23), compared to healthy subjects (Group 2, n=22). For Group 1 patients we collected: blood sample at the time of surgery and tumor tissue from the primary tumor. Step 1: pre-operative plasma from MTC patients (Group 1a) was compared to plasma from healthy subjects (Group 2). Step 2: pre-operative plasma from each MTC patients (Group 1a) was compared to tumor tissue of the same patient (Group 1b). Step 3: data from Step 1 and Step 2 were combined.
Methods: the expression analysis of circulating (pEV) and tissue miRNAs was performed by RT-qPCR with TLDA technology analyzing 754 miRNAs. Results were considered statistically significant when P-values were <0.05
Results: 555 miRNAs are considered to be informative comparing Group 1a and Group 2, 44 of them differentially expressed between two groups. 603 miRNAs are considered to be informative, comparing Group 1a vs Group 1b, 209 of them differentially expressed and 394 equally expressed between two groups, respectively. Combining Step 1 and Step 2 results, 24 miRNAs were identified.
Conclusions: a specific pattern of pEV-miRNAs was observed in MTC patients, which in part reflects tissue miRNAs arrangement. The 24 miRNAs identified represent potential diagnostic biomarkers in MTC, that could play an active role in the modulation of cellular pathways in targeted cells
Contemporary thyroid nodule evaluation and management
No full textContext
Approximately 60% of adults harbor one or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to healthcare favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and non-negligible morbidity for patients.
Evidence Acquisition
We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management.
Evidence Synthesis
The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems [TIRADS]) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally-invasive techniques.
Conclusion
Thyroid nodule evaluation is no longer a one-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs
Variazioni epidemiologiche delle neoplasie tiroidee nel tempo: ruolo della nutrizione iodica
Full text linkLo iodio è cruciale per l’omeostasi tiroidea: oltre ai noti effetti sulla funzione, la deficienza cronica di iodio può favorire lo sviluppo di gozzo o un aumento di prevalenza ed incidenza di noduli tiroidei benigni [1]. La relazione con il carcinoma tiroideo è più controversa e gli studi che hanno indagato questa associazione sono discordi: una revisione della letteratura sull’argomento è stata recentemente pubblicata [2]. Alcuni studi pubblicati negli anni ’90 avevano documentato un rischio incrementato di carcinoma tiroideo nelle popolazioni residenti in aree iodocarenti; in particolare, la distribuzione dei vari istotipi risultava sbilanciata verso una maggiore prevalenza di carcinoma follicolare. Inoltre, alcuni studi longitudinali, effettuati prima e dopo l’introduzione di programmi di iodoprofilassi, hanno documentato un incremento relativo dei carcinomi a rischio più basso (in particolare i carcinomi papilliferi della tiroide). I risultati riportati in letteratura sono comunque discordanti. L’interpretazione di eventi che avvengono durante ampi intervalli temporali, infatti, risulta complicata da molteplici fattori confondenti. Oltre all’implementazione di programmi di profilassi iodica negli anni Ottanta e Novanta, altri fattori possono spiegare la maggior prevalenza (relativa) di carcinomi papilliferi della tiroide. Tali fattori vengono discussi nelle sezioni seguenti e rappresentati in Figura 1 in parallelo all’implementazione dei programmi di profilassi iodica
A Young Patient with Intrathyroidal Papillary Thyroid Cancer and Family History of Differentiated Thyroid Cancer
No full textUp to 10% of all nonmedullary thyroid cancers (NMTCs) are familial. Until now, the diagnosis is clinical: when three or more first-degree relatives are affected, the probability that the cancers are not sporadic exceeds 90%. Some small studies have linked familial NMTCs (FNMTCs) with higher rates of multifocal involvement, lymph node metastases, and recurrence, as well as lower disease-free survival, but others have found no evidence of increased aggressiveness. Management should thus be based on the actual ATA risk classification. The 2015 ATA guidelines list familial disease as a possible indication for thyroidectomy instead of lobectomy but make no recommendation for or against the use of radioiodine remnant ablation (RRA), noting that there is no evidence that it improves disease-specific or disease-free survival of patients with low-risk NMTCs. The guidelines also refrain from recommending for or against ultrasound-based screening of family members: although it may allow earlier diagnosis of thyroid cancer in these individuals, the current evidence does not demonstrate any effect on morbidity or mortality
Fournier's gangrene during lenvatinib treatment: a case report
Full text linkFournier's gangrene is a rare and severe complication reported in patients with cancer treated with antiangiogenic drugs, most frequently with bevacizumab. The present report describes the case of an 80-year-old man with radioactive iodine-refractory metastatic thyroid cancer treated with lenvatinib (an oral multikinase inhibitor with antiangiogenic properties) who developed Fournier's gangrene in the absence of other known risk factors. To the best of our knowledge, this is the first case described during treatment with lenvatinib. The condition was likely due to a perturbation of vascular endothelial cells of the skin due to the inhibition of VEGF/VEGFR signaling. Fournier's gangrene may be a class effect of antiangiogenic treatment that clinicians should be aware of, as early diagnosis and treatment are associated with an improved outcome
Cancer care during COVID-19 era: the quality of life of patients with thyroid malignancies
Full text linkBackground: The Covid-19 pandemic's potential psychological impact has been widely discussed on the basis of expert opinion and previous experience with emergencies of this type. We conducted a survey of cancer patients to explore more objectively the outbreak's impact on their emotional well-being and quality of life.
Methods: Between March 18 and April 4, 2020, at an endocrine cancer center in Rome, Italy, 137 patients were asked to complete an online 6-item questionnaire developed by our staff to explore the emotional effects of the Covid-19 outbreak in Italy (Covid-19 Emotional Impact Survey, C-19EIS). For validation purposes, we also asked participants to complete an online version of the validated Italian translation of the EORTC QLQ-C30 questionnaire. Responses were analyzed in relation to responders' age, sex, and clinical status (advanced/metastatic disease undergoing systemic treatment vs. stable metastatic thyroid cancer in active surveillance vs. low-risk thyroid cancers with no evidence of structural disease during standard follow-up).
Results: Response rates were high (51% for the C-19EIS, 44.5% for the EORTC QLQ-C30). Overall C-19EIS scores indicated high concern over the outbreak (median 8/12). Scores were higher in women (8 [IQR 5–9] vs. 6 [IQR 5–8] in men; p = 0.048) and in patients <65 years (8 [IQR 5–9] vs. 6 [IQR 4–8] in older patients; p = 0.013). No differences emerged across clinical status groups. C-19EIS scores were inversely correlated with the EORTC QLQ-C30 Emotional function subscale (rho −0.69; p < 0.001).
Conclusions: There is objective evidence that the Covid-19 outbreak is causing substantial emotional distress among cancer patients, regardless of their disease severity or current health-care needs
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Sonographically estimated risks of malignancy for thyroid nodules computed with five standard classification systems. Changes over time and their relation to malignancy
No full textOver 50% of newly diagnosed thyroid nodules are either cytologically benign or presumed to be benign on the basis of low-suspicion sonographic findings. The strategies used for their long-term surveillance are based mainly on the estimated residual risk of malignancy calculated with various ultrasonographic classification systems (e.g., Thyroid Image Reporting and Data Systems [TIRADS]). We conducted a longitudinal study to evaluate the temporal stability of the initial risk estimates computed with five widely used systems and to determine whether risk class increases during follow-up are indeed predictive of malignancy. Methods: We re-analyzed data prospectively collected at a single academic referral center on 232 patients (age: 54.1 ± 13.7 years) with 432 asymptomatic, sonographically or cytologically benign thyroid nodules at baseline (T0) and 122 new nodules that were present five years later (T5). At both time points, the sonographically estimated risk of malignancy was calculated as recommended by the American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi, the American College of Radiologists' TIRADS, the American Thyroid Association's 2015 practice guidelines, the European Thyroid Association's TIRADS (EU-TIRADS), and the TIRADS of the Korean Society of Thyroid Radiology (K-TIRADS). Results: For 57 to 127 (13.2-29.4%) of the original nodules, depending on the system used, the estimated malignancy risk increased over the 5-year interval. Of the nodules whose baseline risk had not warranted cytological assessment, very few (6.3-8.3%) met the criteria for cytology at the 5-year evaluation. Biopsy was indicated for only 4 to 8 (3.3-6.6%) of the new nodules based on T5 risk estimates. Despite these changes, none of the 232 patients was ever diagnosed with a cancer. Conclusions: Ultrasound-based risk classes of presumably benign thyroid nodules remain fairly stable over time, and changes warranting biopsy are rare indeed. The appearance of new nodules is a frequent event, but very few (<5%) are classified as high risk, and only the 3-7% meet the criteria for cytological assessment. Collectively, these findings support the view that patients with presumably benign thyroid nodules can be safely followed with less intensive protocols
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