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Cancers
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Classification, Risk Assessment and Clinical Management of Malignant Thyroid Nodules
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Classification, Risk Assessment and Clinical Management of Malignant Thyroid Nodules

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 3753

Special Issue Editors

Prof. Dr. Claudio Spinelli

E-Mail Website
Guest Editor
Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
Interests: endocrine surgery; pediatric surgery; oncologic surgery
Dr. Marco Ghionzoli

E-Mail Website
Guest Editor
Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
Interests: pediatric surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As is already known, thyroid nodules usually occur in the general population and differentiating between benign and malignant ones is still a challenge. The basic tests for the risk stratification of thyroid nodules comprise serum TSH, ultrasonography (US), and fine-needle aspiration (FNA), which are the baseline in general practice, with radionuclide scans performed only for patients with low TSH. Assessing the risk of malignancy of thyroid nodules with US is crucial, as it can support in the selection of those who should undergo fine-needle aspiration (FNA) and subsequent surgery. Several reports identified a few US features that are remarkably more frequent in malignant thyroid nodules, which can be merged to be used as indicators of high risk.

Moreover, the global trend towards customized treatments for any patient warrant that any surgical strategy should take into account tumor-associated biological features and associated syndromes (e.g., APC-associated polyposis, Carney complex, DICER1 syndrome, PTEN hamartoma tumor syndrome).

As pediatric surgeons, huge effort has been made to understand how age is a crucial factor in patient outcome: while thyroid nodules are much more common in adults, they are much more likely to be malignant in children, resulting in a better outcome. Guidelines for the assessment and management of pediatric thyroid nodules have historically been extrapolated from recommendations for adults: a standardized therapeutic approach could be considered an overtreatment for a child; for this reason, recently, specific pediatric guidelines have been published.

Prof. Dr. Claudio Spinelli
Dr. Marco Ghionzoli
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • thyroid nodule
  • thyroid cancer
  • guidelines
  • surgery

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Published Papers (4 papers)

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Research

13 pages, 1386 KiB  
Article
PD-L1 Expression Varies in Thyroid Cancer Types and Is Associated with Decreased Progression Free Survival (PFS) in Patients with Anaplastic Thyroid Cancer
by Leila Shobab, Deema Al-Souri, Liza Mathews-Kim, Matthew McCoy, William Kuenstner, Gretchen K. Hubbard, Sonam Kumari, Jiling Chou, Wen Lee, Jennifer Rosen, Joanna Klubo-Gwiezdzinska, Michael Atkins, Leonard Wartofsky, Vasyl Vasko and Kenneth Burman
Cancers 2024, 16(21), 3632; https://doi.org/10.3390/cancers16213632 - 28 Oct 2024
Viewed by 420
Abstract
Background: Thyroid cancer (TC) remains a significant clinical challenge worldwide, with a subset of patients facing aggressive disease progression and therapeutic resistance. Immune checkpoint inhibitors targeting programmed death-ligand 1 (PD-L1) have emerged as promising therapeutic approaches for various malignancies, yet their efficacy in [...] Read more.
Background: Thyroid cancer (TC) remains a significant clinical challenge worldwide, with a subset of patients facing aggressive disease progression and therapeutic resistance. Immune checkpoint inhibitors targeting programmed death-ligand 1 (PD-L1) have emerged as promising therapeutic approaches for various malignancies, yet their efficacy in TC remains uncertain. The objective of this study was to investigate PD-L1 expression in aggressive TC and its association with histological subtypes, molecular mutation, and progression-free survival. Methods: This is a retrospective study of patients with advanced TC seen in two tertiary health care centers. Included in this study were patients with advanced TC with recurrence or progression on therapy for whom tumor molecular profiling and PD-L1 status were available. Kaplan–Meier estimators were utilized to analyze the progression-free survival (PFS) between patients with PD-L1 positive and negative status in Anaplastic TC (ATC) subgroup. Results: A total of 176 patients with advanced thyroid cancer were included (48.9% female). Of the patients, 13 had ATC, 11 Medullary TC (MTC), 81 Papillary TC Classic Variant (PTCCV), 20 Follicular TC (FTC), 8 Oncocytic TC (OTC), 10 Poorly Differentiated TC (PDTC), and 30 had the Papillary TC Follicular Variant (PTCFV). BRAF mutation was present in 41%, TERT in 30%, RAS in 19%, TP53 in 10%, and RET in 8.6% of patients. PD-L1 positivity was significantly different across different TC types and histological subtypes (p < 0.01): Patients with OTC had the highest frequency of PD-L1 positivity (71%), followed by ATC (69%), PTCCV (28.5%), and FTC (11%). Patients with MTC and PTCFV did not exhibit any PD-L1 positivity. TP53 mutation was positively associated with PD-L1 expression (21.6% vs. 7.5%, p = 0.03), and RAS mutation was negatively associated with PD-L1 expression (8.1% vs. 24.2% p = 0.04). Among patients with ATC, positive PD-L1 expression was associated with lower PFS (p = 0.002). Conclusions: PD-L1 expression varies across different TC types and histological subtypes and may be modulated by the mutational landscape. PD-L1 expression in ATC is associated with shorter PFS. Follow up studies are warranted to elucidate the molecular mechanism driving the observed differences in immune pathways, potentially paving the way for the development of more effective and personalized immune therapies for patients with aggressive TC. Full article
(This article belongs to the Special Issue Classification, Risk Assessment and Clinical Management of Malignant Thyroid Nodules)
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16 pages, 1760 KiB  
Article
The Value of Pretherapeutic Basal Calcitonin Cut-Offs for the Therapeutic Strategy and Prediction of Long-Term Outcome of Patients with Medullary Thyroid Cancer—A 30-Year Single-Center Experience
by Martin B. Niederle, Teresa Binter, Philipp Riss, Bruno Niederle and Christian Scheuba
Cancers 2024, 16(19), 3343; https://doi.org/10.3390/cancers16193343 - 29 Sep 2024
Viewed by 668
Abstract
Background: The clinical relevance of clearly defined pretherapeutic basal calcitonin (bCt) cut-offs for predicting lymph node metastases (LNMs) and long-term outcomes (LOs) has so far not been tested in a large cohort of patients with medullary thyroid cancer included in a Ct screening [...] Read more.
Background: The clinical relevance of clearly defined pretherapeutic basal calcitonin (bCt) cut-offs for predicting lymph node metastases (LNMs) and long-term outcomes (LOs) has so far not been tested in a large cohort of patients with medullary thyroid cancer included in a Ct screening program during the initial diagnostic workup of thyroid nodules. Material and Methods: Female (f) patients with a bCt level of ≤23 pg/mL and male (m) patients with a level of ≤43 pg/mL were assigned to Group 1 (minimal oncologic risk), patients with a bCt between 24 and 84 pg/mL (f) and 44–99 pg/mL (m) to Group 2 (low oncologic risk), and those with a bCt of ≥85 pg/mL (f) and ≥100 pg/mL (m) to Group 3 (high oncologic risk). All patients underwent surgery applying a uniform surgical protocol. The median follow-up was 100 months. Results: The study included 306 patients. In 3/115 (2.6%) patients in Group 1 and in 3/50 (6.0%) in Group 2, LNM in the central but not lateral neck and no distant metastases (DMet) were documented. In both groups, the biochemical long-term cure rate was 95.7% and the disease-specific-survival (DSS) rate was 100% at 10, 15 and 20 years. Lateral LNM and DMet were diagnosed only in Group 3. The bCt levels of N0 and N1 patients showed broadly overlapping ranges, thus impeding the differentiation between those patients through bCt. Both the cure rate and DSS were significantly worse in Group 3. The overall biochemical long-term cure rate was 78.2%. Conclusions: Within a Ct screening program, grouping patients upon pretherapeutic bCt provides a simple risk classification system for indicating surgery, predicting LN involvement, and LOs. Full article
(This article belongs to the Special Issue Classification, Risk Assessment and Clinical Management of Malignant Thyroid Nodules)
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20 pages, 6308 KiB  
Article
Cryopreserved Thyroid Tissue Autotransplant in Pediatric Age Patients: A Feasibility Study and Literature Review
by Claudio Spinelli, Marco Ghionzoli, Linda Idrissi Sahli, Silvia Visintainer, Carla Guglielmo, Chiara Cordola, Simone Lapi, Elisa Biagi, Angela Pucci, Riccardo Morganti, Silvia Martina Ferrari and Alessandro Antonelli
Cancers 2024, 16(11), 2112; https://doi.org/10.3390/cancers16112112 - 31 May 2024
Viewed by 552
Abstract
Background and aims: This paper aims to study an alternative solution to hormonal replacement therapy in specific groups of patients who underwent thyroidectomy during childhood or adulthood. After cryopreservation, thyroid autotransplantation could be an alternative solution which would allow us to use the [...] Read more.
Background and aims: This paper aims to study an alternative solution to hormonal replacement therapy in specific groups of patients who underwent thyroidectomy during childhood or adulthood. After cryopreservation, thyroid autotransplantation could be an alternative solution which would allow us to use the ability of the thyroid tissue of producing hormones according to the physiological needs of the body. Materials and methods: A feasibility study about the effects of the most modern cryopreservation techniques on the structural and functional integrity of the follicular cells of the thyroid tissue has been carried out. Patients who could benefit from the treatment have been found for both autotransplant techniques. Additionally, a literature review has been conducted. Results: The histological analysis has shown that cryopreservation does not alter the original architecture, and the culture examination that cell viability is successfully preserved. Moreover, both thyroid autotransplantation studies on animals and those on humans that were found in the literature have shown good results regarding the viability and functionality of the transplant. Conclusions: The viability of cryopreserved thyroid tissue found in this study is encouraging. Further studies to evaluate the levels of FT3, FT4 and thyroglobulin in thyroid tissue after cryopreservation are needed to verify that the secretory properties of the thyrocytes have been maintained intact. Furthermore, autotransplanted cases found in the literature do not have a long-term follow-up. Full article
(This article belongs to the Special Issue Classification, Risk Assessment and Clinical Management of Malignant Thyroid Nodules)
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18 pages, 1839 KiB  
Article
The Incidence Trend and Management of Thyroid Cancer—What Has Changed in the Past Years: Own Experience and Literature Review
by Krzysztof Kaliszewski, Dorota Diakowska, Michał Miciak, Krzysztof Jurkiewicz, Michał Kisiel, Szymon Makles, Anna Dziekiewicz, Szymon Biernat, Maksymilian Ludwig, Bartłomiej Ludwig, Karolina Sutkowska-Stępień, Maciej Sebastian, Paweł Domosławski, Krzysztof Sutkowski and Beata Wojtczak
Cancers 2023, 15(20), 4941; https://doi.org/10.3390/cancers15204941 - 11 Oct 2023
Cited by 1 | Viewed by 1585
Abstract
Because of ambiguous and widely debated observations concerning the incidence, trend, and management of TC, we performed this analysis. We drew attention to some events, such as “cancer screening activity”, introduction of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) to TC types, [...] Read more.
Because of ambiguous and widely debated observations concerning the incidence, trend, and management of TC, we performed this analysis. We drew attention to some events, such as “cancer screening activity”, introduction of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) to TC types, possibility of papillary thyroid microcarcinoma (PTMC) active surveillance (AS), occurrence of personalized medicine in TC management, and, finally, COVID-19 pandemic time. Because of the opinion that all changes have been made mostly by PTC, we compared it to the remaining types of TC in terms of incidence, clinical and pathological characteristics, and treatment. We analyzed patients treated in a single surgical center in eastern Europe (Poland). The prevalence of TC significantly increased from 5.15% in 2008 to 13.84% in 2015, and then significantly decreased to 1.33% in 2022 when the COVID-19 pandemic lasted (p < 0.0001). A similar trend was observed for PTC, when the incidence significantly increased to 13.99% in 2015 and then decreased to 1.38% in 2022 (p < 0.0001). At that time, the NIFTP category was introduced, and observation of PTMC began. The prevalence of FTC and MTC also increased until 2015 and then decreased. Significant differences in age, types of surgery, necessity of reoperation, and pTNM between PTCs and other types of TCs were observed. The average age was significantly lower in PTC patients than in patients with the remaining types of TC (p < 0.0001). Four milestones, including NIFTP introduction, the possibility of PTMC AS, personalized cancer medicine, and the COVID-19 pandemic, may have influenced the general statistics of TC. Full article
(This article belongs to the Special Issue Classification, Risk Assessment and Clinical Management of Malignant Thyroid Nodules)
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