Since the introduction of the Bethesda System for Reporting Thyroid Cytopathology in 2008, the management of thyroid nodules has become more standardized, with clearly defined algorithms based on risk of malignancy for each of the six cytologic categories. However, the management of a thyroid nodule with a fine-needle aspiration biopsy classified as Bethesda III, or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), remains controversial due to the cytologic heterogeneity and the variability in the reported rates of malignancy. In this review, the history and rationale for the new Bethesda III category is examined, the reported incidence and risk of malignancy from published studies is reviewed and recommendations for management of patients with a thyroid nodule and AUS/FLUS are provided. Recent advances in molecular analysis and their role in the evaluation of patients with AUS/FLUS are also discussed.
{"title":"Evaluation and management of thyroid nodules with atypia/follicular lesion of undetermined significance on fine-needle aspiration","authors":"I. Bobanga, C. McHenry","doi":"10.2217/IJE.15.20","DOIUrl":"https://doi.org/10.2217/IJE.15.20","url":null,"abstract":"Since the introduction of the Bethesda System for Reporting Thyroid Cytopathology in 2008, the management of thyroid nodules has become more standardized, with clearly defined algorithms based on risk of malignancy for each of the six cytologic categories. However, the management of a thyroid nodule with a fine-needle aspiration biopsy classified as Bethesda III, or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), remains controversial due to the cytologic heterogeneity and the variability in the reported rates of malignancy. In this review, the history and rationale for the new Bethesda III category is examined, the reported incidence and risk of malignancy from published studies is reviewed and recommendations for management of patients with a thyroid nodule and AUS/FLUS are provided. Recent advances in molecular analysis and their role in the evaluation of patients with AUS/FLUS are also discussed.","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.20","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thyroid cancer (TC) has several distinct features. In particular, the median age on disease onset is about 45–50 years, which makes it quite different from hormonerelated tumors such as, for example, endometrial or prostate cancer. The prognosis of TC patients is relatively good in populations with differentiated carcinomas. However, it is worse in patients with medullary and anaplastic TC in particular. Prognosis is also poor in male patients, although in men thyroid cancer is seen thrice less often than in women and on average develops at a more advanced age. Besides female gender, there are other TC risk factors, such as radiation, iodine status of the area and excessive thyroid epithelium stimulation by thyrotropin (thyroid-stimulating hormone; TSH) [1]. Another important issue concerns the gradual increase in TC incidence, which has become particularly evident in the last decade. This increase is mostly due to a higher incidence of papillary carcinomas and could be explained by higher – than earlier – effectiveness of diagnostic methods (apparent increase) as well as greater number of new cases (true increase) [2]. The exact contribution of the latter factors is currently a matter of discussion. Our understanding of factors modulating TC incidence increase and mechanisms able to influence TCs clinical course was recently notably enhanced by the data concerned with a possible role of insulin resistance (IR) state. These ideas rely on two well-known facts, namely, on an established connection between IR and metabolic syndrome, some obesity types, and Type 2 diabetes mellitus incidence [3], and on the knowledge that the rate of the latter pathologies has lately reached ‘epidemic’ scale [4], which could also influence hormone-related cancers, such as TC. This short Editorial is mainly concerned with summarizing the current data on connections between IR and TC. The task is to try and point out some prominent aspects, in which these correlations seem to be most important, and describe possible approaches aimed at preventive as well as therapeutic antihormonal and metabolic interventions in TC patients, not limited only to ‘antithyroid’ (anti-TSH) measures.
{"title":"Thyroid cancer and insulin resistance: is it important?","authors":"L. Berstein","doi":"10.2217/IJE.15.24","DOIUrl":"https://doi.org/10.2217/IJE.15.24","url":null,"abstract":"Thyroid cancer (TC) has several distinct features. In particular, the median age on disease onset is about 45–50 years, which makes it quite different from hormonerelated tumors such as, for example, endometrial or prostate cancer. The prognosis of TC patients is relatively good in populations with differentiated carcinomas. However, it is worse in patients with medullary and anaplastic TC in particular. Prognosis is also poor in male patients, although in men thyroid cancer is seen thrice less often than in women and on average develops at a more advanced age. Besides female gender, there are other TC risk factors, such as radiation, iodine status of the area and excessive thyroid epithelium stimulation by thyrotropin (thyroid-stimulating hormone; TSH) [1]. Another important issue concerns the gradual increase in TC incidence, which has become particularly evident in the last decade. This increase is mostly due to a higher incidence of papillary carcinomas and could be explained by higher – than earlier – effectiveness of diagnostic methods (apparent increase) as well as greater number of new cases (true increase) [2]. The exact contribution of the latter factors is currently a matter of discussion. Our understanding of factors modulating TC incidence increase and mechanisms able to influence TCs clinical course was recently notably enhanced by the data concerned with a possible role of insulin resistance (IR) state. These ideas rely on two well-known facts, namely, on an established connection between IR and metabolic syndrome, some obesity types, and Type 2 diabetes mellitus incidence [3], and on the knowledge that the rate of the latter pathologies has lately reached ‘epidemic’ scale [4], which could also influence hormone-related cancers, such as TC. This short Editorial is mainly concerned with summarizing the current data on connections between IR and TC. The task is to try and point out some prominent aspects, in which these correlations seem to be most important, and describe possible approaches aimed at preventive as well as therapeutic antihormonal and metabolic interventions in TC patients, not limited only to ‘antithyroid’ (anti-TSH) measures.","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.24","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68217064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The gold standard treatment of primary hyperparathyroidism was bilateral neck exploration. Video-assisted parathyroidectomy (VAP) facilitated less invasive surgery, however there is lack of evidence comparing it to open parathyroidectomy (OP). A meta-analysis was conducted according to the PRISMA guidelines to compare them. In three eligible randomized controlled trials (241 patients), VAP operative time (61.7 ± 12 min) was comparable to OP (59.9 ± 6 min), less early postoperative pain, higher cosmetic satisfaction (statistically not significant) and 4% failure rate (none in OP). 25% of VAP converted to OP. Hypocalcaemia was six-times less in VAP (RR 6.4). Careful patient selection and unequivocally positive preoperative localization are critical to the success of this procedure. To our knowledge, this is the first meta-analysis comparing the two techniques.
{"title":"Meta-analysis of video-assisted versus open parathyroidectomy for primary hyperparathyroidism","authors":"S. Elwahab, A. Lowery, K. O’Brien, H. Redmond","doi":"10.2217/IJE.15.22","DOIUrl":"https://doi.org/10.2217/IJE.15.22","url":null,"abstract":"The gold standard treatment of primary hyperparathyroidism was bilateral neck exploration. Video-assisted parathyroidectomy (VAP) facilitated less invasive surgery, however there is lack of evidence comparing it to open parathyroidectomy (OP). A meta-analysis was conducted according to the PRISMA guidelines to compare them. In three eligible randomized controlled trials (241 patients), VAP operative time (61.7 ± 12 min) was comparable to OP (59.9 ± 6 min), less early postoperative pain, higher cosmetic satisfaction (statistically not significant) and 4% failure rate (none in OP). 25% of VAP converted to OP. Hypocalcaemia was six-times less in VAP (RR 6.4). Careful patient selection and unequivocally positive preoperative localization are critical to the success of this procedure. To our knowledge, this is the first meta-analysis comparing the two techniques.","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.22","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medullary thyroid carcinoma (MTC) is a differentiated neuroendocrine tumor, mostly slowly growing with a relative good prognosis, with an overall 10-year survival of 61–76% [1,2]. Surgery is the only curative therapy for MTC [3]. After surgery, patients with MTC should be assessed regarding the presence of residual disease, the localization of metastases and the identification of progressive disease. Postoperative staging is used to separate low-risk from high-risk patients with MTC [4]. The TNM system utilizes tumor size, extrathyroidal invasion, nodal metastasis and distant spread of cancer. The number of lymph node metastases and involved compartments as well as postoperative serum calcitonin (CTN) and carcinoembryonic antigen (CEA) levels should be documented in addition. The normalization of serum CTN levels postoperatively is associated with an excellent prognosis (10-year survival >95%). In patients with elevated basal serum CTN levels less than 150 pg/ml following thyroid ectomy, persistent or recurrent disease is almost always confined to lymph nodes in the neck. Unfortunately, many patients with MTC who have regional lymph node metastases also have systemic disease and are not cured biochemically despite aggressive surgery, including bilateral neck dissection [3,5]. In patients with higher CTN levels distant metastases are suspected, having a poor prognosis, with only 40% surviving 10 years [6]. If the postoperative serum CTN level exceeds 150 pg/ml patients should be evaluated by imaging procedures including neck and chest CT, contrast-enhanced MRI and ultrasound of the liver, bone scintigraphy, MRI of the bone and PET/CT. One can estimate the growth rate of MTC metastases from sequential imaging studies using response evaluation criteria in solid tumors (RECIST) [7] that document increases in tumor size over time and by measuring serum levels of CTN or CEA over multiple time points to determine the tumor marker doubling time [8,9]. The treatment goals differ depending on the postoperative tumor stage and the parameters of progressive disease [4]. A risk-stratified follow-up with stage-dependent diagnostic approach and therapy is necessary. One of the main challenges remains to find effective adjuvant and palliative options for patients with metastatic disease. Patients with persistent or recurrent 1
{"title":"Risk-stratified follow-up of patients with medullary thyroid carcinoma","authors":"F. Raue, K. Frank‐Raue","doi":"10.2217/IJE.15.23","DOIUrl":"https://doi.org/10.2217/IJE.15.23","url":null,"abstract":"Medullary thyroid carcinoma (MTC) is a differentiated neuroendocrine tumor, mostly slowly growing with a relative good prognosis, with an overall 10-year survival of 61–76% [1,2]. Surgery is the only curative therapy for MTC [3]. After surgery, patients with MTC should be assessed regarding the presence of residual disease, the localization of metastases and the identification of progressive disease. Postoperative staging is used to separate low-risk from high-risk patients with MTC [4]. The TNM system utilizes tumor size, extrathyroidal invasion, nodal metastasis and distant spread of cancer. The number of lymph node metastases and involved compartments as well as postoperative serum calcitonin (CTN) and carcinoembryonic antigen (CEA) levels should be documented in addition. The normalization of serum CTN levels postoperatively is associated with an excellent prognosis (10-year survival >95%). In patients with elevated basal serum CTN levels less than 150 pg/ml following thyroid ectomy, persistent or recurrent disease is almost always confined to lymph nodes in the neck. Unfortunately, many patients with MTC who have regional lymph node metastases also have systemic disease and are not cured biochemically despite aggressive surgery, including bilateral neck dissection [3,5]. In patients with higher CTN levels distant metastases are suspected, having a poor prognosis, with only 40% surviving 10 years [6]. If the postoperative serum CTN level exceeds 150 pg/ml patients should be evaluated by imaging procedures including neck and chest CT, contrast-enhanced MRI and ultrasound of the liver, bone scintigraphy, MRI of the bone and PET/CT. One can estimate the growth rate of MTC metastases from sequential imaging studies using response evaluation criteria in solid tumors (RECIST) [7] that document increases in tumor size over time and by measuring serum levels of CTN or CEA over multiple time points to determine the tumor marker doubling time [8,9]. The treatment goals differ depending on the postoperative tumor stage and the parameters of progressive disease [4]. A risk-stratified follow-up with stage-dependent diagnostic approach and therapy is necessary. One of the main challenges remains to find effective adjuvant and palliative options for patients with metastatic disease. Patients with persistent or recurrent 1","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Chérif, S. Gaujoux, J. Cros, P. Ruszniewski, A. Sauvanet
Parenchyma-sparing pancreatectomy, including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection (pancreaticoduodenectomy or left/distal pancreatectomy) for pancreatic neuroendocrine tumor (PNET). In selected patients, with small (<2 cm) and low-grade tumors, PSP are associated with excellent both overall and disease-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent long-term postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated PNET.
{"title":"Parenchyma-sparing pancreatectomies for pancreatic neuroendocrine tumors","authors":"R. Chérif, S. Gaujoux, J. Cros, P. Ruszniewski, A. Sauvanet","doi":"10.2217/IJE.15.1","DOIUrl":"https://doi.org/10.2217/IJE.15.1","url":null,"abstract":"Parenchyma-sparing pancreatectomy, including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection (pancreaticoduodenectomy or left/distal pancreatectomy) for pancreatic neuroendocrine tumor (PNET). In selected patients, with small (<2 cm) and low-grade tumors, PSP are associated with excellent both overall and disease-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent long-term postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated PNET.","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells, and can commonly spread to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine and are not sensitive to hormonal manipulation, and therefore surgery is the only effective option for curative therapy, reduction in tumor burden or effective palliation. In patients undergoing preventative operations for hereditary MTC, central lymph node dissection should be considered if the calcitonin level is above 40 pg/ml. Systematic removal of at-risk or involved lymph node compartments should be performed in all patients with palpable primary tumors and recurrent disease, and a ‘berry-picking’ approach should be avoided.
{"title":"Surgery for lymph node metastases of medullary thyroid carcinoma","authors":"L. Jin, J. Moley","doi":"10.2217/IJE.15.15","DOIUrl":"https://doi.org/10.2217/IJE.15.15","url":null,"abstract":"Medullary thyroid carcinoma (MTC) is a neuroendocrine malignancy of the thyroid C cells, and can commonly spread to cervical and mediastinal lymph nodes. MTC cells do not concentrate radioactive iodine and are not sensitive to hormonal manipulation, and therefore surgery is the only effective option for curative therapy, reduction in tumor burden or effective palliation. In patients undergoing preventative operations for hereditary MTC, central lymph node dissection should be considered if the calcitonin level is above 40 pg/ml. Systematic removal of at-risk or involved lymph node compartments should be performed in all patients with palpable primary tumors and recurrent disease, and a ‘berry-picking’ approach should be avoided.","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.15","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tumor size, previous abdominal operation, medical comorbidities and surgeon skill set are factors to determine if a minimally invasive approach is feasible for patients with benign adrenal pathology, as patient outcomes are far superior with this approach. Laparoscopic techniques have largely replaced the open operations, and are often viewed as the standard of care for many general surgery operations. For this reason, general surgeons are very familiar with the anatomy within the peritoneal cavity. Often, the skill set from one advanced laparoscopic procedure may translate to another, potentially allowing a low volume adrenal surgeon but high volume laparoscopic surgeon to safely perform transabdominal laparoscopic adrenalectomy.
{"title":"The transabdominal minimally invasive approach to the isolated adrenal mass","authors":"Sarah C. Oltmann, Herb Chen","doi":"10.2217/IJE.15.11","DOIUrl":"https://doi.org/10.2217/IJE.15.11","url":null,"abstract":"Tumor size, previous abdominal operation, medical comorbidities and surgeon skill set are factors to determine if a minimally invasive approach is feasible for patients with benign adrenal pathology, as patient outcomes are far superior with this approach. Laparoscopic techniques have largely replaced the open operations, and are often viewed as the standard of care for many general surgery operations. For this reason, general surgeons are very familiar with the anatomy within the peritoneal cavity. Often, the skill set from one advanced laparoscopic procedure may translate to another, potentially allowing a low volume adrenal surgeon but high volume laparoscopic surgeon to safely perform transabdominal laparoscopic adrenalectomy.","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pheochromocytomas (PCC) and paragangliomas (PGL) are catecholamine (CA)-producing tumors classified into well (WD)-, moderately (MD)- or poorly differentiated (PD) types by the Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP). Seventy percent of PCCs/PGLs are WD type with 4% metastasis, the rest are MD with 60% and PD are with 88% metastasis. Thus, PCCs/PGLs can also be classified as low-grade (WD type), intermediate grade (MD type) and high-grade malignancies (PD types). MD/PD types are with 70% metastasis. Thus, PCCs/PGLs can also be classified as low-grade (WD type) and high-grade malignancies (MD/PD types) using GAPP. Hereditary PCCs/PGLs have been previously classified into cluster 1 or cluster 2 based on genetic mutations involved and types of catecholamine produced by the tumors. GAPP revealed that tumors in cluster 1 and cluster 2 correspond to MD type and WD type, respectively. Susceptible genes for high-grade malignancy (PD type) are currently unknown.
{"title":"A pathologist's view: molecular profiles for diagnosing pheochromocytomas and paragangliomas","authors":"N. Kimura","doi":"10.2217/IJE.15.16","DOIUrl":"https://doi.org/10.2217/IJE.15.16","url":null,"abstract":"Pheochromocytomas (PCC) and paragangliomas (PGL) are catecholamine (CA)-producing tumors classified into well (WD)-, moderately (MD)- or poorly differentiated (PD) types by the Grading of Adrenal Pheochromocytoma and Paraganglioma (GAPP). Seventy percent of PCCs/PGLs are WD type with 4% metastasis, the rest are MD with 60% and PD are with 88% metastasis. Thus, PCCs/PGLs can also be classified as low-grade (WD type), intermediate grade (MD type) and high-grade malignancies (PD types). MD/PD types are with 70% metastasis. Thus, PCCs/PGLs can also be classified as low-grade (WD type) and high-grade malignancies (MD/PD types) using GAPP. Hereditary PCCs/PGLs have been previously classified into cluster 1 or cluster 2 based on genetic mutations involved and types of catecholamine produced by the tumors. GAPP revealed that tumors in cluster 1 and cluster 2 correspond to MD type and WD type, respectively. Susceptible genes for high-grade malignancy (PD type) are currently unknown.","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.16","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Sakorafas, M. Gkeli, V. Kartsouni, D. Daskalopoulou, D. Thanos, D. Nasikas, Sotirios Gantzoulas
Thyroid nodules are very common among the general population; suspicion of malignancy is a typical indication for surgery in these patients. Despite that, surgery is typically required in patients with nodules >10 mm, resection should be considered for a selected subgroup of patients with small (≤10 mm) nodules. In this study, among 150 patients who underwent thyroidectomy for thyroid nodules during a 18-month period, 19 (12.7%) had small thyroid nodules. Indication for surgery in these patients was preoperative diagnosis of papillary thyroid cancer, after an aggressive diagnostic investigation (using ultrasound-guided fine-needle aspiration) that was performed due to the recognition of specific risk factors (most commonly suspicious ultrasonographic findings, but also cervical lymphadenectomy and strong positive family history).
{"title":"Preoperatively diagnosed microscopic papillary thyroid cancer: an aggressive approach in selected patients with small nodules","authors":"G. Sakorafas, M. Gkeli, V. Kartsouni, D. Daskalopoulou, D. Thanos, D. Nasikas, Sotirios Gantzoulas","doi":"10.2217/IJE.15.13","DOIUrl":"https://doi.org/10.2217/IJE.15.13","url":null,"abstract":"Thyroid nodules are very common among the general population; suspicion of malignancy is a typical indication for surgery in these patients. Despite that, surgery is typically required in patients with nodules >10 mm, resection should be considered for a selected subgroup of patients with small (≤10 mm) nodules. In this study, among 150 patients who underwent thyroidectomy for thyroid nodules during a 18-month period, 19 (12.7%) had small thyroid nodules. Indication for surgery in these patients was preoperative diagnosis of papillary thyroid cancer, after an aggressive diagnostic investigation (using ultrasound-guided fine-needle aspiration) that was performed due to the recognition of specific risk factors (most commonly suspicious ultrasonographic findings, but also cervical lymphadenectomy and strong positive family history).","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.13","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adrenocortical carcinoma is a rare entity affecting 1–2 people per million. It has a relatively poor prognosis, with an overall 5-year survival of 20–45%. The reasons include a high risk of recurrence following resection and relatively poor response to cytotoxic treatment. The use of the adrenalytic mitotane as adjuvant therapy is supported by level III evidence from cohort studies. In the metastatic setting, one randomized controlled trial provides level II evidence for a three-drug chemotherapy combination of cisplatin, etoposide and doxorubicin, with mitotane (EDP–M). We present two cases of adrenocortical carcinoma and discuss their management in light of the literature supporting the treatments. These cases illustrate the practicalities of management requiring a multidisciplinary team with the oncologist, endocrinologist, surgeon, anesthetist, radiologist and pathologist, all working in collaboration.
{"title":"The challenge of managing adrenocortical carcinoma: two case studies","authors":"Y. Kanjanapan, T. Prasanna, S. Perampalam, D. Yip","doi":"10.2217/IJE.15.12","DOIUrl":"https://doi.org/10.2217/IJE.15.12","url":null,"abstract":"Adrenocortical carcinoma is a rare entity affecting 1–2 people per million. It has a relatively poor prognosis, with an overall 5-year survival of 20–45%. The reasons include a high risk of recurrence following resection and relatively poor response to cytotoxic treatment. The use of the adrenalytic mitotane as adjuvant therapy is supported by level III evidence from cohort studies. In the metastatic setting, one randomized controlled trial provides level II evidence for a three-drug chemotherapy combination of cisplatin, etoposide and doxorubicin, with mitotane (EDP–M). We present two cases of adrenocortical carcinoma and discuss their management in light of the literature supporting the treatments. These cases illustrate the practicalities of management requiring a multidisciplinary team with the oncologist, endocrinologist, surgeon, anesthetist, radiologist and pathologist, all working in collaboration.","PeriodicalId":42691,"journal":{"name":"International Journal of Endocrine Oncology","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2015-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/IJE.15.12","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68216383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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