Update from the 2022 World Health Organization Classification of Thyroid Tumors: A Standardized Diagnostic Approach

Jung, Chan Kwon; Bychkov, Andrey; Kakudo, Kennichi

doi:10.3803/enm.2022.1553

Cited by 96 publications

(79 citation statements)

References 52 publications

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“…Fibrotic capsules, if partially visible, were infiltrated by the branches of the lesions. This was in contrast to usually encapsulated PTC nodules in adults ( 24 , 27 ). In all of the patients, the lymphocytic infiltration around the tumour was visible.…”

Section: Discussioncontrasting

confidence: 77%

“…Because the presentation of PTC in children is more severe than in adults, the extent of surgery is larger, and therapy also includes 131I therapy, leading to potential future therapeutic side effects. On the other hand, overall survival in children is excellent ( 24 , 27 , 28 ). Therefore, it is important to focus the research on the early detection of malignancies with the aim to reduce future side effects of oncological therapy for PTC in children with long life-expectancy ( 24 , 27 , 28 ).…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, overall survival in children is excellent ( 24 , 27 , 28 ). Therefore, it is important to focus the research on the early detection of malignancies with the aim to reduce future side effects of oncological therapy for PTC in children with long life-expectancy ( 24 , 27 , 28 ).…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma – a follow-up study

et al. 2023

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BackgroundFollicular cell-derived thyroid carcinoma represents the vast majority of paediatric thyroid cancers (TCs). Papillary thyroid carcinoma (PTC) accounts for over 90% of all childhood TC cases, and its incidence in paediatric patients is increasing. The objective of this follow-up study was to present the outcome of ultrasound (US) and laboratory monitoring of paediatric patients with autoimmune thyroiditis (AIT) prior to the development of PTC.Patients and methodsThis prospective study included 180 children and adolescents (132 females; 73.3%) with a suspicion of thyroid disorder referred to the Outpatient Endocrine Department. The patients were divided into four groups: 1) 28 patients with a mean age of 10.7 [standard deviation (SD), 3.1] y, in whom PTC was detected during the active surveillance of AIT [AIT(+), PTC(+) follow up (F)]; 2) 18 patients with a mean age of 12.8 (SD, 3.4) y, in whom PTC and AIT were detected upon admission (A) [AIT(+), PTC(+) A]; 3) 45 patients with a mean age of 13.0 (SD, 3.4) y, in whom PTC was detected upon admission and AIT was excluded [AIT(-), PTC(+) A]; and 4) an age- and sex-matched control group of 89 patients with AIT and with a mean age of 9.4 (SD, 3.0) y. The analysis included clinical, US, and laboratory assessment results of children on admission (groups 1–4) and during follow-up (groups 1 and 4) in the Paediatric Endocrine Outpatient Department.ResultsUpon admission of those in group 1, the US evaluation revealed a hypoechogenic thyroid gland in 12 and an irregular normoechogenic gland in 16 patients. US monitoring revealed an increase in thyroid echogenicity and an increased irregularity of the thyroid structure during the follow-up period of all of the patients from group 1. Such changes were not noticed in group 4. PTC was diagnosed at the mean time of 3.6 y (3 mo–9 y) since AIT confirmation in group 1. The mean maximum PTC diameter as per the US was significantly smaller in group 1 than in groups 2 and 3 [13.2 (10.8) mm vs. 22.2 (12.8) and 22.05 (15.4) mm]. Fewer patients in group 1 were referred to 131I than in groups 2 and 3 (71.4% vs. 94.4 and 93.3%). Interestingly, significant differences were observed in the thyroglobulin antibody (TgAb)/thyroid peroxidase antibody (TPOAb) ratio between groups 2 and 3, as opposed to group 4, at the beginning of observation [15.3 (27.6) and 3.5 (8.8] vs. 0.77 (1.9)]. In group 1, after the follow-up, an increase in the TgAb/TPOAb ratio was observed [1.2 (9.8) to 5.2 (13.5)]. There were no significant differences between groups 1–3 in labeling index Ki67, lymph nodes metastasis, extrathyroidal extension, and angioinvasion. There were no associations between thyroid-stimulating hormone, TgAb, and the extent of the disease.ConclusionThe use of thyroid US focused on the search for developing tumours in the routine follow-up of patients with AIT may not only help in the early detection of thyroid malignancies that are not clinically apparent but may also influence the invasiveness of oncological therapy and reduce the future side effects of 131I therapy. We propose that the repeat evaluation of TPOAb and TgAb warrants further exploration as a strategy to determine TC susceptibility in paediatric patients with AIT in larger multicentre studies.

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Section: Discussioncontrasting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

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Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma – a follow-up study

et al. 2023

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“…In our opinion, namely such stratification, but not the etiological factor, should be taken into account for decisions on tumor management. Concerning MPTCs, very timely and important changes are expected in the new 5 th edition of the WHO Histological Classification of thyroid tumors ( 50 , 51 ). MPTCs will no longer be just a PTC subtype, but similarly to the tumors of larger size can be considered according to their risk level for personalized treatment protocols.…”

Section: Discussionmentioning

confidence: 99%

The relationship of the clinicopathological characteristics and treatment results of post-Chornobyl papillary thyroid microcarcinomas with the latency period and radiation exposure

Bogdanova

Chernyshov²,

Zurnadzhy³

et al. 2022

Front. Endocrinol.

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IntroductionA worldwide increase in the incidence of thyroid cancer during the last decades is largely due to papillary thyroid microcarcinomas (MPTCs), which are mostly low-risk tumors. In view of recent clinical recommendations to reduce the extent of surgery for low-risk thyroid cancer, and persisting uncertainty about the impact of radiation history, we set out to address whether clinicopathological characteristics and prognosis of post-Chornobyl MPTCs were changing with regard to: i) the latency period, ii) probability of causation (POC) of a tumor due to radiation, and iii) tumor size.MethodsPatients (n = 465) aged up to 50 years at diagnosis who lived in April, 1986 in six northern, most radiocontaminated regions of Ukraine were studied.ResultsLatency period was statistically significantly associated with the reduction of POC level, tumor size and the frequency of fully encapsulated MPTCs. In contrast, the frequency of oncocytic changes and the BRAFV600E mutation increased. Invasive properties and clinical follow-up results did not depend on latency except for a lower frequency of complete remission after postsurgical radioiodine therapy. The POC level was associated with more frequent extrathyroidal extension, and lymphatic/vascular invasion, less frequent oncocytic changes and BRAFV600E, and did not associate with any clinical indicator. Tumor size was negatively associated with the latency period and BRAFV600E, and had a statistically significant effect on invasive properties of MPTCs: both the integrative invasiveness score and its components such as lymphatic/vascular invasion, extrathyroidal extension and lymph node metastases increased. The frequency of total thyroidectomy, neck lymph node dissection and radioiodine therapy also increased with the larger tumor size. The duration of the latency period, POC level or tumor size did not associate with the chance of disease recurrence.DiscussionIn summary, we did not observe overall worsening of the clinicopathological features or treatment results of radiogenic MPTCs that could be associated with the latency period or POC level, suggesting that radiation history did not strongly affect those in the analyzed MPTC patients. However, the increase in the invasive properties with tumor size indicates the need for individual risk stratification for each MPTC patient, regardless of radiation history, for treatment decision-making.

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“…Besides more accurate node selection for puncture and improved training of cytologists as corrective measures, in the future FNAB results will profit from (more widespread) molecular genetic analysis of the aspirate. The new classification of thyroid neoplasms by the WHO, expected in 2024, will require molecular genetic information on the thyroid tumor (as well as a recording of the Ki-67 index and morphological aspects such as the presence of a node capsule and a possible angioinvasion) [ 3 ]. If this hopefully increases the extent of molecular analysis already been carried out preoperatively from FNABs, surgeons will be given additional preoperative diagnostic results and therefore the opportunity to an even more differentiated surgical approach.…”

mentioning

confidence: 99%

Developments to improve outcomes in thyroid surgery

Musholt

2022

Innovative Surgical Sciences

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Update from the 2022 World Health Organization Classification of Thyroid Tumors: A Standardized Diagnostic Approach

Cited by 96 publications

References 52 publications

Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma – a follow-up study

Ultrasound evolution of parenchymal changes in the thyroid gland with autoimmune thyroiditis in children prior to the development of papillary thyroid carcinoma – a follow-up study

The relationship of the clinicopathological characteristics and treatment results of post-Chornobyl papillary thyroid microcarcinomas with the latency period and radiation exposure

Developments to improve outcomes in thyroid surgery

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