Follicular Lesions with Papillary Nuclear Characteristics: Differences in Chromatin Detected by Computerized Image Analysis

ABSTRACT Objective: Follicular lesions of the thyroid with papillary carcinoma nuclear characteristics are classified as infiltrative follicular variant of papillary thyroid carcinoma-FVPTC (IFVPTC), encapsulated/well demarcated FVPTC with tumour capsular invasion (IEFVPTC), and the newly described category "non-invasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) formerly known as non-invasive encapsulated FVPTC. This study evaluated whether computerized image analysis can detect nuclear differences between these three tumour subtypes. Materials and methods: Slides with histological material from 15 cases of NIFTP and 33 cases of FVPTC subtypes (22 IEFVPTC, and 11 IFVPTC) were analyzed using the Image J image processing program. Tumour cells were compared for both nuclear morphometry and chromatin textural characteristics. Results: Nuclei from NIFTP and IFVPTC tumours differed in terms of chromatin textural features (grey intensity): mean (92.37 ± 21.01 vs 72.99 ± 14.73, p = 0.02), median (84.93 ± 21.17 vs 65.18 ± 17.08, p = 0.02), standard deviation (47.77 ± 9.55 vs 39.39 ± 7.18; p = 0.02), and coefficient of variation of standard deviation (19.96 ± 4.01 vs 24.75 ± 3.31; p = 0.003). No differences were found in relation to IEFVPTC. Conclusion: Computerized image analysis revealed differences in nuclear texture between NIFTP and IFVPTC, but not for IEFVPTC.

The risk of recurrence within the first five years is very low in patients with papillary thyroid carcinoma treated with radioiodine

Introduction: In older studies, the frequency of recurrence was approximately 20% among patients with papillary thyroid carcinoma (PTC) treated with radioactive iodine (RAI), but it is possible that many of these cases actually correspond to persistent disease and that the frequency of recurrence is overestimated. Objective: To reevaluate the frequency of recurrence within the first five years in patients with PTC adequately operated upon and treated with RAI who did not exhibit persistent disease (postoperative ultrasonography and post-therapy whole-body scanning showing no apparent tumor). Methods: We selected 293 patients [51 low risk (17.4%) and 242 intermediate risk (82.6%)] submitted to thyroidectomy followed by RAI who did not have persistent disease. Results: Five years after RAI therapy, a tumor was detected in 10 patients (3.4%) (lymph node metastases in seven, pulmonary metastases in two, and bone metastases in one). Structural recurrence was observed in only 2% of low-risk patients and in 3.3% of intermediate-risk patients, with disease progression in none of the low-risk patients and in only one (0.4%) of the intermediate-risk patients. Survival was 100%. Conclusion: The results of this study suggest that, after adequate total thyroidectomy and in the absence of persistent disease, the frequency of recurrence within the first five years is very low in patients with PTC (not high risk) treated with RAI.

The follicular variant of papillary thyroid carcinoma: characteristics of preoperative ultrasonography and cytology

PURPOSE: The goal of this study was to validate the ultrasonography (US) and cytopathological features that are used in the diagnosis of the follicular variant of papillary thyroid carcinoma (FVPTC) and to characterize the role of BRAF(V600E) mutation analysis in the diagnosis of FVPTC. METHODS: From May 2012 to February 2014, 40 thyroid nodules from 40 patients (mean age, 56.2 years; range, 26 to 81 years) diagnosed with FVPTC were included in this study. The US features of the nodules were analyzed and the nodules were classified as probably benign or suspicious for malignancy. Twenty-three thyroid nodules (57.5%) underwent BRAF(V600E) mutation analysis. Clinical information and histopathologic results were obtained by reviewing the medical records of the patients. RESULTS: Thirty nodules (75.0%) were classified as suspicious for malignancy, while 10 (25.0%) were classified as probably benign. Seven of the eight nodules (87.5%) with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) cytology showed suspicious US features, while one of the two nodules (50.0%) with follicular neoplasm cytology presented suspicious US features. Five of the 23 nodules (21.7%) that underwent BRAF(V600E) mutation analysis had positive results, all of which were diagnosed as suspicious for malignancy or malignant based on cytology. None of the nodules with benign, AUS/FLUS, or follicular neoplasm cytology were positive for the BRAF(V600E) mutation. CONCLUSION: US features allow nodules to be classified as suspicious for malignancy, and the presence of suspicious US features in nodules with ambiguous cytology may aid in the diagnosis of FVPTC. BRAF(V600E) mutation analysis is of limited value in the diagnosis of FVPTC.

Comparative study on ultrasonic presentations and pathological features of follicular variant of papillary thyroid carcinoma / 中华医学超声杂志（电子版）

Objective To investigate the ultrasonic features and pathological basis of follicular variant of papillary thyroid carcinoma (FVPTC). Methods Ultrasonic presentation of 30 patients with FVPTC conifrmed by surgery and pathology from the Seventh People′s Hospital of Shaoxing during March 2002 and December 2012 were analyzed retrospectively and compared with pathological results. Results Ultrasonic presentation of 30 FVPTC cases could be classiifed into three types:(1) Six cases (20%, 6/30) of typeⅠ, with typical sonographic features of papillary thyroid carcinoma:nodules with irregular shape, unclear boundary, and very low echo inside, microcalciifcation could be seen. (2) Fourteen cases (47%,14/30) of typeⅡ, presented as clearer iso-echoic or hypo-echoic nodules, with irregular shape, angled and lobular edge, rare microcalciifcation. (3) Ten cases (33%, 10/30) of typeⅢ, presented as adenoma-like features, nodule with clear boundary and regular edge, uniform medium echo inside. The microscopic structure characteristics could be divided into three categories:6 cases of typeⅠ, lesions were featured with no obvious capsule, irregular shape and inifltrative growth;14 cases of type Ⅱ, lesions with irregular shape, which invading the capsule with partial protrusion and peripheral small satellite lesions;10 cases of typeⅢ, lesions with more complete envelope, more regular shape with no signiifcant or lower level and smaller extent invasion of the capsule. Differences in morphology, boundary, aspect ratio, internal echo, presentation of microcalciifcations between the encapsulated type (typeⅡ,Ⅲ) and non-encapsulated type (typeⅠ) FVPTC were statistically signiifcant (Fisher′s exact test, all P0.05). Conclusion Ultrasonic presentation of FVPTC show characteristics of both follicular tumor and papillary carcinoma, and the ultrasonic presentations are closely related to the pathological subtypes.