Both thyroid autoimmunity and increased serum TSH are independent risk factors for malignancy in patients with thyroid nodules

被引:74
作者
Boi, F. [1 ]
Minerba, L. [2 ]
Lai, M. L. [3 ]
Marziani, B. [1 ]
Figus, B. [1 ]
Spanu, F. [1 ]
Borghero, A. [1 ]
Mariotti, S. [1 ]
机构
[1] Univ Cagliari, Endocrinol Unit, Dept Med Sci M Aresu, I-09042 Cagliari, Italy
[2] Univ Cagliari, Dept Publ Hlth, I-09042 Cagliari, Italy
[3] Univ Cagliari, Dept Cytomorphol, San Giovanni di Dio Hosp, I-09042 Cagliari, Italy
关键词
Thyroid autoantibodies; thyroid carcinoma; thyroid cytology; thyroid nodules; TSH; FINE-NEEDLE-ASPIRATION; CHRONIC LYMPHOCYTIC THYROIDITIS; HASHIMOTOS-THYROIDITIS; PAPILLARY CARCINOMA; FOLLICULAR CELLS; IMMUNE-RESPONSE; HIGH PREVALENCE; L-THYROXINE; CANCER; EXPRESSION;
D O I
10.3275/8579
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aim: To assess the relevance of thyroid autoimmunity and TSH as risk factors for malignancy in thyroid nodules (TN). Subjects and methods: Retrospective analysis on 2053 patients with single/prevalent TN submitted to fine needle aspiration cytology (FNAC). Anti-thyroid autoantibodies (ATA) [anti-thyroperoxidase (TPOAb), anti-thyroglobulin (TgAb)] and TSH were measured. Cytology was classified as benign (class II), indeterminate (class III), and suspicious or malignant (class IV). Histology was available in 301 patients. Associations of malignancy with independent variables were determined by multivariate logistic regression analysis. Results: Higher prevalence of class IV (14.2% vs 6.8%: p<0.001) and class III (23.5% vs 17.1%: p<0.001) were found in ATA+ vs ATA- TN. Histology confirmed increased prevalence of cancer in ATA+ (p<0.05) TN and in those with diffuse lymphocytic thyroid infiltration (p<0.05). Interestingly, the prevalence of malignancies observed in operated class III nodules was strikingly lower in ATM- (1/20, 5%), than in ATA- patients (34/67, 50.7%; p<0.001). Increased independent odds ratio (OR) for malignancy was conferred by any ATA [OR 2.21; 95% confidence interval (CI)=1.49-3.29, p<0.0001]; TPOAb (OR 2.15; CI=1.42-3.25, p<0.0001) and TgAb (OR 1.67; CI=1.05-2.67, p<0.05), by serum TSH>1.0 mu UI/ml (OR 1.95; CI=1.01-3.76, p<0.05), and by young age (10-29 yr: OR 2.09; CI=1.02-4.26, p<0.05). A formula was calculated to assess the relative contribution of ATA, TSH, and age to the risk of TN malignancy. Conclusions: Both thyroid autoimmunity and increased TSH represent independent risk factors for TN malignancy. (C) 2013, Editrice Kurtis
引用
收藏
页码:313 / 320
页数:8
相关论文
共 41 条
[21]   Thyroglobulin Antibody Is Associated with Increased Cancer Risk in Thyroid Nodules [J].
Kim, Eun Sook ;
Lim, Dong Jun ;
Baek, Ki Hyun ;
Lee, Jong Min ;
Kim, Mee Kyoung ;
Kwon, Hyuk Sang ;
Song, Ki Ho ;
Kang, Moo Il ;
Cha, Bong Yun ;
Lee, Kwang Woo ;
Son, Ho Young .
THYROID, 2010, 20 (08) :885-891
[22]  
Kumarasinghe MP, 1999, PATHOLOGY, V31, P1
[23]   Increased incidence of well-differentiated thyroid cancer associated with Hashimoto thyrolditis and the role of the PI3k/Akt pathway [J].
Larson, Shawn D. ;
Jackson, Lindsey N. ;
Riall, Taylor S. ;
Uchida, Tatsuo ;
Thomas, Robert P. ;
Qiu, Suimin ;
Evers, B. Mark .
JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2007, 204 (05) :764-773
[24]   Thyroid Fine-Needle Aspiration Biopsy: Variability in Reporting [J].
Lewis, Carol M. ;
Chang, Kuo-Ping ;
Pitman, Martha ;
Faquin, William C. ;
Randolph, Gregory W. .
THYROID, 2009, 19 (07) :717-723
[25]   Independent expression of serological markers of thyroid autoimmunity and hepatitis virus C infection in the general population: Results of a community-based study in north-western Sardinia [J].
Loviselli, A ;
Oppo, A ;
Velluzzi, F ;
Atzeni, F ;
Mastinu, GL ;
Farci, P ;
Orgiana, G ;
Balestrieri, A ;
Cocco, PL ;
Mariotti, S .
JOURNAL OF ENDOCRINOLOGICAL INVESTIGATION, 1999, 22 (09) :660-665
[26]   Fine needle aspiration biopsy of Hashimoto's thyroiditis - Sources of diagnostic error [J].
MacDonald, L ;
Yazdi, HM .
ACTA CYTOLOGICA, 1999, 43 (03) :400-406
[27]   The co-inheritance of type 1 diabetes and multiple sclerosis in Sardinia cannot be explained by genotype variation in the HLA region alone [J].
Marrosu, MG ;
Motzo, C ;
Murru, R ;
Lampis, R ;
Costa, G ;
Zavattari, P ;
Contu, D ;
Fadda, E ;
Cocco, E ;
Cucca, F .
HUMAN MOLECULAR GENETICS, 2004, 13 (23) :2919-2924
[28]   THE CORRELATION BETWEEN PAPILLARY THYROID-CARCINOMA AND LYMPHOCYTIC INFILTRATION IN THE THYROID-GLAND [J].
MATSUBAYASHI, S ;
KAWAI, K ;
MATSUMOTO, Y ;
MUKUTA, T ;
MORITA, T ;
HIRAI, K ;
MATSUZUKA, F ;
KAKUDOH, KI ;
KUMA, K ;
TAMAI, H .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 1995, 80 (12) :3421-3424
[29]   Prevalence of RET/PTC rearrangements in Hashimoto's thyroiditis and papillary thyroid carcinomas [J].
Nikiforova, MN ;
Caudill, CM ;
Biddinger, P ;
Nikiforov, YE .
INTERNATIONAL JOURNAL OF SURGICAL PATHOLOGY, 2002, 10 (01) :15-22
[30]  
OKAYASU I, 1995, CANCER-AM CANCER SOC, V76, P2312, DOI 10.1002/1097-0142(19951201)76:11<2312::AID-CNCR2820761120>3.0.CO