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High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma

PURPOSE: Preoperative distinction of follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) is a diagnostic challenge. Our aim was to investigate whether the Ki-67 proliferation index in fine needle aspiration material can contribute to the diagnosis of FTC. METHODS: We analyzed re...

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Autores principales: Mu, Ninni, Juhlin, C. Christofer, Tani, Edneia, Sofiadis, Anastasios, Reihnér, Eva, Zedenius, Jan, Larsson, Catharina, Nilsson, Inga-Lena
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061212/
https://www.ncbi.nlm.nih.gov/pubmed/29796987
http://dx.doi.org/10.1007/s12020-018-1627-z
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author Mu, Ninni
Juhlin, C. Christofer
Tani, Edneia
Sofiadis, Anastasios
Reihnér, Eva
Zedenius, Jan
Larsson, Catharina
Nilsson, Inga-Lena
author_facet Mu, Ninni
Juhlin, C. Christofer
Tani, Edneia
Sofiadis, Anastasios
Reihnér, Eva
Zedenius, Jan
Larsson, Catharina
Nilsson, Inga-Lena
author_sort Mu, Ninni
collection PubMed
description PURPOSE: Preoperative distinction of follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) is a diagnostic challenge. Our aim was to investigate whether the Ki-67 proliferation index in fine needle aspiration material can contribute to the diagnosis of FTC. METHODS: We analyzed retrospectively cytological Ki-67 index determined in routine clinical setting and clinical data for 61 patients with FTC, 158 patients with FTA and 15 patients with follicular tumor of uncertain malignant potential (FT-UMP) surgically treated and diagnosed by histopathology at Karolinska University Hospital 2006-2017 (Cohort A). A previously published cohort of 109 patients with follicular tumors was re-analyzed as well (Cohort B). RESULTS: In Cohort A, patients with FTC had a higher Ki-67 index (p < 0.001), larger tumor size (p < 0.001) and higher age at diagnosis (p = 0.036) compared to patients with FTA or FT-UMP. Hürthle cell differentiation, present in 50 FTA, 20 FTC and 8 FT-UMP, was associated with higher Ki-67 index (p = 0.009). Multivariate analysis of Cohort A identified a high Ki-67 index (odds ratio [OR]: 1.215, p < 0.001) and large tumor size (OR: 1.038, p < 0.001) as independent predictors of FTC. Results remained consistent after exclusion of Hürthle cell tumors and in pooled analysis of Cohort A + B. The area under curve of the Ki-67 index for predicting FTC was 0.722 and a cut-off for Ki-67 index at above 5% resulted in a specificity at 93% and sensitivity at 31%. Subgroup analysis of FTCs in Cohort A showed an association of higher Ki-67 index to extrathyroidal extension (p = 0.001) as well as widely invasive subtype (p = 0.019) based on the WHO 2017 classification. CONCLUSIONS: Pre-operative Ki-67 index may add diagnostic information for a subset of patients with follicular thyroid tumors.
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spelling pubmed-60612122018-08-09 High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma Mu, Ninni Juhlin, C. Christofer Tani, Edneia Sofiadis, Anastasios Reihnér, Eva Zedenius, Jan Larsson, Catharina Nilsson, Inga-Lena Endocrine Original Article PURPOSE: Preoperative distinction of follicular thyroid carcinoma (FTC) from follicular thyroid adenoma (FTA) is a diagnostic challenge. Our aim was to investigate whether the Ki-67 proliferation index in fine needle aspiration material can contribute to the diagnosis of FTC. METHODS: We analyzed retrospectively cytological Ki-67 index determined in routine clinical setting and clinical data for 61 patients with FTC, 158 patients with FTA and 15 patients with follicular tumor of uncertain malignant potential (FT-UMP) surgically treated and diagnosed by histopathology at Karolinska University Hospital 2006-2017 (Cohort A). A previously published cohort of 109 patients with follicular tumors was re-analyzed as well (Cohort B). RESULTS: In Cohort A, patients with FTC had a higher Ki-67 index (p < 0.001), larger tumor size (p < 0.001) and higher age at diagnosis (p = 0.036) compared to patients with FTA or FT-UMP. Hürthle cell differentiation, present in 50 FTA, 20 FTC and 8 FT-UMP, was associated with higher Ki-67 index (p = 0.009). Multivariate analysis of Cohort A identified a high Ki-67 index (odds ratio [OR]: 1.215, p < 0.001) and large tumor size (OR: 1.038, p < 0.001) as independent predictors of FTC. Results remained consistent after exclusion of Hürthle cell tumors and in pooled analysis of Cohort A + B. The area under curve of the Ki-67 index for predicting FTC was 0.722 and a cut-off for Ki-67 index at above 5% resulted in a specificity at 93% and sensitivity at 31%. Subgroup analysis of FTCs in Cohort A showed an association of higher Ki-67 index to extrathyroidal extension (p = 0.001) as well as widely invasive subtype (p = 0.019) based on the WHO 2017 classification. CONCLUSIONS: Pre-operative Ki-67 index may add diagnostic information for a subset of patients with follicular thyroid tumors. Springer US 2018-05-23 2018 /pmc/articles/PMC6061212/ /pubmed/29796987 http://dx.doi.org/10.1007/s12020-018-1627-z Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Article
Mu, Ninni
Juhlin, C. Christofer
Tani, Edneia
Sofiadis, Anastasios
Reihnér, Eva
Zedenius, Jan
Larsson, Catharina
Nilsson, Inga-Lena
High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma
title High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma
title_full High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma
title_fullStr High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma
title_full_unstemmed High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma
title_short High Ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma
title_sort high ki-67 index in fine needle aspiration cytology of follicular thyroid tumors is associated with increased risk of carcinoma
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061212/
https://www.ncbi.nlm.nih.gov/pubmed/29796987
http://dx.doi.org/10.1007/s12020-018-1627-z
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