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Combined clinical and ultrasound follow-up assists in malignancy detection in Galectin-3 negative Thy-3 thyroid nodules

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Abstract

The use of galectin-3 ThyroTest in the preoperative evaluation of cytologically indeterminate (Thy-3) thyroid nodules has been largely validated by retrospective and prospective multicentre studies. Here we report the results of galectin-3 ThyroTest routinely applied in the management of Thy-3 nodules in combination with clinical and ultrasonography (US) examination, in which galectin-3 positive nodules were directly referred to surgery whereas galectin-3 negative lesions were considered for clinical and US long-term follow-up. A cohort of 331 patients, bearing 340 thyroid Thy-3 nodules, was enrolled and subjected to galectin-3 expression analysis. A total of 256 galectin-3 negative nodules were directed to periodical clinical and US examination, while 84 galectin-3 positive cases were referred to surgery. Excluding 63 dropout patients plus 15 patients that were operated because of clinical reasons the remaining 176 galectin-3 negative nodules were followed with clinical and US examination for an average period of 31 months. During the follow-up, the volume of galectin-3 negative nodules was unchanged in 85 cases (48 %), reduced in 47 (27 %), and increased in 44 (25 %). Based on combined clinical features and US follow-up results, a total of 36 out of 191 galectin-3 negative nodules (19 %) were referred to surgery, with a final histological finding of 28 benign lesions, three follicular tumor of uncertain malignant potential (FT-UMP), and five malignant lesions, corresponding to a 7 % false negative rate. In the group of 84 galectin-3 positive nodules, we detected 65 thyroid cancers with a prevalence of 77 %, 12 FT-UMPs, and 7 false positive lesions, corresponding to a 4 % false positive rate. A total of 150 patients were not operated and are still under clinical and US monitoring while surgery was performed in 118 patients with a final 70 thyroid cancers diagnosed, corresponding to a 59 % prevalence of malignancy detected at surgery and to a 26 % prevalence of malignancy among the entire Thy-3 nodule population. Galectin-3 ThyroTest is an easy and cheap diagnostic procedure that integrates conventional fine-needle-aspiration cytology, reduces the number of unnecessary thyroidectomies and increases the rate of malignancy at surgery. Clinical and US follow-up of galectin-3 negative lesions allows to further reduce false negative cases.

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Acknowledgments

The authors are grateful to Enrico Di Stasio for reviewing the statistical analyses.

Funding

Italian Association for Cancer Research (AIRC), Sapienza University, Niccolò Cusano University Foundation for Medical Scientific Research, Rome Italy, Compagnia di San Paolo, Turin, Italy.

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Authors and Affiliations

  1. Department of Clinical and Molecular Medicine, Sapienza University, Policlinico Umberto I, Viale Regina Elena n. 324, 00161, Rome, Italy

    Salvatore Sciacchitano, Tommaso Porcelli & Stefano Amendola

  2. Laboratorio di Ricerca Biomedica, Fondazione Università Niccolò Cusano per la Ricerca Medico Scientifica, Via Don Carlo Gnocchi 3, 00166, Rome, Italy

    Salvatore Sciacchitano, Luca Lavra, Alessandra Ulivieri, Fiorenza Magi & Leila B. Salehi

  3. Department of Oncological Science, Breast Unit, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy

    Gian Paolo De Francesco

  4. Operative Unit Surgery of Thyroid and Parathyroid, Sapienza University of Rome, S. Andrea Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy

    Carlo Bellotti

  5. Department of Clinical and Experimental Medicine, University of Messina, Policlinico Universitario “G. Martino”, via Consolare Valeria, Gazzi, 98125, Messina, Italy

    Maria Concetta Trovato

  6. Department of Biopathology and Diagnostic Imaging, Tor Vergata University, Via Montpellier, 1, 00133, Rome, Italy

    Leila B. Salehi

  7. Laboratory of Surgical and Experimental Pathology, St Andrea University Hospital, Via di Grottarossa, 1035/39, 00189, Rome, Italy

    Armando Bartolazzi

  8. Department of Oncology-Pathology, Cancer Center Karolinska Universitetssjukhuset Solna, 17176, Stockholm, Sweden

    Armando Bartolazzi

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  1. Salvatore Sciacchitano
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  2. Luca Lavra
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  8. Carlo Bellotti
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  9. Maria Concetta Trovato
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Correspondence to Salvatore Sciacchitano.

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The authors declared no conflict of interest and do not benefit financially from the galectin-3 ThyroTest.

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Sciacchitano, S., Lavra, L., Ulivieri, A. et al. Combined clinical and ultrasound follow-up assists in malignancy detection in Galectin-3 negative Thy-3 thyroid nodules. Endocrine 54, 139–147 (2016). https://doi.org/10.1007/s12020-015-0774-8

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