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Nodular thyroid disease in the elderly: novel molecular approaches for the diagnosis of malignancy

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Abstract

Epithelial thyroid cancers (TC) comprise two differentiated histotypes (DTC), the papillary (PTC) and the follicular (FTC) thyroid carcinomas which, following dedifferentiation, are assumed to give rise to the poorly differentiated thyroid carcinomas and the rare, but highly aggressive and invariably fatal, anaplastic thyroid carcinomas. Although thyroid cancer mortality has not been changed, its annual incidence has increased over the last two decades, mainly because of the improved ability to diagnose malignant transformation in small non-palpable thyroid nodules. Despite DTC patients have a favorable prognosis, aggressive disease is more frequently observed in the elderly showing a higher disease-specific mortality. Of relevance is the high prevalence of nodular thyroid disease in aged patients being higher than 90%, in women older than 60 year, and 60% in men older than 80 year. This implies a careful evaluation of thyroid nodules in this group of patients in order to exclude malignancy. In fact, despite the tremendous progress in the comprehension of the underlying molecular mechanisms deregulated in DTC progression, several aspects of their clinical management remain to be solved and novel diagnostic strategies are sorely needed. Here, we will attempt to review new molecular approaches, which are currently being exploited in order to ameliorate the diagnosis of thyroid nodules.

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Abbreviations

TC:

Thyroid carcinoma

DTC:

Differentiated thyroid carcinoma

PTC:

Papillary thyroid carcinoma

FTC:

Follicular thyroid carcinoma

PDTC:

Poorly differentiated thyroid carcinoma

ATC:

Anaplastic thyroid carcinoma

FNAC:

Fine needle aspiration cytology

AUS/FLUS:

Atypia of undetermined significance/follicular lesion of undetermined significance

FN/SFN:

Follicular neoplasm/suspicious for follicular neoplasm

MAPK:

Mitogen-activated protein kinase

EMT:

Epithelial-to-mesenchymal transition

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Authors and Affiliations

  1. Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy

    Salvatore Sorrenti, Enke Baldini, Francesco Tartaglia, Antonio Catania, Stefano Arcieri, Daniele Pironi, Angelo Filippini & Salvatore Ulisse

  2. Department of Surgical Sciences, University of Cagliari, Cagliari, Italy

    Pier Giorgio Calò

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  1. Salvatore Sorrenti
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  2. Enke Baldini
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  3. Francesco Tartaglia
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Sorrenti, S., Baldini, E., Tartaglia, F. et al. Nodular thyroid disease in the elderly: novel molecular approaches for the diagnosis of malignancy. Aging Clin Exp Res 29 (Suppl 1), 7–13 (2017). https://doi.org/10.1007/s40520-016-0654-y

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