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Oncology: Theory & Practice
Title
Oncology: Theory & Practice
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iConcept Press
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ISBN
978-1-922227-80-5
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Chapter 10

Oncology: Theory & Practice

Relevance of Molecular Biomarkers for Differential Diagnostics of Thyroid Cancer

by Artūrs Ābols, Kristīne Ducena, Aija Linē and Valdis Pīrāgs

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Abstract

Less than 5% of the palpable thyroid nodules are malignant lesions, but still thyroid cancers are the most common malignancy of endocrine organs. According to the European Cancer Observatory data, age-standardized incidence rate is 3.1 and 8.8 cases per 100,000 in men and women, respectively, with a rising tendency over the recent decades. More than 95% of malignant lesions derive from thyroid follicular cells and are divided into papillary (PTC) and follicular (FTC) carcinomas with relatively good prognosis, except the oncocytic (Hürthle) cell tumors that compile 20-25% of all FTC cases. Undifferentiated or anaplastic carcinoma (AC) is a highly aggressive and lethal cancer with 5–year survival rate below 1-17%. Remaining cases are medullary thyroid carcinomas (MTC) that derive from parafollicular cells (C-cells). Ultrasound in conjunction with the cytological examination of fine needle aspiration (FNA) biopsy is the gold standard technique for the pre-operative differential diagnostics of thyroid nodules. However, approximately 10 % of samples are non-diagnostic due to poor sampling technique, but 20% of samples are undetermined or suspicious to malignancy due to poor cellular architecture or insufficient cytological criteria, therefore identification of new molecular biomarkers could aid in these cases. In recent years, many studies have reported the discovery of a wide variety of potential molecular biomarkers – gene expression signatures, mutations, gene rearrangements and immunohistochemical markers that are capable to discriminate thyroid nodule subtypes. For example, ADM3/TFF3 and ADM3/ACTB gene expression ratios could discriminate follicular adenoma from carcinoma in FNA biopsies. Similarly, non-overlapping BRAF, RAS point mutations and RET/PTC and PAX8/PPAR gamma rearrangements are found in 70 % of thyroid cancer and can increase performance of FNA diagnosis in inconclusive PTC cases. Different miRNA expression profiles are also promising. For example miR-146b and miR221 are overexpressed in aggressive PTC. However, several challenges have to be overcome in order to translate these biomarkers into clinically applicable diagnostic tools. In this review we will discuss the current diagnostic issues and summarise studies focused on the identification of the thyroid biomarkers that has a potential to improve the diagnostic accuracy.

Author Details

Artūrs Ābols
Latvian Biomedical Research and Study center, University of Latvia, Rīga, Latvia
Kristīne Ducena
Latvian Biomedical Research and Study center, University of Latvia, Rīga, Latvia
Aija Linē
Latvian Biomedical Research and Study center, University of Latvia, Rīga, Latvia
Valdis Pīrāgs
Pauls Stradiņš Clinical University Hospital, University of Latvia, Rīga, Latvia

Citation

Artūrs Ābols, Kristīne Ducena, Aija Linē and Valdis Pīrāgs. Relevance of Molecular Biomarkers for Differential Diagnostics of Thyroid Cancer. In Oncology: Theory & Practice. ISBN:978-1-922227-80-5. iConcept Press. 2014.

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