Molecular Alterations and Comprehensive Clinical Management of Oncocytic Thyroid Carcinoma: A Review and Multidisciplinary 2023 Update
Recommended Citation
Bischoff LA, Ganly I, Fugazzola L, Buczek E, Faquin WC, Haugen BR, McIver B, McMullen CP, Newbold K, Rocke DJ, Russell MD, Ryder M, Sadow PM, Sherman E, Shindo M, Shonka DC, Jr., Singer MC, Stack BC, Jr., Wirth LJ, Wong RJ, and Randolph GW. Molecular Alterations and Comprehensive Clinical Management of Oncocytic Thyroid Carcinoma: A Review and Multidisciplinary 2023 Update. JAMA Otolaryngol Head Neck Surg 2024.
Document Type
Article
Publication Date
3-1-2024
Publication Title
JAMA Otolaryngol Head Neck Surg
Abstract
IMPORTANCE: Oncocytic (Hürthle cell) thyroid carcinoma is a follicular cell-derived neoplasm that accounts for approximately 5% of all thyroid cancers. Until recently, it was categorized as a follicular thyroid carcinoma, and its management was standardized with that of other differentiated thyroid carcinomas. In 2022, given an improved understanding of the unique molecular profile and clinical behavior of oncocytic thyroid carcinoma, the World Health Organization reclassified oncocytic thyroid carcinoma as distinct from follicular thyroid carcinoma. The International Thyroid Oncology Group and the American Head and Neck Society then collaborated to review the existing evidence on oncocytic thyroid carcinoma, from diagnosis through clinical management and follow-up surveillance.
OBSERVATIONS: Given that oncocytic thyroid carcinoma was previously classified as a subtype of follicular thyroid carcinoma, it was clinically studied in that context. However, due to its low prevalence and previous classification schema, there are few studies that have specifically evaluated oncocytic thyroid carcinoma. Recent data indicate that oncocytic thyroid carcinoma is a distinct class of malignant thyroid tumor with a group of distinct genetic alterations and clinicopathologic features. Oncocytic thyroid carcinoma displays higher rates of somatic gene variants and genomic chromosomal loss of heterozygosity than do other thyroid cancers, and it harbors unique mitochondrial DNA variations. Clinically, oncocytic thyroid carcinoma is more likely to have locoregional (lymph node) metastases than is follicular thyroid carcinoma-with which it was formerly classified-and it develops distant metastases more frequently than papillary thyroid carcinoma. In addition, oncocytic thyroid carcinoma rarely absorbs radioiodine.
CONCLUSIONS AND RELEVANCE: The findings of this review suggest that the distinct clinical presentation of oncocytic thyroid carcinoma, including its metastatic behavior and its reduced avidity to radioiodine therapy, warrants a tailored disease management approach. The reclassification of oncocytic thyroid carcinoma by the World Health Organization is an important milestone toward developing a specific and comprehensive clinical management for oncocytic thyroid carcinoma that considers its distinct characteristics.
Medical Subject Headings
Humans; Iodine Radioisotopes; Thyroid Neoplasms; Adenoma, Oxyphilic; Adenocarcinoma, Follicular; Lymphatic Metastasis
PubMed ID
38206595
ePublication
ePub ahead of print
Volume
150
Issue
3
First Page
265
Last Page
272
