Are There Any Differences in Clinicopathological Features of Thyroid Cancer Between Diabetic and Non-Diabetic Patients?

Abstract

Objectives: Although there are numerous studies about the relationship between diabetes mellitus and thyroid cancer, there are few studies about the clinicopathological features in diabetic patients with thyroid cancer. Our aim is to evaluate whether ultrasonographic and cytopathological features of malignant nodules and distribution of thyroid cancer and its variants are different in diabetic and non-diabetic patients.
Materials and Methods: Data of patients who underwent thyroidectomy between 2007-2014 were reviewed retrospectively. Patients with cyto-histopathological data were included. Hormonal, ultrasonographic, and cyto-histopathologic features of diabetic and non-diabetic patients were compared.       
Results: Of 865 patients, 113 were diabetic (13.06%). Median age was higher in diabetic patients [59 (25-81) years, 48 (19-84) years; p<0.001]. TSH level, anti-TPO and anti-TG autoantibody positivity and number of nodules were similar between groups (p=0.849, 0.268, 0.168, 0.054). Frequency of multifocality was higher in diabetics (45.13% vs 31.38%, p=0.004). The only patient with metastatic disease was in diabetic group. In ultrasonographic evaluation of malignant nodules; dimension, echogenity, texture, anteroposterior/transverse dimension, and presence of halo were similar in two groups. Rates of macrocalcification and presence of irregular margin were higher in diabetic patients (46% vs 31.8%, p=0.01; 80.5% vs 61,5%, p=0.001; respectively). Rate of microcalcification was in limit of significance (55.17% vs 43.88%, p=0.05). Frequency of suspicious for malignancy was significantly lower, and rate of malignancy was two times higher in cytologic evaluation of malignant nodules of diabetic patients compared to those of non-diabetic ones. In histopathologic evaluation, there was no difference in distribution of the type of thyroid cancer. Furthermore, the most frequent thyroid cancer was papillary thyroid cancer (PTC) in two groups. The classical variant of PTC was significantly higher, but follicular variant of PTC was significantly lower in diabetic group. Microcarcinoma rate was significantly higher in diabetic group (p=0.046). Rates of lymphovascular invasion, capsular invasion and extrathyroidal extension were similar in both groups. 
Conclusion: Distribution of the type of thyroid cancer and histopathological features, except variants of PTC, were similar in diabetic and non-diabetic patients. Rate of multifocality and microcarcinoma were higher in diabetic patients compared to non-diabetic ones. Further researches with follow-up data are needed to evaluate the course of thyroid cancer in diabetic patients.

Keywords

• diabetes mellitus,thyroid cancer,ultrasonography,cytology,histopathology

Diyabetik Hastalarda Tiroid Kanserlerinin Klinikopatolojik Özellikleri Non-diyabetik Hastalardan Farklı mıdır?

Öz

Amaç: Diyabetes mellitus ve tiroid kanseri arasında ilişki olup olmadığı ile ilgili yapılmış çok sayıda çalışma olmasına rağmen diyabetik hastalardaki tiroid kanserinin klinikopatolojik özellikleri ile ilgili çok az sayıda çalışma mevcuttur. Bu çalışmadaki amacımız diyabetik hastalarda malign nodüllerin ultrasonografik özellikler, sitolojik özellikler ve tiroid kanseri tiplerinin dağılımı açısından non-diyabetik hastalara göre farklılık olup olmadığının tespit edilmesidir.        
Materyal ve Metot: 2007-2014 yılları arasında tiroidektomi yapılan hastalar retrospektif olarak tarandı. Sitolojik ve histopatolojik verileri tam olan hastalar çalışmaya dahil edildi. Hastalar diyabetik ve non-diyabetik olarak ayrıldı. Demografik, hormonal, ultrasonografik, sitolojik ve histopatolojik özellikler karşılaştırıldı.

Bulgular: Toplam 865 hastanın 113’ü diyabetikti (% 13,06). Diyabetiklerde yaş ortancası daha fazlaydı [59 (25-81), 48 (19-84); p<0,001]. Tiroid stimülan hormon (TSH) düzeyi, anti-tiroid peroksidaz ve anti-tiroglobulin pozitifliği ve nodül sayısı benzerdi (sırasıyla p=0,849; p=0,268, p=0,168 ve p=0,054). Multifokalite oranı diyabetiklerde daha fazlaydı (% 45,13 ve % 31,38, p=0,004). Uzak metastazı olan tek hasta, diyabetik gruptaydı. Malign nodüllerin ultrasonografik incelemesinde; nodül boyutları, ekojenite, nodül yapısı, ön-arka çap/transvers çap oranı ve hipoekoik halo varlığı benzerdi. Makrokalsifikasyon ve sınır düzensizliği oranı diyabetiklerde daha fazlaydı (sırası ile; % 45,98 ve % 31,83, p=0,010; % 80,46 ve % 61,48, p=0,001). Mikrokalsifikasyon oranı anlamlılık sınırındaydı (% 55,17 ve % 43,88, p=0,050). Malign nodüllerin sitolojisi incelendiğinde diyabetiklerde non-diyabetiklere göre malignite şüphesi oranı belirgin az, malignite oranı 2 kat fazlaydı. Histopatolojide tiroid kanseri tipleri dağılımında farklılık yoktu ve her iki grupta da en sık kanser tipi papiller tiroid kanseri (PTK) idi. Diyabetik hastalarda klasik varyant PTK oranı belirgin yüksek, folliküler varyant oranı belirgin düşüktü. Mikrokarsinom oranı diyabetik grupta belirgin fazlaydı (p=0,046). Lenfovasküler invazyon, kapsüler invazyon, ekstratiroidal yayılım açısından fark yoktu.

Sonuç: Diyabetik hastalarda tiroid kanseri tiplerinin dağılımı non-diyabetik hastalarla benzerdir ve PTK varyant dağılımı dışındaki histopatolojik özellikler farklılık göstermemektedir. Multifokalite oranı diyabetik hastalarda non-diyabetiklere göre daha fazladır. Diyabetiklerde tiroid kanserinin seyrini değerlendirmek için takip verilerinin olduğu ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• diabetes mellitus,tiroid kanseri,ultrasonografi,sitoloji,histopatoloji

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