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Medicina
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Diagnosis and Treatment of Thyroid Cancer in the Precision Medicine...
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Diagnosis and Treatment of Thyroid Cancer in the Precision Medicine Era

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 31 March 2026 | Viewed by 2654

Special Issue Editors

Dr. Maria Boudina

E-Mail Website
Guest Editor
Department of Endocrinology, Theageneio Cancer Hospital, 54636 Thessaloniki, Greece
Interests: endocrine; thyroid cancer; endocrine oncology; neuroendocrine tumors; clinical endocrinology
Dr. George Simeakis

E-Mail Website
Guest Editor Assistant
Endocrine Department, 401 General Military Hospital of Athens, 11525 Athens, Greece
Interests: endocrine; thyroid cancer; personalized medicine; liquid biopsy; genetics

Special Issue Information

Dear Colleagues,

Thyroid cancer (TC) is the most frequent endocrine malignancy, albeit it accounts for about 4% of all cancer types. The latest guidelines of the American Thyroid Association regarding Differentiated (DTC), Medullary (MTC), and Anaplastic Thyroid Cancer (ATC) provide thorough recommendations regarding the appropriate therapeutic management of TC patients (i.e., diagnostic assessment, surgical procedure, post-surgical treatment, and follow-up). Nevertheless, issues arise in real-life practice, especially when the physician has to deal with aggressive histological types and, moreover, when initial response to therapy is not excellent. Advanced forms of TC (i.e., metastatic Radioiodine Refractory DTC, MTC, and ATC) pose a challenge in clinical practice, and questions like when and where to use the available diagnostic tools and therapeutic options are of great importance to be answered towards precision medicine implementation. Tumor molecular profiling using Next Generation Sequencing (NGS) analysis, both on the tissue as well as on the Circulating Tumor DNA (ctDNA) and Circulating Tumor Cells (CTCs) level, is an intriguing tool providing information regarding prognosis and possible targeted-treatment options. In this Special Issue, we welcome original studies and reviews on the diagnosis, molecular pathways, and therapy of thyroid cancer. We especially welcome contributions focused on advanced TC, as described above, molecular pathways involved in TC pathogenesis and targeted treatment, and the clinical utility of molecular tools.

Dr. Maria Boudina
Guest Editor

Dr. George Simeakis
Guest Editor Assistant

Manuscript Submission Information

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Keywords

  • thyroid cancer
  • molecular
  • personalized
  • targeted
  • advanced thyroid cancer
  • medullary
  • liquid biopsy

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Published Papers (3 papers)

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Research

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14 pages, 529 KB  
Article
Predictive Factors of Lymph Node Metastasis in Papillary Thyroid Microcarcinoma (PTMC)
by Odysseas Violetis, Maria Sfakiotaki, Ariadni Spyroglou, Evangelia Pissadaki, Konstantinos Iliakopoulos, Eleni-Konstantina Syntzanaki, Panagiota Konstantakou, Eleni Chouliara, Constantinos Nastos, Nikolaos Dafnios, George Simeakis, Konstantinos Bramis, Despoina Myoteri, George Mastorakos, Paraskevi Xekouki and Krystallenia I. Alexandraki
Medicina 2025, 61(10), 1800; https://doi.org/10.3390/medicina61101800 - 6 Oct 2025
Viewed by 428
Abstract
Background and Objectives: The incidence of papillary thyroid microcarcinoma (PTMC) has increased. Some patients present with lymph node metastases (LNM), while risk factors remain unclear. This study aims to examine clinicopathological markers predictive of LNM in PTMC. Materials and Methods: We retrospectively [...] Read more.
Background and Objectives: The incidence of papillary thyroid microcarcinoma (PTMC) has increased. Some patients present with lymph node metastases (LNM), while risk factors remain unclear. This study aims to examine clinicopathological markers predictive of LNM in PTMC. Materials and Methods: We retrospectively analyzed 170 patients with a histological diagnosis of PTMC. The patients were grouped based on the presence of LNM. Results: Our cohort consisted of 133 females and 37 males, aged 47.14 ± 12.81 years. Twenty-seven (15.9%) individuals had LNM. Median tumor size was 5 mm (4.25, 0.15–10), and multifocality was present in 37.1% of patients. Thyroid capsular invasion (TCI) was observed in 22.9% of patients. Extrathyroidal extension (ETE) and aggressive variants were present in 12.9% and 8.8% of patients, respectively. Forty-four patients had a history of autoimmune thyroid disease. From univariate analysis, age < 55 years (OR: 6.317; p = 0.015), TCI (OR: 2.824; p = 0.020), and ETE (OR: 2.987; p = 0.034) were independent predictors of LNM. Multivariate analysis showed that younger patients are at a significantly increased risk of LNM in PTMC (OR: 6.30910; p = 0.016). Conclusions: The findings of this study highlight the need for greater attention to PTMC in younger patients with ultrasonographic features of TCI and ETE, as they may require a more thorough evaluation of LNM, strict follow-up, and may benefit from a surgical decision of lymphadenectomy. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Thyroid Cancer in the Precision Medicine Era)
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13 pages, 953 KB  
Article
A Mixed Model of Clinical Characteristics, Strain Elastography and ACR-TIRADS Predicts Malignancy in Small Thyroid Nodules: A Prospective Single-Center Study
by Nikolaos Angelopoulos, Emmanouil Petropoulos, Ioannis Chrisogonidis, Sarantis Livadas, Rodis D. Paparodis, Ioannis Androulakis, Juan Carlos Jaume, Dimitrios G. Goulis and Ioannis Iakovou
Medicina 2025, 61(10), 1774; https://doi.org/10.3390/medicina61101774 - 1 Oct 2025
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Abstract
Background and Objectives: To identify clinical, ultrasound (US) and real-time elastography (RTE) characteristics indicative of malignancy in small thyroid lesions. Materials and Methods: 141 consecutive patients with incidentally discovered solid thyroid nodules (diameter ≤ 10 mm) by neck US were assessed, [...] Read more.
Background and Objectives: To identify clinical, ultrasound (US) and real-time elastography (RTE) characteristics indicative of malignancy in small thyroid lesions. Materials and Methods: 141 consecutive patients with incidentally discovered solid thyroid nodules (diameter ≤ 10 mm) by neck US were assessed, and RTE was performed. The nodules were classified per American (ACR-TIRADS) and European (EU-TIRADS) criteria; US-guided FNA was conducted on EU-TIRADS 5 nodules. The US and RTE features of nodules classified as benign (Bethesda II) or malignant (Bethesda V and VI) were compared. Results: 41 nodules were classified as EU-TIRADS 5. Their Fine Needle Aspiration (FNA) cytology was Bethesda II (n = 11), III-IV (n = 3), V (n = 10) or VI (n = 17). Bethesda V–VI patients had a higher rate of autoimmune thyroiditis (p = 0.015) and higher ACR-scoring points (p < 0.001) compared with Bethesda II. The elastography ratio was equal between the groups (p = 0.584). In logistic regression analysis, ACR-scoring points predicted FNA results, with an area under the curve (AUC) of 0.993 (sensitivity 92.6% and specificity of 100%). The clinical model (age, body mass index, sex, autoimmunity, L-thyroxine treatment, nodule diameter, elastography ratio) achieved an AUC of 0.744. A “mixed” model, combining clinical characteristics with the ACR scoring points, achieved perfect performance (AUC = 1.000), predicting FNA results with 100% sensitivity and specificity. Conclusions: The proposed “mixed model” can predict Bethesda V–VI in thyroid nodules <10 mm, allowing for the selection of those needing further evaluation. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Thyroid Cancer in the Precision Medicine Era)
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Review

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11 pages, 1035 KB  
Review
A Narrative Review of the Odyssey of Thyroid Cancer Diagnosis: Can 99mTc-SESTAMIBI Molecular Imaging Replace Fine Needle Aspiration Biopsy?
by Ioannis Iakovou, Nikitas Papadopoulos, Paraskevi Exadaktylou, Christos Melidis, Georgia Koutsouki, Ilias Katsadouros, Savvas Frangos, Ioannis Koutelidakis, Kalliopi Kotsa and Evanthia Giannoula
Medicina 2025, 61(6), 1043; https://doi.org/10.3390/medicina61061043 - 5 Jun 2025
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Abstract
Background and Objectives: Many diagnostic methods exist for identifying thyroid malignancy, but most of them resemble an odyssey, as the journey from palpating a nodule to receiving a definitive diagnose is often long and costly. The aim of the present study is to [...] Read more.
Background and Objectives: Many diagnostic methods exist for identifying thyroid malignancy, but most of them resemble an odyssey, as the journey from palpating a nodule to receiving a definitive diagnose is often long and costly. The aim of the present study is to investigate the role of Sestamibi scintigraphy in the characterization of cytological indeterminate thyroid nodules. Materials and Methods: A focused literature review was conducted, emphasizing the comparison between Fine Needle Aspiration Biopsy (FNAB), the main diagnostic method for thyroid cancer, and Sestamibi. Results: It is widely accepted that Sestamibi is the primary alternative for patients with non-diagnostic FNAB. As shown in the literature, Sestamibi has a high negative predictive value in excluding thyroid malignancy. Conclusions: Much like Odysseus’ adventurous 10-year journey returning to Ithaca, the path to diagnosing thyroid cancer is not straightforward. Molecular imaging with 99mTc-Sestamibi may serve as a valuable adjunct in evaluating thyroid nodules with inconclusive cytological findings. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Thyroid Cancer in the Precision Medicine Era)
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