1
|
Yang Z, Zhang M, Yan L, Xiao J, Li Y, Li X, Luo Y. Value of radiofrequency ablation for treating locally recurrent thyroid cancer: a systematic review and meta-analysis for 2-year follow-up. Endocrine 2024; 85:1066-1074. [PMID: 38801598 DOI: 10.1007/s12020-023-03660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/12/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE To evaluate the safety and efficacy of radiofrequency ablation (RFA) in treating locoregional recurrent thyroid cancer (LRTC) after a 2-year follow-up time. METHODS PubMed, Embase and Cochrane Library were searched from inception until 20 September 2022 to find studies reporting the safety and efficacy of RFA in LRTC patients after a 2-year follow-up. Two radiologists performed the data extraction and methodological quality assessment according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS We analyzed 6 studies, 229 LRTC patients with 319 locally recurrent tumors were treated with RFA. The mean follow-up time of each study was ≥24 months. The pooled changes in the largest diameter and volume were 7.22 mm (95% confidence interval (CI), 6.35-8.09 mm) and 164.28 mm3 (95% CI, 87.78-240.77 mm3), respectively; the pooled volume reduction rate was 95.03% (95% CI, 87.56-102.49%). The total complete disappearance rate after treatment was 92% (95% CI, 83-100%). The pooled decrease of serum thyroglobulin levels was 0.02 ng/ml (95% CI, -0.00-0.04 ng/ml). The pooled proportion of recurrence rate was 6% (95% CI, 0-13%). The pooled complication rate was 5% (95% CI, 0-10%). The major complications were voice change and hoarseness, only one patient developed permanent vocal cord paralysis; minor complications were cough and pain. CONCLUSIONS Ultrasound-guided RFA is an effective and safe treatment for LRTC based on 2-year follow-up results.
Collapse
Affiliation(s)
- Zhen Yang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Xinyang Li
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China
- School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Yukun Luo
- Department of Ultrasound, the First Medical Center of Chinese People's Liberty Army General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, China.
| |
Collapse
|
2
|
Mao Y, Zhou H, Wen X, Li Z, Dai M, Zhou S. Mapping the lymph node metastasis landscape: A bibliometric Odyssey of papillary thyroid carcinoma publications (2012-2022). Heliyon 2024; 10:e31398. [PMID: 38818149 PMCID: PMC11137519 DOI: 10.1016/j.heliyon.2024.e31398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Lymph node metastasis in papillary thyroid carcinoma (PTC) has become an area of great interest in the study of thyroid diseases. The aim of this study was to elucidate the research trends and impact of lymph node metastasis of PTC in the study of thyroid diseases through a comprehensive bibliometric analysis. Methods We conducted an extensive bibliometric review of the literature on lymph node metastasis in PTC using the Web of Science Core Database (WOSCC), which included approximately 3292 publications from 2012 to 2022. Data analysis and visualization were performed, using advanced bibliometric tools including VOSviewer, CiteSpace, and bibliometrix R software packages. Results A total of 3292 publications from 81 one countries were identified. The analysis showed a pattern of growth in the number of publications per year from 2012 to 2022, with China having the highest number of papers. Outstanding contributions were made by China, Korea, USA, Italy and Japan, with Thyroid being the most important journal. The author who published the most papers was Jingqiang Zhu. The institutions that published the most papers were Shanghai Jiao Tong University and Yonsei University. The analysis found that prognosis, recurrence, and ultrasound were the keywords with the highest frequency of occurrence in addition to those related to the title of this article. Conclusion Our bibliometric analysis outlines the current state of research on lymph node metastasis in PTC, highlighting significant contributions, trends, and future research directions.
Collapse
Affiliation(s)
- Yu Mao
- Department of Thyroid Surgery, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, No. 238Tongzipo Road, Changsha, 410013, Hunan Province, China
- Department of Thyroid Surgey, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Huatao Zhou
- Department of Cardiovascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Xiaoyong Wen
- Department of Thyroid Surgery, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, No. 238Tongzipo Road, Changsha, 410013, Hunan Province, China
- Department of Thyroid Surgey, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Zeyu Li
- Department of Thyroid Surgery, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, No. 238Tongzipo Road, Changsha, 410013, Hunan Province, China
- Department of Thyroid Surgey, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Mei Dai
- Department of Thyroid Surgey, the Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Shiwei Zhou
- Department of Thyroid Surgery, Hunan Cancer Hospital & The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, No. 238Tongzipo Road, Changsha, 410013, Hunan Province, China
| |
Collapse
|
3
|
Wang Z, Ji X, Zhang H, Sun W. Clinical and molecular features of progressive papillary thyroid microcarcinoma. Int J Surg 2024; 110:2313-2322. [PMID: 38241301 PMCID: PMC11019976 DOI: 10.1097/js9.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
In recent decades, the prevalence of thyroid cancer has risen substantially, with papillary thyroid microcarcinoma (PTMC) constituting over 50% of cases. Although most PTMCs exhibit indolent growth and a favorable prognosis, some present an increased risk of recurrence and an unfavorable prognosis due to high-risk characteristics such as lymph node metastasis, extrathyroidal extension, and distant metastasis. The early identification of clinically progressing PTMC remains elusive. In this review, the authors summarize findings from PTMC progression-related literature, highlighting that factors such as larger tumor size, cervical lymph node metastasis, extrathyroidal extension, younger age, higher preoperative serum thyroid-stimulating hormone levels, family history, and obesity positively correlate with PTMC progression. The role of multifocality in promoting PTMC progression; however, remains contentious. Furthermore, recent studies have shed light on the impact of mutations, such as BRAF and TERT mutations, on PTMC progression. Researchers have identified several mRNAs, noncoding RNAs, and proteins associated with various features of PTMC progression. Some studies propose that peripheral and tumor tissue-infiltrating immune cells could serve as biomarkers for the clinical progression of PTMC. Collectively, these clinical and molecular features offer a rationale for the early detection and the development of precision theranostic strategies of clinically progressive PTMC.
Collapse
Affiliation(s)
| | | | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China
| |
Collapse
|
4
|
Fan Y, Zheng X, Ran Y, Li P, Xu T, Zhang Y, Wei T. Analysis of risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma: a retrospective cohort study. Gland Surg 2024; 13:314-324. [PMID: 38601278 PMCID: PMC11002491 DOI: 10.21037/gs-23-470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/10/2024] [Indexed: 04/12/2024]
Abstract
Background The occurrence of cervical lymph node metastasis in T1 stage papillary thyroid carcinoma (PTC) is frequently observed. Notably, lateral lymph node metastasis (LLNM) emerges as a critical risk factor adversely affecting prognostic outcomes in PTC. The primary aim of this investigation was to delineate the risk factors associated with LLNM in the initial stages of PTC. Methods This retrospective analysis encompassed 3,332 patients diagnosed with T1 stage PTC without evident LLNM at the time of diagnosis. These individuals underwent primary surgical intervention at West China Hospital, Sichuan University between June 2017 and February 2023. The cohort was divided into two groups: patients manifesting LLNM and those without metastasis at the time of surgery. Additionally, T1 stage PTC patients were subdivided into T1a and T1b categories. Factors influencing LLNM were scrutinized through both univariate and multivariate analyses. Results The incidence of LLNM was observed in 6.2% of the cohort (206 out of 3,332 patients). Univariate analysis revealed significant correlations between LLNM and male gender (P<0.001), tumor localization in the upper lobe (P<0.001), maximal volume of the primary tumor (P<0.001), largest tumor diameter (P<0.001), multifocality (P<0.001), and bilaterality (P<0.001), with the exception of age (P=0.788) and duration of active surveillance (AS) (P=0.978). Multivariate logistic regression analysis identified male gender (P<0.001), upper lobe tumor location (P<0.001), maximal primary tumor volume (P<0.001), and multifocality (P<0.001) as independent predictors of LLNM. However, age categories (≤55, >55 years), maximum tumor diameter, bilaterality, and surveillance duration did not exhibit a significant impact. Comparative analyses between T1a and T1b subgroups showed congruent univariate results but revealed differences in multivariate outcomes. In the T1a subgroup, gender, tumor location, and multifocality (all P<0.05) were associated with elevated LLNM risk. Conversely, in the T1b subgroup, tumor location, dimensions, and multifocality (all P<0.05) were significant predictors of LLNM risk, whereas gender (P=0.097) exerted a marginal influence. Conclusions The investigation highlights several key risk factors for LLNM in T1 stage PTC patients, including gender, upper lobe tumor location, larger tumor size, and multifocality. Conversely, prolonged AS and younger age did not significantly elevate LLNM risk, suggesting the viability of AS as a strategic option in selected cases.
Collapse
Affiliation(s)
- Yuanyuan Fan
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xun Zheng
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanhao Ran
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Pengyu Li
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tianfeng Xu
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yujie Zhang
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Wei
- Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Su B, Li L, Liu Y, Liu H, Zhan J, Chai Q, Fang L, Wang L, Chen L. Quantitative parameters of contrast-enhanced ultrasound effectively promote the prediction of cervical lymph node metastasis in papillary thyroid carcinoma. Drug Discov Ther 2024; 18:44-53. [PMID: 38355122 DOI: 10.5582/ddt.2023.01095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Papillary thyroid carcinoma (PTC), the most common endocrine tumor, often spreads to cervical lymph nodes metastasis (CLNM). Preoperative diagnosis of CLNM is important when selecting surgical strategies. Therefore, we aimed to explore the effectiveness of quantitative parameters of contrast-enhanced ultrasound (CEUS) in predicting CLNM in PTC. We retrospectively analyzed 193 patients with PTC undergoing conventional ultrasound (CUS) and CEUS. The CUS features and quantitative parameters of CEUS were evaluated according to PTC size ≤ 10 or > 10 mm, using pathology as the gold standard. For the PTC ≤ 10 mm, microcalcification and multifocality were significantly different between the CLNM (+) and CLNM (-) groups (both P < 0.05). For the PTC > 10 mm, statistical significance was noted between the two groups with respect to the margin, capsule contact, and multifocality (all P < 0.05). For PTC ≤ 10 mm, there was no significant difference between the CLNM (+) and CLNM (-) groups in all quantitative parameters of CEUS (all P > 0.05). However, for PTC > 10 mm, the peak intensity (PI), mean transit time, and slope were significantly associated with CLNM (all P < 0.05). Multivariate analysis showed that PI > 5.8 dB was an independent risk factor for predicting CLNM in patients with PTC > 10 mm (P < 0.05). The area under the curve of PI combined with CUS (0.831) was significantly higher than that of CUS (0.707) or PI (0.703) alone in the receiver operator characteristic curve analysis (P < 0.05). In conclusion, PI has significance in predicting CLNM for PTC > 10 mm; however, it is not helpful for PTC ≤ 10 mm.
Collapse
Affiliation(s)
- Biao Su
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Department of Ultrasound, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lisha Li
- Department of Reproductive Immunology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Hui Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
- Department of Ultrasound, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Qiliang Chai
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| | - Ling Wang
- Department of Reproductive Immunology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China
| |
Collapse
|
6
|
Wang SR, Zhu PS, Li J, Chen M, Cao CL, Shi LN, Li WX. Study on diagnosing thyroid nodules of ACR TI-RADS 4-5 with multimodal ultrasound radiomics technology. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:274-283. [PMID: 38105371 DOI: 10.1002/jcu.23625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Explore the feasibility of using the multimodal ultrasound (US) radiomics technology to diagnose American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) 4-5 thyroid nodules. METHOD This study prospectively collected the clinical characteristics, conventional, and US elastography images of 100 patients diagnosed with ACR TI-RADS 4-5 nodules from May 2022 to 2023. Independent risk factors for malignant thyroid nodules were extracted and screened using methods such as the least absolute shrinkage and selection operator (LASSO) logistic regression (LR) model, and a multimodal US radiomics combined diagnostic model was established. Using a multifactorial LR analysis and a Rad-score rating, the predictive performance was validated and evaluated, and the final threshold range was determined to assess the clinical net benefit of the model. RESULTS In the training set, the US radiomics combined predictive model area under curve (AUC = 0.928) had higher diagnostic performance compared with clinical characteristics (AUC = 0.779), conventional US (AUC = 0.794), and US elastography model (AUC = 0.852). In the validation set, the multimodal US radiomics combined diagnostic model (AUC = 0.829) also had higher diagnostic performance compared with clinical characteristics (AUC = 0.799), conventional US (AUC = 0.802), and US elastography model (AUC = 0.718). CONCLUSION Multi-modal US radiomics technology can effectively diagnose thyroid nodules of ACR TI-RADS 4-5, and the combination of radiomics signature and conventional US features can further improve the diagnostic performance.
Collapse
Affiliation(s)
- Si-Rui Wang
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Pei-Shan Zhu
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Jun Li
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Ming Chen
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Chun-Li Cao
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Li-Nan Shi
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| | - Wen-Xiao Li
- NHC Key Laboratory of Prevention and Treatment of Central Asia High Incidence Diseases, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
- The Ultrasound Diagnosis Department, First Affiliated Hospital of Shihezi University, Shihezi, Xin Jiang, China
| |
Collapse
|
7
|
Alqaryan S, Almousa H, Almutairi R, Altuwaijri A, Doubi A, Alqahtani Z, Almayouf M, Albarrak M, Alessa M, Aldhahri S, Alqahtani K. Papillary thyroid microcarcinoma with and without nodal metastasis: A comparative analysis. Saudi Med J 2024; 45:267-272. [PMID: 38438216 PMCID: PMC11115404 DOI: 10.15537/smj.2024.45.3.20230638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/15/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES To assess the demographics and clinical factors of papillary thyroid microcarcinoma (PTMC) patients in Saudi Arabia and compared and analyzed the differences between the patients with and without lymph node metastasis (LNM). Papillary thyroid microcarcinoma (PTMC) is a common thyroid cancer and is not usually detectable clinically but found incidentally after pathologic evaluation of thyroid tissue following surgery for benign thyroid disorders. However, these tumors have a significant risk of LNM. METHODS All PTMC patients who underwent surgery at King Abdulaziz University Hospital, King Fahad Medical City, and King Abdulaziz Medical City from 2012 to 2022 were included. The incidence rate of LNM was 9.17%. The patients' average age was 44.05. Most of the patients were female. RESULTS Prevalence of LNM among PTMC patients is 9.17% (n=31). The PTMC patients showed the following significant risk factors for LNM: higher Bethesda class, type of pathology, extrathyroidal extension, extracapsular extension, lymphovascular invasion, and residual tumors in patients who had received radioactive iodine. Presence of thyroiditis, multifocality, goitrous thyroid, neural invasion, and tumor size were unrelated to the LNM in the PTMC patients. CONCLUSION Higher Bethesda class, pathology type, extrathyroidal extension, extracapsular extension, lymphovascular invasion, and RAI-treated residual tumors were strongly linked to LNM.
Collapse
Affiliation(s)
- Saleh Alqaryan
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Hisham Almousa
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Raed Almutairi
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Ahmed Altuwaijri
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Aseel Doubi
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Zuhour Alqahtani
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Mohammad Almayouf
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Majed Albarrak
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Mohammed Alessa
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Saleh Aldhahri
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| | - Khalid Alqahtani
- From the Otolaryngology – Head and Neck Surgery Department (Alqaryan, Almousa, Alessa, Aldhahri, Alqahtani), King Saud University; from the Otolaryngology – Head and Neck Surgery Division, Department of Surgery (Alqaryan), King Abdulaziz Medical City, National Guard for Health Affairs; from the Otolaryngology - Head and Neck Surgery Department (Almayouf, Albarrak), King Fahad Medical City; from the Otolaryngology – Head and Neck Surgery Department (Doubi), King Saud Medical City; from the Otolaryngology – Head and Neck Surgery Department (Altuwaijri), Security Forces Hospital; from the College of Medicine (Alqahtani), Imam Mohammad Ibn Saud Islamic University, Riyadh; and from the Otolaryngology – Head and Neck Surgery Department (Almutairi), King Fahad Specialist Hospital, Buraidah, Kingdom of Saudi Arabia.
| |
Collapse
|
8
|
Yang Z, Wang X, Tao T, Zou J, Qiu Z, Wang L, Du H, Chen N, Yin X. Diagnostic value of contrast-enhanced ultrasonography in the preoperative evaluation of lymph node metastasis in papillary thyroid carcinoma: a single-center retrospective study. BMC Surg 2023; 23:325. [PMID: 37875825 PMCID: PMC10599078 DOI: 10.1186/s12893-023-02199-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) has been recently used for the assessment of cervical lymph node metastasis (LNM) to guide surgical operation in patients with papillary thyroid carcinoma (PTC). However, the specificity and sensitivity of CEUS reported from previous studies are not consistent. The objective of this study was to evaluate the diagnostic value of CEUS for the metastasis of cervical lymph nodes in PTC patients based on data from one regional central hospital. METHODS The diagnostic value of CEUS in preoperative LNM of PTC patients was concluded by comparing the results of CEUS on lymph node status with postoperative pathology examination. In addition, this study conducted hierarchical analysis of PTC patients to explore whether tumor size, different lymph node regions, and Hashimoto's thyroiditis influence the assessment of CEUS. RESULTS This research study ultimately enrolled 965 PTC patients, including 266 males and 699 females with a mean age of 42.27 ± 11.34 years. A total of 527 patients were considered clinical-node negative, and 438 were clinical-node positive before surgery. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS in the assessment of LNM in PTC patients were 56.00%, 71.00%, 57.06%, 69.76% and 62.59%, respectively. For central and lateral lymph nodes, the accuracy of CEUS in PTC patients was 49.43% and 54.30%, respectively. In addition, it was shown that the accuracy of CEUS in PTC patients with Hashimoto's thyroiditis (HT) slightly decreased to 58.44%, and the accuracy of CEUS in PTC patients with non-HT in turn increased to 64.17%. The accuracy of CEUS in non-papillary thyroid microcarcinoma (PTMC) and PTMC patients was 65.68% and 61.24%, respectively. The accuracy of CEUS in predicting central LNM was significantly different between PTC patients with or without HT (P < 0.001) in this study but not for lateral lymph nodes (P = 0.114). CONCLUSION The accuracy of CEUS in the assessment of LNM in PTC is not consistently satisfactory, especially for central lymph nodes, small tumor diameters, or patients with HT. More diagnostic technologies for abnormal lymph nodes should be considered in PTC patients.
Collapse
Affiliation(s)
- Zhixin Yang
- Department of Breast and Thyroid, Guiyang Maternal and Child Health Care Hospital & Guiyang Children's Hospital, Guiyang, China
| | - Xiaofeng Wang
- Department of Breast and Thyroid Surgery, Dongying People's Hospital, Dongying City, Shandong, China
| | - Tao Tao
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiali Zou
- Department of Breast and Thyroid, Guiyang Maternal and Child Health Care Hospital & Guiyang Children's Hospital, Guiyang, China
| | - Zhu Qiu
- Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Long Wang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huimin Du
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ni Chen
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xuedong Yin
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
9
|
Lou J, Yang J, Luo Y, Zhu Y, Xu Z, Hua T. Analysis of the influence factors of cervical lymph node metastasis in Papillary thyroid carcinoma: A retrospective observational study. Medicine (Baltimore) 2023; 102:e35045. [PMID: 37682190 PMCID: PMC10489384 DOI: 10.1097/md.0000000000035045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and surgery is crucial for curing PTC. PTC patients often experience lymph node metastasis (LNM) in the neck, and central lymph node metastasis (CLNM) significantly affects the recurrence rate of PTC. Therefore, the thoroughness of the surgery is particularly important for the treatment of PTC. However, there is still controversy regarding the choice of surgical approach. This study retrospectively analyzed the clinical data of 69 PTC patients treated at our hospital from December 2019 to April 2022 and clinically analyzed the high-risk factors for neck LNM. In this study, the patients aged ≤ 55 years were examined in which the number of patients with CLNM were 42 cases (80.77%), tumor diameter >2 cm were 15 cases (100%), the multifocal carcinoma were 38 cases (88.37%) and the involvement of membrane were 38 cases (80.85%), the number of patients whose had lateral cervical lymph node metastasis (LLNM), respectively 43 cases (82.69%), 14 cases (93.33%), 39 cases (90.7%) and 40 cases (85.11%),all of these factors were associated with cervical LNM (P < .05), but was not correlation with sex, double lobe carcinoma, extra glandular invasion and hashimoto (P > .05). The patient's age and number of cancers were independent risk factors for LNM in the central region of the neck (P < .05), while the patient's age, tumor size and number of cancers were significant risk factors for LNM in the lateral cervical region (P < .05). We concluded that cervical LNM was related with the high-risk factors of patient's age, tumor size, multifocal carcinoma in PTC. Especially, modified radical cervical dissection or selective cervical dissection was suggested in the PTC patients who were younger than 42.5 years old, with tumor diameter larger than 2 cm and multifocal carcinoma.
Collapse
Affiliation(s)
- Jinfeng Lou
- Department of Anesthesiology, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, P.R. China
| | - Jiahui Yang
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, P.R. China
| | - Yong Luo
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, P.R. China
| | - Ye Zhu
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, P.R. China
| | - Zheng Xu
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, P.R. China
| | - Tebo Hua
- Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, P.R. China
| |
Collapse
|
10
|
de Jong MC, Mahipal M, Ngiam KY, Tan WB, Yang SP, Parameswaran R. The impact of lymph node ratio on disease recurrence in papillary thyroid microcarcinoma. Ann R Coll Surg Engl 2023; 105:632-638. [PMID: 37652084 PMCID: PMC10471441 DOI: 10.1308/rcsann.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Lymph node (LN) metastases in papillary thyroid microcarcinomas (microPTCs) are common. The lymph node ratio (LNR) has been proposed as a risk factor for recurrence in papillary thyroid cancer. However, its relevance in microPTC is undetermined. METHODS Patients who underwent resection of their microPTC with concomitant LN clearance between 2005 and 2018 were identified. The LNR was calculated as the ratio of positive LNs to the total number of LNs. RESULTS Data on 50 patients (36 female [72%]; median age 47 years [range: 19-84]) who underwent LN clearance (28 central [56%] vs 22 central + lateral [44%]) were analysed. Positive LNs were found in over two-thirds of the patients (n = 34; 68%). After a median follow-up of 61 months, 14 patients (28%) had developed recurrence. Positive LNs were not found to impact recurrence-free survival; extranodal extension and an LNR ≥ 0.26 were found to significantly increase the risk of recurrence on unadjusted analyses (p < 0.05). CONCLUSIONS LN metastases are frequent among patients with microPTC. A higher LNR seems to be associated with recurrence. Additional studies are needed to further clarify these findings and to assess the possible role of LNR in treatment and surveillance.
Collapse
Affiliation(s)
| | - M Mahipal
- National University Hospital, Singapore
| | - KY Ngiam
- National University Hospital, Singapore
| | - WB Tan
- National University Hospital, Singapore
| | | | | |
Collapse
|
11
|
Wang R, Tang Z, Wu Z, Xiao Y, Li J, Zhu J, Zhang X, Ming J. Construction and validation of nomograms to reduce completion thyroidectomy by predicting lymph node metastasis in low-risk papillary thyroid carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1395-1404. [PMID: 37061404 DOI: 10.1016/j.ejso.2023.03.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 04/17/2023]
Abstract
CONTEXT More than 5 central lymph nodes metastases (CLNM) or lateral lymph node metastasis (LLNM) indicates a higher risk of recurrence in low-risk papillary thyroid carcinoma (PTC) and may lead to completion thyroidectomy (CTx) in patients initially undergoing lobectomy. OBJECTIVE To screen potentially high-risk patients from low-risk patients by using preoperative and intraoperative clinicopathological features to predict lymph node status. METHODS A retrospective analysis of 8301 PTC patients in Wuhan Union Hospital database (2009-2021) was performed according to the 2015 American Thyroid Association (ATA) and 2021 National Comprehensive Cancer Network (NCCN) guidelines, respectively. Logistic regression and best subsets regression were used to identify risk factors. Nomograms were established and externally validated using the Differentiated Thyroid Cancer in China cohort. RESULTS More than 5 CLNM or LLNM was detected in 1648 (19.9%) patients. Two predictive models containing age, gender, maximum tumor size, free thyroxine (FT4) and palpable node (all p < 0.05) were established. The nomogram based on NCCN criteria showed better discriminative power and consistency with a specificity of 0.706 and a sensitivity of 0.725, and external validation indicated that 76% of potentially high-risk patients could achieve preoperative conversion of surgical strategy. CONCLUSIONS Models based on large cohorts with good predictive performance were constructed and validated. Preoperative low-risk (T1-2N0M0) patients with age younger than 40 years, male gender, large tumor size, low FT4 and palpable nodes may be at high risk of LLNM or more than 5 CLNM, and they should receive more aggressive initial therapy to reduce CTx.
Collapse
Affiliation(s)
- Rong Wang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zimei Tang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhenghao Wu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yunxiao Xiao
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiexiao Li
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Junling Zhu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ximeng Zhang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jie Ming
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| |
Collapse
|
12
|
Xiao F, Li JM, Han ZY, Liu FY, Yu J, Xie MX, Zhou P, Liang L, Zhou GM, Che Y, Wang SR, Liu C, Cong ZB, Liang P. Multimodality US versus Thyroid Imaging Reporting and Data System Criteria in Recommending Fine-Needle Aspiration of Thyroid Nodules. Radiology 2023; 307:e221408. [PMID: 37367448 DOI: 10.1148/radiol.221408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background Current guidelines recommend the use of conventional US for risk stratification and management of thyroid nodules. However, fine-needle aspiration (FNA) is often recommended in benign nodules. Purpose To compare the diagnostic performance of multimodality US (including conventional US, strain elastography, and contrast-enhanced US [CEUS]) with the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in the recommendation of FNA for thyroid nodules to reduce unnecessary biopsies. Materials and Methods In this prospective study, 445 consecutive participants with thyroid nodules from nine tertiary referral hospitals were recruited between October 2020 and May 2021. With univariable and multivariable logistic regression, the prediction models incorporating sonographic features, evaluated with interobserver agreement, were constructed and internally validated with bootstrap resampling technique. In addition, discrimination, calibration, and decision curve analysis were performed. Results A total of 434 thyroid nodules confirmed at pathologic analysis (259 malignant thyroid nodules) in 434 participants (mean age, 45 years ± 12 [SD]; 307 female participants) were included. Four multivariable models incorporated participant age, nodule features at US (proportion of cystic components, echogenicity, margin, shape, punctate echogenic foci), elastography features (stiffness), and CEUS features (blood volume). In recommending FNA in thyroid nodules, the highest area under the receiver operating characteristic curve (AUC) was 0.85 (95% CI: 0.81, 0.89) for the multimodality US model, and the lowest AUC was 0.63 (95% CI: 0.59, 0.68) for TI-RADS (P < .001). At the 50% risk threshold, 31% (95% CI: 26, 38) of FNA procedures could be avoided with multimodality US compared with 15% (95% CI: 12, 19) with TI-RADS (P < .001). Conclusion Multimodality US had better performance in recommending FNA to avoid unnecessary biopsies than the TI-RADS. Clinical trial registration no. NCT04574258 © RSNA, 2023 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Fan Xiao
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Jian-Ming Li
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Zhi-Yu Han
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Fang-Yi Liu
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Jie Yu
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Ming-Xing Xie
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Ping Zhou
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Lei Liang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Gui-Ming Zhou
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Ying Che
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Shu-Rong Wang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Cun Liu
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Zhi-Bin Cong
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| | - Ping Liang
- From the Department of Interventional Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China (F.X., J.M.L., Z.Y.H., F.Y.L., J.Y., P.L.); Department of Cadet Corps, Chinese PLA Medical School, Beijing, China (F.X.); Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (M.X.X.); Department of Ultrasound, Third Xiangya Hospital, Central South University, Hunan, China (P.Z.); Department of Ultrasound, Aero-space Center Hospital, Beijing, China (L.L.); Department of Ultrasound, Tianjin Medical University General Hospital, Tianjin, China (G.M.Z.); Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China (Y.C.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China (S.R.W.); Department of Ultrasound, Jinan Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China (C.L.); and Department of Ultrasound, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China (Z.B.C.)
| |
Collapse
|
13
|
Xie X, Deng J, Zheng B, Zhong L, Miao J. The effect of central lymph node dissection on the prognosis of cN0 papillary thyroid microcarcinoma: a mid-term follow-up study. BMC Endocr Disord 2023; 23:125. [PMID: 37248461 DOI: 10.1186/s12902-023-01375-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND To investigate the effect of central lymph node dissection on the prognosis of patients with papillary thyroid microcarcinoma (PTMC) without clinical lymph node metastasis (cN0). METHODS According to the inclusion and exclusion criteria, 462 patients with cN0 PTMC underwent surgery in the Second Department of General Surgery, Zhongshan City People's Hospital from January 1, 2007, to June 31, 2017. They were divided into two groups: the undissection group (262 cases) and the dissection group (170 cases). A comparison was made between the two groups in terms of postoperative complications, recurrences, metastases, etc., as well aslymph node metastasis risk factors in the central region of cN0 PTMC. RESULTS There was no lymphatic leakage or death in all patients after the operation. In the dissection group, 64 cases (37.6%) of central lymph node metastasis were found after the postoperative pathological examination. The undissection group was followed up for (92 ± 28.7) months, and the dissection group was followed up for (86 ± 25.4) months (t=-2.165, P = 0.031). In the two groups, there were no lung metastases, bone metastases, or other distant metastases during the follow-up period. In the undissection group, there were 7 cases, while in the dissection group, there were just 2. Recurrence rates between the two groups did not differ significantly (χ2 = 0.126, P = 0.169); Similarly, disease-free survival curves did not differ significantly (χ2 = 2.565, P = 0.708). Hypoparathyroidism and Hypocalcemia also had no difference between the group. In comparison to the undissection group, the capsular invasion rate (P = 0.026), calcification rate(P < 0.001) incidence of postoperative hoarseness (P = 0.017), and hand and foot numbness rate (P < 0.001) were all considerably greater in the dissection group. Multivariate research revealed that capsular invasion (OR = 9.42, P = 0.002), multifocal (OR = 24.57, P < 0.001), and tumor diameter > 5 mm (OR = 5.46, P = 0.019) were the independent risk factors for central lymph node metastasis in cN0 PTMC. CONCLUSIONS Thyroidectomy alone is safe for cN0 PTMC, but longer-term follow-up is still required for changes in central lymph nodes. For cN0 PTMC patients with tumor diameter > 5 mm, multifocal, and capsular invasion, central lymph node metastasis is more likely to occur. Comprehensive evaluation and individualized and precise treatment are essential.
Collapse
Affiliation(s)
- Xiaozhang Xie
- The Second Department of General Surgery, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Zhongshan, Guangdong528403, China
| | - Jianwei Deng
- The Second Department of General Surgery, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Zhongshan, Guangdong528403, China
| | - Bingxing Zheng
- The Second Department of General Surgery, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Zhongshan, Guangdong528403, China
| | - Linkun Zhong
- The Second Department of General Surgery, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Zhongshan, Guangdong528403, China
| | - Jianhang Miao
- The Second Department of General Surgery, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Zhongshan, Guangdong528403, China.
| |
Collapse
|
14
|
Li WH, Yu WY, Du JR, Teng DK, Lin YQ, Sui GQ, Wang H. Nomogram prediction for cervical lymph node metastasis in multifocal papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2023; 14:1140360. [PMID: 37305060 PMCID: PMC10254395 DOI: 10.3389/fendo.2023.1140360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Aim Accurate preoperative prediction of cervical lymph node metastasis (LNM) in patients with mPTMC provides a basis for surgical decision making and the extent of tumor resection. This study aimed to develop and validate an ultrasound radiomics nomogram for the preoperative assessment of LN status. Methods A total of 450 patients pathologically diagnosed with mPTMC were enrolled, including 348 patients in the modeling group and 102 patients in the validation group. Univariate and multivariate logistic regression analyses were performed on the basic information, ultrasound characteristics, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) scores of the patients in the modeling group to identify independent risk factors for LNM in mPTMC and to construct a logistic regression equation and nomogram to predict the risk of LNM. The validation group data were used to evaluate the predictive performance of the nomogram. Results Male sex, age <40 years, a single lesion with a maximum diameter >0.5 cm, capsular invasion, a maximum ACR score >9 points, and a total ACR score >19 points were independent risk factors for the development of cervical LNM in mPTMC. Both the area under the curve (AUC) and concordance index (C-index) of the prediction model constructed from the above six factors were 0.838. The calibration curve of the nomogram was close to the ideal diagonal line. Furthermore, decision curve analysis (DCA) demonstrated a significantly greater net benefit of the model. The external validation demonstrated the reliability of the prediction nomogram. Conclusions The presented radiomics nomogram, which is based on ACR TI-RADS scores, shows favorable predictive value for the preoperative assessment of LNs in patients with mPTMC. These findings may provide a basis for surgical decision making and the extent of tumor resection.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Hui Wang
- *Correspondence: Guo-Qing Sui, ; Hui Wang,
| |
Collapse
|
15
|
Lai Y, Gu Y, Yu M, Deng J. Younger Than 55 Years Old and BRAF V600E Mutation are Risk Factors for Lymph Node Metastasis in Papillary Thyroid Carcinomas ≤1.0 cm but Not in >1.0 cm. Int J Gen Med 2023; 16:1403-1414. [PMID: 37155469 PMCID: PMC10122992 DOI: 10.2147/ijgm.s408588] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/13/2023] [Indexed: 05/10/2023] Open
Abstract
Background Studies on the relationship between BRAF V600E mutation and the clinicopathologic features of papillary thyroid carcinoma (PTC), risk of lymph node metastasis in papillary thyroid microcarcinoma (PTMC) have shown inconsistent results. Methods In this retrospective analysis, clinicopathological data of the patients were collected, and molecular testing was done for BRAF V600E mutation. PTC patients are divided into PTC≤1.0cm (PTMC) and PTC>1.0cm, and the relationship between BRAF V600E mutation and clinicopathologic features was analyzed respectively. Results Of the 520 PTC patients, 432 (83.1%) were female and 416 (80.0%) were <55 years old. BRAF V600E mutation was detected in 422 (81.2%) tumour samples of PTC. There was no significant difference in the frequency of BRAF V600E mutation between different age groups. There were 250 (48.1%) patients with PTMC and 270 (51.9%) patients with PTC>1.0cm. BRAF V600E mutation was significantly associated with bilateral cancer (23.0% vs 4.9%, P=0.005) and lymph node metastasis (61.7% vs 39.0%, P=0.009) in PTMC patients, while BRAF V600E mutation was significantly associated with bilateral cancer (24.9% vs 12.3%, P=0.048) in PTC>1.0cm patients. Logistic regression analysis showed that, after adjusting for gender, Hashimoto's thyroiditis and calcification, we found that younger age (<55 years old) (OR: 2.384, 95% CI: 1.241-4.579, P=0.009) and BRAF V600E mutation (OR: 2.213, 95% CI: 1.085-4.512, P=0.029) were significantly associated with lymph node metastasis in PTMC, similar results were not obtained in PTC>1.0cm. Conclusion Younger age (<55 years old) and BRAF V600E mutation was independent risk factor for lymph node metastasis in PTMC.
Collapse
Affiliation(s)
- Yeqian Lai
- Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
- Correspondence: Yeqian Lai, Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, 63 Huangtang Road, Meijiang District, Meizhou, People’s Republic of China, Email
| | - Yihua Gu
- Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Ming Yu
- Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| | - Jiaqin Deng
- Department of Thyroid Surgery, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People’s Hospital, Meizhou Academy of Medical Sciences, Meizhou, People’s Republic of China
| |
Collapse
|
16
|
Huang Y, Huang Z, Cai H, Zhuge L, Wang S, Yan D, Zhang X, An C, Niu L, Li Z. Evaluation of serum B7-H3 expression, ultrasound and clinical characteristics to predict the risk of cervical lymph node metastases in papillary thyroid carcinoma by nomogram. J Clin Lab Anal 2022; 37:e24811. [PMID: 36525343 PMCID: PMC9833969 DOI: 10.1002/jcla.24811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Improving the preoperative diagnosis of cervical lymph node metastasis (LNM) will help improve the clinical outcomes of papillary thyroid carcinoma (PTC) patients. B7-H3, as an immune checkpoint of the B7 family, is highly expressed in PTC tissues and related to LNM and prognosis. We aimed to explore the clinical values of serum B7-H3 (sB7-H3) in predicting LNM in PTC by a nomogram prediction model. METHODS From September 2019 to May 2021, a total of 344 PTC patients with primary surgery in our hospital were enrolled in this research. Enzyme-linked Immunosorbent Assay (ELISA) was used to detect sB7-H3 from the peripheral blood of PTC patients and normal controls. We created a nomogram prediction model in combination with sB7-H3 expression, clinical and ultrasound characteristics to predict LNM in the early stage. RESULTS Gender (p = 0.001), age (p = 0.015), tumor size (p < 0.001), number of tumors (p = 0.021) and sB7-H3 expression (p = 0.003) were independent risk factors for LNM in PTC. All the factors were included in the nomogram. The area under the curve (AUC) was 73.9% (95% CI, 68.12%-79.69%). CONCLUSION The nomogram is helpful in assessing the risk of LNM in PTC. sB7-H3 has excellent potential in predicting LNM in patients with PTC as an adjunctive ultrasound tool.
Collapse
Affiliation(s)
- Yingcheng Huang
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zehao Huang
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Huizhu Cai
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lingdun Zhuge
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shixu Wang
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Dangui Yan
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiwei Zhang
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Changming An
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lijuan Niu
- Department of UltrasoundNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhengjiang Li
- Department of Head and Neck SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| |
Collapse
|
17
|
Zhou X, Zhang M, Jin L, Tang X, Hu Q, Cheng G, Xiao Y. Quantitative analysis of contrast-enhanced ultrasound combined with ultrasound in the unifocal papillary thyroid micro-carcinoma. Med Eng Phys 2022; 110:103840. [PMID: 35811229 DOI: 10.1016/j.medengphy.2022.103840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate diagnostic value of ultrasound (US) combined with contrast-enhanced ultrasound (CEUS) in the invasiveness of unifocal papillary thyroid micro-carcinoma (UPTMC) without capsule-invasion. METHODS This retrospective study included data from patients with UPTMC who received US and CEUS examinations in the Ultrasound Department of the Central Hospital of Changsha, China between June 2019 and September 2021. Univariate and multivariate logistic regression analysis were used to evaluate the risk of US and CEUS parameters for UPTMC. Diagnostic performance was estimated by ROC analysis. RESULTS A total of 136 cases were enrolled, including invasive UPTMC (n = 47) and non-invasive UPTMC (n = 89), which were divided into test set (n = 109) and validation set (n = 27). The occurrence of microcalcification and the ratios (R) of each time-intensity curve (TIC) of CEUS parameter were significantly higher in patients with invasive UTPMC than non-invasive UPTMC (all P < 0.05). Additionally, nodular diameter was significantly longer in the invasive group (P < 0.05). Multivariate analysis showed that microcalcification (OR = 2.917, 95% CI: 1.002-8.491, P = 0.050), R-TTP > 1 (OR = 3.376, 95%CI: 1.267-8.994, P = 0.015), R-DS > 1 (OR = 6.558, 95% CI: 2.358-18.243, P < 0.010) were independently associated with invasive UPTMC. The sensitivities of US, CEUS and their combined application were 82.1%, 46.2% and 79.5%, respectively, and their specificities were 37.1%, 88.6% and 61.4%, respectively. The combination of the two methods had the best diagnostic efficiency (AUC=0.775)compared to US (AUC = 0.596) and CEUS (AUC = 0.750). CONCLUSION The combination of US and CEUS might have good diagnostic value for UPTMC with capsule non-invasion.
Collapse
Affiliation(s)
- Xiaohui Zhou
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Min Zhang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Linyuan Jin
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Xianpeng Tang
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Qiang Hu
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Guanghui Cheng
- Department of Breast and Thyroid Surgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161, Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China
| | - Yaocheng Xiao
- Department of Ultrasound Diagnostics, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, 161 Shaoshan South Road, Yuhua District, Changsha, Hunan, 410004, P.R. China.
| |
Collapse
|
18
|
Zhan L, Feng HF, Yu XZ, Li LR, Song JL, Tu Y, Yuan JP, Chen C, Sun SR. Clinical and prognosis value of the number of metastatic lymph nodes in patients with papillary thyroid carcinoma. BMC Surg 2022; 22:235. [PMID: 35725426 PMCID: PMC9210823 DOI: 10.1186/s12893-022-01635-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Objective It has been reported that papillary thyroid carcinoma (PTC) patients with lymph node metastasis (LNM) are largely associated with adverse outcomes. The present study aimed to assess the correlation between the number of metastatic lymph nodes (NMLNs) and clinical prognosis in patients with PTC. Methods We retrospectively reviewed the medical records of patients with PTC who underwent initial thyroid cancer surgery in Renmin Hospital of Wuhan University between 2017 and 2019. A total of 694 patients with PTC and cervical lymph node dissection as well as a total checked number of lymph nodes ≥ 5 were involved in this study. The clinicopathological characteristics of patients were compared according to NMLNs, the number of central cervical lymph nodes (CLNs) and the number of lateral lymph nodes (LLNs). Results NMLNs > 5, CLNs > 5 and LLNs > 5 were 222 (32.0%), 159 (24.3%) and 70 (10.1%) seen in the analyzed samples, respectively. Young patients, patients with larger tumor diameter, bilaterality, multifocality and gross extrathyroidal extension (ETE) were more inclined to NMLNs > 5, CLNs > 5 and LLNs > 5 (P < 0.05). It was found that the recurrence-free survival among pN1 patients was significantly discrepant between different groups (NMLNs ≤ 5/5: P = 0.001; LLNs ≤ 5/5: P < 0.001). In multivariate logistic regression analysis, patients aged < 55 years (OR = 1.917), primary tumor size > 10 mm (OR = 2.131), bilaterality (OR = 1.889) and tumor gross ETE (OR = 2.759) were independent predictors for high prevalence of total NMLNs > 5 (P < 0.05). Specially, patients aged < 55 years (OR = 2.864), primary tumor size > 10 mm (OR = 2.006), and tumor gross ETE (OR = 2.520) were independent predictors for high prevalence of CLNs > 5 (P < 0.01); Bilaterality (OR = 2.119), CLNs > 5 (OR = 6.733) and tumor gross ETE (OR = 4.737) were independent predictors for high prevalence of LLNs > 5 (P < 0.05). Conclusions In conclusion, it is evident that NMLNs is related to the invasive clinicopathological features and adverse outcome of patients with PTC which should be correctly evaluated to provide an appropriate guidance for reasonable treatment and careful follow-up.
Collapse
Affiliation(s)
- Ling Zhan
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 17th Tiyu Street, Wuhan, Hubei, 430060, The People's Republic of China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, The People's Republic of China
| | - Hong-Fang Feng
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 17th Tiyu Street, Wuhan, Hubei, 430060, The People's Republic of China.,Department of Breast Surgery, Thyroid Surgery, Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, 435000, Hubei, The People's Republic of China
| | - Xi-Zi Yu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 17th Tiyu Street, Wuhan, Hubei, 430060, The People's Republic of China
| | - Ling-Rui Li
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 17th Tiyu Street, Wuhan, Hubei, 430060, The People's Republic of China
| | - Jun-Long Song
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 17th Tiyu Street, Wuhan, Hubei, 430060, The People's Republic of China
| | - Yi Tu
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 17th Tiyu Street, Wuhan, Hubei, 430060, The People's Republic of China
| | - Jing-Ping Yuan
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, The People's Republic of China
| | - Chuang Chen
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 17th Tiyu Street, Wuhan, Hubei, 430060, The People's Republic of China
| | - Sheng-Rong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, 17th Tiyu Street, Wuhan, Hubei, 430060, The People's Republic of China.
| |
Collapse
|
19
|
Weng HY, Yan T, Qiu WW, Fan YB, Yang ZL. The Prognosis of Skip Metastasis in Papillary Thyroid Microcarcinoma Is Better Than That of Continuous Metastasis. J Clin Endocrinol Metab 2022; 107:1589-1598. [PMID: 35213704 DOI: 10.1210/clinem/dgac107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT A few papillary thyroid microcarcinomas (PTMCs) may have skip metastasis (SLNM), but the risk factors remain controversial and the prognosis is unclear. OBJECTIVES To investigate the incidence, lymph node metastasis (LNM) patterns, risk factors, and prognosis of SLNM in PTMCs. METHODS We reviewed the medical records of PTMC patients who underwent thyroid surgery in our institution. Analyses of risk factors were performed for SLNM. Recurrence-free survival (RFS) of SLNM, central lymph node metastasis (CLNM), and continuous metastasis (CLNM and lateral lymph node metastasis [CLNM + LLNM]) were compared after propensity score matching (PSM). RESULTS SLNM was detected in 1.7% (50/3923) and frequently involved level III (66.7%). Compared with CLNM + LLNM, SLNM had more LNM at a single level (P < 0.01) and less LNM at 2 levels (P < 0.05). A tumor size of 0.5 to 1 cm (odds ratio [OR], 2.26; 95% CI, 1.27-4.00) and location in the upper pole (OR, 3.30; 95% CI, 2.02-5.40) were independent risk factors for SLNM. A total of 910 (23.2%) PTMCs with LNM were included in the prognostic analysis. At a median follow-up of 60 months, the RFS of SLNM did not differ from that of CLNM (P = 0.10) but was significantly higher than that of CLNM + LLNM (P < 0.01) after using PSM. CONCLUSIONS When the tumor size is 0.5 to 1 cm or its location is in the upper pole, we must remain vigilant to SLNM in PTMC. Because its prognosis is comparable to that of only CLNM and better than that of CLNM + LLNM, less intensive treatment should be considered.
Collapse
Affiliation(s)
- Huai-Yu Weng
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ting Yan
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wang-Wang Qiu
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - You-Ben Fan
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zhi-Li Yang
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| |
Collapse
|
20
|
Aldahmani K, Malik A, Aziz F, Beshyah S. Characteristics and management of papillary thyroid microcarcinoma in the United Arab Emirates: Experience from a large tertiary hospital. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:42-48. [PMID: 35283703 PMCID: PMC8869268 DOI: 10.4103/sjmms.sjmms_393_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/26/2021] [Accepted: 12/27/2021] [Indexed: 11/04/2022] Open
|
21
|
Zhao L, Zhou T, Zhang W, Wu F, Jiang K, Lin B, Zhan S, Hu T, Tang T, Zhang Y, Luo D. Blood immune indexes can predict lateral lymph node metastasis of thyroid papillary carcinoma. Front Endocrinol (Lausanne) 2022; 13:995630. [PMID: 36147564 PMCID: PMC9487154 DOI: 10.3389/fendo.2022.995630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore the clinical significance of blood immune indexes in predicting lateral lymph node metastasis (LLNM) of thyroid papillary carcinoma (PTC). METHODS The pathological data and preoperative blood samples of 713 patients that underwent thyroid surgery at affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine from January 2013 to June 2021 were collected as the model group. The pathological data and preoperative blood samples of 177 patients that underwent thyroid surgery in the same hospital from July 2021 to October 2021 were collected as the external validation group. Univariate and multivariate logistic regression analyses were used to determine the independent risk factors of LLNM in PTC patients. A predictive model for assessing LLNM in PTC patients was established and externally validated using the external data. RESULTS According to univariate and multivariate logistic regression analyses, tumor diameter (P < 0.001, odds ratios (OR): 1.205, 95% confidence interval (CI): 1.162-1.249) and the preoperative systemic immune-inflammation index (SII) (P = 0.032, OR: 1.001, 95% CI: 1.000-1.002) were independent risk factors for distinguishing LLNM in PTC patients. When the Youden index was the highest, the area under the curve (AUC) was 0.860 (P < 0.001, 95% CI: 0.821-0.898). The externally validated AUC was 0.827 (P < 0.001, 95% CI: 0.724-0.929), the specificity was 86.4%, and the sensitivity was 69.6%. The calibration curve and the decision curve indicated that the model had good diagnostic value. CONCLUSION Blood immune indexes can reflect the occurrence of LLNM and the biological behavior of PTC. The predictive model established in combination with SII and tumor diameter can effectively predict the occurrence of LLNM in PTC patients.
Collapse
Affiliation(s)
- Lingqian Zhao
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Tianhan Zhou
- Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, The Department of General Surgery, Hangzhou, China
| | - Wenhao Zhang
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Fan Wu
- Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Department of Oncological Surgery, Hangzhou, China
| | - Kecheng Jiang
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Bei Lin
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Siqi Zhan
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Tao Hu
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Tian Tang
- Zhejiang Chinese Medical University, Fourth Clinical Medical College, Hangzhou, China
| | - Yu Zhang
- Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Department of Oncological Surgery, Hangzhou, China
| | - Dingcun Luo
- Affiliated Hangzhou First People’s Hospital Zhejiang University School of Medicine, Department of Oncological Surgery, Hangzhou, China
- *Correspondence: Dingcun Luo,
| |
Collapse
|
22
|
Wu X, Yu P, Jia C, Mao N, Che K, Li G, Zhang H, Mou Y, Song X. Radiomics Analysis of Computed Tomography for Prediction of Thyroid Capsule Invasion in Papillary Thyroid Carcinoma: A Multi-Classifier and Two-Center Study. Front Endocrinol (Lausanne) 2022; 13:849065. [PMID: 35692398 PMCID: PMC9174423 DOI: 10.3389/fendo.2022.849065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the application of computed tomography (CT)-based radiomics model for prediction of thyroid capsule invasion (TCI) in papillary thyroid carcinoma (PTC). METHODS This retrospective study recruited 412 consecutive PTC patients from two independent institutions and randomly assigned to training (n=265), internal test (n=114) and external test (n=33) cohorts. Radiomics features were extracted from non-contrast (NC) and artery phase (AP) CT scans. We also calculated delta radiomics features, which are defined as the absolute differences between the extracted radiomics features. One-way analysis of variance and least absolute shrinkage and selection operator were used to select optimal radiomics features. Then, six supervised machine learning radiomics models (k-nearest neighbor, logistic regression, decision tree, linear support vector machine [L-SVM], Gaussian-SVM, and polynomial-SVM) were constructed. Univariate was used to select clinicoradiological risk factors. Combined models including optimal radiomics features and clinicoradiological risk factors were constructed by these six classifiers. The prediction performance was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS In the internal test cohort, the best combined model (L-SVM, AUC=0.820 [95% CI 0.758-0.888]) performed better than the best radiomics model (L-SVM, AUC = 0.733 [95% CI 0.654-0.812]) and the clinical model (AUC = 0.709 [95% CI 0.649-0.783]). Combined-L-SVM model combines 23 radiomics features and 1 clinicoradiological risk factor (CT-reported TCI). In the external test cohort, the AUC was 0.776 (0.625-0.904) in the combined-L-SVM model, showing that the model is stable. DCA demonstrated that the combined model was clinically useful. CONCLUSIONS Our combined model based on machine learning incorporated with CT radiomics features and the clinicoradiological risk factor shows good predictive ability for TCI in PTC.
Collapse
Affiliation(s)
- Xinxin Wu
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Pengyi Yu
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Chuanliang Jia
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Kaili Che
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Guan Li
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Haicheng Zhang
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yakui Mou
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- *Correspondence: Xicheng Song, ; Yakui Mou,
| | - Xicheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- *Correspondence: Xicheng Song, ; Yakui Mou,
| |
Collapse
|
23
|
Jiang KC, Lin B, Zhang Y, Zhao LQ, Luo DC. Total tumor diameter is a better indicator of multifocal papillary thyroid microcarcinoma: A propensity score matching analysis. Front Endocrinol (Lausanne) 2022; 13:974755. [PMID: 36004348 PMCID: PMC9393720 DOI: 10.3389/fendo.2022.974755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Accurate evaluation of the risk of papillary thyroid microcarcinoma (PTMC) is the key to treatment. However, the maximum diameter (MD), which is currently used in various staging systems, may not truly reflect the aggressiveness of multifocal tumors. METHODS Clinical and pathological data for 1001 patients with papillary thyroid carcinoma who underwent surgery at the Hangzhou First People's Hospital were retrospectively analyzed. First, the relationship between total tumor diameter (TTD) and clinicopathological features in multifocal PTMC was explored. Then, patients were divided into subgroups according to the TTD. The baseline was consistent after using the propensity score matching method, and the differences between groups were compared. In addition, the effectiveness of TTD and MD in evaluating central lymph node metastasis (CLNM) was analyzed and compared. RESULTS TTD is associated with a range of clinicopathological features, including lymph node metastasis, extrathyroidal extension, and risk stratification. Assuming the same MD and number of foci, the invasiveness of multifocal PTMC with TTD >1 cm was significantly higher than that with TTD <1 cm, and even higher than unifocal non-PTMC. Moreover, the efficiency of TTD in predicting CLNM was also significantly higher than that of MD. CONCLUSION For multifocal PTMC, TTD is a more realistic indicator of tumor biological characteristics than MD. The aggressiveness of PTMC with TTD >1 cm was significantly enhanced, and surgical treatment should be actively sought in such cases.
Collapse
Affiliation(s)
- Ke-cheng Jiang
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bei Lin
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yu Zhang
- Department of Surgical Oncology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ling-qian Zhao
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ding-cun Luo
- Department of Surgical Oncology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Ding-cun Luo,
| |
Collapse
|
24
|
Lin P, Liang F, Ruan J, Han P, Liao J, Chen R, Luo B, Ouyang N, Huang X. A Preoperative Nomogram for the Prediction of High-Volume Central Lymph Node Metastasis in Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:753678. [PMID: 35002954 PMCID: PMC8729159 DOI: 10.3389/fendo.2021.753678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/26/2021] [Indexed: 12/07/2022] Open
Abstract
Background High-volume lymph node metastasis (HVLNM, equal to or more than 5 lymph nodes) is one of the adverse features indicating high recurrence risk in papillary thyroid carcinoma (PTC) and is recommended as one of the indications of completion thyroidectomy for patients undergoing thyroid lobectomy at first. In this study, we aim to develop a preoperative nomogram for the prediction of HVLNMs in the central compartment in PTC (cT1-2N0M0), where preoperative imaging techniques perform poor. Methods From October 2016 to April 2021, 423 patients were included, who were diagnosed as PTC (cT1-2N0M0) and underwent total thyroidectomy and prophylactic central compartment neck dissection in our center. Demographic and clinicopathological features were recorded and analyzed using univariate and multivariate logistic regression analysis. A nomogram was developed based on multivariate logistic regression analysis. Results Among the included patients, 13.4% (57 cases) were found to have HVLNMs in the central compartment. Univariate and multivariate logistic regression analysis showed that age (=35 years vs. >35 years), BRAF with V600E mutated, nodule diameter, and calcification independently predicted HVLNMs in the central compartment. The nomogram showed good discrimination with an AUC of 0.821 (95% CI, 0.768-0.875). Conclusion The preoperative nomogram can be used to quantify the probability of HVLNMs in the central compartment and may reduce the reoperation rate after thyroid lobectomy.
Collapse
Affiliation(s)
- Peiliang Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Faya Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingliang Ruan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Han
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianwei Liao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Renhui Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nengtai Ouyang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
25
|
Faro FN, Simões VRF, Ricardo GP, Cabral CP, de Cássia Braga Ribeiro K, Scalissi NM, Cury AN, Marone MM, do Prado Padovani R, Ferraz C. Prognostic factors for incomplete response in thyroid microcarcinoma: an analysis of initial response to therapy in 517 patients. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:579-587. [PMID: 33740337 PMCID: PMC10528575 DOI: 10.20945/2359-3997000000341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 01/10/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Although thyroid microcarcinoma (TMC) usually has a favorable prognosis, some patients present a higher risk of disease recurrence or persistence. Thus, we aimed at identifying possible risk factors associated with an incomplete response to therapy in TMC. METHODS This was a retrospective study of 517 patients with TMC treated with total thyroidectomy, with or without radioactive iodine (RAI) therapy, reclassified after 1.1 ± 0.4 years according to the response to treatment into "favourable" (excellent/indeterminate) or "unfavorable" (biochemical/structural incomplete) responses. We evaluated participants' age, sex, tumor size, histological variants, multifocality, presence of vascular/lymphatic/perineural invasion, extrathyroidal extension, metastatic lymph nodes (LN), and distant metastasis. The effect of RAI therapy on the response range was analyzed in a given subgroup. RESULTS The mean age observed was 46.4 ± 12.0 years, and 89.7% were female. We noted 97.5% with papillary carcinoma, 27.8% with multifocality and 11.2% with LN metastasis. Although the majority of patients had a low risk of recurrence/persistence (78%), 75% were submitted to RAI therapy. Incomplete response (20.7%) was associated with multifocality (p=0.041; OR=1.619) and metastatic LN (p=0.041; OR=1.868). These variables were strongly correlated (p=0.000; OR=3.283). No cut-off of tumor size was identified as a predictor of incomplete response by the receiver operating curve analysis. RAI treatment did not influence the response of patients with multifocality or LN metastasis. CONCLUSION Multifocality and LN metastasis are independent risk factors for incomplete response in TMC patients and are strongly correlated. Additional RAI therapy was not associated with a more favorable response in these subgroups.
Collapse
Affiliation(s)
- Fernanda Nascimento Faro
- Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Vivian Roberta Ferreira Simões
- Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Gustavo Piech Ricardo
- Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Cristal Peters Cabral
- Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | | | - Nilza Maria Scalissi
- Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Adriano Namo Cury
- Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Marília Martins Marone
- Serviço de Medicina Nuclear, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Rosália do Prado Padovani
- Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
- Serviço de Medicina Nuclear, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Carolina Ferraz
- Unidade de Doenças da Tireoide, Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil,
| |
Collapse
|
26
|
Dirikoc A, Tam AA, Ince N, Ozdemir D, Topaloglu O, Alkan A, Yazgan AK, Ersoy R, Cakir B. Papillary thyroid microcarcinomas that metastasize to lymph nodes. Am J Otolaryngol 2021; 42:103023. [PMID: 33838358 DOI: 10.1016/j.amjoto.2021.103023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/13/2021] [Accepted: 03/28/2021] [Indexed: 02/09/2023]
Abstract
PURPOSE We aimed to determine clinicopathological features that can predict lymph node metastasis (LNM) in papillary thyroid microcarcinomas (PTMC). METHODS Medical records of 872 patients with papillary thyroid cancer >1 cm (PTC > 1 cm) and 1184 patients with papillary thyroid microcancer (PTMC) (≤1 cm) were reviewed retrospectively. Demographical, clinical and histopathological features of (PTC > 1 cm) and PTMC were compared. Association between clinicopathological features and LNM in PTMC was investigated. RESULTS The median age of patients with PTMC was significantly higher than patients with PTC > 1 cm (49 vs 46 years old, p < 0.001). Multifocality, capsular invasion, vascular invasion, extrathyroidal extension (ETE) and LNM were more frequent in patients with PTC > 1 cm compared to patients with PMTC (p < 0.001 for each). In PTMC group, those with LNM had significantly higher proportion of multifocality, capsular invasion, vascular invasion and ETE compared to those without LNM (p = 0.007, <0.001, p = 0.011 and p < 0.001, respectively). Multifocality and ETE were significant factors for LNM with logistic regression analysis. Multifocality increased the risk of LNM by 1.737 times (95% CI: 1.079-2.979) and ETE increased the risk by 3.528 times (95%: 1.914-6.503). Primary tumor diameter ≥ 5.75 mm was predictive for LNM with a sensitivity of 0.782 and a specificity of 0.517 in PTMC. CONCLUSIONS LNM should be investigated more carefully in patients with PTMC in the presence of tumor diameter ≥ 5.75 mm, multifocality or ETE.
Collapse
|
27
|
Park HM, Lee J, Kwak JY, Park VY, Rho M, Lee M, Yoon JH. Using ultrasonographic features to predict the outcomes of patients with small papillary thyroid carcinomas: a retrospective study implementing the 2015 ATA patterns and ACR TI-RADS categories. Ultrasonography 2021; 41:298-306. [PMID: 34674455 PMCID: PMC8942744 DOI: 10.14366/usg.21097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate whether risk stratification systems using ultrasonographic (US) features show associations with the outcomes of patients with small papillary thyroid carcinomas (PTCs). METHODS This retrospective study received institutional review board approval. From March 2007 to February 2010, 775 patients who underwent surgery for small PTCs (10-20 mm) were included. Based on preoperative US features, PTCs were categorized according to the 2015 American Thyroid Association (ATA) guideline and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). The associations of clinicopathological and US features with postoperative patient outcomes were evaluated. RESULTS In total, 61 patients had high-volume central lymph node metastasis (CLNM, 7.9%) and 100 patients had lateral lymph node metastasis (LLNM, 12.9%). In univariable analyses, a high number of suspicious US features and higher ACR TI-RADS point totals were significantly associated with both high-volume CLNM (P=0.001, each) and LLNM (P<0.001, each). In multivariable analyses of preoperative features, a higher number of suspicious US features and higher ACR TI-RADS point totals were independently associated with high-volume CLNM (odds ratio [OR], 1.516 and 1.201; P=0.002 and P=0.001, respectively) and LLNM (OR, 1.763 and 1.293; all P<0.001). Individual US features, ATA categories, and ACR TI-RADS point totals were not significantly associated with recurrence or distant metastasis. CONCLUSION The number of suspicious US features and the ACR TI-RADS point total are potential risk factors for cervical lymph node metastasis in patients with small PTCs.
Collapse
Affiliation(s)
- Hee Min Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jihye Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miribi Rho
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Minah Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Wu X, Li J, Mou Y, Yao Y, Cui J, Mao N, Song X. Radiomics Nomogram for Identifying Sub-1 cm Benign and Malignant Thyroid Lesions. Front Oncol 2021; 11:580886. [PMID: 34164333 PMCID: PMC8215667 DOI: 10.3389/fonc.2021.580886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 05/19/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To develop and validate a radiomics nomogram for identifying sub-1 cm benign and malignant thyroid lesions. METHOD A total of 171 eligible patients with sub-1 cm thyroid lesions (56 benign and 115 malignant) who were treated in Yantai Yuhuangding Hospital between January and September 2019 were retrospectively collected and randomly divided into training (n = 136) and validation sets (n = 35). The radiomics features were extracted from unenhanced and arterial contrast-enhanced computed tomography images of each patient. In the training set, one-way analysis of variance and least absolute shrinkage and selection operator (LASSO) logistic regression were used to select the features related to benign and malignant lesions, and the LASSO algorithm was used to construct the radiomics signature. Combined with clinical independent predictive factors, a radiomics nomogram was constructed with a multivariate logistic regression model. The performance of the radiomics nomogram was evaluated by using the receiver operating characteristic (ROC) and calibration curves in the training and validation sets. The clinical usefulness was evaluated by using decision curve analysis (DCA). RESULTS The radiomics signature consisting of 13 selected features achieved favorable prediction efficiency. The radiomics nomogram, which incorporated radiomics signature and clinical independent predictive factors including age and Thyroid Imaging Reporting and Data System category, showed good calibration and discrimination in the training (area under the ROC [AUC]: 0.853; 95% confidence interval [CI]: 0.797, 0.899) and validation sets (AUC: 0.851; 95% CI: 0.735, 0.931). DCA demonstrated that the nomogram was clinically useful. CONCLUSION As a noninvasive preoperative prediction tool, the radiomics nomogram incorporating radiomics signature and clinical predictive factors shows favorable predictive efficiency for identifying sub-1 cm benign and malignant thyroid lesions.
Collapse
Affiliation(s)
- Xinxin Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Jingjing Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- School of Clinical Medicine, Binzhou Medical University, Yantai, China
| | - Yakui Mou
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Yao Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Jingjing Cui
- Collaboration Department, Huiying Medical Technology Co., Ltd, Beijing, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xicheng Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| |
Collapse
|
29
|
Added Value of Postoperative Radioiodine Scan for Staging and Risk Stratification in Papillary Thyroid Microcarcinoma. J ASEAN Fed Endocr Soc 2021; 36:64-68. [PMID: 34177090 PMCID: PMC8214359 DOI: 10.15605/jafes.036.01.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
Objective The complete staging and risk stratification of Papillary thyroid microcarcinoma (PTMC) is usually not done due to its theoretically low recurrence rates. This study aimed to determine the value of postoperative radioiodine diagnostic scan and SPECT/CT for the accurate staging and risk stratification in PTMC patients. Methodology This study was a retrospective review of PTMC patients from January 2014 to May 2017 who underwent I-131 scans. All PTMC patients were initially staged by the 8th edition AJCC/TNM staging system and risk-stratified, based on clinical information, histopathology and stimulated thyroglobulin (sTg). After I-131 scan, staging and risk stratification were re-assessed. The proportion of patients who ended up with a higher stage and risk stratification were reported. Results and Conclusion Fifty-two patients were included. The overall upgrading of cancer stage was 7.7 %. The overall higher risk stratification was 19.2% with radioiodine-avid lymph node, lung, and bone metastases. Neck and paratracheal node metastases were found in 37.3% of the initial low-risk patients with sTg less than 5 ng/mL. Lung metastasis was found in the initial intermediate-risk patient. The I-131 scan helps to localize metastatic lesions and results in a higher stage in 50% of the initial high-risk patients. This study provides some evidence showing the value of postoperative radioiodine WBS for accurate staging and risk stratification in PTMC patients. Larger studies with analytical design should be further performed to prove its significant utility.
Collapse
|
30
|
Chen Y, Chen S, Lin X, Huang X, Yu X, Chen J. Clinical Analysis of Cervical Lymph Node Metastasis Risk Factors and the Feasibility of Prophylactic Central Lymph Node Dissection in Papillary Thyroid Carcinoma. Int J Endocrinol 2021; 2021:6635686. [PMID: 33603782 PMCID: PMC7868159 DOI: 10.1155/2021/6635686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/04/2021] [Accepted: 01/17/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To identify the risk factors for cervical lymph node metastasis (CLNM) and the feasibility of prophylactic central lymph node dissection. METHODS The characteristics of 1107 patients were extracted and analyzed. Univariate and multivariate analyses were used to identify risk factors associated with lymph node metastasis. The relationship between the central lymph node dissection (CLND) and lateral lymph node metastasis (LLNM) was analyzed using the correlation analysis. RESULTS The probability of CLNM was closely related to the male gender, age <55, and the increase of tumor size. Those patients with an increase in tumor size and CLNM were extremely prone to LLNM. Also, LLNM was more likely to happen in those with the more positive central lymph nodes. Routine prophylactic central lymph node dissection (P-CLND) did not increase the risk of complications. CONCLUSION P-CLND should be considered as a reasonable surgical treatment for PTC.
Collapse
Affiliation(s)
- Yifan Chen
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
| | - Shuo Chen
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
- Department of Gynaecology and Obstetrics, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
| | - Xiaoying Lin
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
| | - Xiangqing Huang
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
| | - Xiaofang Yu
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Department of Anesthesiology, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
| | - Juying Chen
- Department of General Surgery, South Branch of Fujian Provincial Hospital, Fuzhou 350000, Fujian, China
- Provincial Clinical Medical College of Fujian Medical University, Fuzhou 350000, Fujian, China
| |
Collapse
|
31
|
Sun J, Jiang Q, Wang X, Liu W, Wang X. Nomogram for Preoperative Estimation of Cervical Lymph Node Metastasis Risk in Papillary Thyroid Microcarcinoma. Front Endocrinol (Lausanne) 2021; 12:613974. [PMID: 33868164 PMCID: PMC8044509 DOI: 10.3389/fendo.2021.613974] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 03/03/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Accurate preoperative identification of cervical lymph node metastasis (CLNM) is essential for clinical management and established of different surgical protocol for patients with papillary thyroid microcarcinoma (PTMC). Herein, we aimed to develop an ultrasound (US) features and clinical characteristics-based nomogram for preoperative diagnosis of CLNM for PTMC. METHOD Our study included 552 patients who were pathologically diagnosed with PTMC between January 2015 and June 2019. All patients underwent total thyroidectomy or lobectomy and divided into two groups: CLNM and non-CLNM. Univariate and multivariate analysis were performed to examine risk factors associated with CLNM. A nomogram comprising the prognostic model to predict the CLNM was established, and internal validation in the cohort was performed. RESULTS CLNM and non-CLNM were observed in 216(39.1%) and 336(60.9%) cases, respectively. Seven variables of clinical and US features as potential predictors including male sex (odd ratio [OR] = 1.974, 95% confidence interval [CI], 1.243-2.774; P =0.004), age < 45 years (OR = 4.621, 95% CI, 2.160-9.347; P < 0.001), US-reported CLN status (OR = 1.894, 95% CI, 0.754-3.347; P =0.005), multifocality (OR = 1.793, 95% CI, 0.774-2.649; P =0.007), tumor size ≥ 0.6cm (OR = 1.731, 95% CI,0.793-3.852; P =0.018), ETE (OR = 3.772, 95% CI, 1.752-8.441;P< 0.001) and microcalcification (OR = 2.316, 95% CI, 1.099-4.964; P < 0.001) were taken into account. The predictive nomogram was established by involving all the factors above used for preoperative prediction of CLNM in patients with PTCM. The nomogram model showed an AUC of 0.839 and an accuracy of 77.9% in predicting CLNM. Furthermore, the calibration curve demonstrated a strong consistency between nomogram and clinical findings in prediction CLNM for PTMC. CONCLUSIONS The nomogram achieved promising results for predicting preoperative CLNM in PTMC by combining clinical and US risk factor. Our proposed prediction model is able to help determine an individual's risk of CLNM in PTMC, thus facilitate reasonable therapy decision making.
Collapse
Affiliation(s)
- Jinxiao Sun
- Department of Ultrasonography, Taihu Lake Cadre Sanatorium of Jiangsu Province, Wuxi, China
- Department of Ultrasonography, Affiliated Renmin Hospital, Jiangsu University, Zhenjiang, China
| | - Qi Jiang
- Department of Ultrasonography, Affiliated Renmin Hospital, Jiangsu University, Zhenjiang, China
- Department of Ultrasonography, Yunyang People’s Hospital of Danyang, Danyang, China
| | - Xian Wang
- Department of Ultrasonography, Affiliated Renmin Hospital, Jiangsu University, Zhenjiang, China
| | - Wenhua Liu
- Department of Ultrasonography, Affiliated Renmin Hospital, Jiangsu University, Zhenjiang, China
| | - Xin Wang
- Department of Ultrasonography, Taihu Lake Cadre Sanatorium of Jiangsu Province, Wuxi, China
- Department of Ultrasonography, Affiliated Renmin Hospital, Jiangsu University, Zhenjiang, China
- *Correspondence: Xin Wang,
| |
Collapse
|
32
|
Rui ZY, Liu Y, Zheng W, Wang X, Meng ZW, Tan J, Li N, Jia Q. A retrospective study of the risk factors and the prognosis in patients with papillary thyroid carcinoma depending on the number of lymph node metastasis. Clin Exp Med 2021; 21:277-286. [PMID: 33386568 DOI: 10.1007/s10238-020-00675-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023]
Abstract
To retrospectively analyze the risk factors and the prognosis according to the number of lymph node metastases (LNMs) in different neck compartments in papillary thyroid carcinoma (PTC) patients. In total, 962 patients with PTC were enrolled in this study. According to the methods of the 2015 American Thyroid Association, the treatment response of the patients was divided into a good prognosis and a poor prognosis. First, their clinical characteristics were summarized. Then, according to whether they had LNMs and the number of LNMs in different neck compartments, their risk factors and their prognosis were analyzed. Male sex, younger (< 45 years), extrathyroid extension (ETE), T1 staging and higher stimulated thyroglobulin (sTg) levels were the risk factors for LNM. The cutoff for a poor prognosis of the number of LNMs was > 4. Male sex, younger age, higher sTg levels and ETE were correlated with LNM > 4. Furthermore, the cutoffs for a poor prognosis of central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and CLNM + LLNM were > 6, > 1 and > 5, respectively. Younger age and ETE were strongly correlated with CLNM > 6. Male sex, younger age, higher sTg levels and ETE were correlated with LLNM > 1. Younger age, ETE and higher sTg levels were correlated with CLNM + LLNM > 5. Further analysis revealed a positive correlation between CLNM and LLNM. We should pay more attention to LNMs in PTC patients who are male, are of a younger age, have ETE, T1 staging and have higher sTg levels. The neck regional LNMs should be correctly evaluated to guide the surgical options for the neck LNMs in PTC. When the number of LNMs in different neck compartments has exceeded the cutoff value, they can be considered as predictors of the outcome of 131I treatment.
Collapse
Affiliation(s)
- Zhong Ying Rui
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Yang Liu
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China.
| | - Xuan Wang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Zhao Wei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Ning Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, 154 Anshan Road, He ping, Tianjin, 300052, People's Republic of China
| |
Collapse
|
33
|
Zhao L, Sun X, Luo Y, Wang F, Lyu Z. Clinical and pathologic predictors of lymph node metastasis in papillary thyroid microcarcinomas. Ann Diagn Pathol 2020; 49:151647. [PMID: 33126150 DOI: 10.1016/j.anndiagpath.2020.151647] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022]
Abstract
Papillary thyroid microcarcinoma (PTMC) has the highest incidence among all thyroid carcinomas. Although surgery is the primary treatment for PTMC, it inevitably leads to trauma and some complications. To formulate an optimal treatment strategy, we aim to clarify the risk factors for lymph node metastasis (LNM) in PTMC patients. This study retrospectively analyzed patients who underwent thyroidectomy during 1995-2015, and grouped them according to lymph node metastasis. Age, gender, tumor size, thyroid functions, Hashimoto's thyroiditis, multifocal tumor, extrathyroidal extensions, capsular invasion were analyzed. Of the 2434 PTMC subjects, proportion of patients with no LNM (NLNM), LNM, central LNM (CLNM), lateral LNM (LLNM), CLNM + LLNM were 82.9%, 17.1%, 7.0%, 7.6% and 2.5%. Patients with NLNM were older and had a lower proportion of males compared to patients with CLNM, LLNM and CLNM + LLNM (p < 0.05). The NLNM group also had a smaller size of ultrasound tumor, lower proportion of multifocal tumor and extrathyroidal extension compared to CLNM, LLNM and CLNM + LLNM groups (p < 0.05). On univariate analyses, male gender, age <45 years, tumor size of pathology (˃0.75 cm), multifocality, and extrathyroidal extension were significantly associated with LNM. Multivariate analyses revealed that male gender, age <45 years, multifocality were risk factors for LNM. In conclusion, PTMC patients with male gender, age <45 years and multifocality should be evaluated carefully for possible LNM.
Collapse
Affiliation(s)
- Ling Zhao
- The Department and Key Laboratory of Endocrinology and Metabolism, The First Medical Center of PLA General Hospital, Beijing 100853, China; Department of Endocrinology, The 940th Hospital of Joint Logistics Support force of Chinese PLA, Lanzhou 730050, China
| | - Xiaoya Sun
- Department of Endocrinology, Peking University First Hospital, Beijing 100034, China
| | - Yukun Luo
- Department of Ultrasonography, The First Medical Center of PLA General Hospital, 100853 Beijing, China
| | - Fulin Wang
- Department of Pathology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Zhaohui Lyu
- The Department and Key Laboratory of Endocrinology and Metabolism, The First Medical Center of PLA General Hospital, Beijing 100853, China.
| |
Collapse
|
34
|
Song M, Huang Z, Wang S, Huang J, Shi H, Liu Y, Huang Y, Yin Y, Wu Z. Predictive factors of lateral lymph node metastasis in conventional papillary thyroid carcinoma. Gland Surg 2020; 9:1000-1007. [PMID: 32953608 PMCID: PMC7475366 DOI: 10.21037/gs-20-482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lymph node metastasis (LNM) has been a significant predictor for local recurrence and distant metastasis in papillary thyroid carcinoma (PTC). However, the clinical predictors for conventional papillary thyroid carcinoma (CPTC) with lateral lymph node metastasis (LLNM) have yet to be established. Our work aimed to effectively identify the risk factors of LLNM in CPTC, helping surgeons to devise better individualized therapy strategies. METHODS We retrospectively analyzed 652 patients who were diagnosed with CPTC in the Department of General Surgery at Guangdong Provincial People's Hospital between October 2015 and June 2019. Univariate and multivariate logistic regression was used to analyze the correlation between clinicopathological characteristics and the LLNM of CPTC. RESULTS The incidence of LLNM in CPTC was 29.75% (194 of 652 patients). Univariate analysis found that LLNM was significantly associated with gender, age, number of central lymph nodes (CLNs), primary tumor location, multifocality, maximum tumor diameter, and BRAF V600E mutation. Independent risk factors for LLNM were multifocality (P=0.017, OR =4.325, 95% CI: 1.298-14.408), maximum tumor diameter (P<0.001, OR =4.076, 95% CI: 1.945-8.540), primary tumor location (P=0.037, OR =2.127, 95% CI: 1.046-4.328), number of CLNs (P<0.001, OR =8.604, 95% CI: 3.630-20.390), and BRAF V600E mutation (P=0.001, OR =3.913, 95% CI: 1.803-8.496) by multivariate analysis. CONCLUSIONS LLNM in CPTC was related to the large volume of central lymph node metastasis (CLNM), tumor located in the upper lobe, multifocality, tumor diameter >2 cm, and BRAF V600E mutation-negative, which should be considered when examining patients with suspected metastasis in the lateral compartment.
Collapse
Affiliation(s)
- Muye Song
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Ziyang Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Shujie Wang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jianhao Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hongyan Shi
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yongchen Liu
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yijie Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Yin
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zeyu Wu
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
35
|
Dou Y, Hu D, Chen Y, Xiong W, Xiao Q, Su X. PTC located in the upper pole is more prone to lateral lymph node metastasis and skip metastasis. World J Surg Oncol 2020; 18:188. [PMID: 32723382 PMCID: PMC7389816 DOI: 10.1186/s12957-020-01965-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background Lateral lymph node metastasis (LLNM) is very common in papillary thyroid carcinoma (PTC). The influence of tumour location on LLNM remains controversial. The purpose of this study was to reveal the association between PTC tumours located in the upper pole and LLNM. Methods We reviewed a total of 1773 PTC patients who underwent total thyroidectomy with central and lateral lymph node dissection between 2013 and 2018. Patients were divided into two groups according to tumour location. Univariate and multivariate analyses were performed to identify risk factors associated with LLNM and “skip metastasis”. Results In the upper pole group, LLNM and skip metastasis were significantly likely to occur. Multivariate analysis showed that tumours located in the upper pole, male sex, extrathyroidal extension (ETE), central lymph node metastasis (CLNM) and tumour size were independent risk factors for LLNM, with odds ratios ([ORs], 95% confidence intervals [CIs]) of 2.136 (1.707–2.672), 1.486 (1.184–1.867), 1.332 (1.031–1.72), 4.172 (3.279–5.308) and 2.496 (1.844–3.380), respectively. Skip metastasis was significantly associated with the primary tumour location in the upper pole and age > 55 years, with ORs of 4.295 (2.885–6.395) and 2.354 (1.522–3.640), respectively. Conclusions In our opinion, papillary thyroid tumours located in the upper pole may have an exclusive drainage pathway to the lateral lymph nodes. When the tumour is located in the upper pole, lateral neck dissection should be evaluated meticulously.
Collapse
Affiliation(s)
- Yi Dou
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Daixing Hu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yingji Chen
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Xiong
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qi Xiao
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xinliang Su
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| |
Collapse
|
36
|
Ruiz Pardo J, Rodríguez JM, Ríos A. Reply - Risk Factors of Metastatic Lymph Nodes in Papillary Thyroid Microcarcinoma. Cir Esp 2020; 98:497-498. [PMID: 32622516 DOI: 10.1016/j.ciresp.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- José Ruiz Pardo
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - José Manuel Rodríguez
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia, y Ginecología, Universidad de Murcia, Murcia, España
| | - Antonio Ríos
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia, y Ginecología, Universidad de Murcia, Murcia, España
| |
Collapse
|
37
|
Zhu M, Zheng W, Xiang Y, Gu J, Wang K, Shang J. The relationship between central lymph node metastasis and the distance from tumor to thyroid capsule in papillary thyroid microcarcinoma without capsule invasion. Gland Surg 2020; 9:727-736. [PMID: 32775263 DOI: 10.21037/gs-20-478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background This study aims to explore the predictive factors of central lymph node metastasis (CLNM) in patients with papillary thyroid microcarcinoma (PTMC) without capsule invasion. Methods From January 2016 to October 2018, 1,622 patients with PTMC, who underwent surgical treatment at Zhejiang Cancer Hospital, were enrolled in the present study. A model of multivariate logistic regression was developed to find the variables that were independently associated with CLNM. The results were presented in the odds ratio (OR) with a 95% confidence interval (CI). The nomogram for predicting CLNM was developed based on the results of the multivariate logistic regression analysis. The distance (distance >0) from tumor to capsule is defined as the shortest distance from the tumor boundary to the capsule or trachea. Results The multivariate logistic regression analysis indicated that age, gender, tumor maximum diameter, tumor mean diameter, and tumor volume were independently associated with CLNM. In the 692 cases without capsular invasion, the distance from the capsule was not correlated to the CLNM. The joint model, which included age, gender, tumor volume, and capsular invasion, were analyzed using the ROC curve. The cut-off point for the prediction of CLNM was defined as a value of 0.208. The area under the ROC curve was 0.687, the sensitivity was 65.4%, and the specificity was 63.3%. Conclusions Gender, age, maximum diameter, mean diameter, tumor volume, and capsular invasion were independently associated with the CLNM. When there was no capsular invasion, the distance between the tumor and capsule was not correlated to the CLNM, suggesting that considering whether the tumor is close to the capsule may not be necessary for low-risk PTMC.
Collapse
Affiliation(s)
- Mengting Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Weihui Zheng
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Yangfeng Xiang
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Jialei Gu
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Kejing Wang
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Jinbiao Shang
- Department of Head and Neck Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences; Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| |
Collapse
|
38
|
Wu X, Li B, Zheng C, He X. Predicting factors of central lymph node metastases in patients with unilateral multifocal papillary thyroid microcarcinoma. Gland Surg 2020; 9:695-701. [PMID: 32775259 DOI: 10.21037/gs.2020.03.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Unilateral multifocal papillary thyroid microcarcinoma (UM-PTMC) is not rare, and the suitable extent of operation is controversial. Total thyroidectomy is associated with a high risk of hypoparathyroidism and recurrent laryngeal nerve injury. Hemithyroidectomy should be considered in patients without lymph node metastases. This study aimed to identify factors predicting central lymph node metastases (CLNM) in patients with UM-PTMC. Methods A total of 1,453 patients with thyroid cancer underwent surgery at our hospital from January 2018 to June 2018, and 115 patients with UM-PTMC were selected and assessed retrospectively. The relationship between CLNM and clinicopathologic features of UM-PTMC were analyzed by both univariate and multivariate analyses. Results Of the 115 patients with UM-PTMC, CLNM were confirmed by pathology in 57 patients. Univariate and multivariate analyses identified the sum diameter of all tumors (≥1.0 cm) [odds ratio (OR) =2.295; 95% confidence interval (CI): 1.036-5.086; P=0.041] and positive CLNM via ultrasonography (OR =5.882; 95% CI: 1.562-22.153; P=0.009) as independent predictors of CLNM. Conclusions CLNM are common in patients with UM-PTMC. The sum diameter of all tumors (≥1.0 cm) and positive CLNM via ultrasonography are independent risk factors for CLNM. Our data should be considered in the decision process relating to performing total thyroidectomy or hemithyroidectomy in patients with UM-PTMC.
Collapse
Affiliation(s)
- Xin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Binglu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chaoji Zheng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiaodong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
39
|
González-Sánchez MDC, Franch-Arcas G. Risk factors of metastatic lymph nodes in papillary thyroid microcarcinoma. Comment on patients selection for the study. Cir Esp 2020; 98:496-497. [PMID: 32456780 DOI: 10.1016/j.ciresp.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- María Del Carmen González-Sánchez
- Unidad de Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Departamento de Cirugía, Universidad de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España.
| | - Guzmán Franch-Arcas
- Unidad de Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Departamento de Cirugía, Universidad de Salamanca, Salamanca, España; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| |
Collapse
|
40
|
Feng JW, Pan H, Wang L, Ye J, Jiang Y, Qu Z. Total tumor diameter: the neglected value in papillary thyroid microcarcinoma. J Endocrinol Invest 2020; 43:601-613. [PMID: 31749082 DOI: 10.1007/s40618-019-01147-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tumor multifocality is not uncommon in papillary thyroid carcinoma (PTC), especially in micro-PTC. However, assessing the size of the largest tumor may underestimate effect of additional foci. We aimed to investigate the effect of total tumor diameter (TTD) on clinicopathological features of micro-PTC. METHODS Data from 442 patients who underwent thyroidectomy with cervical lymph node dissection for PTC were retrospectively analyzed. Patients were classified into subgroups according to multifocality and TTD. The relationships of clinicopathological features among these groups were analyzed. RESULTS Multifocality was observed in 119 patients (26.9%). TTD > 1 cm and presence of extrathyroidal extension (ETE) were significantly higher in multifocal tumors compared to unifocal tumor (P < 0.001, P = 0.016, respectively). When comparing multifocal micro-PTC with TTD > 1 cm to those with unifocal micro-PTC or multifocal micro-PTC with TTD ≤ 1 cm, the proportions of cases with ETE, central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM) were significantly higher (all P < 0.05). There was no significant difference in terms of these parameters between multifocal micro-PTC with TTD > 1 cm and macro-PTC or multifocal macro-PTC. The risk of CLNM was 2.056 (P = 0.044) times higher in multifocal micro-PTC with TTD > 1 cm than in unifocal micro-PTC. CONCLUSION For multifocal micro-PTC, TTD can better assess the aggressiveness of the tumor. Multifocal micro-PTC with TTD > 1 cm was more aggressive than unifocal micro-PTC or multifocal micro-PTC with TTD ≤ 1 cm.
Collapse
Affiliation(s)
- J-W Feng
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - H Pan
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - L Wang
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - J Ye
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Y Jiang
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
| | - Z Qu
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
| |
Collapse
|
41
|
Wu X, Li BL, Zheng CJ, He XD. Predictive factors for central lymph node metastases in papillary thyroid microcarcinoma. World J Clin Cases 2020; 8:1350-1360. [PMID: 32368529 PMCID: PMC7190943 DOI: 10.12998/wjcc.v8.i8.1350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/04/2020] [Accepted: 04/04/2020] [Indexed: 02/05/2023] Open
Abstract
Papillary thyroid microcarcinoma (PTMC) measures 1 cm or less in its longest dimension. The incidence of PTMC is increasing worldwide. Surgery is the primary treatment; however, prophylactic central lymph node dissection is controversial, and discrepancies between different guidelines have been noted. Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis, while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients. To selectively perform prophylactic lymph node dissections in high-risk patients, it is important to identify predictive factors for lymph node metastases in patients with PTMC. Several studies have reported on this, but their conclusions are not entirely consistent. Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases, and the most commonly reported factors include age, gender, tumor size and location, multifocality, bilaterality, extrathyroidal extension, and abnormal lymph node found using ultrasound. Here, we provide an overview of previous studies along with a favorable opinion on or against these factors, with the aim of increasing the understanding of this topic among the medical community. In addition, current opinions about prophylactic central lymph node dissection are reviewed and discussed.
Collapse
Affiliation(s)
- Xin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bing-Lu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Chao-Ji Zheng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xiao-Dong He
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
42
|
Li X, Gao F, Li F, Han XX, Shao SH, Yao MH, Li CX, Zheng J, Wu R, Du LF. Qualitative analysis of contrast-enhanced ultrasound in the diagnosis of small, TR3-5 benign and malignant thyroid nodules measuring ≤1 cm. Br J Radiol 2020; 93:20190923. [PMID: 32242748 DOI: 10.1259/bjr.20190923] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To evaluate the performance of contrast-enhanced ultrasound in the diagnosis of small, solid, TR3-5 benign and malignant thyroid nodules (≤1 cm). METHODS From January 2016 to March 2018, 185 thyroid nodules from 154 patients who underwent contrast enhanced ultrasound (CEUS) and fine-needle aspiration or thyroidectomy in Shanghai General Hospital were included. The χ2 test was used to compare the CEUS characteristics of benign and malignant thyroid nodules, and the CEUS features of malignant nodules assigned scores. The total score of the CEUS features and the scores of the above nodules were evaluated according to the latest 2017 version of the Thyroid Imaging Reporting and Data System (TI-RADS). The diagnostic performance of the two were compared based on the receiver operating characteristic curves generated for benign and malignant thyroid nodules. RESULTS The degree, enhancement patterns, boundary, shape, and homogeneity of enhancement in thyroid small solid nodules were significantly different (p<0.05). No significant differences were seen between benign and malignant thyroid nodules regarding completeness of enhancement and size of enhanced lesions (p>0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the TI-RADS classification TR5 in diagnosis of malignant nodules were 90.10%, 55.95%, 74.59%, 72.22%, and 82.46%, respectively (area under the curve [AUC]=0.738; 95% confidence interval[CI], 0.663-0.813). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the total score of CEUS qualitative analysis indicators were 86.13%, 89.29%, 87.57%, 90.63%, and 84.27% respectively (AUC = 0.916; 95% CI, 0.871-0.961). CONCLUSION CEUS qualitative analysis is superior to TI-RADS in evaluating the diagnostic performance of small, solid thyroid nodules. Qualitative analysis of CEUS has a significantly higher specificity for diagnosis of malignant thyroid nodules than TI-RADS. ADVANCES IN KNOWLEDGE The 2017 version of TI-RADS has recently suggested the malignant stratification of thyroid nodules by ultrasound. In this paper we applied this system and CEUS to evaluate 185 nodules and compare the results with pathological findings to access the diagnostic performance.
Collapse
Affiliation(s)
- Xin Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Feng Gao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xiao-Xia Han
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Si-Hui Shao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ming-Hua Yao
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Chun-Xiao Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jun Zheng
- Department of Pathology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Rong Wu
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Lian-Fang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| |
Collapse
|
43
|
Xue S, Han Z, Lu Q, Wang P, Chen G. Clinical and Ultrasonic Risk Factors for Lateral Lymph Node Metastasis in Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:436. [PMID: 32309215 PMCID: PMC7145902 DOI: 10.3389/fonc.2020.00436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 03/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Clinical and ultrasonic risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid microcarcinoma (PTMC) are not well-defined. Herein, a systematic review and meta-analysis was conducted to investigate clinicopathologic and ultrasonic risk features for LLNM in PTMC. Methods: A systematic search of electronic databases (PubMed, Embase, Cochrane Library, and Web of Science) for studies published until April 2019 was performed. Case–control studies and randomized controlled trials that studied clinical and ultrasonic risk factors of LLNM in PTMC were included. Results: Fourteen studies (all retrospective studies) involving 43,750 patients met final inclusion criteria. From the pooled analyses, younger age<45 (OR, 1.55; 95% CI, 1.16–2.07; P = 0.003), male patients (OR, 1.94; 95% CI, 1.55–2.42; P < 0.00), extrathyroidal extension (OR, 3.63; 95% CI, 2.28–5.77; P <0.00), tumor multifocality (OR, 2.24; 95% CI, 1.53–3.28; P <0.00), tumor > 0.5 cm (OR, 2.24; 95% CI, 1.53–3.28; P < 0.00), central lymph node metastasis (OR, 5.61; 95% CI, 4.64–6.79; P < 0.00), >25% tumor contact with thyroid capsule (OR, 6.66; 95% CI, 1.96–22.65; P = 0.002), tumor calcification (OR, 2.90; 95% CI, 1.71–4.93; P < 0.00), upper tumor (OR, 3.18; 95% CI, 2.23–4.55; P < 0.00) were significantly associated with increased risk of LLNM in PTMC, while Hashimoto's thyroiditis and other ultrasonic features (solid tumor, hypoechoic tumor, smooth margin, and taller than wide tumor) were not significantly associated with LLNM in PTMC. Conclusions: Our analysis identified several clinicopathologic and ultrasonic factors associated with LLNM in PTMC. This finding highlights the need for a cautious and frequent postoperative surveillance of the lateral neck in high-risk PTMC patients. Moreover, high-risk ultrasonic features also need to be considered during selection of PTMC for active surveillance.
Collapse
Affiliation(s)
- Shuai Xue
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Zhe Han
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Qiyu Lu
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Peisong Wang
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| | - Guang Chen
- Department of Thyroid Surgery, The 1st Hospital of Jilin University, Changchun, China
| |
Collapse
|
44
|
Papaioannou C, Lamnisos D, Kyriacou K, Lyssiotis T, Constantinides V, Frangos S, Economides A, Economides PA. Lymph Node Metastasis and Extrathyroidal Extension in Papillary Thyroid Microcarcinoma in Cyprus: Suspicious Subcentimeter Nodules Should Undergo FNA When Multifocality is Suspected. J Thyroid Res 2020; 2020:3567658. [PMID: 32351678 PMCID: PMC7128046 DOI: 10.1155/2020/3567658] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/28/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the prevalence of lymph node (LN) metastasis and extrathyroidal extension (ETE) in patients with papillary thyroid microcarcinoma (PTMC) in Cyprus and to evaluate the role of preoperative ultrasound (U/S) examination. METHODS A retrospective study of 102 patients who underwent thyroidectomy for PTMC in a 2-year period. Preoperatively, all patients had a thyroid and neck U/S examination with LN mapping. Tumor size according to the largest diameter, number of foci, LN metastasis, and ETE data was collected from the histopathological report and was compared to the preoperative U/S reports. RESULTS LN metastasis was present in 23.5% of patients. 15.7% had central, 3.9% had lateral, and 3.9% had both central and lateral LN metastasis. ETE was present in 27.5% of patients. 21.6% had multifocal disease, and in this group, 40.9% had LN metastasis and 36.4% had ETE. Multifocality (p = 0.03), size of tumor (p = 0.05), and ETE (p ≤ 0.001) were significantly associated with LN metastasis. The prevalence of LN metastasis in multifocal PTMC ≤5 mm was the same with multifocal PTMC >5 mm. The preoperative U/S sensitivity for the suspicious lateral neck and central LN was 100%, and the specificity was 100%. The preoperative U/S sensitivity for nodules suspicious for ETE was 53.6%, and the specificity was 100%. CONCLUSION The presence of LN metastasis and ETE in our PTMC patients in Cyprus is frequent. Neck U/S mapping is a highly reliable and accurate tool in identifying metastatic nodes. LN metastasis is associated with ETE and multifocality. Suspicious subcentimeter nodules should undergo FNA irrespective of size when multifocality is suspected.
Collapse
Affiliation(s)
- Christos Papaioannou
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | | - Savvas Frangos
- Bank of Cyprus Oncology Center, Strovolos, Nicosia, Cyprus
| | - Aliki Economides
- European University Cyprus, Engomi, Nicosia, Cyprus
- Thyroid & Endocrinology Center, Engomi, Nicosia, Cyprus
| | - Panayiotis A. Economides
- European University Cyprus, Engomi, Nicosia, Cyprus
- Thyroid & Endocrinology Center, Engomi, Nicosia, Cyprus
| |
Collapse
|
45
|
Prognostic Value of Hyperechoic Echo Halo in cN0 Papillary Thyroid Microcarcinoma and Its Correlation with Age and Gender. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6479582. [PMID: 32190674 PMCID: PMC7064847 DOI: 10.1155/2020/6479582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 01/07/2020] [Accepted: 02/14/2020] [Indexed: 11/18/2022]
Abstract
Purpose. To investigate the pathology and prognostic value of hyperechoic echo halo in cN0 papillary thyroid microcarcinoma (PTMC) and the relationship between age, gender, and the formation of abnormal hyperechoic echo halo and cervical lymph node metastasis. Data of 97 patients who underwent surgical treatment for the first time for single PTMC between April 2016 and March 2017 were analyzed retrospectively. The boundary status of the PTMC was determined preoperatively. Grayscale values of the nodular center, hyperechoic echo halo, and normal thyroid tissue were acquired with Adobe Photoshop CS6 software. The histopathology of the boundary and status of the cervical lymph node metastasis were analyzed. Formation of abnormal hyperechoic halo and cervical lymph node metastasis in relation to age and gender were explored. The abnormal hyperechoic halo mainly represents cancer cell infiltration with reactive hyperplasia of inflammatory cells and fibrous tissue. In the hyperechoic halo group, the grayscale values for the nodular center, hyperechoic echo halo, and normal thyroid tissue were 1552.6 ± 578.6, 5792.0 ± 747.6, and 3582.7 ± 759.0, respectively (P < 0.05). The cervical lymph node metastasis rate was significantly lower in patients with hyperechoic halo (15.0%) than in those without (41.6%; P < 0.05) and significantly higher in those aged <45 years (53.3%) than in those aged ≥45 years (28.4%; P < 0.05). There were no significant correlations between gender and cervical lymph node metastasis or between age, gender, and hyperechoic halo formation (P > 0.05). cN0 PTMC patients with abnormal hyperechoic halo and age >45 years have a significantly reduced risk of cervical lymph node metastasis and relatively good prognosis.
Collapse
|
46
|
Tallini G, De Leo A, Repaci A, de Biase D, Bacchi Reggiani ML, Di Nanni D, Ambrosi F, Di Gioia C, Grani G, Rhoden KJ, Solaroli E, Monari F, Filetti S, Durante C. Does the Site of Origin of the Microcarcinoma with Respect to the Thyroid Surface Matter? A Multicenter Pathologic and Clinical Study for Risk Stratification. Cancers (Basel) 2020; 12:cancers12010246. [PMID: 31963890 PMCID: PMC7016743 DOI: 10.3390/cancers12010246] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 02/05/2023] Open
Abstract
It is unclear whether the site of origin of papillary thyroid microcarcinoma (mPTC) with respect to the thyroid surface has an influence on clinicopathologic parameters. The objectives of the study were to: (i) Accurately measure the mPTC distance from the thyroid surface; (ii) analyze whether this distance correlates with relevant clinicopathologic parameters; and (iii) investigate the impact of the site of origin of the mPTC on risk stratification. Clinicopathologic features and BRAF mutational status were analyzed and correlated with the site of origin of the mPTC in a multicenter cohort of 298 mPTCs from six Italian medical institutions. Tumors arise at a median distance of 3.5 mm below the surface of the thyroid gland. Statistical analysis identified four distinct clusters. Group A, mPTC: size ≥ 5 mm and distance of the edge of the tumor from the thyroid capsule = 0 mm; group B, mPTC: size ≥ 5 mm and distance of the edge of the tumor from the thyroid capsule > 0 mm; group C, mPTC: size < 5 mm and distance of the edge of the tumor from the thyroid capsule = 0 mm; and group D, mPTC: size < 5 mm and distance of the edge of the tumor from the thyroid capsule > 0 mm. Univariate analysis demonstrates significant differences between the groups: Group A shows the most aggressive features, and group D the most indolent ones. By multivariate analysis, group A tumors are characterized by tall cell histotype, BRAF V600E mutation, tumor fibrosis, aggressive growth with invasive features, vascular invasion, lymph node metastases, and intermediate ATA risk. The mPTC clinicopathologic features vary according to the tumor size and distance from the thyroid surface. A four-group model may be useful for risk stratification and to refine the selection of nodules to be targeted for fine needle aspiration.
Collapse
Affiliation(s)
- Giovanni Tallini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna–Molecular Diagnostic Unit, 40138 Azienda USL di Bologna, Italy; (D.D.N.); (F.A.)
- Correspondence: ; Tel.: +39-051-214-4717
| | - Antonio De Leo
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Andrea Repaci
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Dario de Biase
- Department of Pharmacy and Biotechnology, University of Bologna–Molecular Diagnostic Unit, Azienda USL di Bologna, University of Bologna, 40138 Bologna, Italy;
| | - Maria Letizia Bacchi Reggiani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Doriana Di Nanni
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna–Molecular Diagnostic Unit, 40138 Azienda USL di Bologna, Italy; (D.D.N.); (F.A.)
| | - Francesca Ambrosi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna–Molecular Diagnostic Unit, 40138 Azienda USL di Bologna, Italy; (D.D.N.); (F.A.)
| | - Cira Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Giorgio Grani
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00185 Rome, Italy; (G.G.); (C.D.)
| | - Kerry Jane Rhoden
- Genetics Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Erica Solaroli
- Endocrinology Unit, Ospedale Maggiore, 40133 Bologna, Italy;
| | - Fabio Monari
- Radiation Therapy Unit, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00185 Rome, Italy; (G.G.); (C.D.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00185 Rome, Italy; (G.G.); (C.D.)
| |
Collapse
|
47
|
Gu JH, Zhao YN, Xie RL, Xu WJ, You DL, Zhao ZF, Wang F, Fei J. Analysis of risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma: a study of 268 patients. BMC Endocr Disord 2019; 19:124. [PMID: 31729977 PMCID: PMC6858775 DOI: 10.1186/s12902-019-0450-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/28/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To investigate the risk factors of cervical lymph node (LN) metastasis in papillary thyroid microcarcinoma (PTMC) patients. METHODS We retrospectively analyzed the clinicopathologic data of all patients who received standard lobectomy for PTMC at our institution between October 2017 and January 2019. Central LNs were dissected in all patients. Lateral LNs were dissected if metastasis to the lateral LNs was suggested based on pre-op fine-needle aspiration biopsy. The relationship between variables available prior to surgery and cervical LN metastasis was examined using multivariate regression. RESULTS Post-op pathologic examination revealed cervical LN metastasis in 79 (29.5%) patients. Seventy subjects had metastasis only to central LNs, and 4 (1.5%) patients had metastasis only to lateral LNs. Five patients had metastasis to both central and lateral LNs. In comparison to patients without cervical LN metastasis, those with LN metastasis were significantly younger (40.63 ± 13.07 vs. 44.52 ± 12.23 years; P = 0.021) and had significantly larger tumor diameter on pathology (6.7 ± 2.2 vs. 5.9 ± 2.4 mm; P = 0.010). Multivariate regression analysis identified the following independent risks for cervical LN metastasis: male sex (OR 2.362, 95%CI 1.261~4.425; P = 0.007), age (OR 0.977, 95%CI 0.956~0.999; P = 0.042) and ultrasound tumor diameter at > 5 mm (OR 3.172, 95%CI 1.389~7.240; P = 0.006). CONCLUSION Cervical LN metastasis occurs in a non-insignificant proportion of PTMC patients. Independent risks included male sex, younger age and larger tumor diameter on ultrasound.
Collapse
Affiliation(s)
- Jian-hua Gu
- Department of General Surgery, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Yan-na Zhao
- Department of Ultrasound, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Rong-li Xie
- Department of Surgery, Luwan Branch, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-juan Xu
- Department of General Surgery, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
| | - Da-li You
- Department of Critical Care Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Zhi-feng Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Wang
- Department of Critical Care Medicine, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jian Fei
- Department of General Surgery, Shanghai Ruijin Rehabilitation Hospital, Shanghai, China
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
48
|
Campennì A, Amato E, Laudicella R, Alibrandi A, Cardile D, Pignata SA, Trimarchi F, Ruggeri RM, Auditore L, Baldari S. Recombinant human thyrotropin (rhTSH) versus Levo-thyroxine withdrawal in radioiodine therapy of differentiated thyroid cancer patients: differences in abdominal absorbed dose. Endocrine 2019; 65:132-137. [PMID: 30875058 DOI: 10.1007/s12020-019-01897-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/07/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE In DTC patients, 131-radioiodine therapy has routinely been used for many years for thyroid remnant ablation after thyroid surgery. To date, two different strategies can be used to achieve sufficient TSH stimulation on thyroid remnant: (I) Levo-thyroxine withdrawal or (II) rhTSH stimulation. The aim of our study was to compare the abdominal absorbed dose ratio between differentiated thyroid cancer patients who underwent thyroid remnant ablation after either L-T4 withdrawal or rhTSH stimulation. METHODS We reviewed the records of 63 patients affected by differentiated thyroid cancer. All patients underwent thyroid remnant ablation after either L-T4 withdrawal or rhTSH stimulation. A post-therapy whole-body scan was obtained 5 days after 131-radioiodine therapy. Qualitative and quantitative image analysis was performed. Quantitative analysis was performed by drawing seven regions of interest on the abdomen (anterior and posterior views) to estimate both the activity ratio (AR) and absorbed dose ratio (DR) obtained in patients treated in hypothyroidism or after rhTSH stimulation. RESULTS The values of the activity and absorbed dose ratios obtained on each abdomen region (liver, stomach, ascending colon, transverse colon, descending colon, rectum, and small intestine) were always higher in patients treated after L-T4 withdrawal than after rhTSH stimulation with p-values of 0.000, 0.000, 0.001, 0.000, 0.022, 0.007, and 0.002, respectively. CONCLUSIONS DTC patients treated with 131-radioiodine after rhTSH stimulation have lower abdominal radioiodine activity than hypothyroid patients. Our data could be of practical relevance in terms of patient management. The potential impact on rare radioiodine-related gastrointestinal side effects is to be established in specifically designed prospective studies.
Collapse
Affiliation(s)
- Alfredo Campennì
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.
| | - Ernesto Amato
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Riccardo Laudicella
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Davide Cardile
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Salvatore Antonio Pignata
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Francesco Trimarchi
- Accademia Peloritana dei Pericolanti at the University of Messina, Messina, Italy
| | - Rosaria Maddalena Ruggeri
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Messina, Messina, Italy
| | - Lucrezia Auditore
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - Sergio Baldari
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
| |
Collapse
|
49
|
Cheng F, Chen Y, Zhu L, Zhou B, Xu Y, Chen Y, Wen L, Chen S. Risk Factors for Cervical Lymph Node Metastasis of Papillary Thyroid Microcarcinoma: A Single-Center Retrospective Study. Int J Endocrinol 2019; 2019:8579828. [PMID: 30774660 PMCID: PMC6350584 DOI: 10.1155/2019/8579828] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 12/11/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To identify the clinicopathological features correlated to lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC). METHODS Clinical data of 785 PTMC patients who underwent surgical treatment at the Lishui Municipal Central Hospital from September 2008 to December 2017 were retrospectively analyzed. Clinical and pathological risk factors for lymph node metastasis (LNM), central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM) were analyzed. RESULTS LNM was found in 236 (30.2%) patients. Multivariate logistic regression analysis revealed that in PTMC, male gender, age < 55 years, tumor size > 5 mm, bilateral lesions, and extrathyroidal extension were independent risk factors for LNM in general and for CLNM. For LLNM, tumor size > 5 mm, multifocal lesions, and extrathyroidal extension were independent risk factors. CONCLUSIONS Identification of risk factors for cervical LNM could assist individualization of clinical management for PTMC.
Collapse
Affiliation(s)
- Feng Cheng
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui 323000, China
| | - Yanyan Chen
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Lei Zhu
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui 323000, China
| | - Bin Zhou
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui 323000, China
| | - Yonghong Xu
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui 323000, China
| | - Yiran Chen
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Liping Wen
- Department of Surgical Oncology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Shuzheng Chen
- Department of Thyroid and Breast Surgery, Lishui Hospital of Zhejiang University, Lishui Municipal Central Hospital, Lishui 323000, China
| |
Collapse
|
50
|
Xue S, Wang P, Zhang Q, Yin Y, Guo L, Wang M, Jin M, Chen G. Routine Lateral Level V Dissection May Not Be Necessary for Papillary Thyroid Microcarcinoma With Lateral Lymph Node Metastasis: A Retrospective Study of 252 Cases. Front Endocrinol (Lausanne) 2019; 10:558. [PMID: 31481929 PMCID: PMC6710992 DOI: 10.3389/fendo.2019.00558] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 12/27/2022] Open
Abstract
Background: Lateral lymph node metastasis (LLNM) is associated with distant metastasis, locoregional recurrence and cancer-specific mortality, although the prevalence of LLNM among patients with papillary thyroid microcarcinoma (PTMC) is relatively low. The potential benefits and risks of routine lateral level V dissection (LVD) for PTMC with LLNM have not been previously investigated. Methods: A total of 6,880 consecutive PTMC patients who underwent initial surgery at the First Hospital of Jilin University from January 2009 to July 2017 were retrospectively analyzed. A total of 252 N1b PTMC patients were enrolled in our study. Results: The overall and occult metastasis rates in level V lymph nodes were 21.4 and 6.4%, respectively. Patients with N1b PTMC who received LVD did not show a significantly lower disease-free survival (DFS) than that of patients who did not receive LVD [hazard ratio = 1.11 (CI 0.38-3.21); p = 0.85]. Meanwhile, LVD simultaneously increased the hospital stay and cost (p = 0.03; 0.02). Multivariate logistic regression analysis revealed that 3-level simultaneous metastasis in the lateral neck was an independent risk factor for level V metastasis [odds ratio = 8.6 (CI 1.42-51.72); p = 0.02]. Conclusions: Because of the low metastasis rate in level V lymph nodes, the lack of benefit for recurrence, the longer hospital stay and the higher cost associated with LVD, N1b PTMC patients without clinical level V metastasis may not need to undergo routine dissection. Prophylactic LVD may be recommended only for patients with N1b PTMC with 3-level simultaneous metastasis.
Collapse
Affiliation(s)
- Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Peisong Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Qiang Zhang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Yue Yin
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Liang Guo
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Ming Wang
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Meishan Jin
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Meishan Jin
| | - Guang Chen
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
- Guang Chen
| |
Collapse
|