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Fields TD, Underwood HJ, Pitt SC. Management of Small Papillary Thyroid Cancers. Surg Clin North Am 2024; 104:725-740. [PMID: 38944494 DOI: 10.1016/j.suc.2024.02.003] [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: 07/01/2024]
Abstract
Thyroid cancer is the most common endocrine malignancy. With increasing imaging utilization, there has been an increase in the recognition of small, indolent cancers that would otherwise go undiagnosed. Historically, the surgical recommendation for all patients with thyroid cancer was a total thyroidectomy. However, over the last 20 years, there have been numerous studies evaluating the de-escalation of interventions for low-risk thyroid cancers, transitioning from total thyroidectomy to thyroid lobectomy or active surveillance when indicated. Here, we review the current literature and recommendations with each of these treatment options.
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Affiliation(s)
- Tyler D Fields
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Hunter J Underwood
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. https://twitter.com/HJUnderwoodMD
| | - Susan C Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. https://twitter.com/susieQP8
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2
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Shah M, McManus C. The Role of Radiofrequency Ablation in Benign and Malignant Thyroid Nodules. Surg Clin North Am 2024; 104:779-789. [PMID: 38944498 DOI: 10.1016/j.suc.2024.02.007] [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: 07/01/2024]
Abstract
Radiofrequency ablation (RFA) offers a minimally invasive solution for benign, autonomously functioning (AFTN), and malignant thyroid nodules. The technique utilizes high-frequency alternating current to induce coagulative necrosis, effectively destroying target tissue. RFA is performed in the outpatient setting with local anesthesia and sonographic guidance. RFA is effective in producing substantial volume reduction rates in benign nodules and is emerging as a favorable option in AFTN and papillary thyroid microcarcinoma. RFA's advantages include lower complication rates, minimal scarring, and improved quality-of-life outcomes compared to surgery. However, its efficacy in larger and recurrent malignancies requires further investigation.
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Affiliation(s)
- Meghal Shah
- Department of Surgery, Columbia University Medical Center, New York, NY, USA.
| | - Catherine McManus
- Division of HPB/Endocrine Surgery, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10032, USA
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Altshuler B, Bikas A, Pappa T, Marqusee E, Cho NL, Nehs MA, Liu JB, Doherty GM, Landa I, Ahmadi S, Alexander EK. Nonoperative, Active Surveillance of Larger Malignant and Suspicious Thyroid Nodules. J Clin Endocrinol Metab 2024; 109:1996-2002. [PMID: 38349208 DOI: 10.1210/clinem/dgae082] [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: 10/06/2023] [Revised: 01/05/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
CONTEXT Active surveillance for papillary thyroid cancer (PTC) meeting criteria for surgical resection is uncommon. Which patients may prove reasonable candidates for this approach is not well defined. OBJECTIVE This work aimed to examine the feasibility and safety of active surveillance for patients with known or suspected intrathyroidal PTC up to 4 cm in diameter. METHODS A retrospective review was conducted of all consecutive patients who underwent nonoperative active surveillance of suspicious or malignant thyroid nodules over a 20-year period from 2001 to 2021. We included patients with an initial ultrasound-fine-needle aspiration confirming either (a) Bethesda 5 or 6 cytology or (b) a "suspicious" Afirma molecular test. The primary outcomes and measures included the rate of adverse oncologic outcomes (mortality and recurrence), as well as the cumulative incidence of size/volume growth. RESULTS Sixty-nine patients were followed with active surveillance for 1 year or longer (average 55 months), with 26 patients (38%) having nodules 2 cm or larger. No patients were found to develop new-incident occurrence of lymph node or distant metastasis. One patient, however, demonstrated concern for progression to a dedifferentiated cancer on repeat core biopsy 17 years after initial start of nonoperative selection. A total of 21% of patients had an increase in maximum diameter more than 3 mm, while volume increase of 50% or greater was noted in 25% of patients. Thirteen patients ultimately underwent delayed (rescue) surgery, and no disease recurrence was noted after such treatment. Age and initial nodule size were not predictors of nodule growth. CONCLUSION These data expand consideration of active surveillance of PTC in select patients with intrathyroidal suspected malignancy greater than 1 cm in diameter. Rescue surgery, if required at a later time point, appears effective.
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Affiliation(s)
- Benjamin Altshuler
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Athanasios Bikas
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Theodora Pappa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Ellen Marqusee
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Nancy L Cho
- Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Matthew A Nehs
- Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Jason B Liu
- Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Gerard M Doherty
- Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Iñigo Landa
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Sara Ahmadi
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Erik K Alexander
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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4
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Zhang J, Liu J, Yi W, Liu Y, Liu Y, Xu J. Thermal ablation for multifocal papillary thyroid microcarcinoma: a systematic review and meta-analysis. Endocrine 2024; 85:35-43. [PMID: 38319587 DOI: 10.1007/s12020-024-03710-w] [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: 11/28/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Clinical studies have indicated the potential safety and efficacy of thermal ablation (TA) in treating multifocal papillary thyroid microcarcinoma (MPTMC). However, a comprehensive systematic evaluation of its effectiveness was still lack. METHODS PubMed, EMBASE and Cochrane Library databases were systematically searched for studies published until October 23, 2023, that reported on the effectiveness of thermal ablation in the management of MPTMC. Data extraction and methodological quality assessment were independently conducted by two reviewers following the guidelines outlined in the PRISMA. RESULTS This systematic review and meta-analysis identified 389 tumors in 169 patients from four studies. After treatment with different TA, the combined rate of complete disappearance of MPTMC was 92.8% [95% confidence interval (CI): 68.2-100] and the combined rate of overall complications was 4.4% [95% CI: 1.5-8.5]. During the follow-up period, local tumor recurrence was observed in only 2 patients with a combined rate of 0.2% [95% CI: 0.0-2.6]; lymph node metastasis (LNM) was observed in 3 patients with a combined rate of 1.2% [95% CI: 0-4.1]. Additionally, 6 patients developed new PTMC. It is noteworthy that no patients were observed to develop distant metastases during the follow-up period, and no patients had delayed surgery after underwent ablation. CONCLUSIONS For patients grappling with MPTMC, TA emerges as an excellent approach for achieving localized tumor control. Nonetheless, achieving favorable outcomes necessitates stringent inclusion criteria and a profound level of expertize.
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Affiliation(s)
- Junping Zhang
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jiarong Liu
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wanting Yi
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yanling Liu
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ying Liu
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, China
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, Jiangxi, China
| | - Jixiong Xu
- Department of Endocrine and Metabolism, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Jiangxi Clinical Research Center for Endocrine and Metabolic Disease, Nanchang, Jiangxi, China.
- Jiangxi Branch of National Clinical Research Center for Metabolic Disease, Nanchang, Jiangxi, China.
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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.
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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
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Papini E, Guglielmi R, Novizio R, Pontecorvi A, Durante C. Management of low-risk papillary thyroid cancer. Minimally-invasive treatments dictate a further paradigm shift? Endocrine 2024:10.1007/s12020-024-03864-7. [PMID: 38767774 DOI: 10.1007/s12020-024-03864-7] [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: 03/25/2024] [Accepted: 05/05/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Current management options for PTMC include lobo-isthmectomy and active surveillance (AS). Recently, ultrasound-guided minimally invasive procedures (MITs) are offered as a nonsurgical therapy for PTMC because they do not require hospitalization and general anaesthesia, and do not result in loss of thyroid function or cosmetic damage. MITs are reported to consistently provide, mostly in large retrospective series of patients, a rapid, safe, and cost-effective way to eradicate low-risk thyroid malignancies. However, conclusive data from well-conducted prospective studies on the histologically-proven completeness of tumor ablation and the long-term clinical advantages versus AS are still lacking. OBJECTIVES This study aimed to evaluate the efficacy and safety of ultrasound-guided minimally invasive treatments (MITs) for PTMC in comparison to traditional surgical methods and active surveillance, and to assess their role in current clinical practice. METHODS A structured literature review was conducted using keywords related to PTMC, MIT, and comparative techniques. Studies were evaluated based on treatment modality, patient selection, follow-up duration, complication rates, and clinical outcomes. RESULTS MITs have shown promising results in the management of PTMC. These treatments offer several advantages over surgery, such as reduced use of surgical resources, lower costs, minimal work disruption, and fewer major complications. However, there are still limitations, including the need for long-term surveillance and the potential risk of incomplete tumor ablation. CONCLUSIONS MITs represent a promising non-surgical option for managing low-risk PTMC, especially for patients ineligible for or refusing surgery. Despite favorable outcomes, more robust prospective data are needed to confirm their long-term benefits and completeness of tumor ablation. Interdisciplinary discussions and thorough patient education on the advantages and limitations of MITs are crucial for informed decision-making.
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Affiliation(s)
- E Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - R Guglielmi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - R Novizio
- Department of Endocrinology, Catholic University of The Sacred Heart, Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - A Pontecorvi
- Department of Endocrinology, Catholic University of The Sacred Heart, Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Alexis M, Ginzberg SP, Soegaard Ballester JM, Mandel SJ, Langer JE, Kelz RR, Wachtel H. Assessing the Frequency of Deferrable Thyroid Nodule Biopsies to De-escalate Low-Value Care. Endocr Pract 2024; 30:305-310. [PMID: 38160939 PMCID: PMC10990838 DOI: 10.1016/j.eprac.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Thyroid nodules are common, yet fewer than 1 in 10 harbors malignancy. When present, thyroid cancer is typically indolent with excellent survival. Therefore, patients who are not candidates for thyroid cancer treatment due to comorbid disease may not require further thyroid nodule evaluation. The goal of this study was to determine the rate of deferrable thyroid nodule biopsies in patients with limited life expectancy. METHODS We identified patients who underwent thyroid fine needle aspiration (FNA) between 2015 and 2018 at our institution. The primary outcome was the number of deferrable FNAs, defined as FNAs performed in patients who died within 2 years after biopsy. Secondary outcomes included cytologic Bethesda score, procedure costs, and final diagnosis on surgical pathology. Multivariable logistic and Cox proportional hazards regressions were used to evaluate factors associated with FNA in patients with limited life expectancy. RESULTS A total of 2565 FNAs were performed. Most patients were female (79%), and 37 (1.5%) patients died within 2 years. Nonthyroid specialists were significantly more likely to order deferrable FNAs (odds ratio 4.13, P < .001). Of the patients who died within 2 years, most (78%) had a concomitant diagnosis of nonthyroid cancer, and 4 went on to have thyroid surgery (Bethesda scores: 3, 4, 4, and 6). Spending associated with deferrable FNAs and subsequent surgery totaled over $98 000. CONCLUSIONS Overall, the rate of deferrable thyroid nodule biopsies was low. However, there is an opportunity to reduce low-value biopsies in patients with a concurrent nonthyroid cancer by partnering with oncology providers.
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Affiliation(s)
- Maya Alexis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara P Ginzberg
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Susan J Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jill E Langer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Xiao WC, Li X, Shan R, Mei F, Song SB, Chen J, Sun BK, Yuan CH, Liu Z. Pregnancy and Progression of Differentiated Thyroid Cancer: A Propensity Score-Matched Retrospective Cohort Study. J Clin Endocrinol Metab 2024; 109:837-843. [PMID: 37738427 DOI: 10.1210/clinem/dgad557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 09/24/2023]
Abstract
CONTEXT AND OBJECTIVE Differentiated thyroid cancer (DTC) is very common in women of reproductive age. However, it remains unclear whether pregnancy is associated with DTC progression before surgical treatment. METHODS This retrospective cohort study, conducted at the Peking University Third Hospital in Beijing, China between January 2012 and December 2022, included 311 eligible women aged 20 to 45 years. To control for potential confounders, we first used propensity score matching (PSM) to match the pregnant group (n = 48) with the nonpregnant group (n = 154) on age, tumor size, tumor type, and Hashimoto's thyroiditis status at baseline, and then used Cox proportional risk models stratified by the matched pairs to estimate the association of pregnancy with DTC progression. RESULTS After PSM, the pregnant and nonpregnant groups were well comparable at baseline (standardized difference < 10% and P > .05). Over an average observation period of 2.5 years, we observed no difference between the pregnant group and the matched nonpregnant group in DTC progression-free survival (hazard ratio [HR] = 0.96; 95% CI, 0.56 to 1.65; P = .895), tumor enlargement-free survival (HR = 0.99; 95% CI, 0.56 to 1.76; P = .969) or lymph node metastasis-free survival (LNM) (HR = 0.67; 95% CI, 0.21 to 2.13; P = .498). The postoperative pathological characteristics also showed no significant difference between the pregnant and nonpregnant groups (P > .05). CONCLUSION Pregnancy seemed to be irrelevant to DTC progression-free survival before surgical treatment. Further prospective cohort studies are needed to translate this finding into clinical practice.
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Affiliation(s)
- Wu-Cai Xiao
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Xin Li
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Rui Shan
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Fang Mei
- Department of Pathology, Peking University Third Hospital, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Shi-Bing Song
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Jing Chen
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
| | - Bang-Kai Sun
- Information Management and Big Data Center, Peking University Third Hospital, Beijing 100191, China
| | - Chun-Hui Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Zheng Liu
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
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9
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Ledesma-Leon T, Solis-Pazmino P, Lincango EP, Figueroa LA, Ellenhorn J, Nasseri Y, Cohen J, Romero-Arenas M, Garcia C, Sanabria A, Rojas T, Torres-Román J, Camacho E, Vallejo S, Alvarado-Mafla B, Dream S, James BC, Ponce OJ, Sharma A, Brito JP. Ablation techniques or active surveillance compared to surgical resection in patients with low-risk papillary thyroid cancer: a systematic review and meta-analysis. Endocrine 2024; 83:330-341. [PMID: 37658978 DOI: 10.1007/s12020-023-03502-8] [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: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND The global prevalence of thyroid cancer is on the rise. About one-third of newly diagnosed thyroid cancer cases comprise low-risk papillary thyroid cancer (1.5 cm or more minor). While surgical removal remains the prevailing approach for managing low-risk papillary thyroid cancer (LPTC) in patients, other options such as active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) are also being considered as viable alternatives. This study evaluated and compared surgical thyroid resection (TSR) versus non-surgical (NS) methods for treating patients with LPTC. METHODS The study encompassed an analysis of comparisons between surgical thyroid resection (TSR) and alternative approaches, including active surveillance (AS), radiofrequency ablation (RFA), microwave ablation (MWA), or laser ablation (LA). The focus was on patients with biopsy-confirmed low-risk papillary thyroid cancer (LPTC) of less than 1.5 cm without preoperative indications of local or distant metastasis. The primary outcomes assessed were recurrence rates, disease-specific mortality, and quality of life (QoL). Data were collected from prominent databases, including Cochrane Database, Embase, MEDLINE, and Scopus, from inception to June 3rd, 2020. The CLARITY tool was utilized to evaluate bias risk. The analysis involved odds ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes, as well as mean differences (MD) and standardized mean differences (SMD) for continuous outcomes. The study is registered on PROSPERO under the identifier CRD42021235657. RESULTS The study incorporated 13 retrospective cohort studies involving 4034 patients. Surgical thyroid resection (TSR), active surveillance (AS), and minimally invasive techniques like radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) were performed in varying proportions of cases. The analysis indicated that specific disease mortality rates were comparable among AS, MWA, and TSR groups. The risk of recurrence, evaluated over different follow-up periods, showed no significant differences when comparing AS, RFA, MWA, or LA against TSR. Patients undergoing AS demonstrated better physical health-related quality of life (QoL) than those undergoing TSR. However, no substantial differences were observed in the overall mental health domain of QoL when comparing AS or RFA with TSR. The risk of bias was moderate in nine studies and high in four. CONCLUSION Low-quality evidence indicates comparable recurrence and disease-specific mortality risks among patients with LPTC who underwent ablation techniques or active surveillance (AS) compared to surgery. Nevertheless, individuals who opted for AS exhibited enhanced physical quality of life (QoL). Subsequent investigations are warranted to validate these findings.
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Affiliation(s)
- Tannya Ledesma-Leon
- Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
| | - Paola Solis-Pazmino
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
- Surgery Group Los Angeles, Los Angeles, CA, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eddy P Lincango
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
| | - Luis A Figueroa
- Universidad Central del Ecuador, Facultad de Ciencias Médicas, Quito, Ecuador
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
| | | | | | - Jason Cohen
- Surgery Group Los Angeles, Los Angeles, CA, USA
| | - Minerva Romero-Arenas
- Department of Surgery, Weill Cornell Medicine New York Presbyterian Brooklyn Methodist Hospital, New York, NY, USA
| | - Cristhian Garcia
- Instituto de la Tiroides y Enfermedades de Cabeza y Cuello, Quito, Ecuador
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia. -Centro de Excelencia en Enfermedades de Cabeza y Cuello. CEXCA, Medellin, Colombia
| | - Tatiana Rojas
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
| | | | - Emilia Camacho
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
| | - Sebastian Vallejo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Sophie Dream
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Benjamin C James
- Beth Israel Deaconess Medical Center Department of Surgery, 484273, Surgery, 185 Pilgrim Road, Palmer 605, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Oscar J Ponce
- CaTaLiNA- Cancer de Tiroides en Latino America, Quito, Ecuador
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA
| | - Arun Sharma
- MultiCare Health System Tacoma General Hospital, Tacoma, WA, USA
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, 55905, USA.
- Mayo Clinic, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Rochester, MN, 55905, USA.
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Kim MJ, Moon JH, Lee EK, Song YS, Jung KY, Lee JY, Kim JH, Kim K, Park SK, Park YJ. Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines. Endocrinol Metab (Seoul) 2024; 39:47-60. [PMID: 38356210 PMCID: PMC10901665 DOI: 10.3803/enm.2024.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.
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Affiliation(s)
- Min Joo Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Young Shin Song
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Deparment of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Deparment of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyungsik Kim
- Deparment of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sue K. Park
- Deparment of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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11
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Wang D, Yang Y, He Y, Yang H, Yang L. Natural History and Prognostic Model of Untreated Papillary Thyroid Cancer: A SEER Database Analysis. Cancer Control 2024; 31:10732748241253956. [PMID: 38756002 PMCID: PMC11102674 DOI: 10.1177/10732748241253956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/27/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE This investigation leveraged the SEER database to delve into the progression patterns of PTC when left untreated. Furthermore, it aimed to devise and authenticate a nomogram for prognosis prediction for such patients. METHODS We extracted data from the SEER database, focusing on PTC-diagnosed individuals from 2004-2020. To discern disease progression intervals, median survival times across stages were gauged, and the disease progression time was estimated by subtracting the median survival time of a more severe stage from its preceding stage. Prognostic determinants in the training set were pinpointed using both univariate and multivariate Cox regression. Using these determinants, a prognostic nomogram was crafted. RESULTS In untreated PTC patients, those in stages I and II had a favorable prognosis, with 10-year overall survival rates of 86.34% and 66.03%, respectively. Patients in stages III and IV had a relatively poorer prognosis. The median survival time of stage III, stage IVA, stage IVB and stage IVC patients was 108months, 43 months, 20 months and 8 months, respectively. The deduced progression intervals from stages III-IVC were 65, 23, and 12 months. In the training set, age, tumor stage, gender, and marital status were identified as independent risk factors influencing the prognosis of untreated PTC, and a nomogram was constructed using these variables. CONCLUSION In the absence of treatment intervention, early-stage PTC progressed slowly with an overall favorable prognosis. However, in mid to advanced-stage PTC, as tumor stage increased, disease progression accelerated, and prognosis gradually worsened. Age, tumor stage, marital status, and gender were independent risk factors influencing the prognosis of untreated PTC, and the nomogram based on these factors demonstrated good prognostic capability.
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Affiliation(s)
- Dasong Wang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Yan Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Yu He
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Hongwei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Lei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
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12
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Li Y, Wu F, Ge W, Zhang Y, Hu Y, Zhao L, Gou W, Shi J, Ni Y, Li L, Fu W, Lin X, Yu Y, Han Z, Chen C, Xu R, Zhang S, Zhou L, Pan G, Peng Y, Mao L, Zhou T, Zheng J, Zheng H, Sun Y, Guo T, Luo D. Risk stratification of papillary thyroid cancers using multidimensional machine learning. Int J Surg 2024; 110:372-384. [PMID: 37916932 PMCID: PMC10793787 DOI: 10.1097/js9.0000000000000814] [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: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is one of the most common endocrine malignancies with different risk levels. However, preoperative risk assessment of PTC is still a challenge in the worldwide. Here, the authors first report a Preoperative Risk Assessment Classifier for PTC (PRAC-PTC) by multidimensional features including clinical indicators, immune indices, genetic feature, and proteomics. MATERIALS AND METHODS The 558 patients collected from June 2013 to November 2020 were allocated to three groups: the discovery set [274 patients, 274 formalin-fixed paraffin-embedded (FFPE)], the retrospective test set (166 patients, 166 FFPE), and the prospective test set (118 patients, 118 fine-needle aspiration). Proteomic profiling was conducted by FFPE and fine-needle aspiration tissues from the patients. Preoperative clinical information and blood immunological indices were collected. The BRAFV600E mutation were detected by the amplification refractory mutation system. RESULTS The authors developed a machine learning model of 17 variables based on the multidimensional features of 274 PTC patients from a retrospective cohort. The PRAC-PTC achieved areas under the curve (AUC) of 0.925 in the discovery set and was validated externally by blinded analyses in a retrospective cohort of 166 PTC patients (0.787 AUC) and a prospective cohort of 118 PTC patients (0.799 AUC) from two independent clinical centres. Meanwhile, the preoperative predictive risk effectiveness of clinicians was improved with the assistance of PRAC-PTC, and the accuracies reached at 84.4% (95% CI: 82.9-84.4) and 83.5% (95% CI: 82.2-84.2) in the retrospective and prospective test sets, respectively. CONCLUSION This study demonstrated that the PRAC-PTC that integrating clinical data, gene mutation information, immune indices, high-throughput proteomics and machine learning technology in multicentre retrospective and prospective clinical cohorts can effectively stratify the preoperative risk of PTC and may decrease unnecessary surgery or overtreatment.
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Affiliation(s)
| | - Fan Wu
- Department of Oncological Surgery
| | - Weigang Ge
- bWestlake Omics (Hangzhou) Biotechnology Co., Ltd
| | - Yu Zhang
- Department of Oncological Surgery
| | - Yifan Hu
- bWestlake Omics (Hangzhou) Biotechnology Co., Ltd
| | - Lingqian Zhao
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University
| | - Wanglong Gou
- Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang
| | | | - Yeqin Ni
- Department of Oncological Surgery
| | - Lu Li
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University
- Research Centre for Industries of the Future, Westlake University
- Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang Province
| | - Wenxin Fu
- bWestlake Omics (Hangzhou) Biotechnology Co., Ltd
| | - Xiangfeng Lin
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong Province, People’s Republic of China
| | - Yunxian Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University
| | | | | | | | - Shirong Zhang
- Centre of Translational Medicine, Hangzhou First People’s Hospital
| | - Li Zhou
- Department of Oncological Surgery
| | - Gang Pan
- Department of Oncological Surgery
| | - You Peng
- Department of Oncological Surgery
| | | | - Tianhan Zhou
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University
| | - Jusheng Zheng
- Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang
| | - Haitao Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong Province, People’s Republic of China
| | - Yaoting Sun
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University
- Research Centre for Industries of the Future, Westlake University
- Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang Province
| | - Tiannan Guo
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University
- Research Centre for Industries of the Future, Westlake University
- Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang Province
| | - Dingcun Luo
- Department of Oncological Surgery
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University
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13
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Liu Q, Song M, Zhang H. Choice of management strategy for papillary thyroid microcarcinoma: active surveillance or immediate surgery? J Cancer 2024; 15:1009-1020. [PMID: 38230222 PMCID: PMC10788711 DOI: 10.7150/jca.91612] [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: 10/28/2023] [Accepted: 12/16/2023] [Indexed: 01/18/2024] Open
Abstract
Overdiagnosis of papillary thyroid microcarcinoma (PTMC) is prevalent, and effective management of PTMC is an important matter. The high incidence and low mortality rate of papillary thyroid carcinoma (PTC) justify the preference for active surveillance (AS) over immediate surgery (IS), particularly in cases of low-risk PTMC. Japan began AS in the 1990s as an alternative surgical option for PTMC and it has shown promising results. The safety and efficacy of AS management in PTMC have been verified. However, AS may not be suitable for all PTMC cases. How to find the balance between the decision-making of AS and IS requires careful consideration. Therefore, we collected and analyzed the relevant evidence on the clinical strategies for PTC and discussed AS and IS from the perspectives of health, economic, and psychological aspects, to help clinicians in choosing a more appropriate clinical strategy for PTC.
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Affiliation(s)
| | | | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
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14
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Dong P, Teng DK, Sui GQ, Lin YQ, Luo Q, Wang QM, Li HQ, Wang H. Long-term efficacy of microwave ablation for multifocal papillary thyroid microcarcinoma: a 5-year follow-up study. Eur Radiol 2024; 34:715-723. [PMID: 37581653 DOI: 10.1007/s00330-023-10117-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES Microwave ablation (MWA) has achieved excellent long-term efficacy in treating unifocal papillary thyroid microcarcinoma (UPTMC). The therapeutic effect of this treatment on multifocal papillary thyroid microcarcinoma (MPTMC) is unknown. Therefore, we evaluated the long-term efficacy of MWA for low-risk MPTMC and to provide evidence-based medicine for the revision of clinical guidelines. METHODS This study included 66 MPTMC patients with a total of 158 lesions, all of whom received MWA. We collected and retrospectively analyzed the patients' follow-up data before MWA, at 1, 3, 6, and 12 months posttreatment and every 6 months thereafter until 5 years posttreatment. We evaluated the MWA complication rate, technical success rate (TSR), lesion volume reduction rate (VRR), and complete disappearance rate (CDR) during follow-up and in those patients with tumor progression and delayed surgery. RESULTS After 60 months of follow-up, all 158 lesions disappeared in 66 patients, and the volume was reduced from 43.82 mm3 to 0.00 mm3. The TSR and VRR were both 100%. The CDRs at 1 year, 2 years, and 3 years were 57.59%, 93.67%, and 100%, respectively. The complication rate was 3.03% (2/66), and the incidence of tumor progression was 3.03% (2/66), including one new intrathyroidal lesion and one cervical lymph node metastasis (LNM). These lesions were retreated with MWA, and the lesions disappeared during the follow-up period. CONCLUSIONS Ultrasound-guided MWA for low-risk MPTMC is safe and effective and may serve as an alternative option for patients who refuse surgery or active surveillance (AS). CLINICAL RELEVANCE STATEMENT This study concludes that ultrasound-guided microwave ablation for low-risk multifocal papillary thyroid microcarcinoma is safe and effective and may serve as an alternative option for patients who refuse surgery or active surveillance. KEY POINTS • Ultrasound-guided microwave ablation for low-risk multifocal papillary thyroid microcarcinoma is safe and effective. • During 5 years of follow-up, multifocal papillary thyroid microcarcinoma patients treated with microwave ablation had a favorable prognosis. • To provide evidence-based medicine for the revision of clinical guidelines.
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Affiliation(s)
- Peng Dong
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Guo-Qing Sui
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Yuan-Qiang Lin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Qiang Luo
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Qi-Meihui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - He-Qun Li
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China.
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15
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Gao X, Yang Y, Wang Y, Huang Y. Efficacy and safety of ultrasound-guided radiofrequency, microwave and laser ablation for the treatment of T1N0M0 papillary thyroid carcinoma on a large scale: a systematic review and meta-analysis. Int J Hyperthermia 2023; 40:2244713. [PMID: 37604507 DOI: 10.1080/02656736.2023.2244713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND To analyze the efficacy and safety of radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation (LA) in T1N0M0 papillary thyroid carcinoma (PTC) patients by evaluating data on several outcomes on a large scale. MATERIALS AND METHODS Literature searches were conducted in PUBMED, EMBASE and the Cochrane Library for studies of thermal ablation (TA) for treating T1N0M0 PTC. Data on the volume reduction rate (VRR) at the 12-month follow-up and final follow-up, complete disappearance rate, local recurrence rate, lymph node metastasis rate, and complication rate of RFA, MWA and LA were evaluated separately. RFA effects were compared between T1aN0M0 and T1bN0M0 patients. RESULTS A total of 36 eligible studies were included. RFA presented superior efficacy than MWA in 12-month VRR. At the final follow-up, the difference was slight in subgroups, showing a significant reduction. The complete disappearance rate of LA (93.00%) was higher than that of RFA (81.00%) and MWA (71.00%). Additionally, the local recurrence rate pooled proportions of MWA and RFA were both 2.00%, lower than that of the LA group (3.00%). There was no event of distant metastasis. The lymph node metastasis rates were similar, as RFA (1.00%) had the lowest. For minor complication rates, the pooled proportions of RFA (3.00%) were smaller than those of LA (6.00%) and MWA (13.00%). T1aN0M0 lesions presented with better outcomes than T1bN0M0 lesions. CONCLUSION RFA, MWA and LA were reliable in curing PTC, and RFA presented advantages in most outcomes. T1aN0M0 patients may experience fewer side effects than T1bN0M0 patients.
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Affiliation(s)
- Xuemeng Gao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yang Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yitong Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Huang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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16
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Yang X, Wang Y, Luo Y, Guo T, Zhang G. A dynamic study of the postoperative management of thyroid cancer from 2003 to 2022: a bibliometric analysis. Gland Surg 2023; 12:1579-1593. [PMID: 38107489 PMCID: PMC10721565 DOI: 10.21037/gs-23-218] [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: 05/20/2023] [Accepted: 09/22/2023] [Indexed: 12/19/2023]
Abstract
Background Over the past 20 years, the global incidence of thyroid cancer has continued to increase. The volume of literature on the postoperative management of thyroid cancer comprises 1,040 articles, from 64 countries, with 1,400 journals publishing the relevant literature, and several guidelines on the treatment of thyroid cancer. This study used bibliometric methods to identify research hotspots and explore future directions in this field. Methods We comprehensively searched the Science Citation Index Expanded (SCI-E) database of the Web of Science Core Collection (WOSCC) for articles published from 2003 to 2022 on the postoperative management of thyroid cancer. Using CiteSpace 6.1.R6 and Microsoft Office Excel 2010, we evaluated and visualized the search results. Using R Studio, we generated a network of spatial geographic distribution maps and cooperative network. Results A total of 1,040 publications were included in the study. The results revealed an overall upward trend in the number of publications and citations over the past 20 years. The United States of America (USA) had the largest number of publications and the highest centrality (n=282, centrality =0.28). Johns Hopkins University had highest centrality (centrality =0.15) and was the academic center of the field. Thyroid was the journal with the highest number of citations (n=826), and the American Journal of Surgical Pathology was the journal with the highest centrality (centrality =0.08). The top 10 citations in the literature were mainly guidelines and consensus statements on the management of thyroid cancer. A keyword-based clustering analysis revealed the prominence of clusters of keywords, such as follow-up, recurrent laryngeal nerve, and medullary thyroid carcinoma (MTC). A keyword burst detection analysis showed that the term papillary had the highest burst intensity (strength =8.02), while management guidelines, association guidelines, active surveillance (AS), microcarcinoma, and differentiated thyroid cancer were the current burst words. Conclusions Over the past two decades, the number of relevant publications in the postoperative management of thyroid cancer field has continued to grow. Among the many research directions, follow-up, recurrent laryngeal nerve, and MTC are research hotspots. Future research is likely to revolve around guidelines and consensus statements on the management of thyroid cancer, AS, and microcarcinoma in differentiated thyroid cancer.
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Affiliation(s)
- Xi Yang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yiming Wang
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yunpeng Luo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Teng Guo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Guangde Zhang
- Department of Endocrinology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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17
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Yan L, Yang Z, Li Y, Li X, Xiao J, Jing H, Luo Y. Five-year Outcome Between Radiofrequency Ablation vs Surgery for Unilateral Multifocal Papillary Thyroid Microcarcinoma. J Clin Endocrinol Metab 2023; 108:3230-3238. [PMID: 37318878 DOI: 10.1210/clinem/dgad360] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
CONTEXT Ultrasound (US)-guided radiofrequency ablation (RFA) has been considered as an alternative to surgery or active surveillance for papillary thyroid microcarcinoma (PTMC). However, little is known about the long-term outcomes of RFA in comparison with surgery for unilateral multifocal PTMC. OBJECTIVE This work aims to report the comparison between RFA vs surgery for unilateral multifocal PTMC over a more than 5-year follow-up period. METHODS This was a retrospective study at a primary care center with a median follow-up period of 72.9 months. A total of 97 patients with unilateral multifocal PTMC were treated with RFA (RFA group, n = 44) or surgery (surgery group, n = 53). In the RFA group, patients were treated by a bipolar RFA generator and an 18-gauge bipolar RF electrode with a 0.9-cm active tip. In the surgery group, patients underwent thyroid lobectomy with prophylactic central neck dissection. RESULTS During the follow-up, no statistically significant differences were found in disease progression (4.5% vs 3.8%; P = ≥.999), lymph node metastasis (2.3% vs 3.8%; P = ≥.999), persistent lesion (2.3% vs 0%; P = .272), and RFS rates (97.7% vs 96.2%; P = .673) in the RFA and surgery groups. Patients undergoing RFA had a shorter hospitalization (0 vs 8.0 [3.0] d; P < .001), shorter procedure time (3.5 [2.4] vs 80.0 [35.0] min; P < .001), lower estimated blood loss (0 vs 20.0 [15.0] mL; P < .001), and lower costs ($1768.3 [0.1] vs $2084.4 [1173.8]; P = .001) than those in the surgery group. The complication rate in the surgery group was 7.5%, whereas none of the RFA-treated patients experienced any complications (P = .111). CONCLUSION This study revealed 6-year comparable outcomes between RFA and surgery for unilateral multifocal PTMC. RFA may be a safe and effective alternative to surgery in selected patients with unilateral multifocal PTMC.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhen Yang
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Yingying Li
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Xinyang Li
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Jing Xiao
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - HaoYu Jing
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
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18
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Hwang H, Choi JY, Yu HW, Moon JH, Kim JH, Lee EK, Kim YK, Lee CY, Cho SW, Chung EJ, Ryu CH, Ryu J, Yi KH, Park DJ, Lee KE, Park YJ, Kim SJ, Jung YS. Surgical Outcomes in Patients With Low-risk Papillary Thyroid Microcarcinoma From MAeSTro Study: Immediate Operation Versus Delayed Operation After Active SurveillanceA Multicenter Prospective Cohort Study. Ann Surg 2023; 278:e1087-e1095. [PMID: 36912439 DOI: 10.1097/sla.0000000000005841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To investigate surgical, and clinical outcomes in patients with low-risk papillary thyroid microcarcinoma (PTMC) according to treatment options [immediate operation (IOP) vs delayed operation after active surveillance (AS) (DOP)]. BACKGROUND AS has been adopted as an alternative to immediate surgery in patients with low-risk PTMC. Although some patients undergo surgery during AS, there is little information on surgical, and clinical outcomes after delayed operation after AS. METHODS A multicenter prospective cohort study including 1177 patients was conducted at 3 tertiary hospitals in Korea from June 2016 to January 2020. Patients with low-risk PTMC were enrolled. The participants were self-assigned into AS or IOP, and during AS, the patients underwent surgery if there were signs of disease progression or if the patient's choice changed. RESULTS A total of 516 patients underwent operation; 384 (74.4%) in the IOP group and 132 (25.6%) in the DOP group. Compared with the IOP group, the DOP group was significantly associated with a larger tumor size ( P =0.002), higher rates of lymphatic invasion ( P =0.002), and multifocality ( P =0.008). However, the rates of total thyroidectomy, postoperative hypoparathyroidism and vocal cord palsy did not differ significantly between the groups ( P = 0.283, P =0.184, and P =0.284, respectively). Of the 132 patients in the DOP group, disease progression was present in 39 (29.5%) patients. The DOP group with disease progression had a significantly higher rate of lymph node metastasis ( P =0.021) and radioiodine therapy ( P =0.025) than the DOP group without disease progression. CONCLUSIONS These results suggest that AS might be considered an alternative treatment option for patients with low-risk PTMC regarding the extent of thyroidectomy and postoperative complications in the DOP group. To assess oncologic outcomes, long-term follow-up will be needed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02938702.
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Affiliation(s)
- Hyeonuk Hwang
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Yeo Koon Kim
- Department of Radiology, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Chang Yoon Lee
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea
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Shi L, Le K, Qi H, Feng Y, Zhou L, Wang J, Xie L. The safety and efficacy of delayed surgery by simulating clinical progression of observable papillary thyroid microcarcinoma: a retrospective analysis of 524 patients from a single medical center. Front Oncol 2023; 13:1046014. [PMID: 37881490 PMCID: PMC10597687 DOI: 10.3389/fonc.2023.1046014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
Objective When active surveillance (AS) is developed in the patients with low-risk papillary thyroid microcarcinoma (PTMC), a medical center needs to ensure the delayed operation that is caused by PTMC clinical progression to have the same prognosis as that of immediate operation. The objective of this study was to investigate the efficacy of delayed surgery by simulating clinical progression (tumor size enlargement and appearance of lymph node metastasis) of PTMCs with AS in a single medical center. Methods We retrospectively analyzed the response to therapy in 317 papillary thyroid carcinoma patients treated with total thyroidectomy and post-operative radioactive iodine ablation. They were classified into three groups according to tumor size (group A ≤0.5 cm; group B >0.5 cm and ≤1 cm; group C >1 cm and ≤1.5 cm) or two groups according to the presence (cN1) or absence (cN0) of the clinical lymph node (LN) metastasis. Groups C and cN1 were regarded as simulated clinical progression of observational PTMC and the operation for them was assumed to be "delayed surgery". However, Groups A, B and cN0 were regarded as no clinical progression and the operation for them was considered as immediate surgery. Results There were no significantly differences in excellent response to therapy and recurrence-free survival not only among the group A, B and C, but also between the group cN0 and cN1. In other words, these insignificant differences were found between immediate and simulated "delayed" surgeries. Conclusion For the PTMC patients suitable for AS, the oncological outcomes were also excellent even if surgery was delayed until after the presence of clinical progression, according to our clinical simulation. Furthermore, we consider that it was feasible for medical centers to assess the ability to implement AS for PTMC patients by retrospectively analyzing their own previous clinical data using the described simulation.
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Affiliation(s)
- Liuhong Shi
- Department of Head and Neck Surgery, Affiliated to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kehao Le
- Department of Head and Neck Surgery, Affiliated to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Haiou Qi
- Department of Nursing, Affiliated to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yibing Feng
- Department of Second Surgery, Longyou County People’s Hospital, Sir Run Run Shaw Hospital, Quzhou, Zhejiang, China
| | - Liang Zhou
- Department of Head and Neck Surgery, Affiliated to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianbiao Wang
- Department of Head and Neck Surgery, Affiliated to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lei Xie
- Department of Head and Neck Surgery, Affiliated to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Lin Y, Wu Y. Trends in incidence and overdiagnosis of thyroid cancer in China, Japan, and South Korea. Cancer Sci 2023; 114:4052-4062. [PMID: 37488752 PMCID: PMC10551580 DOI: 10.1111/cas.15909] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
We used data from 13 cancer registries in China, Japan, and South Korea to analyze time trends in overdiagnosis of thyroid cancer between 1998 and 2012. Age-standardized and age-specific incidence and annual percentage changes were calculated. The number of thyroid cancers diagnosed and the proportion attributable to overdiagnosis were estimated, with calculations stratified by sex and age group. The Spearman method was used to analyze the correlation between thyroid cancer incidence and overdiagnosis. From 1998 to 2012, both the incidence and proportions of overdiagnoses of thyroid cancer in China, Japan, and South Korea showed an increasing trend, with higher rates in women than men. South Korea had both the highest incidence for men (10.1/105 ) and women (46.7/105 ) and the highest proportions of overdiagnosis (men, 90.3%; women, 94.9%). The fastest growth in overdiagnosis was in Chinese men and women (annual percentage changes 6.1 and 4.6, respectively). We found significant positive correlations between age-standardized incidence and proportions of overdiagnosis for both men (Spearman r = 0.98, p < 0.05) and women (Spearman r = 0.99, p < 0.05) in the three countries. Age-specific incidence curves in Chinese and South Korean individuals were of an inverted U-shape. Overdiagnosis of thyroid cancer in Japan was mainly concentrated in middle-aged and older patients, whereas in China and South Korea, it occurred primarily in the middle-aged. The incidence and overdiagnosis of thyroid cancer in China, Japan, and South Korea are increasing, necessitating the implementation of comprehensive measures to reduce these overdiagnoses.
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Affiliation(s)
- Yongtian Lin
- Department of EpidemiologyClinical Oncology School of Fujian Medical University, Fujian Cancer HospitalFuzhouChina
| | - Yu Wu
- Department of Head and Neck SurgeryClinical Oncology School of Fujian Medical University, Fujian Cancer HospitalFuzhouChina
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21
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Lin P, Liang F, Han P, Cai Q, Chen R, Lin X, Huang X. Gasless endoscopic thyroidectomy via the anterior chest approach: the experience with 1500 cases. Surg Endosc 2023; 37:7867-7875. [PMID: 37640955 DOI: 10.1007/s00464-023-10401-6] [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: 03/15/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Conventional thyroidectomy leaves an eye-catching scar in the anterior neck region. Endoscopic thyroidectomy may achieve a better esthetic effect and improve quality of life postoperatively. The aim of this study was to undertake a complete review of a large cohort of the patients undergoing gasless endoscopic thyroidectomy (GET) via anterior chest approach (ACA) with a long-term follow-up period, and evaluate the results and limits of this procedure. METHODS Between 2003 and 2022, 1413 patients undergoing GET via ACA in our department were included. The demographic, clinicopathological characteristics, oncologic and esthetic outcomes were summarized and analyzed. RESULTS The indication for surgery was papillary thyroid carcinoma in 686 (48.5%) patients and benign thyroid diseases in 727 (51.5%) patients. Among them, 802 (56.8%) patients took hemithyroidectomy, and 611 (43.2%) patients did sub-total/total thyroidectomy. Meanwhile, 598 (42.3%) ones had central neck dissection, while 88 (6.2%) lateral neck dissection. The most common complication was transient hypoparathyroidism with an incidence of 2.9%. During the follow-up period of 2 to 232 months, three patients were confirmed locoregional recurrence. Most of the patients were satisfied with the cosmetic results. CONCLUSION Gasless endoscopic thyroidectomy via anterior chest approach is a safe and feasible procedure, which could achieve excellent oncologic and esthetic outcomes.
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Affiliation(s)
- Peiliang Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
| | - Faya Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
| | - Ping Han
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
| | - Qian Cai
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
| | - Renhui Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
| | - Xijun Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China
| | - Xiaoming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China.
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Guangzhou, 510289, Guangdong, China.
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22
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Liu C, Zhao H, Xia Y, Cao Y, Zhang L, Zhao Y, Gao L, Liu R, Liu Y, Liu H, Meng Z, Liu S, Lu Y, Li X. Active surveillance versus immediate surgery: A comparison of clinical and quality of life outcomes among patients with highly suspicious thyroid nodules 1 cm or smaller in China. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106917. [PMID: 37137793 DOI: 10.1016/j.ejso.2023.04.016] [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: 02/21/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Active surveillance (AS) is considered an alternative to immediate surgery (IS) for low-risk papillary thyroid microcarcinoma (PTMC) patients. However, it is difficult to decide between AS and IS due to limited evidence regarding risks and benefits for patients in China. METHODS This study prospectively enrolled 485 patients with highly suspicious thyroid nodules = 1 cm who chose AS and 331 patients who underwent IS during the same period. The oncological outcomes, adverse events and quality of life, were compared between the two groups. RESULTS The oncological outcomes of the IS and AS groups were similarly excellent. The IS group had significantly higher rates of temporary vocal cord paralysis (VCP) and temporary hypoparathyroidism than the AS group (2.7% vs. 0.2%, p = 0.002; 13.6% vs.1.9%, p < 0.001, respectively). The IS group had significantly more patients on hormone replacement therapy (98.4% vs. 10.9%, p < 0.001) and a significantly higher incidence of neck scarring (94.3% vs. 9.1%, p < 0.001) compared to the AS group. In the early stages, the quality of life questionnaire showed significant differences with respect to three items: voice, throat/mouth, and surgical scarring, with more complaints in the IS group. However, one year or more after surgery, the main complaint was surgical scarring. CONCLUSION In China, AS can achieve similar short-term therapeutic effects as IS. As this approach can reduce the occurrence of unfavorable events, achieve better quality of life, it is a feasible option for patients with highly suspicious thyroid nodules.
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Affiliation(s)
- Chunhao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Liyang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Ya Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Ruifeng Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Yuewu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Hongfeng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Zhilan Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Shuzhou Liu
- Department of Otolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan, 570311, China.
| | - Ying Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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23
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Orloff LA, Parangi S. History of Thyroid Surgery in the Last Century. Thyroid 2023; 33:1029-1038. [PMID: 37594750 DOI: 10.1089/thy.2022.0629] [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] [Indexed: 08/19/2023]
Abstract
Before the 20th century, thyroid surgery was regarded as "horrid butchery" such that no honest and sensible surgeon would ever engage in it. Yet, by the mid-20th century, thyroidectomy had become a respected, life-saving, safe, and increasingly practiced operation. From Kocher to Wells and onward into the 21st century, the evolution of thyroid surgery has continued, enhanced by the integration of endocrinology, genetics, immunology, physiology, technology, training, and multidisciplinary care. The ability to personalize and optimize the care of thyroid disorders has been progressively achieved through shared insights and discoveries, highlights of which are described herein.
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Affiliation(s)
- Lisa A Orloff
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sareh Parangi
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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24
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AIUM Practice Parameter for the Performance and Interpretation of Diagnostic Ultrasound of the Thyroid and Extracranial Head and Neck. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:E55-E62. [PMID: 37172222 DOI: 10.1002/jum.16251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/14/2023]
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25
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Kim J, Roth EG, Carlisle K, Munir KM, Fletke KJ, Slejko JF, Mullins CD, Hu Y. Eliciting Low-Risk Thyroid Cancer Treatment Preferences Using Clinical Vignettes: A Pilot Study. Endocr Pract 2023; 29:525-528. [PMID: 37121401 PMCID: PMC10330205 DOI: 10.1016/j.eprac.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE While surgical resection has been the traditional standard treatment for small (≤1 cm), differentiated thyroid cancers, active surveillance (AS) and radiofrequency ablation (RFA) are increasingly considered. The aim of this study was to explore patient preferences in thyroid cancer treatment using a series of clinical vignettes. METHODS Thyroid cancer survivors and general population volunteers were recruited to rank experience-driven clinical vignettes in order of preference. Rankings were compared using Wilcoxon signed rank. Formative qualitative methods were used to develop and refine clinical vignettes that captured 4 treatments-thyroid lobectomy (TL), total thyroidectomy (TT), AS, and RFA-along with 6 treatment complications. Content was validated via interviews with 5 academic subspecialists. RESULTS Nineteen volunteers participated (10 survivors, 9 general population). Treatment complications were ranked lower than uncomplicated counterparts in 99.0% of cases, indicating excellent comprehension. Counter to our hypothesis, among uncomplicated vignettes, median rankings were 1 for AS, 2 for RFA, 3.5 for TL, and 5 for TT. Trends were consistent between thyroid cancer survivors and the general population. AS was significantly preferred over RFA (P = .02) and TT (P < .01). Among surgical options, TL was significantly preferred over TT (P < .01). CONCLUSION When treatments for low-risk thyroid cancer are described clearly and accurately through clinical vignettes, patients may be more likely to choose less invasive treatment options over traditional surgical resection.
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Affiliation(s)
- Justin Kim
- Department of Surgery, University of Maryland, Baltimore, Baltimore, Maryland
| | - Erin G Roth
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Kendyl Carlisle
- Department of Surgery, University of Maryland, Baltimore, Baltimore, Maryland
| | - Kashif M Munir
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kyle J Fletke
- Department of Family Medicine, University of Maryland Baltimore, Baltimore, Maryland
| | - Julia F Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - C Daniel Mullins
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Yinin Hu
- Department of Surgery, University of Maryland, Baltimore, Baltimore, Maryland.
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26
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Yan L, Liu Y, Li W, Zhu Y, Wang J, Zhang M, Tang J, Che Y, Wang H, Wang S, Luo Y. Long-term Outcomes of Ultrasound-guided Thermal Ablation for the Treatment of Solitary Low-risk Papillary Thyroid Microcarcinoma: A Multicenter Retrospective Study. Ann Surg 2023; 277:846-853. [PMID: 36727947 DOI: 10.1097/sla.0000000000005800] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report more than 5-year outcomes of ultrasound-guided thermal ablation (TA) for patients with solitary low-risk papillary thyroid microcarcinoma (PTMC) in a large multicenter cohort. BACKGROUND TA, including radiofrequency ablation (RFA) and microwave ablation (MWA) have been used in patients with low-risk PTMC who refuse surgery or active surveillance. However, its clinical value remains controversial. MATERIALS AND METHODS This retrospective multicenter study included 474 patients with solitary low-risk PTMC treated with TA (357 for RFA; 117 for MWA) from 4 centers and followed up for at least 5 years. Disease progression including lymph node metastasis and recurrent tumors, volume reduction rate (VRR), tumor disappearance rate, complications, and delayed surgery were assessed. RFA and MWA outcomes were compared using propensity score matching. RESULTS During the median follow-up period of 77.2 months, disease progression incidence, lymph node metastasis, and recurrent tumors rates were 3.6%, 1.1%, and 2.5%, respectively. Age below 40 years old, male sex, Hashimoto thyroiditis, and tumor size were not independent factors associated with disease progression by Cox analysis. The median VRR was 100% and 471 tumors disappeared radiographically. Eight patients experienced transient voice change (1.7%) which recovered within 3 months. None of the patients underwent delayed surgery because of anxiety. After 1:1 matching, no significant differences were found in the disease progression, VRR, tumor disappearance rate, or complications between RFA and MWA subgroups. CONCLUSION This multicenter study revealed that TA was an effective and safe treatment for patients with solitary low-risk PTMC, which could be offered as a treatment option for the management for low-risk PTMC.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Liu
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
| | - WenHui Li
- Depart of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - YaLin Zhu
- Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinling Wang
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Tang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Che
- Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hui Wang
- Depart of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Shurong Wang
- Department of Medical Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics & Traumatology, Yantai, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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Won HR, Jeon E, Heo DB, Chang JW, Shong M, Kim JR, Ko H, Kang YE, Yi HS, Lee JH, Joung KH, Kim JM, Lee Y, Kim SW, Jeong YJ, Ji YB, Tae K, Koo BS. Age-Dependent Clinicopathological Characteristics of Patients with T1b Papillary Thyroid Carcinoma: Implications for the Possibility of Active Surveillance. Ann Surg Oncol 2023; 30:2246-2253. [PMID: 36581723 DOI: 10.1245/s10434-022-13011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Active surveillance (AS) of low-risk T1a papillary thyroid carcinoma (PTC) is generally accepted as an alternative to immediate surgery. The cut-off in the size criterion for AS has recently been extended in select individuals, especially older patients. We evaluated the clinicopathological differences of T1b PTC according to age to investigate the possibility of AS in older patients. PATIENTS AND METHODS From a cohort study of 1269 patients undergoing lobectomy for PTC, 1223 PTC patients with T1 stage disease (tumor ≤ 2 cm) were enrolled. The clinicopathological characteristics between T1a and T1b patients according to age were analyzed. RESULTS Among the 1223 T1 cases, 918 (75.1%) were T1a (≤ 1 cm) and 305 (34.9%) T1b (> 1 and ≤ 2 cm). T1b PTC was associated with male sex, minimal extrathyroidal extension, lymphovascular invasion, occult central lymph node (LN) metastasis, and a higher number of metastatic LNs than T1a. However, in patients over 55 years of age, the clinicopathological features of the patients with T1a and T1b PTC were not significantly different except for minimal extrathyroidal extension, although many clinicopathological differences were observed in patients under 55 years of age. CONCLUSION The clinicopathological features of patients with T1b PTC over 55 years of age are similar to those with T1a PTC and less aggressive than those with T1b PTC under 55 years of age. These findings suggest that AS may be possible in patients with T1b PTC over 55 years of age without high-risk features on preoperative examinations.
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Affiliation(s)
- Ho-Ryun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Eonju Jeon
- Department of Internal Medicine, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Da Beom Heo
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Minho Shong
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Je Ryong Kim
- Department of Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hyemi Ko
- Department of Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Yea Eun Kang
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Hyon-Seung Yi
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Ju Hee Lee
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
| | - Kyong Hye Joung
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Ji Min Kim
- Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea
- Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Younju Lee
- Departments of Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Sung-Woo Kim
- Department of Internal Medicine, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Young Ju Jeong
- Department of Surgery, School of Medicine, Daegu Catholic University, Daegu, Republic of Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Kyung Tae
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Bon Seok Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea.
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Smulever A, Pitoia F. Conservative management of low-risk papillary thyroid carcinoma: a review of the active surveillance experience. Thyroid Res 2023; 16:6. [PMID: 36907911 PMCID: PMC10009928 DOI: 10.1186/s13044-023-00148-6] [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: 10/12/2022] [Accepted: 01/22/2023] [Indexed: 03/14/2023] Open
Abstract
The detection of low-risk thyroid carcinoma has increased in recent decades, although disease-specific mortality remained without changes. The high prevalence of occult carcinomas in autopsy studies, and hence the underlying indolent course of this entity, prompted the emergence of active surveillance as an alternative approach to these tumors. This strategy aims to recognize the minority group of patients who will develop clinical progression and probably benefit from deferred surgery. Experience around the world has shown that during active surveillance these tumors are mostly unchanged in size, with very-slow growth and even a decrease in diameter. Moreover, the rates of lymph node metastases were low and easily handled by rescue surgery, and distant metastases have not been reported. Given the high prevalence of small thyroid carcinomas and the excellent outcomes for observation, active surveillance provides a safe and feasible alternative in properly selected patients with low-risk thyroid cancer.
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Affiliation(s)
- Anabella Smulever
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, Argentina
| | - Fabian Pitoia
- Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, Argentina.
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29
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Scherer HC, Fernandes PM, Scheffel RS, Zanella AB, Maia AL, Dora JM. Papillary Thyroid Microcarcinoma: Insights from a Cohort of 257 Thyroidectomized Patients. Horm Metab Res 2023; 55:161-168. [PMID: 36796412 DOI: 10.1055/a-2008-0824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Papillary thyroid microcarcinoma management evolved, and less aggressive strategies are now considered. Questions, however, remain on these tumors' behavior, particularly on developing countries' real ground healthcare scenarios. Our aim is to gather insights on the natural history of papillary thyroid microcarcinoma on patients treated with thyroidectomy in Brazil. Consecutive patients diagnosed with papillary thyroid microcarcinoma had their clinical characteristics, interventions, and outcomes described. Patients were classified as incidental or nonincidental based on the diagnosis after or before surgery, respectively. A sum of 257 patients were included, 84.0% of which were women, and the mean age was of 48.3±13.5 years. The mean tumor size was of 0.68±0.26 cm, 30.4% were multifocal, 24.5% had cervical metastasis, and 0.4% distant metastasis. The nonincidental and incidental tumors differed in tumor size (0.72±0.24 and 0.60±0.28 cm, respectively, p=0.003) and in presence of cervical metastasis (31.3% and 11.9%, respectively, p<0.001). Male sex, nonincidental diagnosis, and younger age were independent predictors of cervical metastasis. After 5.5 years (P25-75 2.5-9.7) of follow-up, only 3.8% of patients had persistent structural disease (3.4% cervical). Predictors of persistent disease at multivariate analysis included cervical metastasis and multicentricity. In conclusion, incidental and nonincidental papillary thyroid microcarcinoma patients of the population studied displayed excellent outcomes. Cervical metastasis and multicentricity were frequent findings and prognostic factors for persistent disease.
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Affiliation(s)
| | | | - Rafael Selbach Scheffel
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Borsatto Zanella
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Endocrinology, Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jose Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Walter LB, Scheffel RS, Zanella AB, Farenzena M, Faccin CS, Graudenz MS, Dora JM, Maia AL. Active Surveillance of Differentiated Thyroid Cancer Metastatic Cervical Lymph Nodes: A Retrospective Single-Center Cohort Study. Thyroid 2023; 33:312-320. [PMID: 36680747 DOI: 10.1089/thy.2022.0542] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: The most frequent site of recurrence of differentiated thyroid cancer (DTC) is cervical lymph nodes (LNs), which often necessitates repeated surgical interventions and morbidity in a generally indolent disease. Data on active surveillance (AS) of small cervical nodal metastasis are still scarce, particularly in real-world clinical settings. In this study, we evaluated the DTC outcomes of AS of metastatic cervical LNs and explored factors associated with disease progression. Methods: We conducted a retrospective cohort study, including DTC patients with biopsy-proven metastatic cervical LNs, who were followed on AS in a tertiary care, university-based institution in Brazil. The inclusion criteria were cervical metastasis ≤2.0 cm and an AS duration of at least 6 months. We excluded lesions with aggressive histology, those in close proximity to or invading local structures. The primary outcome was disease progression (enlargement ≥3 mm in any diameter or a new cervical metastasis). Results: Data from 40 patients were analyzed. Most were female (77.5%) and had papillary thyroid cancer (97.5%). The mean age was 47.0 (± standard deviation 15.8) years. The 8th edition of the tumor, node, metastasis stage (TNM8) staging for DTC was as follows: 29 in stage I (74.4%), 8 in stage II (20.5%), and 2 in stage IV (5.0%). The median maximum LN diameter was 0.9 (interquartile range [IQR], 0.8-1.3) cm, and the median AS follow-up duration was 27.5 (IQR, 16.5-47.3) months. Disease progression occurred in 14 (35%) patients: 7 (17.5%) due to enlargement ≥3 mm, and 7 (17.5%) had new cervical metastasis. The cervical progression-free survival was 51.0 (confidence interval, 47.0-55.0) months. No demographic, oncological, or biochemical factors were associated with disease progression. Of the 14 patients with disease progression, 8 were referred for surgery. No permanent surgical complications were reported. Of the six patients who remained on AS despite disease progression, five showed no further progression during subsequent follow-up (range 6-40 months). Conclusions: We observed that most small metastatic cervical LNs remained stable and were safely managed with AS. Nevertheless, these observations are limited by the retrospective design, small sample size, and short follow-up. Further prospective and long-term studies are warranted.
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Affiliation(s)
- Leonardo Barbi Walter
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Selbach Scheffel
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Department of Pharmacology, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andre Borsatto Zanella
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mauricio Farenzena
- Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carlo Sasso Faccin
- Department of Radiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcia Silveira Graudenz
- Department of Pathology, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - José Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Ahmadi S, Alexander EK. Active Surveillance for Low-Risk Differentiated Thyroid Cancer. Endocr Pract 2023; 29:148-153. [PMID: 36270610 DOI: 10.1016/j.eprac.2022.10.005] [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: 06/19/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 02/07/2023]
Abstract
Less aggressive treatment options, including hemithyroidectomy and active surveillance, have been accepted as treatment options for low-risk small, differentiated thyroid carcinoma (DTC). Multiple studies have shown a low rate of cancer growth and lymph node metastases and no evidence of distant metastases during active surveillance of low-risk small DTC. However, not all patients with low -risk small DTC are ideal or appropriate candidate for active surveillance. Patients with thyroid cancer adjacent to either the trachea or recurrent laryngeal nerve or those with evidence of extrathyroidal extension, a high-risk molecular profile, lymph node, or distant metastases are considered inappropriate candidates for active surveillance. In addition, there are other essential factors that clinicians should consider while recommending active surveillance, including patient financial and insurance status; availability of high-quality neck ultrasounds and experienced radiologists, endocrinologists, and surgeons; and patient preference, level of anxiety, and willingness to undergo prolonged surveillance and follow-up imaging.
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Affiliation(s)
- Sara Ahmadi
- Department of Medicine, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Erik K Alexander
- Department of Medicine, Thyroid Section, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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McQueen A, Al-Zuhir N, Ali T. Incidentalomas in the head & neck. Br J Radiol 2023; 96:20220164. [PMID: 36317814 PMCID: PMC9975523 DOI: 10.1259/bjr.20220164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Incidental findings (IFs) in the head & neck are a frequent challenge to the reporting radiologist. A combination of complex anatomy, widely varied imaging techniques and the high prevalence of benign pathology, makes safe and appropriate management of head & neck IFs problematic. The non-head & neck radiologist is unlikely to have prior personal experience of the relevant specialties or current involvement with the pertinent multidisciplinary teams, creating unfamiliarity with both the clinical aspects of head & neck disease and the value of examination techniques. This triumvirate of complex anatomy, pathology and imaging creates the perfect environment for excessive investigation and overdiagnosis. In this article, the most frequently encountered and clinically relevant head & neck IFs are summarised. To reflect daily clinical practice, we will firstly consider anatomic abnormalities identified on cross-sectional imaging and ultrasound, followed by a review of PET-CT incidental findings.
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Affiliation(s)
- Andrew McQueen
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Naail Al-Zuhir
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Tamir Ali
- Department of Radiology, Freeman Hospital Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Sasaki T, Miyauchi A, Fujishima M, Ito Y, Kudo T, Noda T, Sano T, Kishi T, Nakamura T. Comparison of Postoperative Unfavorable Events in Patients with Low-Risk Papillary Thyroid Carcinoma: Immediate Surgery Versus Conversion Surgery Following Active Surveillance. Thyroid 2023; 33:186-191. [PMID: 36205580 PMCID: PMC9986002 DOI: 10.1089/thy.2022.0444] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: Active surveillance (AS) for low-risk papillary thyroid microcarcinoma (PTMC) was initiated at Kuma Hospital in 1993 and has gradually spread worldwide. We previously demonstrated that AS is associated with a much lower incidence of unfavorable events than immediate surgery (IS). However, conversion surgery (CS) raises concerns about increased surgical complications due to advanced disease. In this study, we conducted a comparative analysis of unfavorable events after IS and CS. Methods: Between 2005 and 2019, 4635 patients clinically diagnosed with low-risk PTMC at Kuma Hospital were enrolled. Of these, 2896 underwent AS (AS group), and the remaining 1739 underwent IS (IS group). To date, 242 patients (0.8%) in the AS group have undergone CS for various reasons (CS group). Results: The incidence of unfavorable events, such as levothyroxine administration after surgery, postoperative hematoma, transient/persistent hypoparathyroidism, and transient/persistent vocal cord paralysis, did not differ between the CS and IS groups. None of the patients in the CS group had permanent vocal cord paralysis; however, this occurred in 15 patients (0.9%) in the IS group and was caused by accidental injury in 4 patients and carcinoma invasion in 11 patients. The incidence of surgery, levothyroxine administration, postoperative hematoma, transient/permanent hypoparathyroidism, and vocal cord paralysis was significantly higher (p < 0.001) in the IS group than in the AS group. There were no differences in the incidence of lymph node recurrence and overall mortality between the AS and IS groups. None of the patients in the AS and IS groups showed distant metastasis or died from thyroid carcinoma. Conclusions: There were no differences in the incidence of unfavorable events between the CS group and the IS group. Although none of the CS and AS groups had permanent vocal cord paralysis, accidental injury of the recurrent laryngeal nerve occurred in four patients (0.2%) in the IS group. The IS group had a significantly higher incidence of unfavorable events than the AS group. The prognoses of patients in both the AS and IS groups were excellent. Therefore, we recommend AS as the first-line management for low-risk PTMC.
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Affiliation(s)
- Takahiro Sasaki
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
- Address correspondence to: Takahiro Sasaki, MD, Department of Head and Neck Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Kobe 650-0011, Japan
| | | | | | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe, Japan
| | - Takuya Noda
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | - Tsutomu Sano
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
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Pace-Asciak P, Russell JO, Tufano RP. Surgical treatment of thyroid cancer: Established and novel approaches. Best Pract Res Clin Endocrinol Metab 2023; 37:101664. [PMID: 35534363 DOI: 10.1016/j.beem.2022.101664] [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] [Indexed: 11/28/2022]
Abstract
Thyroid surgery is one of the most common head and neck procedures. The thyroid can be accessed through an anterior cervical incision, or by remote access techniques such as the transoral endoscopic thyroidectomy vestibular approach (TOETVA) which is favored for its ease, safety and direct plane to the thyroid gland. Other novel approaches for targeting small-localized well-differentiated thyroid cancer are by thermal ablation, namely ultrasound guided radiofrequency ablation. These innovative techniques for minimizing a cutaneous scar or for targeting small cancers directly without removal of the gland have developed alongside our realization that low risk well-differentiated thyroid cancer tends to be slow growing and indolent. Up to date, the most robust data supports offering these therapies primarily to patients who would be eligible for active surveillance protocols. In this paper, we review the traditional surgical approaches for removing well-differentiated thyroid cancer, as well as innovative remote access techniques (namely TOETVA), and minimally invasive thermal ablation (namely RFA).
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Affiliation(s)
- Pia Pace-Asciak
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, St. Joseph's Hospital, 30 Queensway, Sunny Side West, Suite 230, M6R-1B5, Toronto, Ontario, Canada.
| | - Jonathon O Russell
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, Johns Hopkins Outpatient Center, 601 N. Caroline St., 6th Floor, Baltimore, MD, 21287, MD, USA.
| | - Ralph P Tufano
- Sarasota Memorial Health Care System Multidisciplinary Thyroid and Parathyroid Center, 1901 Floyd St., Ste.304, Sarasota, 34239, Florida, USA.
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35
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van Dijk D, Groen AH, van Dijk BAC, van Veen TL, Sluiter WJ, Links TP, Plukker JTHM. The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines. Clin Endocrinol (Oxf) 2023; 98:123-130. [PMID: 35781313 PMCID: PMC10087791 DOI: 10.1111/cen.14795] [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: 03/11/2022] [Revised: 06/06/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch thyroid cancer guidelines (NL-15) and American Thyroid Association guidelines (ATA-15). DESIGN Retrospectively, the recommendations of the NL-15 and ATA-15 guidelines were evaluated to estimate potentially adequate, under- and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017. PATIENTS A total of 240 patients with a cT1-T3aN0-1aM0 DTC fulfilled the inclusion criteria. MEASUREMENTS After actual treatment was given, patients were again categorized according to both guidelines into low, intermediate, or high-risk based on tumour status. Next, they were categorized into a congruent low-risk (n = 60), congruent high-risk (n = 73), or incongruent risk group (n = 107). Follow-up data were used to estimate the proportion of potentially adequate, under-, and overtreatment according to both guidelines. RESULTS Comparing treatment recommended by NL-15 and ATA-15 showed significantly more over- and adequate treatment when following NL-15 recommendations, and more undertreatment following ATA-15 (all: p < .001). Subanalysis of the congruent low-risk group showed overtreatment in 64% when following NL-15 guidelines (p < .001). No treatment differences were found in the congruent high-risk group. Undertreatment was most often seen in the incongruent risk group when following ATA-15 (p < .001). CONCLUSIONS Low-risk patients were treated too aggressively when following NL-15 recommendations, where the less aggressive ATA-15 approach seemed more adequate. Treatment of intermediate risk DTC patients varies greatly, with a relative higher rate of undertreatment according to the recommendations of the ATA-15, advocating further refining of the risk classification in this patient group.
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Affiliation(s)
- Deborah van Dijk
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andries H Groen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim L van Veen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Internal Medicine, Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Internal Medicine, Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John T H M Plukker
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abstract
Recently, the incidence of thyroid carcinoma has been increasing rapidly worldwide. This is interpreted as an increase in the incidental detection of small papillary thyroid carcinomas by the widespread use of high-resolution imaging techniques such as ultrasonography. However, the mortality rates of thyroid carcinoma have not changed, suggesting that small papillary thyroid carcinomas may be overdiagnosed and overtreated. Active surveillance management has been introduced from Japan since the 1990s, as one of the measures to prevent overtreatment of low-risk papillary thyroid microcarcinoma. Based on the favorable outcomes, active surveillance has been gradually adopted worldwide as an alternative to immediate surgery. The management should be carried out with strict eligibility criteria and close monitoring for cancer progression, under a multidisciplinary team. In addition, an adequate shared decision-making is mandatory for individual patients. Papillary thyroid microcarcinomas with clinically apparent lymph node metastasis, distant metastasis, or invasion to adjacent organs should have surgery.
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Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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37
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Leboulleux S, Lamartina L, Lecornet Sokol E, Menegaux F, Leenhardt L, Russ G. SFE-AFCE-SFMN 2022 Consensus on the management of thyroid nodules : Follow-up: How and how long? ANNALES D'ENDOCRINOLOGIE 2022; 83:407-414. [PMID: 36283461 DOI: 10.1016/j.ando.2022.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians, surgeons, and other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This section deals with the follow-up of thyroid nodules, low-grade tumors and microcarcinomas.
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Affiliation(s)
- Sophie Leboulleux
- Service d'Endocrinologie, Hôpitaux Universitaires de Genève, 4 Rue Gabrielle Perret-Gentil, 1205 Genève, Switzerland.
| | - Livia Lamartina
- Endocrine Oncology, Gustave Roussy and University Paris Saclay, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | | | - Fabrice Menegaux
- Endocrine Surgery Department, Pitié-Salpêtrière Hospital APHP, Institute of Cancer IUC, Sorbonne University GRC N°16, 83 Boulevard de l'Hôpital, 75013 Paris, France; Centre de Pathologie et d'Imagerie, 14 Avenue René Coty, 75014 Paris, France
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumors Department, Pitié Salpêtrière Hospital, APHP, Institute of Cancer IUC, Sorbonne University, 83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Gilles Russ
- Centre de Pathologie et d'Imagerie, 14 Avenue René Coty, 75014 Paris, France; Thyroid and Endocrine Tumors Department, Pitié-Salpêtrière Hospital APHP, Institute of Cancer IUC, Sorbonne University GRC N°16, 83 Boulevard de l'Hôpital, 75013 Paris, France
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Wang H, Wang J, Wang X, Zhu Y, Sun Y, Zhang X, Hou X, Zheng K, Liu S, Lin Y, Lin Y. Comments on National guidelines for diagnosis and treatment of thyroid cancer 2022 in China (English version). Chin J Cancer Res 2022; 34:447-450. [PMID: 36398124 PMCID: PMC9646462 DOI: 10.21147/j.issn.1000-9604.2022.05.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/13/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hao Wang
- Department of Clinical Oncology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266012, China
| | - Jian Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiang Wang
- Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yiming Zhu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuqing Sun
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Xin Zhang
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Kun Zheng
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China,Shaoyan Liu. Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Yansong Lin
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China,Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing 100730, China,Yansong Lin. Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Linhares SM, Scola WH, Remer LF, Farrá JC, Lew JI. Morbidity Associated With Surgical Removal of Substernal Thyroid Goiters. J Surg Res 2022; 277:254-260. [DOI: 10.1016/j.jss.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/09/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022]
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40
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Baidoun F, Abdel-Rahman O. The role of surgery in small differentiated thyroid cancer. Endocrine 2022; 77:469-479. [PMID: 35657579 DOI: 10.1007/s12020-022-03097-6] [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: 02/11/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The incidence of small, differentiated thyroid cancer (DTC) cases has been increasing in the United States and the world mainly due to incidental detection because of widespread use of diagnostic modalities. While the option of active surveillance instead of surgical resection is getting more popular, there is still an open discussion about the best approach in these cases. MATERIALS AND METHODS The National Cancer Database was queried for patients diagnosed with non-metastatic small T1/N0 DTC between 2004 and 2016, who have known surgical status and Charlson comorbidity index of two or less. We evaluated the overall survival (OS) based on the surgery status using Kaplan-Meier estimates and multivariable cox regression analyses. RESULTS A total of 98,501 patients with non-metastatic small DTC were included, within which 96,612 (98.1%) were treated with surgery, and 1889 (1.9%) were not treated with surgery or other ablative modalities. We found that patients who were treated with surgery had better OS compared to patients who were not treated with surgery (mean OS 171 months vs 134.1 months, P < 0.001, median OS was not reached). This difference was still statistically significant even after we used propensity score matching for age, gender, race, Charlson-Deyo score, tumor size, and histology. On multivariate analysis, surgery was associated with better OS (HR 0.218; 95% CI: 0.196-0.244; P < 0.001). Same trend was found in subgroup analysis when we split the cohort according to tumor size (<1 and ≥1 cm), histology (follicular, papillary and Hurthle cell carcinoma), and age (<55 years vs ≥55 years). CONCLUSION Patients with non-metastatic small DTC who were treated with surgery had significant improvement in OS compared to patients who were not treated with surgery. Notwithstanding the limitations of the current analysis, these results call for caution prior to recommending routine surveillance for all patients with small DTC.
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Affiliation(s)
- Firas Baidoun
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Omar Abdel-Rahman
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada
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Liu C, Zhao H, Xia Y, Cao Y, Zhang L, Zhao Y, Gao L, Liu R, Liu Y, Liu H, Meng Z, Liu S, Li X. Active surveillance of highly suspicious thyroid nodules cohort in China shows a worse psychological status in younger patients. Front Oncol 2022; 12:981495. [PMID: 36091122 PMCID: PMC9458970 DOI: 10.3389/fonc.2022.981495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Active surveillance has been considered a safe alternative to surgery for low-risk papillary thyroid microcarcinoma. This study aimed to assess the oncological outcomes and psychological status of active surveillance of highly suspicious thyroid nodules ≤10 mm in China. Methods This prospective single-center cohort study enrolled 336 patients with highly suspicious thyroid nodules for active surveillance to assess oncological outcomes and psychological status. The psychological status of patients was assessed by two different questionnaires and compared among different patient groups. Results During a median follow-up period of 28.5 months, eight patients underwent delayed surgery for tumor enlargement and one for lymph node metastases. The cumulative incidence of disease progression at 5 and 10 years was 6.0% and 12.8%, respectively. Patients who underwent delayed surgery had no permanent complications, and no patient had distant metastasis or death. Patients ≤30 years old had a higher baseline anxiety score (4.9 vs. 3.8, p=0.024), a higher proportion of baseline anxiety score, i.e., ≥8 points (24.0% vs. 12.6%, p=0.033), and a worse baseline emotional function (62.7 vs. 70.7, p=0.013) than patients >30. During AS, patients ≤30 years of age had higher overall anxiety levels (p=0.005) and a worse overall emotional function (p=0.001). Conclusions Active surveillance in Chinese patients with highly suspicious subcentimetre thyroid nodules has good oncological outcomes and can be used as a safe alternative to surgery. Younger patients (≤30) show a worse psychological status; therefore, more attention should be paid to younger patients.
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Affiliation(s)
- Chunhao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liyang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruifeng Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuewu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongfeng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhilan Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuzhou Liu
- Department of Otolaryngology Head and Neck Surgery, Hainan General Hospital, Haikou, China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Xiaoyi Li,
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Linhares SM, Scola WH, Remer LF, Khan ZF, Nguyen DM, Lew JI. Depth of mediastinal extension can predict sternotomy need for substernal thyroid goiters. Surgery 2022; 172:1373-1378. [PMID: 36031445 DOI: 10.1016/j.surg.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/08/2022] [Accepted: 06/23/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Surgical excision of substernal thyroid goiters is usually achieved through a conventional transcervical approach, and transthoracic excision is rarely necessary. Currently, there are no clear guidelines for substernal thyroid goiters that may require a transthoracic approach. This study examined what preoperative factors were significantly associated with transthoracic surgical excision for substernal thyroid goiters. METHODS A retrospective review of prospectively collected data of 109 patients with substernal thyroid goiters from a single institution was performed. The patients were stratified by transcervical and transthoracic approaches for substernal thyroid goiters. The factors possibly predictive of a transthoracic approach, including substernal extension beyond the thoracic inlet, patient-reported symptoms, tracheal deviation, and malignancy, were analyzed. Demographics including age, sex, and race, among others, were also studied. RESULTS Of 1,080 patients who underwent surgical resection for multinodular goiter, there were 109 (10%) patients with substernal thyroid goiters. Of the substernal thyroid goiter group, 11 (10%) patients underwent partial sternotomy, whereas 6 (5.5%) underwent total sternotomy. On logistic regression, only substernal component of the thyroid goiter extending beyond the sternal notch into the mediastinum was statistically significant in predicting sternotomy (odds ratio 3.43, confidence interval 1.65-6.41, P < .001). Substernal thyroid goiters with mediastinal extension of ≥5 cm beyond the sternal notch showed a sensitivity of 94% and specificity of 86.5% to predict need of sternotomy. CONCLUSION Patients with substernal thyroid goiters who exhibit progressive enlargement and/or compressive symptoms should undergo surgical excision. Although most are removed through the conventional transcervical approach, substernal thyroid goiters with a depth of mediastinal extension ≥5 cm have a high likelihood of requiring sternotomy.
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Affiliation(s)
- Samantha M Linhares
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL.
| | - William H Scola
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Lindsay F Remer
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Zahra F Khan
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - Dao M Nguyen
- Division of Thoracic Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, FL
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Haddad RI, Bischoff L, Ball D, Bernet V, Blomain E, Busaidy NL, Campbell M, Dickson P, Duh QY, Ehya H, Goldner WS, Guo T, Haymart M, Holt S, Hunt JP, Iagaru A, Kandeel F, Lamonica DM, Mandel S, Markovina S, McIver B, Raeburn CD, Rezaee R, Ridge JA, Roth MY, Scheri RP, Shah JP, Sipos JA, Sippel R, Sturgeon C, Wang TN, Wirth LJ, Wong RJ, Yeh M, Cassara CJ, Darlow S. Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:925-951. [PMID: 35948029 DOI: 10.6004/jnccn.2022.0040] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Differentiated thyroid carcinomas is associated with an excellent prognosis. The treatment of choice for differentiated thyroid carcinoma is surgery, followed by radioactive iodine ablation (iodine-131) in select patients and thyroxine therapy in most patients. Surgery is also the main treatment for medullary thyroid carcinoma, and kinase inhibitors may be appropriate for select patients with recurrent or persistent disease that is not resectable. Anaplastic thyroid carcinoma is almost uniformly lethal, and iodine-131 imaging and radioactive iodine cannot be used. When systemic therapy is indicated, targeted therapy options are preferred. This article describes NCCN recommendations regarding management of medullary thyroid carcinoma and anaplastic thyroid carcinoma, and surgical management of differentiated thyroid carcinoma (papillary, follicular, Hürthle cell carcinoma).
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Affiliation(s)
| | | | - Douglas Ball
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Paxton Dickson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Quan-Yang Duh
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Shelby Holt
- UT Southwestern Simmons Comprehensive Cancer Center
| | - Jason P Hunt
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | - Susan Mandel
- Abramson Cancer Center at the University of Pennsylvania
| | - Stephanie Markovina
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Rod Rezaee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Mara Y Roth
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Jennifer A Sipos
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Cord Sturgeon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Michael Yeh
- UCLA Jonsson Comprehensive Cancer Center; and
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Hughes DT, Reyes-Gastelum D, Ward KC, Hamilton AS, Haymart MR. Barriers to the Use of Active Surveillance for Thyroid Cancer Results of a Physician Survey. Ann Surg 2022; 276:e40-e47. [PMID: 33074908 PMCID: PMC8549720 DOI: 10.1097/sla.0000000000004417] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to determine physician-reported use of and barriers to active surveillance for thyroid cancer. SUMMARY BACKGROUND DATA It is not clear whether active surveillance for thyroid cancer is widely used. METHODS Surgeons and endocrinologists identified by thyroid cancer patients from the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles County were surveyed between 2018 and 2019. Multivariable weighted logistic regression analyses were conducted to determine physician acceptance and use of active surveillance. Results: Of the 654 eligible physicians identified, 448 responded to the survey (69% response rate). The majority (76%) believed that active surveillance was an appropriate management option, but only 44% used it in their practice. Characteristics of physicians who stated that active surveillance was appropriate management, but did not report using it included more years in practice (reference group <10 years in practice): 10 to 19 years [odds ratio, OR 0.50 [95% confidence interval, CI 0.28-0.92]; 20 to 29 years [OR 0.31 (95% CI 0.15-0.62)]; >30 years [OR 0.30 (95% CI 0.15-0.61)] and higher patient volume 11 to 30 patients per year [OR 0.39 (95% CI 0.21 -0.70)] and >50 patients per year [OR 0.33 (95% CI 0.16-0.71)] compared to < 10, with no significant difference in those seeing 31 to 50 patients. Physicians reported multiple barriers to implementing active surveillance including patient does not want (80.3%), loss to follow-up concern (78.4%), more patient worry (57.6%), and malpractice lawsuit concern (50.9%). CONCLUSION AND RELEVANCE Despite most physicians considering active surveillance to be appropriate management, more than half are not using it. Addressing existing barriers is key to improving uptake.
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Affiliation(s)
- David T Hughes
- Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - David Reyes-Gastelum
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Kevin C Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Megan R Haymart
- Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI
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Noda T, Miyauchi A, Ito Y, Kudo T, Sano T, Sasaki T, Ando T, Yamamoto M, Fujishima M, Masuoka H, Higashiyama T, Kihara M, Onoda N, Miya A. Observational management of papillary microcarcinoma appearing in the remnant thyroid after hemithyroidectomy. Endocr J 2022; 69:635-641. [PMID: 34955475 DOI: 10.1507/endocrj.ej21-0557] [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] [Indexed: 11/23/2022] Open
Abstract
Active surveillance for papillary thyroid microcarcinomas (PTMCs) initiated in Japan is becoming adopted worldwide as a management option. However, it remains unclear how to manage newly appearing PTMCs in the remnant thyroid after hemithyroidectomy. We investigated the outcomes of similar observational management (OM) for PTMCs appearing in the remnant thyroid after hemithyroidectomy for papillary thyroid carcinoma (PTC) and benign thyroid nodules. Eighty-three patients were newly diagnosed with PTMC in the remnant thyroid between January 1998 and March 2017. Of these, 42 patients underwent OM with >3 times ultrasound examinations. Their initial diagnoses were PTC (initially malignant group) in 37 patients and benign nodule (initially benign group) in 5 patients. We calculated the tumor volume doubling rate (TV-DR) during OM for each PTMC. The TV-DR (/year) was <-0.1, -0.1-0.1, 0.1-0.5, and >0.5 in 12, 19, 5, and 6 patients, respectively. The TV-DRs in both groups did not statistically differ, but six patients (16%) in the initially malignant group showed moderate growth (TV-DR >0.5/year). They underwent conversion surgery and none of them had further recurrence. The remaining 36 patients retained OM without disease progression. The TV-DR in the initially malignant group was not significantly associated with patients' backgrounds or their initial clinicopathological features. None of the patients in this study showed distant metastases/recurrences or died of thyroid carcinoma. Although a portion of PTMCs appearing after hemithyroidectomy for thyroid malignancy are moderately progressive, OM may be acceptable as a management option for PTMCs appearing in the remnant thyroid after hemithyroidectomy.
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Affiliation(s)
- Takuya Noda
- Department of Head and Neck Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe 650-0011, Japan
| | - Tsutomu Sano
- Department of Head and Neck Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Takahiro Sasaki
- Department of Head and Neck Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Takahito Ando
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | | | | | - Hiroo Masuoka
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | | | - Minoru Kihara
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Naoyoshi Onoda
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
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Kanokwongnuwat W, Larbcharoensub N, Sriphrapradang C, Suppasilp C, Thamnirat K, Sakulpisuti C, Kositwattanarerk A, Utamakul C, Sritara C, Chamroonrat W. Risk-stratified papillary thyroid microcarcinoma: post-operative management and treatment outcome in a single center. Endocrine 2022; 77:134-142. [PMID: 35476179 PMCID: PMC9242919 DOI: 10.1007/s12020-022-03060-5] [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: 12/18/2021] [Accepted: 04/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This article aims to review and assess the post-operative management and treatment outcomes of papillary thyroid microcarcinoma (PTMC) in risk-stratified patients. METHODS We retrospectively analyzed the data of PTMC patients who underwent thyroid surgery with or without radioactive iodine treatment (RAI) in a single center between January 2011 and December 2017. Demographic and clinicopathologic data were collected. Risk stratification according to the 2015 American Thyroid Association guideline was applied. RESULTS Three hundred forty PTMC patients were included. Post-operative RAI was performed in 216/340 (63.53%) patients. In the non-RAI scenario, there were 122 low-risk and two intermediate-risk patients. In total, 261 (76.77%), 57 (16.76%), and 22 (6.47%) patients were classified as low, intermediate, and high risk, respectively. With a median follow-up time of 36 months (interquartile range: 23, 52), we found unfavorable outcomes (evidenced by imaging or out-of-range serum tumor marker levels: high thyroglobulin [Tg] or rising Tg antibody [TgAb] levels) in 8/340 (2.35%) patients, all of which received RAI. PTMC patients with unfavorable outcomes were stratified as low risk (4/261 [1.53%]), intermediate risk (1/57 [1.75%]), or high risk (3/22 [13.64%]). One death occurred in a patient with initial distant metastasis in the high-risk group. Initial high-risk stratification and initial stimulated Tg (of at least 10 ng/mL) were demonstrated as independent predictors for PTMC unfavorable outcomes (persistent or recurrent disease). Five patients with unfavorable outcomes (four with persistent disease and one with recurrent disease) had abnormal Tg or TgAb values despite unremarkable imaging findings. Moreover, 79/124 (63.71%) patients in the non-RAI scenario were only followed up with neck ultrasound. CONCLUSIONS In general, at least 98% of low-risk and intermediate-risk PTMC patients showed favorable outcomes without persistent or recurrent disease, defined by either imaging or serum tumor markers. Nevertheless, aggressive disease could occur in few PTMC patients. Decisions on post-operative management and follow-up may be guided by initial high-risk stratification and initial stimulated Tg levels (≥10 ng/mL) as independent predictors for PTMC unfavorable outcomes. Monitoring using both imaging and serum tumor markers is crucial and should be implemented for patients with PTMC.
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Affiliation(s)
- Wasit Kanokwongnuwat
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Division of Nuclear Medicine, Department of Radiology, Prapokklao Hospital, Chanthaburi, Thailand
| | - Noppadol Larbcharoensub
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutintorn Sriphrapradang
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Chaiyawat Suppasilp
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kanungnij Thamnirat
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaninart Sakulpisuti
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Arpakorn Kositwattanarerk
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chirawat Utamakul
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chanika Sritara
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wichana Chamroonrat
- Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Won HR, Koo BS. Active Surveillance or Surgery in Papillary Thyroid Microcarcinoma: An Ongoing Controversy. Clin Exp Otorhinolaryngol 2022; 15:123-124. [PMID: 35644606 PMCID: PMC9149227 DOI: 10.21053/ceo.2022.00605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
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Chaturvedi P, Singh A, Bhattacharjee A, Tuljapurkar V, Nair D, Chaukar D, Dikshit R. Population-level Outcomes of Early Thyroid Cancers: A Need to Revisit Current Practice. Rambam Maimonides Med J 2022; 13:RMMJ.10467. [PMID: 35482460 PMCID: PMC9049149 DOI: 10.5041/rmmj.10467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early thyroid cancers have excellent long-term outcomes, yet the word "cancer" draws unnecessary apprehension. This study aimed to define when the recommendations for observation and surveillance may be extended to early thyroid cancers at the population level. METHODS Non-metastasized thyroid cancers ≤40 mm diameter were identified from the 1975-2016 Surveillance, Epidemiology and End Results (SEER) database. Causes of death were compared across demographic data. Disease-specific outcomes were compared to the age-adjusted healthy United States (US) population. Survival estimates were computed using Kaplan-Meier and compared using the Cox proportional hazard model. Dynamic benchmarks impacting disease-specific overall survival were determined by decision tree modeling and tested by the Cox model. RESULTS Of the 28,728 thyroid cancers included in this study, 98.4% underwent some form of thyroid-specific treatment and were followed for a maximum of 10.9 years. This group had a 4.3% mortality rate at the end of follow-up (10.9 years maximum), with 13 times more deaths attributed to competing risks rather than thyroid cancer (stage T1a versus stage T1b, P=1.000; T1 versus T2, P<0.001). Among the untreated T1a or T1b tumors, the risk of disease-specific death was 21 times lower than death due to other causes. There was no significant difference between T1a and T1b tumors nor across sex. The age-adjusted risk of death for the healthy US population was higher than for the population with thyroid cancer. Dynamic categorization demonstrated worsening outcomes up to 73 years, uninfluenced by sex or tumor size. For patients over 73 years of age, only tumors >26 mm impacted outcomes. CONCLUSION Based on the current data, T1a and T1b nodules have similar survival outcomes and are not significantly impacted even when left untreated. Multi-institutional prospective studies are needed to confirm these findings so that current observation and surveillance recommendations can be extended to certain T1 thyroid nodules.
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Affiliation(s)
- Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Arjun Singh
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre and HBNI, Mumbai, India
- To whom correspondence should be addressed. E-mail:
| | - Vidisha Tuljapurkar
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Oncology, Tata Memorial Centre and HBNI, Mumbai, India
| | - Rajesh Dikshit
- Centre for Cancer Epidemiology, Tata Memorial Centre and HBNI, Mumbai, India
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Chou R, Dana T, Haymart M, Leung AM, Tufano RP, Sosa JA, Ringel MD. Active Surveillance Versus Thyroid Surgery for Differentiated Thyroid Cancer: A Systematic Review. Thyroid 2022; 32:351-367. [PMID: 35081743 DOI: 10.1089/thy.2021.0539] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Active surveillance has been proposed as an appropriate management strategy for low-risk differentiated thyroid cancer (DTC), due to the typically favorable prognosis of this condition. This systematic review examines the benefits and harms of active surveillance vs. immediate surgery for DTC, to inform the updated American Thyroid Association guidelines. Methods: A search on Ovid MEDLINE, Embase, and Cochrane Central was conducted in July 2021 for studies on active surveillance vs. immediate surgery. Studies of surgery vs. no surgery for DTC were assessed separately to evaluate relevance to active surveillance. Quality assessment was performed, and evidence was synthesized narratively. Results: Seven studies (five cohort studies [N = 5432] and two cross-sectional studies [N = 538]) of active surveillance vs. immediate surgery, and seven uncontrolled treatment series of active surveillance (N = 1219) were included. One cross-sectional study was rated fair quality, and the remainder were rated poor quality. In patients with low risk (primarily papillary), small (primarily ≤1 cm) DTC, active surveillance, and immediate surgery were associated with similar, low risk of all-cause or cancer-specific mortality, distant metastasis, and recurrence after surgery. Uncontrolled treatment series reported no cases of mortality in low-risk DTC managed with active surveillance. Among patients managed with active surveillance, rates of tumor growth were low; rates of subsequent surgery varied and primarily occurred due to patient preference rather than tumor progression. Four cohort studies (N = 88,654) found that surgery associated with improved all-cause or thyroid cancer mortality compared with nonsurgical management, but findings were potentially influenced by patient age and tumor risk category and highly susceptible to confounding by indication; eligibility for, and receipt of, active surveillance; and timing of surgery was unclear. Conclusions: In patients with small low-risk (primarily papillary) DTC, active surveillance and immediate surgery may be associated with similar mortality, risk of recurrence, and other outcomes, but methodological limitations preclude strong conclusions. Studies of no surgery vs. surgery are difficult to interpret due to clinical heterogeneity and potential confounding factors and are unsuitable for assessing the utility of active surveillance. Research is needed to clarify the benefits and harms of active surveillance and determine outcomes in nonpapillary DTC, larger (>1 cm) cancers, and older patients.
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Affiliation(s)
- Roger Chou
- The Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Tracy Dana
- The Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Megan Haymart
- Division of Metabolism, Endocrinology, and Diabetes and Hematology/Oncology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Matthew D Ringel
- Divison of Endocrinology, Diabetes, and Metabolism and Cancer Biology Program, The Ohio State University College of Medicine and Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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Schumm MA, Shu ML, Kim J, Tseng CH, Zanocco K, Livhits MJ, Leung AM, Yeh MW, Sacks GD, Wu JX. Perception of risk and treatment decisions in the management of differentiated thyroid cancer. J Surg Oncol 2022; 126:247-256. [PMID: 35316538 DOI: 10.1002/jso.26858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES The recent de-escalation of care for differentiated thyroid cancer (DTC) has broadened the range of initial treatment options. We examined the association between physicians' perception of risk and their management of DTC. METHODS Thyroid specialists were surveyed with four clinical vignettes: (1) indeterminate nodule (2) tall cell variant papillary thyroid cancer (PTC), (3) papillary thyroid microcarcinoma (mPTC), and (4) classic PTC. Participants judged the operative risks and likelihood of structural cancer recurrence associated with more versus less aggressive treatments. A logistic mixed effect model was used to predict treatment choice. RESULTS Among 183 respondents (13.4% response rate), 44% were surgical and 56% medical thyroid specialists. Risk estimates and treatment recommendation varied markedly in each case. Respondents' estimated risk of 10-year cancer recurrence after lobectomy for a 2.0-cm PTC ranged from 1% to 53% (interquartile range [IQR]: 3%-12%), with 66% recommending lobectomy and 34% total thyroidectomy. Respondents' estimated 5-year risk of metastastic disease during active surveillance of an 0.8-cm mPTC ranged from 0% to 95% (IQR: 4%-15%), with 36% choosing active surveillance. Overall, differences in perceived risk reduction explained 10.3% of the observed variance in decision-making. CONCLUSIONS Most of the variation in thyroid cancer treatment aggressiveness is unrelated to perceived risk of cancer recurrence.
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Affiliation(s)
- Max A Schumm
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Michelle L Shu
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jiyoon Kim
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Kyle Zanocco
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Masha J Livhits
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA.,Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Greg D Sacks
- Department of Surgery, New York University Langone Health, New York, New York, USA
| | - James X Wu
- Section of Endocrine Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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