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Yan L, Yang Z, Jing H, Xiao J, Li Y, Li X, Zhang M, Luo Y. Comparative outcomes of ultrasound-guided radiofrequency ablation vs. microwave ablation for patients with T1N0M0 papillary thyroid carcinoma: a retrospective cohort study. Eur Radiol 2025:10.1007/s00330-024-11286-2. [PMID: 39836201 DOI: 10.1007/s00330-024-11286-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 10/14/2024] [Accepted: 11/08/2024] [Indexed: 01/22/2025]
Abstract
OBJECTIVE To compare the clinical outcomes between radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of T1N0M0 papillary thyroid carcinoma (PTC) in a large cohort. MATERIALS AND METHODS This retrospective study included 1111 patients with solitary T1N0M0 PTC treated with RFA (n = 894) or MWA (n = 215) by experienced physicians. A propensity score matching was used to compare disease progression, including lymph node metastases (LNM), recurrent tumors and persistent tumors, recurrence-free survival (RFS), volume reduction ratio (VRR), and complications between the RFA and MWA groups. The subgroup outcomes of T1a and T1b tumors treated with RFA and MWA were also compared. RESULTS During a mean follow-up period of 41.7 ± 12.6 months, the overall incidence rates of disease progression, LNM, recurrent tumors, and persistent tumors were 2.1%, 0.7%, 1.2%, and 0.2%, respectively. Eight patients (0.7%) experienced transient voice change and recovered within 3 months. After 1:1 matching, there were no significant differences in disease progression (3.3% vs. 3.7%, p = 0.793), LNM (1.4% vs. 1.9%, p = 1.000), recurrent tumor (1.4% vs. 1.9%, p = 1.000), persistent tumors (0.5% vs. 0%, p = 0.317), RFS rates (96.7% vs. 96.3%, p = 0.821), VRR (99.3 ± 3.0% vs. 98.3 ± 8.5%, p = 0.865), tumor disappearance rate (87.9% vs. 81.4%, p = 0.061) and complications (1.4% vs. 1.9%, p = 1.000) between the RFA and MWA groups. For T1a and T1b tumors, clinical outcomes were comparable between RFA and MWA. CONCLUSIONS RFA and MWA did not show significant differences in clinical outcomes for T1N0M0 PTC. The choice between RFA and MWA could depend on physician expertise and resources of local center resources. A qualified and experienced physician with extensive knowledge of the modalities is recommended when thermal ablation is performed. KEY POINTS Question With radiofrequency ablation (RFA) and microwave ablation (MWA) used worldwide for T1N0M0 papillary thyroid carcinoma (PTC), is one of them superior to the others? Findings There were no significant differences in disease progression, recurrence-free survival, volume reduction ratio, tumor disappearance, or complications between techniques for solitary T1N0M0 papillary thyroid carcinoma. Clinical relevance The choice between RFA and MWA could depend on physician expertise and resources of the local center resources. A qualified and experienced physician with extensive knowledge of the modalities is recommended when thermal ablation is performed.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Zhen Yang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Haoyu Jing
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Yingying Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - XinYang Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
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Jing H, Wang Z, Yan L, Xiao J, Li X, Yang Z, Zhang M, Wang H, Liu Y, Luo Y. Multicenter study of thermal ablation versus partial thyroidectomy for paratracheal papillary thyroid microcarcinoma. Eur Radiol 2025:10.1007/s00330-024-11326-x. [PMID: 39825891 DOI: 10.1007/s00330-024-11326-x] [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: 05/27/2024] [Revised: 11/20/2024] [Accepted: 11/29/2024] [Indexed: 01/20/2025]
Abstract
OBJECTIVE To compare the clinical outcomes of patients with unifocal paratracheal papillary thyroid microcarcinoma (PTMC) after thermal ablation (TA) vs. partial thyroidectomy (PT). MATERIALS AND METHODS This retrospective multicenter study included 436 patients with unifocal, clinical N0 paratracheal PTMC who underwent TA (210 patients) or PT (236 patients) between June 2014 and December 2020. The propensity score matching method was used to mitigate confounding factors between the two groups. Disease progression, progression-free survival (PFS), complications, and treatment variables were compared. Adjusted Cox regression models were utilized to assess the impact of treatment on disease progression. RESULTS After matching, a comparable incidence of disease progression (3.3% vs. 2.2%, p = 0.79) and comparable 5-year PFS rates (97.0% vs. 97.4%, p = 0.75) were observed between the TA and PT groups. Adjusted Cox regression models showed no significant correlation between TA and disease progression. TA was associated with shorter hospitalization (0 vs. 6.0 days), less estimated blood loss (0 vs. 15.0 mL), shorter incision length (0.3 vs. 6.0 cm), and lower costs ($1748.3 vs. $2898.0) compared with PT (all p < 0.001). The complication rate was 1.1% after TA and 3.3% after PT (p = 0.28), with permanent complications were exclusively observed in the PT group. CONCLUSION The mid-term incidence of disease progression and PFS rates were similar between TA and PT in patients with unifocal paratracheal PTMC. TA might represent a promising alternative treatment to PT for eligible patients with paratracheal PTMC. KEY POINTS Question Is thermal ablation a viable alternative treatment to partial thyroidectomy for treating paratracheal papillary thyroid microcarcinoma? Findings Comparable incidence of disease progression and 5-year progression-free survival rates were observed between thermal ablation and partial thyroidectomy. Clinical relevance Thermal ablation, as a minimally invasive procedure, provides a promising alternative to partial thyroidectomy, with comparable clinical outcomes for patients with paratracheal papillary thyroid microcarcinoma.
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Affiliation(s)
- Haoyu Jing
- Chinese PLA Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zixin Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jing Xiao
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xinyang Li
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Zhen Yang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126, Xian Tai Street, Changchun, Jilin, 130033, China.
| | - Yujiang Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Yongan Road No. 95, Xicheng District, Beijing, 100050, China.
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Zhou G, Xu D, Zhang B, Su R, Xu K, Zhang X, Li F, Zhao W, Cai T. Is ultrasound-guided radiofrequency ablation a reliable treatment option for unifocal T1aN0M0 papillary thyroid carcinoma in the isthmus: a retrospective comparative study based on large-sample data. Int J Hyperthermia 2024; 41:2438853. [PMID: 39658025 DOI: 10.1080/02656736.2024.2438853] [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: 10/29/2024] [Revised: 12/01/2024] [Accepted: 12/02/2024] [Indexed: 12/12/2024] Open
Abstract
OBJECTIVE To evaluate whether ultrasound-guided radiofrequency ablation (RFA) is reliable for unifocal T1aN0M0 papillary thyroid carcinoma in the isthmus (PTCI). METHODS 431 patients who underwent ultrasound-guided RFA for unifocal T1aN0M0 papillary thyroid carcinoma (PTC) were divided by location of the lesion into the PTCI group (52 females, 7 males, mean age 43.79 ± 12.04 years, range 22-74 years) and the PTCL group ((291 females, 81 males, mean age 43.42 ± 10.87 years, range 18-75 years) for comparative analysis. The efficacy of ultrasound-guided RFA was evaluated by volume reduction rate (VRR), complete disappearance rate (CDR) and disease progression, and the safety was evaluated by incidence of complications. RESULTS The two groups exhibited a consistent trend of change, with the PTCI group performing better in volume, VRR and CDR at all follow-up time points expect 1 month, but the differences were not statistically significant (p > 0.05). The mean initial volume of the PTCI group vs the PTCL group decreased significantly from 65.4 ± 69.79 vs 86.38 ± 87.09 mm³ (range 10.92-427.58 vs 3.05-471.6 mm³) to 0 vs 0 mm³ at a mean follow-up time of 31.12 ± 12.5 months (range 12-60 months); their VRR increased significantly from -618.62 ± 655.61% vs -789.85 ± 1135.07% at 1 month to 100% vs 100% at 48 months. No disease progression was found in the two groups. The PTCI group had no complications, whereas the PTCL group had a total of 7 complications (1.88%). CONCLUSIONS Ultrasound-guided RFA is reliable for unifocal T1aN0M0 PTCI. It can be promoted as an alternative to immediate surgery for selected PTC patients.
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Affiliation(s)
| | - Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, China
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, TaiZhou, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou, China
| | | | | | - Ke Xu
- Hangzhou Weja Hospital, Hangzhou, China
| | | | - Feng Li
- Hangzhou Weja Hospital, Hangzhou, China
| | - Wei Zhao
- Hangzhou Weja Hospital, Hangzhou, China
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Yao XY, Li X, Yu B, Liu SR, Wang BY, Lu SY, Li HW, Song SB, Cui LG, Tan S. Ultrasound Visualization of the Recurrent Laryngeal Nerve: A Prospective Clinical Validation Study. Ann Surg Oncol 2024:10.1245/s10434-024-16529-6. [PMID: 39557719 DOI: 10.1245/s10434-024-16529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 10/30/2024] [Indexed: 11/20/2024]
Abstract
BACKGROUND This study aimed to optimize a lateral transthyroid approach by using high-resolution ultrasonography (HRUS) for recurrent laryngeal nerve (RLN) visualization. PATIENTS AND METHODS In this prospective study of 85 patients undergoing thyroidectomy, the RLN was visualized preoperatively by using a lateral transthyroid approach via HRUS. The inferior thyroid artery, thyroid nodule, and cricoid cartilage were used as landmarks. RLN visibility was graded from poor to excellent. The accuracy of the preoperative localization of the RLN was determined by intraoperative HRUS, neuromonitoring, and surgical findings. RESULTS RLN visualization and localization were verified intraoperatively by ultrasound-guided stimulation via a neuromonitoring probe in eight patients with extended incisions owing to the need for neck dissection. A total of 110 RLNs were present in 85 patients, and the locations of 103 RLNs detected by preoperative ultrasound were confirmed intraoperatively, with an accuracy rate of 93.6%. All detected RLNs were well visualized at the inferior thyroid artery and thyroid nodule levels. The RLN was visible in 83.5% of cases at the cricoid cartilage level. The maximum short-axis diameter and cross-sectional area of the RLN at all three levels were significantly larger in males than in females (p < 0.05). In total, ten RLNs were bifurcated and two showed tumor invasions. These findings were confirmed intraoperatively. CONCLUSIONS Effective RLN visualization can be achieved using a lateral transthyroid approach via HRUS. The precise localization, prediction of anatomic variation, and invasion of RLN provide significant advantages in the individualized treatment, surgical planning, and nerve protection of patients with thyroid lesions.
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Affiliation(s)
- Xiang-Yun Yao
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Xin Li
- Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Bo Yu
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Shi-Rong Liu
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Bing-Yan Wang
- Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Si-Yi Lu
- Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Hui-Wen Li
- Department of Ultrasound, Ordos Central Hospital, Ordos, Inner Mongolia, China
| | - Shi-Bing Song
- Department of General Surgery, Peking University Third Hospital, Haidian District, Beijing, China
| | - Li-Gang Cui
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China
| | - Shi Tan
- Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, China.
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Zhong X, Cao Y, Zhang X, Liu W, Zhou P. The relationship between ablation range and ablation energy in papillary thyroid microcarcinoma: a comparison between microwave ablation and laser ablation. Eur Radiol 2024; 34:6072-6081. [PMID: 38337071 PMCID: PMC11364595 DOI: 10.1007/s00330-024-10636-4] [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: 10/11/2023] [Revised: 12/09/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To study the relationship between the ablation range and applied energy of laser ablation (LA) and microwave ablation (MWA) in papillary thyroid microcarcinoma (PTMC). METHODS A total of 201 PTMC patients were treated with LA (n = 102) or MWA (n = 99) with single-applicator fixed ablation. The ablation range was determined by contrast-enhanced ultrasound. The ratios of ablation volume, longitudinal diameter, and orthogonal diameter to ablation energy (RAV/E, RAL/E, RAO/E) were analyzed and compared between MWA and LA. The effects of PTMC characteristics and Hashimoto's thyroiditis (HT) on ablation efficiency were evaluated by linear regression. RESULTS The RAV/E was 0.72 (0.65-0.84) mm3/J for MWA and 0.48 (0.39-0.54) mm3/J for LA. HT was significantly correlated with RAV/E of LA (coefficient = - 0.367, p < 0.0001). RAL/E did not differ significantly between MWA and LA (MWA 0.026 mm/J, LA 0.025 mm/J; p = 0.957). However, MWA had a greater RAO/E than LA (MWA 0.014 mm/J, LA 0.012 mm/J; p < 0.0001). The plateau values of MWA and LA on the ablation orthogonal diameter were 10.7 mm and 8.69 mm, respectively. CONCLUSIONS MWA showed a higher RAV/E than LA. More intuitively, MWA had a better ablation performance than LA on the orthogonal axis rather than the longitudinal axis. Theoretically, MWA and LA could achieve complete ablation of ≤ 6.70 mm and ≤ 4.69 mm PTMC separately by single-applicator fixed ablation considering a unilateral 2-mm safe margin. HT had a negative effect on LA but not on MWA. CLINICAL RELEVANCE STATEMENT This study establishes strong connections between ablation energy and ablation range in papillary thyroid microcarcinoma (PTMC) in vivo, possibly contributing to the supplementation of the PTMC Ablation Consensus or Guidelines and providing a scientific basis for choosing clinical ablation parameters in PTMC. KEY POINTS • Both microwave ablation (MWA) and laser ablation (LA) have excellent performance on the ablation longitudinal axis (easily exceeding 10 mm) for papillary thyroid microcarcinoma (PTMC). • MWA performed much better than LA on the ablation orthogonal axis. • MWA and LA are expected to achieve complete ablation of ≤ 6.70 mm and ≤ 4.69 mm PTMC separately by single-applicator fixed ablation considering a unilateral 2-mm safe margin.
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Affiliation(s)
- Xinyu Zhong
- Department of Ultrasonography, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yuting Cao
- Institute of Ultrasound Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Xinghao Zhang
- Department of Ultrasonography, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Wengang Liu
- Department of Ultrasonography, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Ping Zhou
- Department of Ultrasonography, The Third Xiangya Hospital, Central South University, No.138 Tongzipo Road, Changsha, 410013, Hunan, China.
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Hekimsoy İ, Ertan Y, Serin G, Karabulut AK, Özbek SS. Comparison of ultrasound findings of papillary thyroid carcinoma subtypes based on the 2022 WHO classification of thyroid neoplasms. Front Endocrinol (Lausanne) 2024; 15:1434787. [PMID: 39205684 PMCID: PMC11349574 DOI: 10.3389/fendo.2024.1434787] [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: 05/18/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose The present study aimed to analyze and compare sonographic features of papillary thyroid carcinoma (PTC) subtypes to determine whether ultrasound (US) may aid in differentiating particular subtypes. Methods This retrospective study enrolled 133 patients diagnosed with 142 histopathologically proven PTCs as per the fifth edition of the World Health Organization classification of thyroid neoplasms between January 2013 and May 2023. US features based on the American College of Radiology and European Thyroid Imaging and Reporting Data Systems (TIRADS), and histopathological characteristics of nodules were assessed and compared. Results Histopathological analysis yielded 55 (38.7%) classic PTC, 32 (22.5%) invasive encapsulated follicular variant (IEFV) PTC, 20 (14.1%) oncocytic subtype, 14 (9.9%) non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), 11 (7.8%) infiltrative follicular subtype, 7 (4.9%) tall cell subtype, 2 (1.4%) solid subtype, and 1 (0.7%) diffuse sclerosing subtype. The US findings indicating malignancy, such as taller-than-wide shape, irregular margins, echogenic foci, and higher TIRADS categories, were more frequently demonstrated in nodules with classic PTC and the tall cell subtype, in line with their histopathological features. Conversely, IEFV-PTC and NIFTP rarely exhibited these high-risk sonographic features. US appearance of the oncocytic subtype more frequently overlapped with IEFV-PTC, yet hypo/very hypoechoic nodules with larger nodular diameters and higher TIRADS scores may favor the diagnosis of this subtype. Conclusion US features of certain subtypes may guide the differential diagnosis regarding shape, margin, echogenic foci, and TIRADS category of nodules; however, definitive subtyping is not yet possible using US images alone.
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Affiliation(s)
- İlhan Hekimsoy
- Department of Radiology, İzmir Torbalı State Hospital, Izmir, Türkiye
| | - Yeşim Ertan
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Gürdeniz Serin
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Türkiye
| | | | - Süha Süreyya Özbek
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Türkiye
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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; 85:584-592. [PMID: 38767774 PMCID: PMC11291527 DOI: 10.1007/s12020-024-03864-7] [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: 03/25/2024] [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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Issa G, Beland MD. Beyond the AJR: American College of Radiology TI-RADS Validation Study-Can We Perform Fine-Needle Aspiration of Even Fewer Nodules? AJR Am J Roentgenol 2024; 223:e2330693. [PMID: 38170829 DOI: 10.2214/ajr.23.30693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Ghada Issa
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903
| | - Michael D Beland
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903
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Ghai S, Goldstein DP, Sawka AM. Ultrasound Imaging in Active Surveillance of Small, Low-Risk Papillary Thyroid Cancer. Korean J Radiol 2024; 25:749-755. [PMID: 39028013 PMCID: PMC11306002 DOI: 10.3348/kjr.2024.0148] [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: 02/08/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 07/20/2024] Open
Abstract
The recent surge in the incidence of small papillary thyroid cancers (PTCs) has been linked to the widespread use of ultrasonography, thereby prompting concerns regarding overdiagnosis. Active surveillance (AS) has emerged as a less invasive alternative management strategy for low-risk PTCs, especially for PTCs measuring ≤1 cm in maximal diameter. Recent studies report low disease progression rates of low-risk PTCs ≤1 cm under AS. Ongoing research is currently exploring the feasibility of AS for larger PTCs (<20 mm). AS protocols include meticulous ultrasound assessment, emphasis on standardized techniques, and a multidisciplinary approach; they involve monitoring the nodules for size, growth, potential extrathyroidal extension, proximity to the trachea and recurrent laryngeal nerve, and potential cervical nodal metastases. The criteria for progression, often defined as an increase in the maximum diameter of the PTC, warrant a review of precision and ongoing examinations. Challenges exist regarding the reliability of volume measurements for defining PTC disease progression. Although ultrasonography plays a pivotal role, challenges in assessing progression and minor extrathyroidal extension underscore the importance of a multidisciplinary approach in disease management. This comprehensive overview highlights the evolving landscape of AS for PTCs, emphasizing the need for standardized protocols, meticulous assessments, and ongoing research to inform decision-making.
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Affiliation(s)
- Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Canada.
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Canada
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10
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Yan L, Li W, Zhu Y, Li X, Li Y, Li Y, Song Q, Che Y, Wang H, Luo Y. Long-term comparison of image-guided thermal ablation vs. lobectomy for solitary papillary thyroid microcarcinoma: a multi-center retrospective cohort study. Int J Surg 2024; 110:4867-4875. [PMID: 38752497 PMCID: PMC11325954 DOI: 10.1097/js9.0000000000001595] [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: 03/27/2024] [Accepted: 04/25/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Image-guided thermal ablation has been applied in patients with papillary thyroid microcarcinoma (PTMC) who refuse surgery or active surveillance. However, evidence to support ablation is limited by single-center designs and a lack of long-term data. The purpose of this study was to compare long-term outcomes between ablation and lobectomy for patients with solitary PTMC. MATERIALS AND METHODS This multi-center retrospective study included 1021 consecutive patients with solitary PTMC who underwent ablation ( n =444) or lobectomy ( n =577) at the four university-affiliated hospitals. The primary outcomes were disease progression [lymph node metastasis (LNM), recurrent tumors, persistent tumors and distant metastasis] and disease-free survival (DFS). Secondary outcomes were complications, hospitalization, procedure time, estimated blood loss and cost. The two groups were compared using propensity score matching. RESULTS After matching, no significant differences were observed in disease progression (4.7% vs. 3.4%, P =0.307), LNM (1.6% vs. 1.6%, P =1.000), recurrent tumors (2.9% vs. 1.8%, P =0.269), persistent tumors(0.2% vs. 0%, P =0.317) and DFS (95.5% vs. 97.1%, P =0.246) between the ablation and lobectomy groups during the median follow-up of 96.5 months. The ablation group had significantly lower complication rates (0.7% vs. 5.2%, P <0.001), shorter post-treatment hospitalization {median [interquartile range (IQR)], 0 vs. 4.0 [3.0] days, P <0.001}, shorter procedure time [8.5 (2.8) vs. 90.0 (43.8) min, P <0.001], reduced estimated blood loss [0 vs. 20.0 (10.0) ml, P <0.001], and lower cost [$1873.2 (254.0) vs. $2292.9 (797.8), P <0.001] than the lobectomy group. CONCLUSIONS This study revealed comparable disease progression and survival outcomes between ablation and lobectomy for solitary PTMC. Imaged-guided thermal ablation could be effective and safe alternatives to lobectomy for properly selected patients with PTMC.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - WenHui Li
- Department 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
| | - Xinyang Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yingying Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yiming Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ying Che
- Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
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11
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Xu D, Sui L, Zhang C, Xiong J, Wang VY, Zhou Y, Zhu X, Chen C, Zhao Y, Xie Y, Kong W, Yao J, Xu L, Zhai Y, Wang L. The clinical value of artificial intelligence in assisting junior radiologists in thyroid ultrasound: a multicenter prospective study from real clinical practice. BMC Med 2024; 22:293. [PMID: 38992655 PMCID: PMC11241898 DOI: 10.1186/s12916-024-03510-z] [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: 01/21/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND This study is to propose a clinically applicable 2-echelon (2e) diagnostic criteria for the analysis of thyroid nodules such that low-risk nodules are screened off while only suspicious or indeterminate ones are further examined by histopathology, and to explore whether artificial intelligence (AI) can provide precise assistance for clinical decision-making in the real-world prospective scenario. METHODS In this prospective study, we enrolled 1036 patients with a total of 2296 thyroid nodules from three medical centers. The diagnostic performance of the AI system, radiologists with different levels of experience, and AI-assisted radiologists with different levels of experience in diagnosing thyroid nodules were evaluated against our proposed 2e diagnostic criteria, with the first being an arbitration committee consisting of 3 senior specialists and the second being cyto- or histopathology. RESULTS According to the 2e diagnostic criteria, 1543 nodules were classified by the arbitration committee, and the benign and malignant nature of 753 nodules was determined by pathological examinations. Taking pathological results as the evaluation standard, the sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) of the AI systems were 0.826, 0.815, 0.821, and 0.821. For those cases where diagnosis by the Arbitration Committee were taken as the evaluation standard, the sensitivity, specificity, accuracy, and AUC of the AI system were 0.946, 0.966, 0.964, and 0.956. Taking the global 2e diagnostic criteria as the gold standard, the sensitivity, specificity, accuracy, and AUC of the AI system were 0.868, 0.934, 0.917, and 0.901, respectively. Under different criteria, AI was comparable to the diagnostic performance of senior radiologists and outperformed junior radiologists (all P < 0.05). Furthermore, AI assistance significantly improved the performance of junior radiologists in the diagnosis of thyroid nodules, and their diagnostic performance was comparable to that of senior radiologists when pathological results were taken as the gold standard (all p > 0.05). CONCLUSIONS The proposed 2e diagnostic criteria are consistent with real-world clinical evaluations and affirm the applicability of the AI system. Under the 2e criteria, the diagnostic performance of the AI system is comparable to that of senior radiologists and significantly improves the diagnostic capabilities of junior radiologists. This has the potential to reduce unnecessary invasive diagnostic procedures in real-world clinical practice.
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Affiliation(s)
- Dong Xu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Lin Sui
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Jing Xiong
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Vicky Yang Wang
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Yahan Zhou
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Xinying Zhu
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
| | - Chen Chen
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Wenling Institute of Big Data and Artificial Intelligence in Medicine, Taizhou, 317502, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
- Taizhou Key Laboratory of Minimally Invasive Interventional Therapy & Artificial Intelligence, Taizhou Campus of Zhejiang Cancer Hospital (Taizhou Cancer Hospital), Taizhou, 317502, China
| | - Yu Zhao
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Yiting Xie
- Demetics Medical Technology Co. Ltd., Hangzhou, 310022, China
| | - Weizhen Kong
- Department of Mathematics, The University of Hong Kong, Hong Kong, 999077, China
| | - Jincao Yao
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China
| | - Lei Xu
- Zhejiang Qiushi Institute for Mathematical Medicine, Hangzhou, 310022, China.
- Present address: Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
| | - Yuxia Zhai
- The Second Affiliated Hospital of Shantou University Medical College, Guangdong, 515041, China.
| | - Liping Wang
- Department of Diagnostic Ultrasound Imaging & Interventional Therapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, China.
- Zhejiang Provincial Research Center for Cancer Intelligent Diagnosis and Molecular Technology, Hangzhou, 310022, China.
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Wang SS, Ye DX, Wang B, Li MY, Zhao WX. USP15 promotes the progression of papillary thyroid cancer by regulating HMGB1 stability through its deubiquitination. J Cancer 2024; 15:2561-2572. [PMID: 38577597 PMCID: PMC10988300 DOI: 10.7150/jca.92386] [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: 11/19/2023] [Accepted: 01/16/2024] [Indexed: 04/06/2024] Open
Abstract
Purpose: Papillary thyroid cancer (PTC) stands as one of the most prevalent types of thyroid cancers, characterized by a propensity for in-situ recurrence and distant metastasis. The high mobility group protein (HMGB1), a conserved nuclear protein, plays a pivotal role in carcinogenesis by stimulating tumor cell growth and migration. Nevertheless, the underlying mechanism driving aberrant HMGB1 expression in PTC necessitates further elucidation. Materials and methods: Our study unraveled the impact of low and overexpression of USP15 on the proliferation, invasion, and metastasis of PTC cells. Through a comprehensive array of molecular techniques, we uncovered the intricate relationship between HMGB1 and USP15 in the progression of PTC. Results: In this study, we identified USP15, a deubiquitinase in the ubiquitin-specific proteases family, as a true deubiquitylase of HMGB1 in PTC. USP15 was shown to interact with HMGB1 in a deubiquitination activity-dependent manner, deubiquitinating and stabilizing HMGB1. USP15 depletion significantly decreased PTC cell proliferation, migration, and invasion. In addition, the effects induced by USP15 depletion could be rescued by further HMGB1 overexpression. But when HMGB1 is knocked down, even overexpression of USP15 could not promote the progression of PTC cells. Conclusion: In essence, our discoveries shed light on the previously uncharted catalytic role of USP15 as a deubiquitinating enzyme targeting HMGB1, offering a promising avenue for potential therapeutic interventions in the management of PTC.
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Affiliation(s)
- Si-si Wang
- Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, Fujian 350001, P.R. China
| | - Dao-xiong Ye
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, Fujian 350001, P.R. China
| | - Bo Wang
- Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Meng-yao Li
- Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Wen-xin Zhao
- Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, 29 Xinquan Road, Fuzhou, Fujian 350001, P.R. China
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13
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Tian J, Liang J, Lin Y, Wang L, Chen X. Diagnostic performance of ACR-TIRADS combined with superb microvascular imaging for differential diagnosis of mummified thyroid nodules and papillary thyroid carcinomas. Endocr Connect 2024; 13:e230388. [PMID: 38235807 PMCID: PMC10895311 DOI: 10.1530/ec-23-0388] [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: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 01/19/2024]
Abstract
Objective The aim was to investigate the ability of superb microvascular imaging (SMI) to improve the differential diagnosis of mummified thyroid nodules (MTNs) and papillary thyroid carcinomas (PTCs) using the 2017 American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS). Materials and methods We enrolled 110 cases of MTNs and 110 cases of PTCs confirmed by fine needle aspiration (FNA) or surgery. Conventional ultrasound (US) and the quantity of microvessels detected by SMI were analyzed for all nodules. Thyroid nodules were initially categorized by ACR-TIRADS based on US imaging features and then reclassified based on ACR-TIRADS combined with SMI blood-flow grade (SMI-TIRADS). We compared the diagnostic performances of ACR-TIRADS and SMI-TIRADS by receiver operating characteristic curve, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results US-detected margin, shape, and echogenic foci differed between MTNs and PTCs (P < 0.05). The SMI blood-flow grade was significantly greater in PTCs compared with MTNs (Χ2 = 158.78, P < 0.05). There was no significant difference in ACR-TIRADS indicators between MTNs and PTCs (Χ2 = 1.585, P = 0.453); however, reclassification by SMI-TIRADS showed significant differences between the groups (Χ2 = 129.521, P < 0.001). The area under the curve was significantly lower for ACR-TIRADS compared with SMI-TIRADS (0.517 vs 0.887, P < 0.05). SMI-TIRADS had significantly higher diagnostic value for distinguishing MTNs and PTCs than ACR-TIRADS (sensitivity: 91.82% vs 74.55%, P < 0.05; specificity: 84.55% vs 21.82%, P < 0.05; accuracy: 88.18% vs 48.18%, P < 0.05; PPV: 85.59% vs 48.81%, P < 0.05; and NPV: 91.18% vs 46.15%, P < 0.05). Conclusion The detection of microvascular flow and large vessels in thyroid nodules by SMI resulted in high diagnostic specificity and sensitivity. ACR-TIRADS combined with SMI could effectively distinguish between MTNs and PTCs, to avoid unnecessary FNA or surgical excision.
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Affiliation(s)
- Jiali Tian
- Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Jinlei Liang
- Ultrasound Department, Zhuhai People's Hospital, Zhuhai, China
| | - Yuhong Lin
- Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Liping Wang
- Ultrasound Department, Zhuhai Xiangzhou District People's Hospital, Zhuhai, China
| | - Xiaobo Chen
- Ultrasound Department, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
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Usman M, Yao P, Luckett K, Andreadis K, Thomas R, Hickner A, Christos PJ, Tassler A, Kutler D, Kuhel W, Banuchi V. The use of thyroid isthmusectomy for management of well differentiated thyroid carcinoma - A systematic review and meta-analysis. Surg Oncol 2024; 52:102032. [PMID: 38159364 DOI: 10.1016/j.suronc.2023.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE With the growing global incidence of thyroid carcinomas, there is an increasing need for distinct guidelines for isthmus-confined carcinomas. Here, we performed the first systematic review on the topic to date, aiming to provide understanding to isthmusectomy as surgical management for well-differentiated thyroid carcinoma of the isthmus. METHODS We conducted a systematic review following the PRISMA guidelines, analyzing English-language studies from the past decade that report on thyroid isthmusectomy. Exclusion criteria included isthmusectomy performed alongside full thyroidectomy or partial thyroid lobectomy, lack of data on tumor characteristics or survival outcomes, and non-English publications where a translation was unavailable. Our review identified a total of 227 patients from seven studies. RESULTS The average 5-year overall survival and disease-free survival rates for patients with isthmus-confined PTC who underwent isthmusectomy were 100 % and 93.1 %, respectively. Similar to that of total thyroidectomy. 3.1 % of patients required completion thyroidectomy. Furthermore, isthmusectomy resulted in fewer surgical complications than total thyroidectomy. CONCLUSIONS The scarcity of studies providing detailed tumor characteristics and patient outcomes limits our ability to fully evaluate the safety and efficacy of isthmusectomy for isthmus-confined PTC. Additionally, the variable sample sizes and restricted geographic distribution of the included studies calls into questions the generalizability of their findings. Despite these limitations, the data suggest that isthmusectomy may be a viable surgical option for select patients with small, isthmus-confined PTC. In the absence of a randomized controlled trial on the noninferiority of isthmusectomy, significantly more publications are needed before strong conclusions can be drawn.
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Affiliation(s)
- Moon Usman
- NewYork-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Peter Yao
- NewYork-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Kathleen Luckett
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Katerina Andreadis
- Department of Population Health Science, Weill Cornell Medical College, New York, NY, USA
| | | | - Andy Hickner
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell, New York, NY, USA
| | - Paul J Christos
- Department of Population Health Science, Weill Cornell Medical College, New York, NY, USA
| | - Andrew Tassler
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - David Kutler
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - William Kuhel
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Victoria Banuchi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA.
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15
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Ruan J, Chen Z, Chen S, Xu Z, Wen L, Mao Z, Shen J, Liu J, Wang W. Lateral lymph node metastasis in papillary thyroid microcarcinoma: a study of 5241 follow-up patients. Endocrine 2024; 83:414-421. [PMID: 37596455 DOI: 10.1007/s12020-023-03486-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
PURPOSE To investigate the impact of lateral lymph node metastasis in papillary thyroid microcarcinoma (PTMC). METHODS 5241 PTMC patients with follow-up information were enrolled in the current study. These patients underwent primary surgery in our situation from January 1997 to December 2016. Additionally, a validation cohort consisting of 274 PTMC patients who underwent primary surgery between January 2020 and December 2021 was also included. Univariable and multivariate logistic analyses were conducted to identify the association between clinicopathologic features and lateral lymph node metastasis (LLNM). Kaplan-Meier survival curve analysis was used to calculate the disease-free survival (DFS) rate. The fitting curve was generated to identify the quantitative relationship between central lymph node metastases (CLNM) and LLNM. RESULTS Of 5241 PTMC patients, cervical lymph node metastasis was detected in 1494 (28.5%) cases, including 1364 (26.0%) with CLNM only and 130 (2.5%) with LLNM. With a median follow-up time of 60 months (interquartile range [IQR], 44-81), recurrence was detected in 114 patients (2.2%). Multivariate Cox regression analyses showed that LNM was the only independent risk factor for recurrence, with HR values of 3.03 in CLNM and 11.14 in LLNM, respectively. Tumor diameter >0.5 cm (hazard ratio [HR]:1.80), multifocality (HR:2.59), bilaterality (HR:2.13), extrathyroidal invasion (HR:2.13), and CLNM (HR:5.11) were independent risk factors for LLNM. The prevalence of LLNM escalated significantly with increasing number of lymph node involvement in CLNM when stratified by the number of metastatic lymph nodes and trend was observed similarly in the validation cohort. The fitting curve showed that the incidence of LLNM could be as high as 20.7% when the number of CLNM ≥ 5. CONCLUSIONS By analyzing a large database with follow-up information, our study provides evidence that LLNM is significantly correlated with tumor recurrence in patients with PTMC. Tumor size (>0.5 cm), multifocality, bilaterality, extrathyroidal extension (ETE) and CLNM are independent risk factors for LLNM.
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Affiliation(s)
- Jiaying Ruan
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhendong Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shitu Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zehang Xu
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liping Wen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhuochao Mao
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiejie Shen
- Community Health Service Center, Jingjiang Street, Xiaoshan District, Hangzhou, China
| | - Jian Liu
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Weibin Wang
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Shaha AR, Tuttle RM. Active surveillance for micropapillary thyroid carcinoma: a clinical review. Gland Surg 2024; 13:100-107. [PMID: 38323232 PMCID: PMC10839699 DOI: 10.21037/gs-22-558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/08/2023] [Indexed: 02/08/2024]
Abstract
With the rapid rise in the incidence of micropapillary carcinoma, there is increasing concern about its overdiagnosis and overtreatment. There is considerable interest in managing patients with micropapillary carcinoma with active surveillance or deferred intervention. Various institutions around the world are practicing active surveillance. The major question remains as to who the ideal candidates are and how best to monitor these patients. This clinical review will discuss the ideal, appropriate, and inappropriate patients for active surveillance. It will also discuss the follow-up strategy for these patients and some of the adverse clinical features that will be used to decide against active surveillance. There are uncertainties as to who should be offered active surveillance. Various studies have shown approximately 10% of the patients switching to surgery primarily related to fear factor rather than increase in the tumor size or lymph node metastasis. The results of immediate surgery do raise issues related to complications of thyroid surgery and quality of life. The most ideal candidate would be patients with a tumor below 1 cm, intrathyroidal. For the patient who is a minimalist, the follow up strategy includes, ultrasound every 6 months for the first 1 or 2 years, and then every year after that. If there is a substantial change in the tumor volume or nodal metastasis, surgery should be considered, which happens in less than 10 percent of patients according to many studies. Based on existing literature and clinical experience, it appears that active surveillance is an appropriate strategy for monitoring micropapillary carcinoma.
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Affiliation(s)
- Ashok R. Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R. Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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17
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Jin L, Zhou L, Wang JB, Tao L, Lu XX, Yan N, Chen QM, Cao LP, Xie L. Whether Detection of Gene Mutations Could Identify Low- or High-Risk Papillary Thyroid Microcarcinoma? Data from 393 Cases Using the Next-Generation Sequencing. Int J Endocrinol 2024; 2024:2470721. [PMID: 38268989 PMCID: PMC10805555 DOI: 10.1155/2024/2470721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/20/2023] [Accepted: 12/30/2023] [Indexed: 01/26/2024] Open
Abstract
Objective The objective of this study is to explore the utilization of next-generation sequencing (NGS) technology in evaluating the likelihood of identifying individuals with papillary thyroid microcarcinoma (PTMC ≤10 mm) who are at high or low risk. Design NGS was used to analyze 393 formalin-fixed, paraffin-embedded tissues of PTC tumors, all of which were smaller than 15 mm. Results The study found that bilateralism, multifocality, intrathyroidal spread, and extrathyroidal extension were present in 84 (21.4%), 153 (38.9%), 16 (4.1%), and 54 (13.7%) cases, respectively. Metastasis of cervical lymph nodes was identified in 226 (57.5%) cases and 96 (24.4%) cases with CLNM >5. Out of the total number of cases studied, 8 cases (2.3%) showed signs of tumor recurrence, all of which were localized and regional. Genetic alterations were detected in 342 cases (87.0%), with 336 cases revealing single mutations and 6 cases manifesting compound mutations. 332 cases (84.5%) had BRAFV600E mutation, 2 cases had KRASQ61K mutation, 2 cases had NRASQ61R mutation, 8 cases had RET/PTC1 rearrangement, 3 cases had RET/PTC3 rearrangement, and 1 case had TERT promoter mutation. Additionally, six individuals harbored concurrent mutations in two genes. These mutations were of various types and combinations: BRAFV600E and NRASQ61R (n = 2), BRAFV600E and RET/PTC3 (n = 2), BRAFV600E and RET/PTC1 (n = 1), and BRAFV600E and TERT promoter (n = 1). The subsequent analysis did not uncover a significant distinction in the incidence of gene mutation or fusion between the cN0 and cN1 patient cohorts. The presence of BRAFV600E mutation and CLNM incidence rates were found to be positively correlated with larger tumor size in PTMC. Our data showed that gene mutations did not appear to have much to do with high-risk papillary thyroid microcarcinoma (PTMC). However, when we looked at tumor size, we found that if the tumor was at least 5 millimeters in size, there was a higher chance of it being at high risk for PTM (P < 0.001, odds ratio (OR) = 2.55, 95% confidence interval (CI): 1.57-4.14). Identification of BRAFV600E mutation was not demonstrated to be significantly correlated with advanced clinicopathological characteristics, although it was strongly associated with a bigger tumor diameter (OR = 4.92, 95% CI: 2.40-10.07, P < 0.001). Conclusion In clinical practice, BRAFV600E mutation does not consistently serve as an effective biomarker to distinguish high-risk PTMC or predict tumor progression. The size of the tumor has a significant correlation with its aggressive characteristics. PTMC with a diameter of ≤5 mm should be distinguished and targeted as a unique subset for specialized treatment.
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Affiliation(s)
- Lei Jin
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Liang Zhou
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian-Biao Wang
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Tao
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Xiao Lu
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Na Yan
- Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Co., Ltd., Hangzhou, Zhejiang, China
| | - Qian-Ming Chen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Hangzhou, Zhejiang, China
| | - Li-Ping Cao
- Department of General Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China
| | - Lei Xie
- Department of Head and Neck Surgery, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Holoubek SA, Sippel RS. Lymph node imaging for thyroid cancer. Clin Endocrinol (Oxf) 2024; 100:96-101. [PMID: 38009335 DOI: 10.1111/cen.14993] [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: 07/18/2023] [Revised: 09/25/2023] [Accepted: 11/09/2023] [Indexed: 11/28/2023]
Abstract
Cervical lymph nodes (LNs) in the central (level VI) and lateral (levels II-V) compartments of the neck are the most common sites of locoregional metastases associated with thyroid cancer. Prophylactic nodal dissections are uncommon in modern thyroid surgery and are not routinely performed due to concern for increased morbidity and do not offer improved survival. Therefore, a selective approach for LN dissections is increasingly important. Preoperatively, this is most frequently assessed with cervical ultrasound (US). Contrast-enhanced computed tomography (CT) of the neck can also be used for preoperative assessment. Both US and CT imaging can be used to characterise LNs in levels II-VI and their risk of malignancy based on size, morphology, and growth. US-guided fine-needle aspiration of equivocal LN with thyroglobulin (Tg) washout can also determine if a LN harbours malignancy. For postoperative surveillance after total thyroidectomy, both US and CT continue to play an important role at 6-12 months intervals. These patients may also benefit from additional biochemical data such as Tg levels in addition to LN and thyroid bed imaging. Thyroid uptake scans may also play a role in LN surveillance postoperatively for well-differentiated thyroid carcinoma in certain clinical contexts. Less commonly, positron emitted tomography may play a role, but is typically reserved for patients with aggressive or radioactive iodine refractory disease.
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Affiliation(s)
- Simon A Holoubek
- Endocrine Surgery Division, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Rebecca S Sippel
- Endocrine Surgery Division, University of Wisconsin-Madison, Madison, Wisconsin, USA
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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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Ramalho D, Teixeira E, Cueto R, Correia S, Rocha G, Oliveira MJ, Soares P, Póvoa AA. Subcentimetric Papillary Thyroid Carcinoma: Does the Diagnosis Kind Impact Prognosis? Cureus 2023; 15:e49563. [PMID: 38156179 PMCID: PMC10754029 DOI: 10.7759/cureus.49563] [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] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Subcentimetric papillary thyroid carcinoma (SPTC) (papillary thyroid carcinoma with less than 10 mm in size) usually presents an excellent prognosis, with few aggressive reported cases. Given the globally increased incidence of SPTC, physicians are struggling with the need to identify prognostic factors to stratify SPTC. The aim was to compare clinicopathological variables and prognosis between clinically and incidentally diagnosed SPTC. Materials and methodsː This is a retrospective observational study on patients with SPTC who underwent thyroidectomy between 2002 and 2015. Two groups were considered: G1 (n=60 (61.9%)), clinical diagnosis (Bethesda III-VI cytology in the thyroid tumor/in cervical lymphadenopathies) and G2 (n=37 (38.1%)), incidental diagnosis (thyroidectomy for benign thyroid pathology). The histological material was reviewed, and molecular analysis of the BRAF, RAS, and TERT promoter (TERTp) genes was performed. Resultsː Ninety-seven individuals were included, 60 (61.9%) of which were from G1, with a predominance of female sex (n=83 (85.6%)). Individuals of G1 were younger (53.0±14.2 versus 59.3±13.9 years; p=0.035), were more frequently treated with 131-iodine (39.2% versus 13.4%; p=0.007), had the largest diameter (8 (p25-p75: 7-9) versus 5 (p25-p75: 4-6.5) mm; p<0.001), and higher frequency of minimal extracapsular invasion (45% versus 24.3%; p=0.041). Increased tumor size was the only independent predictor of a clinical diagnosis (p<0.001). Conclusionsː Clinically and incidentally diagnosed SPTC showed excellent medium- to long-term prognosis. A larger SPTC was more likely a driver of clinical detection than a marker of tumor aggressiveness, but caution should be taken as contradictory data persists.
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Affiliation(s)
- Diogo Ramalho
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Elisabete Teixeira
- Pathology, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, PRT
| | - Rosa Cueto
- Pathological Anatomy, Hospital Parc Taulí, Sabadell, ESP
| | - Sara Correia
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Gustavo Rocha
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Maria J Oliveira
- Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Paula Soares
- Pathology, Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, PRT
| | - Antonia A Póvoa
- General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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Amado A, Teixeira E, Canberk S, Macedo S, Castro B, Pereira H, Varanda J, Graça S, Tavares A, Soares C, Oliveira MJ, Oliveira M, Soares P, Sobrinho Simões M, Póvoa AA. Subcentimetric papillary thyroid carcinoma with extensive lymph node and brain metastasis: case report and review of literature. Endocrinol Diabetes Metab Case Rep 2023; 2023:23-0025. [PMID: 38108305 PMCID: PMC10762550 DOI: 10.1530/edm-23-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/27/2023] [Indexed: 12/19/2023] Open
Abstract
Summary We report a 61-year-old male patient without personal history of thyroid carcinoma or radiation exposure. In 2011, he presented with a cervical mass whose biopsy diagnosed a papillary thyroid carcinoma (PTC) in a lymph node metastasis (LNM). Total thyroidectomy with lymphadenectomy of central and ipsilateral compartment was performed. Histopathology identified a 2 mm follicular variant of PTC and LNM in 25/25 lymph nodes. The patient was treated with 150 mCi of radioactive iodine (RAI), followed by levothyroxine suppressive therapy. In 2016, a retrotracheal mass was diagnosed, suggesting local recurrence; patient was submitted to surgical excision and RAI therapy (120 mCi). Due to seizures, in 2019, a brain CT was performed that diagnosed brain metastases. The patient underwent debulking of the main lesion. Histopathology analysis confirmed a metastatic lesion with variated morphology: classical PTC and follicular pattern and hobnail and tall cell features. Molecular analysis revealed BRAFV600E in LNM at presentation and BRAFV600E and TERT promoter (TERTp) mutations in the recurrent LNM and brain metastasis. Based upon this experience we review the reported cases of subcentimetric PTC with brain metastases and discuss the molecular progression of the present case. Learning points Papillary microcarcinoma (PMCs) usually have very good prognosis with low impact on patient survival. PMCs presenting in elderly patients with LNM at diagnosis may carry a guarded outcome. Brain metastasis although rare indicate aggressive phenotypic features. Patient risk stratification of PMCs based on histopathological analysis and genetic testing may have a significant impact on prognosis providing therapeutic markers, that may predict disease progression and overall outcome.
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Affiliation(s)
- Andreia Amado
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Elisabete Teixeira
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Sule Canberk
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Sofia Macedo
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, R. Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal
| | - Bárbara Castro
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Hugo Pereira
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - João Varanda
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Susana Graça
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Amélia Tavares
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Soares
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Maria João Oliveira
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Manuel Oliveira
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
| | - Paula Soares
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Sobrinho Simões
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Centro Hospitalar Universitário São João, Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Antónia Afonso Póvoa
- Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal, R. Conceição Fernandes S/N, 4434-502 Vila Nova de Gaia, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Yamamoto M, Miyauchi A, Ito Y, Fujishima M, Sasaki T, Kudo T. Active Surveillance Outcomes of Patients with Low-Risk Papillary Thyroid Microcarcinoma According to Levothyroxine Treatment Status. Thyroid 2023; 33:1182-1189. [PMID: 37310904 DOI: 10.1089/thy.2023.0046] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: During active surveillance (AS), serum thyrotropin (TSH) levels may affect papillary thyroid microcarcinoma (PTMC) progression. We investigated AS outcomes according to whether levothyroxine (LT4) treatment was administered. Patients and Methods: From 2005 to 2019, 2896 patients with low-risk PTMC underwent AS. Of these, 2509 patients were included: 2187 patients did not receive LT4 at diagnosis (group I), 1935 patients did not receive LT4 during AS (group IA), and 252 patients started LT4 during AS (group IB). The remaining 322 patients were administered LT4 before or at diagnosis (group II). The tumor volume doubling rate (TVDR) and tumor size based on ultrasound examination results and time-weighted detailed TSH scores were calculated. Disease progression was defined as tumor enlargement ≥3 mm and/or the appearance of novel lymph node metastasis. Results: At diagnosis, group II had more high-risk features, such as younger age and larger tumors, than group I. However, group II had a lower disease progression rate (2.9% at 10 years) than group I (6.1%) (p = 0.091). The disease progression rate of group IB (13.8% at 10 years) was significantly higher than that of groups IA (5.0%) and II (2.9%) (p < 0.01). The TVDR of group IB before LT4 administration was significantly higher than that of groups IA and II (0.095 per year, -0.0085 per year, and -0.057 per year, respectively; p < 0.01), suggesting that patients with progression signs during AS were selectively prescribed LT4. The time-weighted detailed TSH score of group IB significantly decreased after LT4 administration compared with those before administration (3.35 and 3.05, respectively; p < 0.01). The TVDR also decreased from 0.13 per year to 0.036 per year (p = 0.08). The proportions of patients with rapid or moderate growth decreased significantly after LT4 (from 26.8% to 12.5%, p < 0.01). A multivariable analysis revealed group IB status was independently associated with disease progression (odds ratio [OR] = 3.42 [CI 2.15-5.44], p < 0.01), whereas age ≥40 years and <60 years and age ≥60 years were independently negatively associated with this outcome (OR = 0.23 [CI 0.14-0.38, p < 0.01 and OR = 0.16 [CI 0.10-0.27], p < 0.01). Conclusion: LT4 treatment may be associated with decreased tumor growth during AS of PTMC, but further confirmatory research is needed.
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Affiliation(s)
| | | | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | | | - Takahiro Sasaki
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe, Japan
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23
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Zhang L, Wang P, Li K, Xue S. A novel nomogram for identifying high-risk patients among active surveillance candidates with papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2023; 14:1185327. [PMID: 37780614 PMCID: PMC10541211 DOI: 10.3389/fendo.2023.1185327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Objective Active surveillance (AS) has been recommended as the first-line treatment strategy for low-risk (LR) papillary thyroid microcarcinoma (PTMC) according to the guidelines. However, preoperative imaging and fine-needle aspiration could not rule out a small group of patients with aggressive PTMC with large-volume lymph node micro-metastasis, extrathryoidal invasion to surrounding soft tissue, or high-grade malignancy from the AS candidates. Methods Among 2,809 PTMC patients, 2,473 patients were enrolled in this study according to the inclusion criteria. Backward stepwise multivariate logistic regression analysis was used to filter clinical characteristics and ultrasound features to identify independent predictors of high-risk (HR) patients. A nomogram was developed and validated according to selected risk factors for the identification of an HR subgroup among "LR" PTMC patients before operation. Results For identifying independent risk factors, multivariable logistic regression analysis was performed using the backward stepwise method and revealed that male sex [3.91 (2.58-5.92)], older age [0.94 (0.92-0.96)], largest tumor diameter [26.7 (10.57-69.22)], bilaterality [1.44 (1.01-2.3)], and multifocality [1.14 (1.01-2.26)] were independent predictors of the HR group. Based on these independent risk factors, a nomogram model was developed for predicting the probability of HR. The C index was 0.806 (95% CI, 0.765-0.847), which indicated satisfactory accuracy of the nomogram in predicting the probability of HR. Conclusion Taken together, we developed and validated a nomogram model to predict HR of PTMC, which could be useful for patient counseling and facilitating treatment-related decision-making.
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Affiliation(s)
- Li Zhang
- Department of Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Peisong Wang
- General Surgery Center, Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Kaixuan Li
- General Surgery Center, Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Shuai Xue
- General Surgery Center, Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
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Huang EYF, Kao NH, Lin SY, Jang IJH, Kiong KL, See A, Venkatanarasimha N, Lee KA, Lim CM. Concordance of the ACR TI-RADS Classification With Bethesda Scoring and Histopathology Risk Stratification of Thyroid Nodules. JAMA Netw Open 2023; 6:e2331612. [PMID: 37703017 PMCID: PMC10500370 DOI: 10.1001/jamanetworkopen.2023.31612] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 07/24/2023] [Indexed: 09/14/2023] Open
Abstract
Importance Although most thyroid nodules are benign, 10% to 15% of them harbor cancer. Thyroid ultrasonography is useful for risk stratification of nodules, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) classification provides recommendations for fine-needle aspiration cytology (FNAC) based on objective ultrasonographic features of these nodules. Objective To validate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology. Design, Setting, and Participants This retrospective cohort study was performed to evaluate the concordance of ACR TI-RADS classification with Bethesda classification and histopathology and was conducted in Singapore General Hospital Outpatient Otolaryngology clinic in March 2021 to May 2021. Data analysis was performed in May 2021. Main Outcomes and Measures Results were deemed concordant when ACR TI-RADS recommendations aligned with Bethesda scores. Conversely, results were classified as nonconcordant with Bethesda scores and/or histopathology results when nodules that were recommended for FNAC yielded benign results or nodules that were not recommended for FNAC yielded malignant results. Results A total of 446 patients (370 women [83%]; mean [range] age, 60 [24-89] years) who underwent ultrasonography of the thyroid and ultrasonography-guided thyroid FNACs were identified. A total of 492 of 630 nodules (78.1%) were benign on FNAC (Bethesda II). Score 3 ACR TI-RADS nodules yielded the highest negative predictive values: 94.6% (95% CI, 92.9%-95.9%; P < .001) compared with Bethesda scoring and 100.0% (95% CI, 15.8%-100.0%; P = .003) compared with histopathology. Score 4 or 5 ACR TI-RADS nodules yielded positive predictive values of 2.8% and 16.2%, respectively, compared with Bethesda scoring and 6.1% and 66.7%, respectively, compared with histopathology. Small (<1.5 cm) ACR TI-RADS nodules of scores of 4 and 5 that were not recommended for FNAC yielded a malignant risk of 5.7% and 25.0% on Bethesda 5 and 6, respectively. On surgical excision, 5 of 46 (10.9%) ACR TI-RADS 4 nodules and 15 of 21 (71.4%) of ACR TI-RADS 5 nodules were confirmed to be malignant. Among nodules initially not recommended for FNAC, histopathology-proven cancer was found in 4 of 13 (30.7%) and 3 of 6 (50.0%) of nodules, respectively. Conclusions and Relevance These findings suggest that ACR TI-RADS score 3 nodules have a low risk of cancer and should be considered for FNAC only if nodules are 2.5 cm or larger. Patients with small (<1.5 cm) ACR TI-RADS 4 and 5 nodules should be appropriately counseled for FNAC to exclude cancer.
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Affiliation(s)
- Elaine Y. F. Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Nern Hoong Kao
- Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
- Department of General Surgery–Head and Neck Surgery, Changi General Hospital, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Isabelle J. H. Jang
- Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
| | - Kimberley Liqin Kiong
- Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
- Surgery Academic Program, Duke-NUS Medical School, Singapore
| | - Anna See
- Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
- Surgery Academic Program, Duke-NUS Medical School, Singapore
| | - Nanda Venkatanarasimha
- Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Singapore
| | - Kristen Alexa Lee
- Department of Diagnostic and Interventional Radiology, Singapore General Hospital, Singapore
| | - Chwee Ming Lim
- Department of Otorhinolaryngology, Head and Neck Surgery, Singapore General Hospital, Singapore
- Surgery Academic Program, Duke-NUS Medical School, Singapore
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25
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de Jong MC, Mahipal M, Ngiam KY, Tan WB, Yang SP, Parameswaran R. The impact of lymph node ratio on disease recurrence in papillary thyroid microcarcinoma. Ann R Coll Surg Engl 2023; 105:632-638. [PMID: 37652084 PMCID: PMC10471441 DOI: 10.1308/rcsann.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Lymph node (LN) metastases in papillary thyroid microcarcinomas (microPTCs) are common. The lymph node ratio (LNR) has been proposed as a risk factor for recurrence in papillary thyroid cancer. However, its relevance in microPTC is undetermined. METHODS Patients who underwent resection of their microPTC with concomitant LN clearance between 2005 and 2018 were identified. The LNR was calculated as the ratio of positive LNs to the total number of LNs. RESULTS Data on 50 patients (36 female [72%]; median age 47 years [range: 19-84]) who underwent LN clearance (28 central [56%] vs 22 central + lateral [44%]) were analysed. Positive LNs were found in over two-thirds of the patients (n = 34; 68%). After a median follow-up of 61 months, 14 patients (28%) had developed recurrence. Positive LNs were not found to impact recurrence-free survival; extranodal extension and an LNR ≥ 0.26 were found to significantly increase the risk of recurrence on unadjusted analyses (p < 0.05). CONCLUSIONS LN metastases are frequent among patients with microPTC. A higher LNR seems to be associated with recurrence. Additional studies are needed to further clarify these findings and to assess the possible role of LNR in treatment and surveillance.
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Affiliation(s)
| | - M Mahipal
- National University Hospital, Singapore
| | - KY Ngiam
- National University Hospital, Singapore
| | - WB Tan
- National University Hospital, Singapore
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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: 17] [Impact Index Per Article: 8.5] [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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Semerci O, Gucer H. The Significance of Unsampled Microscopic Thyroid Carcinomas in Multinodular Goiter. Endocr Pathol 2023; 34:119-128. [PMID: 36527546 DOI: 10.1007/s12022-022-09743-z] [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] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Thorough gross examination and appropriate sampling of the thyroidectomy specimens are fundamental to the diagnosis and clinical risk management of patients. This study aims to investigate the frequency and clinical significance of initially unsampled microscopic thyroid carcinomas in total thyroidectomy specimens with presumed benign multinodular thyroid disease. Seventy-two total thyroidectomy specimens belonging to multinodular goiter patients were randomly selected and included in this prospectively designed study. Inclusion criteria were set as no suspicion of malignancy before surgery as well as lack of intra-parenchymal primary thyroid carcinoma after histopathological evaluation of slides generated from initial sampling. Subsequently, the remaining thyroidectomy specimens were submitted for microscopic examination and sign-outs were finalized following the microscopic examination of the entire thyroid tissue. Microcarcinomas, with a maximum diameter of 3.5 mm, were detected in 29 cases (40.2%) after the whole gland sampling. Although most of these tumors were low-risk papillary microcarcinomas confined to the thyroid, one specimen also showed a medullary microcarcinoma measuring 1.5 mm. Three had micrometastatic nodal disease. There was no local recurrence or distant metastatic disease during the follow-up (mean 51.4 months). This study further supports microscopic carcinomas, including papillary microcarcinoma, and medullary microcarcinoma might stay hidden in thyroidectomy specimens. Increased glandular weight, male gender, and advanced age were significant risk factors in the detection of microcarcinomas in this series. While each multinodular thyroidectomy specimen is unique, we recommend dynamic extensive sampling (rather than bare-minimum approach) strategy based on careful gross and initial histologic examination findings as well as by taking into consideration risk factors.
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Affiliation(s)
- Orhan Semerci
- Department of Pathology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Hasan Gucer
- Department of Pathology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
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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: 11] [Impact Index Per Article: 5.5] [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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Clinical value of artificial intelligence in thyroid ultrasound: a prospective study from the real world. Eur Radiol 2023:10.1007/s00330-022-09378-y. [PMID: 36622410 DOI: 10.1007/s00330-022-09378-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of a commercial artificial intelligence (AI)-assisted ultrasonography (US) for thyroid nodules and to validate its value in real-world medical practice. MATERIALS AND METHODS From March 2021 to July 2021, 236 consecutive patients with 312 suspicious thyroid nodules were prospectively enrolled in this study. One experienced radiologist performed US examinations with a real-time AI system (S-Detect). US images and AI reports of the nodules were recorded. Nine residents and three senior radiologists were invited to make a "benign" or "malignant" diagnosis based on recorded US images without knowing the AI reports. After referring to AI reports, the diagnosis was made again. The diagnostic performance of AI, residents, and senior radiologists with and without AI reports were analyzed. RESULTS The sensitivity, accuracy, and AUC of the AI system were 0.95, 0.84, and 0.753, respectively, and were not statistically different from those of the experienced radiologists, but were superior to those of the residents (all p < 0.01). The AI-assisted resident strategy significantly improved the accuracy and sensitivity for nodules ≤ 1.5 cm (all p < 0.01), while reducing the unnecessary biopsy rate by up to 27.7% for nodules > 1.5 cm (p = 0.034). CONCLUSIONS The AI system achieved performance, for cancer diagnosis, comparable to that of an average senior thyroid radiologist. The AI-assisted strategy can significantly improve the overall diagnostic performance for less-experienced radiologists, while increasing the discovery of thyroid cancer ≤ 1.5 cm and reducing unnecessary biopsies for nodules > 1.5 cm in real-world medical practice. KEY POINTS • The AI system reached a senior radiologist-like level in the evaluation of thyroid cancer and could significantly improve the overall diagnostic performance of residents. • The AI-assisted strategy significantly improved ≤ 1.5 cm thyroid cancer screening AUC, accuracy, and sensitivity of the residents, leading to an increased detection of thyroid cancer while maintaining a comparable specificity to that of radiologists alone. • The AI-assisted strategy significantly reduced the unnecessary biopsy rate for thyroid nodules > 1.5 cm by the residents, while maintaining a comparable sensitivity to that of radiologists alone.
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Thyroid-Stimulating Hormone, Age, and Tumor Size are Risk Factors for Progression During Active Surveillance of Low-Risk Papillary Thyroid Microcarcinoma in Adults. World J Surg 2023; 47:392-401. [PMID: 36182976 PMCID: PMC9803751 DOI: 10.1007/s00268-022-06770-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Active surveillance (AS) of low-risk papillary thyroid microcarcinoma (PTMC) was initiated at Kuma Hospital in 1993 and is gradually spreading worldwide. We assessed the effect of thyroid-stimulating hormone (TSH) levels on PTMC enlargement in patients on AS. METHODS We enrolled 2705 patients with cytologically diagnosed PTMC who had undergone AS between January 2005 and July 2019. Patients with Graves disease were excluded. The median AS period was 5.5 years (range 1.0-15.7 years). Tumor enlargement was defined as a size increase ≥3 mm. Chi-square test, Kaplan-Meier method, log-rank test, Cox proportional hazard, and logistic regression were used to compare variables. RESULTS Ninety-two patients (3.4%) experienced tumor enlargement; the 5-, 10-, and 15-year enlargement rates were 3.0%, 5.5%, and 6.2%, respectively. Young age (<40 years, p < 0.001), large tumor size (≥9 mm, p = 0.017), and high detailed TSH score (≥3, higher than the lower normal limit, p = 0.011) were significant factors relating to tumor enlargement in the multivariate analysis. In a subset of patients aged <40 years, a low detailed TSH score (<3) was an independent factor against tumor enlargement (p = 0.039). Only 22 patients (0.8%) experienced novel lymph node metastasis; the 5-, 10-, and 15-year node metastasis rates were very low, at 0.9%, 1.1%, and 1.1%, respectively. CONCLUSIONS Young patients with PTMC are more likely to experience tumor growth. Mild TSH suppression to achieve a low normal range may prevent carcinoma enlargement; however, prospective studies are needed to draw more reliable conclusions.
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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: 4] [Impact Index Per Article: 1.3] [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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Sun YD, Zhang H, Zhu HT, Wu CX, Chen ML, Han JJ. A systematic review and meta-analysis comparing tumor progression and complications between radiofrequency ablation and thyroidectomy for papillary thyroid carcinoma. Front Oncol 2022; 12:994728. [PMID: 36530996 PMCID: PMC9748571 DOI: 10.3389/fonc.2022.994728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/08/2022] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is the most frequent thyroid cancers worldwide. The efficacy and acceptability of radiofrequency ablation (RFA) in the treatment of PTC have been intensively studied. The aim of this study is to focus on extra detailed that may influent for PTC or papillary thyroid microcarcinoma (PTMC). MATERIALS AND METHODS We identified a total of 1,987 records of a primary literature searched in PubMed, Embase, Cochrane Library, and Google Scholar by key words, from 2000 to 2022. The outcome of studies included complication, costs, and local tumor progression. After scrutiny screening and full-text assessment, six studies were included in the systematic review. Heterogeneity was estimated using I2, and the quality of evidence was assessed for each outcome using the GRADE guidelines. RESULTS Our review enrolled 1,708 patients reported in six articles in the final analysis. There were 397 men and 1,311 women in the analysis. Two of these studies involved PTC and four focused on PTMC. There were 859 patients in the RFA group and 849 patients in the thyroidectomy group. By contrast, the tumor progression of RFA group was as same as that surgical groups [odds ratio, 1.31; 95% CI, 0.52-3.29; heterogeneity (I2 statistic), 0%, p = 0.85]. The risk of complication rates was significantly lower in the RFA group than that in the surgical group [odds ratio, 0.18; 95% CI, 0.09-0.35; heterogeneity (I2 statistic), 40%, p = 0.14]. CONCLUSIONS RFA is a safe procedure with a certain outcome for PTC. RFA can achieve a good efficacy and has a lower risk of major complications.
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Affiliation(s)
- Yuan-dong Sun
- Department of Interventional Radiology, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Hao Zhang
- Department of Interventional Radiology, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | | | - Chun-xue Wu
- Graduate School of Shandong First Medical University, Jinan, China
| | - Miao-ling Chen
- Graduate School of Shandong First Medical University, Jinan, China
| | - Jian-jun Han
- Department of Interventional Radiology, Shandong Cancer Hospital and Institute Affiliated Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Feng JW, Ye J, Hong LZ, Hu J, Wang F, Liu SY, Jiang Y, Qu Z. Nomograms for the prediction of lateral lymph node metastasis in papillary thyroid carcinoma: Stratification by size. Front Oncol 2022; 12:944414. [PMID: 36248990 PMCID: PMC9554485 DOI: 10.3389/fonc.2022.944414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/06/2022] [Indexed: 12/30/2022] Open
Abstract
Background Lateral lymph node metastasis (LLNM) is a risk factor of poor prognosis in papillary thyroid cancer (PTC). We aimed to determine predictive factors and develop the nomograms for LLNM in patients with papillary thyroid microcarcinoma (PTMC) and macro-PTC. Methods We reviewed the medical records of 1,106 patients who underwent surgery between January 2019 and January 2022. Patients were divided into a PTMC and a macro-PTC group. We developed preoperative and postoperative nomograms for predicting LLNM based on results of multivariate analysis. Internal calibration was performed for these models. Results The number of metastatic lymph nodes in lateral compartment was higher in macro-PTC patients. LLNM was independently associated with gender, the number of foci, location, shape, and central lymph node metastasis (CLNM) in PTMC patients. For macro-PTC patients, chronic lymphocytic thyroiditis, the number of foci, location, margin, CLNM, and central lymph node ratio were all independent predictors for LLNM. All the above factors were incorporated into nomograms, which showed the perfect discriminative ability. Conclusion The diameter of the tumor has an impact on the rate of LLNM. Separate predictive systems should be used for PTMC and macro-PTC patients for more accurate clinical assessment of lateral lymph node status. Through these nomograms, we can not only detect high-risk patients with occult LLNM preoperatively, but also form appropriate treatment protocols for postoperative management of PTC patients with different risks.
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Affiliation(s)
| | | | | | | | | | | | | | - Zhen Qu
- *Correspondence: Yong Jiang, ; Zhen Qu,
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de Carlos J, Ernaga A, Irigaray A, Pineda JJ, Echegoyen A, Salvador P, Anda E. Incidentally discovered papillary thyroid microcarcinoma in patients undergoing thyroid surgery for benign disease. Endocrine 2022; 77:325-332. [PMID: 35639243 DOI: 10.1007/s12020-022-03089-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The incidence of thyroid carcinoma has grown significantly over the last few decades. A possible explanation is the increased diagnosis of small thyroid microcarcinoma (TMc). TMc reach a maximum diameter of ≤1 cm, identified during histopathology examination following a thyroidectomy performed for reasons not pertaining to malignancy. This study aims to investigate the prevalence of papillary thyroid microcarcinoma (PTMc) according to the benign pathology that refers patients to surgery and its trend evolution. METHODS Retrospective cohort analysis of 1815 patients who underwent total thyroidectomy for non-malignant diseases in the 2005-2020 period. RESULTS The mean age of the subjects was 53.5 years, with a higher proportion of women (1481, 82.1%). A total of 167 PTMc (9.3%) were incidentally discovered. A multivariate logistic regression analysis was performed, showing no differences in prevalence according to sex or age in patients with PTMc compared to final benign histology. Multinodular goiter increases the risk of PTMc with an odds ratio of 2.2 (p = 0.001) compared to Hashimoto's thyroiditis and Graves' disease (GD). There is a statistically significant increase in the incidence of PTMc in the group operated in the 2017-2020 vs. 2005-2008 period (p = 0.005). CONCLUSION The overall prevalence of PTMc in patients who underwent thyroid surgery for the benign disease was 9.3%. Thyroid nodular hyperplasia was the most frequent benign pathology associated with PTMc compared to Hashimoto's or GD. Gender and age were not correlated with the prevalence of TMc. Over the years, surgical findings of PTMc have grown, particularly in the 2017-2020 period.
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Affiliation(s)
- Joaquín de Carlos
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | - Ander Ernaga
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Ana Irigaray
- Section of Endocrinology, Hospital García Orcoyen, Estella, Navarra, Spain
| | - Jose Javier Pineda
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Ana Echegoyen
- Pathology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Pilar Salvador
- General Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
| | - Emma Anda
- Endocrinology Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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Hwangbo Y, Choi JY, Lee EK, Ryu CH, Cho SW, Chung EJ, Hah JH, Jeong WJ, Park SK, Jung YS, Kim JH, Kim MJ, Kim SJ, Kim YK, Lee CY, Lee JY, Lee YJ, Yu HW, Park DJ, Ryu J, Park YJ, Lee KE, Moon JH. A Cross-Sectional Survey of Patient Treatment Choice in a Multicenter Prospective Cohort Study on Active Surveillance of Papillary Thyroid Microcarcinoma (MAeSTro). Thyroid 2022; 32:772-780. [PMID: 35698288 DOI: 10.1089/thy.2021.0619] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Active surveillance (AS) is offered as a choice to patients with low-risk papillary thyroid microcarcinoma (PTMC). This study aimed to identify patient and physician factors associated with the choice of AS. Methods: We conducted a cross-sectional survey of patients with low-risk PTMC who were enrolled in a prospective study comparing outcomes following AS and surgery. Patients completed a questionnaire to assess their prior knowledge of the disease, considerations in the decision-making process, and reasons for choosing the treatment. We also surveyed 19 physician investigators about their disease management preferences. Variables affecting the patients' choice of AS, including patients' characteristics and their decision-making process, were analyzed in a multivariable analysis. Results: The response rate of the patient survey was 72.8% (857/1177). Among the patients who responded to the survey, 554 patients (128 male; mean age 49.4 ± 11.6 years; response rate 73.4%) with low-risk PTMC chose AS (AS group), whereas 303 patients (55 male; 46.6 ± 10.7 years; 71.8%) chose immediate surgery (iOP group). In the AS group, 424 patients (76.5%) used a decision aid, and 144 (47.5%) used it in the iOP group. The choice of AS was associated with the following variables: patient age >50 years (odds ratio 1.713 [confidence interval, CI 1.090-2.690], p = 0.020), primary tumor size ≤5 mm (odds ratio 1.960 [CI 1.137-3.379], p = 0.015), and consulting an endocrinologist (odds ratio 114.960 [CI 48.756-271.057], p < 0.001), and use of a decision aid (odds ratio 2.469 [CI 1.320-4.616], p = 0.005). The proportion of patients who were aware of AS before their initial consultation for treatment decision was higher in the AS group than in the iOP group (64.6% vs. 56.8%). Family members were reported to have influenced the treatment decisions more in the iOP group (p = 0.025), whereas the AS group was more influenced by information from the media (p = 0.017). Physicians' attitudes regarding AS of low-risk PTMC tended to be more favorable among endocrinologists than surgeons and all became more favorable as the study progressed. Conclusions: Emerging evidence suggests that physicians' attitudes and communication tools influence the treatment decision of low-risk PTMC patients. Support is needed for patient-centered decision making. (Clinical trial No: NCT02938702).
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Affiliation(s)
- Yul Hwangbo
- Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Eun Kyung Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Chang Hwan Ryu
- Center for Thyroid Cancer, 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
| | - Jeong Hun Hah
- Department of Otorhinolaryngology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Yuh-Seog Jung
- Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Min Joo Kim
- Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, 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
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - You Jin Lee
- Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Junsun Ryu
- Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Young Joo 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
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea
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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: 31] [Impact Index Per Article: 10.3] [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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Ochoa J, Pitt SC. Less-Intensive Management Options for Low-Risk Thyroid Cancer. Endocrinol Metab Clin North Am 2022; 51:351-366. [PMID: 35662445 DOI: 10.1016/j.ecl.2021.11.018] [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: 11/21/2022]
Abstract
The incidence of thyroid cancer is increasing, whereas mortality remains relatively stable. An increasing body of research supports the use of less-intensive treatment for low-risk thyroid cancer, as the overall prognosis is excellent. Although total thyroidectomy was the gold standard for many years, the options of lobectomy alone, active surveillance, and other ablative modalities are increasingly being used. The clinicohistologic features of any thyroid cancer are important to help determine the optimal management for a given tumor. However, the patient's own desires and goals in their cancer treatment must be evaluated.
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Affiliation(s)
- Joana Ochoa
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Faculty Clinic 3rd Floor, Jacksonville, FL 33209, USA
| | - Susan C Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 1500 East Medical Center Drive, Taubman 2920F, Ann Arbor, MI 48109, USA.
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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: 1.0] [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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Weng HY, Yan T, Qiu WW, Fan YB, Yang ZL. The Prognosis of Skip Metastasis in Papillary Thyroid Microcarcinoma Is Better Than That of Continuous Metastasis. J Clin Endocrinol Metab 2022; 107:1589-1598. [PMID: 35213704 DOI: 10.1210/clinem/dgac107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT A few papillary thyroid microcarcinomas (PTMCs) may have skip metastasis (SLNM), but the risk factors remain controversial and the prognosis is unclear. OBJECTIVES To investigate the incidence, lymph node metastasis (LNM) patterns, risk factors, and prognosis of SLNM in PTMCs. METHODS We reviewed the medical records of PTMC patients who underwent thyroid surgery in our institution. Analyses of risk factors were performed for SLNM. Recurrence-free survival (RFS) of SLNM, central lymph node metastasis (CLNM), and continuous metastasis (CLNM and lateral lymph node metastasis [CLNM + LLNM]) were compared after propensity score matching (PSM). RESULTS SLNM was detected in 1.7% (50/3923) and frequently involved level III (66.7%). Compared with CLNM + LLNM, SLNM had more LNM at a single level (P < 0.01) and less LNM at 2 levels (P < 0.05). A tumor size of 0.5 to 1 cm (odds ratio [OR], 2.26; 95% CI, 1.27-4.00) and location in the upper pole (OR, 3.30; 95% CI, 2.02-5.40) were independent risk factors for SLNM. A total of 910 (23.2%) PTMCs with LNM were included in the prognostic analysis. At a median follow-up of 60 months, the RFS of SLNM did not differ from that of CLNM (P = 0.10) but was significantly higher than that of CLNM + LLNM (P < 0.01) after using PSM. CONCLUSIONS When the tumor size is 0.5 to 1 cm or its location is in the upper pole, we must remain vigilant to SLNM in PTMC. Because its prognosis is comparable to that of only CLNM and better than that of CLNM + LLNM, less intensive treatment should be considered.
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Affiliation(s)
- Huai-Yu Weng
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ting Yan
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wang-Wang Qiu
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - You-Ben Fan
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zhi-Li Yang
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Non-Marked Hypoechogenic Nodules: Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison. Medicina (B Aires) 2022; 58:medicina58020257. [PMID: 35208581 PMCID: PMC8875125 DOI: 10.3390/medicina58020257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The aim of the study was to evaluate the predictive value of the ultrasound criterion “non-marked hypoechogenicity” for malignancy and to determine whether classification of these nodules as TIRADS 3 could improve the overall accuracy of consequently adjusted M-TIRADS score. Materials and Methods: A total of 767 patients with 795 thyroid nodules were subject to ultrasonography examination and ultrasound-guided fine needle aspiration biopsy. Nodules were classified by Kwak TIRADS and modified (M-TIRADS) categories 4A, 4B, and 5 according to number of suspicious US features (marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, taller-than-wide shape, metastatic lymph nodes). Non-marked hypoechoic nodules were classified as TIRADS 3. Results: Thyroid nodules were classified as TIRADS 2, 3, 4A, 4B, and 5 in 14.5, 57.5, 14.2, 8.1, and 5.7%, respectively. Only histopathologic results (125 nodules underwent surgery) and highly specific cytology results (Bethesda II, VI) were accepted as a standard of reference, forming a sub-cohort of 562/795 nodules (70.7%). Malignancy was found in 7.7%. Overall, M-TIRADS showed sensitivity/specificity of 93.02/81.31%, and for PPV/NPV, these were 29.2/99.29%, respectively (OR—18.62). Irregular margins showed the highest sensitivity and specificity (75.68/93.74%, respectively). In TIRADS 3 category, 37.2% nodules were isoechoic, 6.6% hyperechoic, and 52.2% hypoechoic (there was no difference of malignancy risk in hypoechoic nodules between M-TIRADS and Kwak systems—0.9 vs. 0.8, respectively). Accuracy of M-TIRADS classification in this cohort was 78.26% vs. 48.11% for Kwak. Conclusions: The non-marked hypoechoic nodule pattern correlated with low risk of malignancy; classification of these nodules as TIRADS 3 significantly improved the predictive value and overall accuracy of the proposed M-TIRADS scoring with malignancy risk increase in TIRADS 4 categories by 20%; and no significant alteration of malignancy risk in TIRADS 3 could contribute to reducing overdiagnosis, obviating the need for FNA.
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Zhang X, Ze Y, Sang J, Shi X, Bi Y, Shen S, Zhang X, Zhu D. Risk factors and diagnostic prediction models for papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:938008. [PMID: 36133306 PMCID: PMC9483149 DOI: 10.3389/fendo.2022.938008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/15/2022] [Indexed: 12/07/2022] Open
Abstract
Thyroid nodules (TNs) represent a common scenario. More accurate pre-operative diagnosis of malignancy has become an overriding concern. This study incorporated demographic, serological, ultrasound, and biopsy data and aimed to compare a new diagnostic prediction model based on Back Propagation Neural Network (BPNN) with multivariate logistic regression model, to guide the decision of surgery. Records of 2,090 patients with TNs who underwent thyroid surgery were retrospectively reviewed. Multivariate logistic regression analysis indicated that Bethesda category (OR=1.90, P<0.001), TIRADS (OR=2.55, P<0.001), age (OR=0.97, P=0.002), nodule size (OR=0.53, P<0.001), and serum levels of Tg (OR=0.994, P=0.004) and HDL-C (OR=0.23, P=0.001) were statistically significant independent differentiators for patients with PTC and benign nodules. Both BPNN and regression models showed good accuracy in differentiating PTC from benign nodules (area under the curve [AUC], 0.948 and 0.924, respectively). Notably, the BPNN model showed a higher specificity (88.3% vs. 73.9%) and negative predictive value (83.7% vs. 45.8%) than the regression model, while the sensitivity (93.1% vs. 93.9%) was similar between two models. Stratified analysis based on Bethesda indeterminate cytology categories showed similar findings. Therefore, BPNN and regression models based on a combination of demographic, serological, ultrasound, and biopsy data, all of which were readily available in routine clinical practice, might help guide the decision of surgery for TNs.
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Affiliation(s)
- Xiaowen Zhang
- Department of Endocrinology and Metabolism, Endocrine and Metabolic Disease Medical Center, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Yuyang Ze
- Department of Endocrinology and Metabolism, The Fifth People’s Hospital of Suzhou Wujiang, Suzhou, China
| | - Jianfeng Sang
- Department of Thyroid Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Xianbiao Shi
- Department of Thyroid Surgery, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Yan Bi
- Department of Endocrinology and Metabolism, Endocrine and Metabolic Disease Medical Center, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Shanmei Shen
- Department of Endocrinology and Metabolism, Endocrine and Metabolic Disease Medical Center, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
| | - Xinlin Zhang
- Department of Cardiology, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
- *Correspondence: Xinlin Zhang, ; Dalong Zhu,
| | - Dalong Zhu
- Department of Endocrinology and Metabolism, Endocrine and Metabolic Disease Medical Center, Nanjing University Medical School Affiliated Drum Tower Hospital, Nanjing, China
- *Correspondence: Xinlin Zhang, ; Dalong Zhu,
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Mohorea I, Terzea D, Mihalache D, Socea B, Şerban D, Ceausu M. Cytomorphological study of thyroid carcinoma. Exp Ther Med 2022; 23:117. [PMID: 34970340 PMCID: PMC8713177 DOI: 10.3892/etm.2021.11040] [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: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022] Open
Abstract
The most common neoplasm of the endocrine system is found in the thyroid gland with a significant increase in recent decades largely due to modern diagnostic methods. Thyroid tumors generally have a favorable evolution, but there are also aggressive variants with a poor prognosis. In these aggressive tumors, the most reliable method of detecting and making a differential diagnosis is represented by ultrasound-guided fine-needle cytopuncture, confirmed by histopathological examination. Although fine-needle aspiration puncture and cytological examination are considered to have a high sensitivity and specificity, diagnostic certainty is established later only by histopathological examination. Fine-needle aspiration cytopuncture of the thyroid gland correlated with histopathological examination has played a crucial role in recognizing and identifying variants of papillary carcinoma known to have aggressive biological behavior, especially in cases of poorly differentiated carcinoma. Recognition of aggressive variants of papillary carcinoma is of major importance in the prognosis and clinical management of patients. The aim of this study was to present the correlations found in a series of thyroid tumors from patients treated in surgery and oncology departments, as well as tumors accidentally detected during autopsies in the department of forensics. All the cases selected in the study benefited from a complex histopathological diagnosis adapted to each case in order to ensure maximum efficiency.
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Affiliation(s)
- Iuliana Mohorea
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Pathology, Braila Emergency County Hospital, 810325 Braila, Romania
| | - Dana Terzea
- Department of Pathology, 'C.I. Parhon' Clinical Hospital for Endocrine Diseases, 011863 Bucharest, Romania
| | - Daniela Mihalache
- Department of Pathology, Braila Emergency County Hospital, 810325 Braila, Romania.,Department of Pathology, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University of Galati, 800008 Galati, Romania
| | - Bogdan Socea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Sf. Pantelimon' Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Dragoş Şerban
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, University Emergency Hospital, 050098 Bucharest, Romania
| | - Mihai Ceausu
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Juan Z, Yongping L, Han X, Wang Z, Liu J, Zhao Y, Liu W, Zhou P. A 5-year follow-up study on the efficacy and safety of ultrasound-guided laser ablation in elderly patients with papillary thyroid microcarcinoma: A retrospective, single-center study from China. Front Endocrinol (Lausanne) 2022; 13:972589. [PMID: 36407301 PMCID: PMC9671076 DOI: 10.3389/fendo.2022.972589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the long-term efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for the treatment of elderly patients with papillary thyroid microcarcinoma (PTMC). METHODS From September 2015 to April 2017, 38 elderly patients with PTMC confirmed through fine-needle aspiration biopsy (FNAB) were treated with PLA. Before the treatment, the location and volume of the nodule together with the patients' symptoms were evaluated. Twenty-four hours after the treatment, contrast-enhanced ultrasound (CEUS) was performed to evaluate the completeness of the ablation. To evaluate the volume of the ablation area and recurrence or metastasis, ultrasound examination was performed at 1, 3, 6, and 12 months after the treatment and every 6 months thereafter. FNAB was performed for any suspicious recurrence or metastasis lesions. RESULT The ablation of all the 38 patients was all achieved completely as confirmed by CEUS. No obvious complications were found. The success rate of single ablation was 100%. The average follow-up time was 64.58 ± 5.29 months (60-78 months). By the time of the last follow-up, 31 (81.58%) ablation lesions disappeared completely and seven (18.42%) ablation lesions showed scar-like changes. The volume of nodules was 40.69 ± 16.45 mm3 before operation, which decreased to 0.22 ± 0.76 mm3 by the end of 42 months, and all nodules disappeared 4 years after ablation (P < 0.01). At 6, 12, 18, 24, 30, 36, and 42 months after ablation, the average volume reduction rates (VRRs) were 12.09%, 31.21%, 50.9%, 72.06%, 84.79%, 95.65%, and 100%, respectively. Of all the patients enrolled, one patient (2.6%) had local recurrence and was treated with PLA again. No regrowth of treated nodule or lymph node metastasis and distant metastases was detected. CONCLUSION Ultrasound-guided PLA is effective and safe for the treatment of elderly patients with PTMC who are ineligible for surgery.
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Affiliation(s)
- Zhang Juan
- Department of Breast Surgery, Tangshan People’s Hospital, North China University of Science and Technology, Tangshan, China
| | - Liang Yongping
- Department of Ultrasound, Tangshan People’s Hospital, North China University of Science and Technology, Tangshan, China
| | - Xiaochen Han
- Department of Otolaryngology — Head and Neck, Tangshan People’s Hospital, North China University of Science and Technology, Tangshan, China
| | - Zhiwu Wang
- Department of Medical Oncology, Tangshan People’s Hospital, North China University of Science and Technology, Tangshan, China
| | - Jingping Liu
- Department of Ultrasound, Tangshan People’s Hospital, North China University of Science and Technology, Tangshan, China
| | - Yongfeng Zhao
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
| | - Wengang Liu
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ping Zhou
- Department of Ultrasound, Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ping Zhou,
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Zha X, Miao Z, Huang X, Wang X, Xie R, Jin J, Zou D, Yang P, Huang Y. The Risk Stratification of Papillary Thyroid Cancer With Bethesda Category III (Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance) by Thyroid Fine-Needle Aspiration Could Be Assisted by Tumor Size for Precision Treatment. Front Endocrinol (Lausanne) 2022; 13:822423. [PMID: 35197932 PMCID: PMC8859163 DOI: 10.3389/fendo.2022.822423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate the clinical characteristics of papillary thyroid cancer (PTC) classified as Bethesda category III [atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS)] by fine-needle aspiration (FNA) for precision treatment. METHODS A total of 1,739 patients diagnosed with Bethesda category III (AUS/FLUS) by FNA were investigated, and 290 patients diagnosed with PTC were analyzed. RESULTS The rate of papillary thyroid microcarcinoma (PTMC) was 82.1% (238/290). The rates of lymph node metastases were 44.9% (22/49) and 25.2% (56/222) for PTC and PTMC, respectively (p = 0.006). The rates of extra-thyroid extension were 46.2% (24/52) and 19.8% (47/237) (p < 0.001). Compared with PTMC, PTC had significantly higher odds ratios (ORs) of 3.41 (1.81-6.44, p < 0.001), 2.19 (1.16-4.13, p = 0.016), and 2.51 (1.29-4.88, p = 0.007) for extra-thyroid extension, multifocality, and lymph node metastases, respectively, after adjustment for age and gender. The larger size and BRAF V600E mutation had a robust synergistic effect for invasive features. The rates of lymph node metastases, multifocality, and extra-thyroid extension were significantly increased with larger sizes harboring BRAF V600E mutation. Compared with PTMC harboring wild type (WT)-BRAF, PTC harboring BRAF V600E mutation had adjusted higher ORs of 3.01 (1.26-8.68, p = 0.015), 3.20 (1.22-8.42, p = 0.018), and 5.62 (2.25-14.01, p < 0.001) for lymph node metastases, multifocality, and extra-thyroid extension, respectively. CONCLUSIONS In this study, risk stratification was recommended for patients with Bethesda category III (AUS/FLUS) nodules with a size under 1 cm harboring WT-BRAF being regarded as low risk and should be recommended for active surveillance. Nodules with a size over 1 cm harboring WT-BRAF or those under 1 cm harboring BRAF V600E mutation could be regarded as moderate risk, and molecular testing should be recommended. However, those with a size over 1 cm harboring BRAF V600E mutation should be regarded as high risk, and a diagnostic surgery should be recommended.
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Affiliation(s)
- Xiaojuan Zha
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhenchun Miao
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiu Huang
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xingchun Wang
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruting Xie
- Department of Pathology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiaoying Jin
- Department of Pathology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Dajin Zou
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Peng Yang
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yueye Huang
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Yueye Huang,
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Parvathareddy SK, Siraj AK, Iqbal K, Qadri Z, Ahmed SO, Al-Rasheed M, AlQatie AA, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. TERT Promoter Mutations Are an Independent Predictor of Distant Metastasis in Middle Eastern Papillary Thyroid Microcarcinoma. Front Endocrinol (Lausanne) 2022; 13:808298. [PMID: 35360077 PMCID: PMC8962954 DOI: 10.3389/fendo.2022.808298] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/11/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Papillary thyroid microcarcinomas (PTMCs) have been attributed to the recent increased incidence of thyroid cancer. Although indolent, a subset of PTMC could potentially develop distant metastasis (DM). This study aimed to evaluate the clinico-pathological features and molecular characteristics of PTMC and identify the risk factors for DM in PTMC patients from Middle Eastern ethnicity. METHODS We retrospectively analyzed 210 patients with histologically confirmed PTMC. Clinico-pathological associations for DM, BRAF mutation and TERT mutation were analyzed successfully in 184 patients. Multivariate analysis was performed using Cox proportional hazards model and logistic regression analysis. RESULTS Among the PTMC patients included in this cohort, DM was noted in 6.0% (11/184), whereas tumor relapse occurred in 29/184 (15.8%). Of the 11 cases with DM, lung metastasis occurred in 8 cases, bone metastasis in 2 cases and brain metastasis in 1 case. Presence of extrathyroidal extension and male sex were significantly associated with DM. Molecular analysis showed BRAF V600E mutations to be the most frequent, being detected in 45.7% (84/184). TERT promoter mutations were detected in 16 (8.7%) cases and were significantly associated with DM and shorter metastasis-free survival in multivariate analysis. CONCLUSIONS Our study indicates a surprisingly high frequency of TERT promoter mutation in Saudi patients with PTMC. Identifying TERT promoter mutations as an independent predictor of DM in patients with microcarcinoma could explain the inherent aggressive nature of PTMC from Middle Eastern ethnicity and magnify its role in patient risk stratification, which might help in improving therapeutic strategy for these patients.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdul K. Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Kaleem Iqbal
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zeeshan Qadri
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saeeda O. Ahmed
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maha Al-Rasheed
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed A. AlQatie
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- *Correspondence: Khawla S. Al-Kuraya,
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46
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Caulley L, Eskander A, Yang W, Auh E, Cairncross L, Cho NL, Golbon B, Iyer S, Liu JC, Lee PJ, Lindeman B, Meltzer C, Molin N, Moore A, Noel J, Nozolino H, Pasternak J, Price B, Ramsay T, Rolighed L, Sajisevi M, Sharma A, Sinclair C, Sorensen M, Tae K, Tang AL, Tsao G, Williams M, Wrenn S, Xing MH, Zafereo M, Stack BC, Randolph G, Davies L. Trends in Diagnosis of Noninvasive Follicular Thyroid Neoplasm With Papillarylike Nuclear Features and Total Thyroidectomies for Patients With Papillary Thyroid Neoplasms. JAMA Otolaryngol Head Neck Surg 2021; 148:99-106. [PMID: 34817546 DOI: 10.1001/jamaoto.2021.3277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Increasing detection of early-stage papillary thyroid neoplasms without improvements in mortality has prompted development of strategies to prevent or mitigate overtreatment. Objective To determine adoption rates of 2 recent strategies developed to limit overtreatment of low-risk thyroid cancers: (1) a new classification, noninvasive follicular thyroid neoplasm with papillarylike nuclear features (NIFTP), and (2) hemithyroidectomy for selected papillary thyroid carcinomas (PTCs) up to 4 cm in size. Design, Setting, and Participants This is a cross-sectional analysis of 3368 pathology records of 2 cohorts of patients from 18 hospitals in 6 countries during 2 time periods (2015 and 2019). Participating hospitals were included from the US (n = 12), Canada (n = 2), Denmark (n = 1), South Korea (n = 1), South Africa (n = 1), and India (n = 1). The records of the first 100 patients per institution for each year who underwent thyroid-directed surgery (hemithyroidectomy, total thyroidectomy, or completion thyroidectomy) were reviewed. Main Outcomes and Measures Frequency of diagnosis of NIFTP, PTCs, and thyroidectomies during the study period. Results Of the 790 papillary thyroid neoplasms captured in the 2019 cohort, 38 (4.8%) were diagnosed as NIFTP. Diagnosis of NIFTP was observed in the US, South Africa, and India. There was minimal difference in the total proportion of PTCs in the 2015 cohort compared with the 2019 cohort (778 [47.1%] vs 752 [44.5%]; difference, 2.6% [95% CI, -16.9% to 22.1%]). The proportion of PTCs eligible for hemithyroidectomy but treated with total thyroidectomy in the 2 cohorts demonstrated a decreasing trend from 2015 to 2019 (341 of 453 [75.3%] vs 253 of 434 [58.3%]; difference, 17.0% [95% CI, -1.2% to 35.2%]). Conclusions and Relevance Results of this cohort study showed that the 2 mitigation strategies for preventing overtreatment of early-stage thyroid cancer have had mixed success. The diagnosis of NIFTP has only been applied to a small proportion of thyroid neoplasms compared with expected rates. However, more patients eligible for hemithyroidectomy received it in 2019 compared with 2015, showing some success with this deescalation strategy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.,Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Weining Yang
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Edel Auh
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lydia Cairncross
- Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bahar Golbon
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Kochi, India
| | - Jeffrey C Liu
- Division of Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Paul J Lee
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brenessa Lindeman
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | | | - Nicole Molin
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Alessandra Moore
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julia Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California
| | - Halie Nozolino
- Department of General Surgery, School of Medicine, University of Alabama at Birmingham, Birmingham
| | - Jesse Pasternak
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendon Price
- Division of Anatomical Pathology, Department of Pathology, Faculty of Health Sciences, University of Cape Town/National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lars Rolighed
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mirabelle Sajisevi
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Larner College of Medicine, University of Vermont Medical Center, Burlington
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Meredith Sorensen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Alice L Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gabriel Tsao
- The Permanente Medical Group, Santa Rosa, California
| | - Michelle Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Sean Wrenn
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer Foundation, New York, New York
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, New York, New York
| | - Greg Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Louise Davies
- VA Outcomes Group, White River Junction, Vermont.,Section of Otolaryngology-Head and Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients. Int Arch Otorhinolaryngol 2021; 25:e585-e593. [PMID: 34737832 PMCID: PMC8558954 DOI: 10.1055/s-0040-1722253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction
The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial.
Objective
To identify the clinical and pathological factors predictive of tumor recurrence.
Methods
We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the American Thyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence.
Results
After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (
p
= 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (
p
= 0.032; HR: 1.76; 95%CI: 1.05 to 2.96), and the presence of lymph-node metastasis (
p
< 0.001; HR: 3.69; 95%CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients.
Conclusions
The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age < 55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.
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Goulart APFE, Batista ERM, Figueira MG, Magalhães PKR, Maciel LMZ. Evaluation of thyroid nodules in the Brazilian Public Health Care System, Supplementary Health System, and Private Health System in the northeastern region of the State of São Paulo. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:779-786. [PMID: 33049130 PMCID: PMC10528606 DOI: 10.20945/2359-3997000000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To obtain data about the evaluation of thyroid nodules (TNs) in the northeastern of the State of São Paulo, compared by health care type, and measure the performance of cytology as a screening test for thyroid cancer (TC). METHODS We collected data of 597 patients treated in the Brazilian public health care system (SUS), supplementary health (SH) and in private health system (PHS) in 2014. A total of 803 TNs were aspirated, and 125 patients underwent surgery. RESULTS The distribution of all cytologic results according to the Bethesda system was: I, 135 (16.8%); II, 475 (59.2%); III, 107 (13.3%); IV, 32 (4.0%); V, 20 (2.5%); VI, 34 (4.2%). The time between cytologic analysis and surgery was longer in the SUS than in the SH for TNs in general (p < 0.001) and for TNs with Bethesda V and VI cytology (p = 0.01). The sizes of the TNs and resected malignant TNs was larger in the SUS than in the SH (p = 0.001 and p = 0.02, respectively). The number of PHS surgeries was too small and was not compared. The prevalence of TC was 9.2% and 23.6% of them were treated in the SUS. Cytology showed a 93.6% sensitivity, 95.8% specificity, and 94.7% accuracy when Bethesda III and IV were excluded. CONCLUSION Cytology was a good screening test for TC categories Bethesda II, V, and VI. The differences between the SUS and SH indicate a need for improved access to consultations and specialized tests in the SUS.
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Affiliation(s)
- Ana Paula Figueiredo Engler Goulart
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | | | | | - Patrícia Künzle Ribeiro Magalhães
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Léa Maria Zanini Maciel
- Divisão de Endocrinologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto, SP, Brasil,
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49
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Bosset M, Bonjour M, Castellnou S, Hafdi-Nejjari Z, Bournaud-Salinas C, Decaussin-Petrucci M, Lifante JC, Perrin A, Peix JL, Moulin P, Sassolas G, Pugeat M, Borson-Chazot F. Long-Term Outcome of Lobectomy for Thyroid Cancer. Eur Thyroid J 2021; 10:486-494. [PMID: 34956920 PMCID: PMC8647111 DOI: 10.1159/000510620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/01/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Recent guidelines of the American Thyroid Association (ATA) suggest that a lobectomy may be sufficient to treat low- to intermediate-risk patients with thyroid tumors ≤40 mm, without extrathyroidal extension or lymph node metastases. The present study aimed to evaluate long-term recurrence after lobectomy for differentiated thyroid cancer and to analyze factors associated with recurrence. METHODS In this retrospective cohort study, patients who underwent a lobectomy for thyroid cancer in a tertiary center between 1970 and 2010 were included. The outcome was the proportion of pathology-confirmed thyroid cancer recurrence, assessed in the whole cohort or in subgroups according to tumor size (≤ or >40 mm). RESULTS A total of 295 patients were included, and these were followed-up for a mean (standard deviation, SD) 19.1 (7.8) years (5,649 patient-years); 61 (20.7%) were male and the mean (SD) age at diagnosis was 39.7 (12) years. Histological subtype was papillary in 263 (89.2%) patients and mean cancer size was 22.9 (16.9) mm. According to the 2015 ATA guidelines, 271 (91.9%) cancers had a low risk of recurrence and 24 (8.1%) an intermediate risk. A reoperation was performed in 54 patients (18.3%) and recurrence was confirmed in 40 (13.6%), diagnosed for 55% of cases more than 10 years after their initial surgery. Among recurrent patients, 14 (4.8% of the cohort) were operated for a contralateral papillary thyroid microcarcinoma and 26 (8.8% of the cohort) for a locoregional or metastatic recurrence. Non-suspicious nodular recurrences were monitored without reoperation in 53 (18.0%) patients. At the end of follow-up, 282 (95.6%) patients were in remission. Tumors with locoregional or metastatic recurrence were more frequent among tumors with aggressive histology (19.2 vs. 4.1%, p = 0.015) and of intermediate risk category (28.6 vs. 7.1%, p = 0.018). Tumors >40 mm, which would have been treated by thyroidectomy according to the 2015 ATA guidelines criteria, were found in 34 (11.5%) patients and were associated with a higher frequency of recurrence (20.6 vs. 7.3%, p = 0.024) and less remission (85.3 vs. 96.9%, p = 0.001). CONCLUSION The outcome of thyroid cancer treated by lobectomy is very good, particularly for cancer ≤40 mm. A prolonged follow-up is required due to the risk of late recurrence.
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Affiliation(s)
- Matthieu Bosset
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Maxime Bonjour
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Solène Castellnou
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- *Solène Castellnou, Fédération d'Endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, 59 Boulevard Pinel, FR–69500 Bron (France),
| | - Zakia Hafdi-Nejjari
- Registre des Cancers Thyroïdiens du Département du Rhône, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Claire Bournaud-Salinas
- Centre de Médecine Nucléaire, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Myriam Decaussin-Petrucci
- Service d'Anatomie-Pathologique, Hospices Civils de Lyon, Groupement Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Jean Christophe Lifante
- Service de Chirurgie Endocrinienne, Hospices Civils de Lyon, Groupement Hospitalier Lyon-Sud, Pierre Bénite, France
- Laboratoire Health Services and Performance Research (EA 7425 HESPER), Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Agnès Perrin
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Jean-Louis Peix
- Service de Chirurgie Endocrinienne, Hospices Civils de Lyon, Groupement Hospitalier Lyon-Sud, Pierre Bénite, France
| | - Philippe Moulin
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- CarMeN Laboratory, Université Claude-Bernard Lyon 1, Inserm U1060, INRA U1397, INSA Lyon, IMBL, Villeurbanne, France
| | - Geneviève Sassolas
- Registre des Cancers Thyroïdiens du Département du Rhône, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Michel Pugeat
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
| | - Françoise Borson-Chazot
- Fédération d'Endocrinologie, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- Registre des Cancers Thyroïdiens du Département du Rhône, Hospices Civils de Lyon, Groupement Hospitalier Est, Bron, France
- Laboratoire Health Services and Performance Research (EA 7425 HESPER), Université Claude Bernard Lyon 1, Villeurbanne, France
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50
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Yan L, Zhang M, Song Q, Luo Y. Ultrasound-Guided Radiofrequency Ablation Versus Thyroid Lobectomy for Low-Risk Papillary Thyroid Microcarcinoma: A Propensity-Matched Cohort Study of 884 Patients. Thyroid 2021; 31:1662-1672. [PMID: 34269611 DOI: 10.1089/thy.2021.0100] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Thermal ablation (TA) has been applied in patients with low-risk papillary thyroid microcarcinoma (PTMC) who refuse surgery or active surveillance (AS). Recently, TA has been proposed as a potential therapeutic option for patients who are suitable for surgery or AS. However, the clinical outcomes of TA versus surgery remains controversial because of a lack of sufficient data. This study aimed to compare the clinical outcomes between radiofrequency ablation (RFA) versus thyroid lobectomy (TL) for low-risk PTMC in a large cohort. Methods: This retrospective study evaluated 884 patients with unifocal low-risk PTMC treated with TL or RFA from June 2014 to March 2018. Among them, 460 patients underwent TL (TL group) and 424 patients, who refused surgery or AS, underwent RFA (RFA group). Patients were regularly followed up after treatment. Local tumor progression, recurrence-free survival (RFS), complications, and treatment variables, including procedure time, estimated blood loss, hospitalization, and cost, were compared after propensity score matching (PSM). Results: After PSM, a total of 332 patients underwent TL (mean ages 43.8 ± 9.5 years) and 332 underwent RFA (mean ages 44.1 ± 9.5 years). During the follow-up (median [interquartile ranges], 48.3 [23.2] months), no significant differences were observed in local tumor progression (1.8% vs. 3.3%, p = 0.209), lymph node metastasis (0.6% vs. 0.6%, p = 1.000), recurrent PTMC (1.2% vs. 2.4%, p = 0.244), persistent lesion (0% vs. 0.3%, p = 0.317), and 4-year RFS rates (98.2% vs. 97.0%, p = 0.223) between the TL and RFA groups. Distant metastasis was not detected. None of the patients who were treated by RFA underwent delayed surgery. Patients undergoing RFA had shorter procedure time (3.4 [2.5] vs. 86.0 [37.0] minutes, p < 0.001), lower estimated blood loss (0 vs. 20 [10.0] mL, p < 0.001), shorter hospitalization (0 vs. 7.0 [3.0] days, p < 0.001), lower cost ($2035.7 [254.0] vs. $2269.1 [943.4], p < 0.001) and lower complication rate (0% vs. 4.5%, p < 0.001) than those treated by TL. The association between treatment modality and recurrence remained nonsignificant after Cox analysis (p = 0.247). Conclusions: This large matched study revealed comparable four-year clinical outcomes between RFA and TL for low-risk PTMC. As a minimally invasive modality, RFA may be a promising alternative to the existing treatment options for low-risk PTMC.
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Affiliation(s)
- Lin Yan
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Qing Song
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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