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Higgins RC, King TS, Tucker J, Engle L, Goldenberg D. Papillary thyroid microcarcinoma: Does management differ based on facility variables? Am J Otolaryngol 2024; 45:104460. [PMID: 39106681 DOI: 10.1016/j.amjoto.2024.104460] [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: 07/12/2024] [Accepted: 07/30/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE Papillary thyroid carcinoma detection has increased dramatically in the United States. However, the indolent nature of papillary thyroid microcarcinoma (mPTC) has led the American Thyroid Association (ATA) to advocate for more conservative management. The 2015 ATA recommendations advocated for observation or lobectomy for mPTC. However, the majority of mPTCs continue to be treated with more aggressive surgical management. In this study, we aim to understand the management of mPTC based on facility variables. MATERIALS AND METHODS A retrospective observational study of patients diagnosed with mPTC between 2004 and 2018 was performed using the National Cancer Database incidence data. We collected data on patient sex, age, tumor size, race, ethnicity, geographic location, thyroid surgical volume at the facility, and treatment modality for mPTC were collected. Conservative and non-conservative treatment modalities based on patient and facility characteristics were compared both longitudinally and cross-sectionally between pre- and post-2015 ATA recommendations. RESULTS Total thyroidectomy with or without radioactive iodine ablation (RAI) remains the treatment of choice regardless of patient and facility characteristics. Patients treated at low-volume facilities were actually more likely to be treated conservatively. CONCLUSIONS Despite 2015 ATA recommendations advocating for observation or lobectomy for mPTC, patients with mPTC are still more likely to be treated with total thyroidectomy with or without RAI, especially at high-volume facilities.
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Affiliation(s)
- Ryan C Higgins
- Department of Otolaryngology, University of Nebraska Medical Center, Omaha, NE, United States of America
| | - Tonya S King
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
| | - Jacqueline Tucker
- Department of Otolaryngology, University of Minnesota, College of Medicine, Minneapolis, MN, United States of America
| | - Linda Engle
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, United States of America
| | - David Goldenberg
- Department of Otolaryngology, The Pennsylvania State University, College of Medicine, Hershey, PA, United States of America.
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Xiao X, Zhu Y, Li L, Liao Y, Li N. The effectiveness and safety of thermal ablation for thyroid carcinoma lymph node metastasis are affected by the diameter of metastatic lymph nodes: A meta-analysis. Surgery 2024; 176:396-405. [PMID: 38777658 DOI: 10.1016/j.surg.2024.04.009] [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: 09/12/2023] [Revised: 02/17/2024] [Accepted: 04/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND To explore the diameter of lymph nodes with metastatic thyroid carcinoma and the effectiveness and safety of thermal ablation. METHODS Several databases were searched for literature on the treatment of thyroid carcinoma metastatic lymph nodes by thermal ablation. A subgroup analysis was performed according to the diameter of the metastatic lymph nodes. The measures included pooled estimates of mean volume reduction, pooled proportions of total disappearance and recurrence, and the pooled proportions of overall complications. RESULTS There were 20 studies with 372 patients and 620 metastatic lymph nodes included. Based on the average maximum diameter of the metastatic lymph nodes, they were divided into three groups: A (≤ 10 mm), B (10 < diameter ≤ 20 mm), and C (> 20 mm). The study results indicated a significant decrease in the average volume only in groups A and B. The ratio of tumor disappearance showed that group A had the highest percentage, followed by group B and then group C. The recurrence rates were comparable between groups A and B, but slightly lower than in group C. Moreover, the overall complication rates for the three groups were ranked as follows: group A > group C > group B. CONCLUSION Overall, thermal ablation is an effective and safe treatment for thyroid cancer metastatic lymph nodes with diameters of 10-20mm.
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Affiliation(s)
- Xiaoyi Xiao
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yun Zhu
- Department of Ultrasound, The First Hospital of Hunan University of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Linzhe Li
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yacong Liao
- The Second Xiangya Hospital of Central South University, Ultrasound Changsha, Hunan, People's Republic of China
| | - Na Li
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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Yoon JH, Park JY, Hong AR, Kim HK, Kang HC. Predictors of lateral lymph node metastasis and skip metastasis in patients with papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2024; 15:1392247. [PMID: 39015180 PMCID: PMC11250241 DOI: 10.3389/fendo.2024.1392247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/03/2024] [Indexed: 07/18/2024] Open
Abstract
Background Papillary thyroid microcarcinoma (PTMC) is characterized by its favorable prognosis and potential for active surveillance (AS) as a management option. However, the presence of cervical lymph node (LN) metastasis, especially lateral LN metastasis, significantly impacts management and prognosis. Previous studies have focused on post-surgery risk factors for cervical LN metastasis. This study aims to identify predictors of lateral LN metastasis by analyzing pre-operative ultrasonographic findings alongside clinicopathological factors. Methods A retrospective review of medical records was conducted for patients with PTMC who underwent surgery at Chonnam National University Hwasun Hospital between 2004 and 2013. This is a case-control study that compares patients with lateral LN metastasis (N1b) to age- and sex-matched patients without LN metastasis (N0). Subgroup analysis was performed to evaluate risk factors of skip metastasis. Results The study included 90 patients with PTMC with lateral LN metastasis (N1b) and 268 age- and sex-matched patients without LN metastasis (N0). The mean age was 49.3 years, and female patients were dominant in both groups. Structural recurrences of 4.4% (4/90) were observed only in the N1b group. The N1b group exhibited a higher frequency of upper lobe tumor location compared to the N0 group (38.9% vs. 16.0%, p < 0.001). There was no significant difference in the locations with the presence of invasion to adjacent organs. A higher proportion of non-parallel shape was observed in the N1b group than the N0 group (80.0% vs. 66.0%, p = 0.013). There were no differences in echogenicity, sonographic feature, margin, and AP diameter of the thyroid gland between the two groups. In multivariate analysis, independent risk factors for lateral LN metastasis included extrathyroidal extension, multiplicity, upper lobe tumor location, and non-parallel shape. Skip metastasis in patients with PTMC was associated with upper lobe tumor location. Conclusion Detailed ultrasound examinations, evaluating tumor location, number, orientation, and the presence of ETE, are crucial in accurately predicting lateral LN metastasis especially when primary tumor was in the upper lobe to avoid missing skip metastasis. These evaluations can help guide the decision between AS and immediate surgery in patients with PTMC.
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Affiliation(s)
- Jee Hee Yoon
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Ji Yong Park
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - A Ram Hong
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
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Sanabria A, Ferraz C, Ku CHC, Padovani R, Palacios K, Paz JL, Roman A, Smulever A, Vaisman F, Pitoia F. Implementing active surveillance for low-risk thyroid carcinoma into clinical practice: collaborative recommendations for Latin America. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230371. [PMCID: PMC11192484 DOI: 10.20945/2359-4292-2023-0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/08/2024] [Indexed: 08/03/2024]
Abstract
The incidence of thyroid cancer is increasing globally, but mortality rates have remained steady. Many patients with thyroid cancer have low-risk, nonmetastatic intrathyroidal tumors smaller than 2 cm. Active surveillance has shown benefits in these patients, but the adoption of this approach remains below standard in Latin America. The purpose of this article is to identify ways to improve the incorporation of active surveillance into clinical practice for patients with low-risk thyroid carcinoma in Latin America, taking into consideration cultural and geographic factors. Current recommendations include three steps involving patient participation. The first step, which consists of the initial clinical examination, has eight factors requiring special attention. Anxiety must be managed while considering individual, disease-related, cognitive, and environmental aspects. Terms like "overdiagnosis", "incidentaloma," and "overtreatment" must be explained to the patient. Implementing precise terminology contributes to adequate disease perception, substantially reducing stress and anxiety. Clarifying the nonprogressive nature of thyroid cancer helps dispel myths surrounding the disease. The second step includes advice about procedures and guidelines for patients who choose active surveillance. Flexible monitoring techniques should be implemented, with regular check-ins scheduled based on patient needs. Reasons for adjusting treatment must be clearly communicated to the patient, and changes in preference regarding active surveillance should be considered in advance. The third step includes assistance during follow-up. Patients must be educated about ultrasound results and receive surgical indications from specialized physicians. The effectiveness of active surveillance can be reinforced by explaining to the patients the dynamics of changes in nodule size using clear and concise visual aids.
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Affiliation(s)
- Alvaro Sanabria
- Universidad de AntioquiaFacultad de MedicinaDepartamento de CirugíaMedellínColombiaDepartamento de Cirugía, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Centro de Excelencia en Enfermedades de Cabeza y CuelloMedellínColombiaCentro de Excelencia en Enfermedades de Cabeza y Cuello (CEXCA), Medellín, Colombia
| | - Carolina Ferraz
- Irmandade da Santa Casa de Misericórdia de São PauloDivisão de EndocrinologiaDepartamento de MedicinaSão PauloSPBrasilDivisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Chih Hao Chen Ku
- Universidad de Costa RicaDepartamento de Farmacología Clínica y ToxicologíaSan JoséCosta RicaDepartamento de Farmacología Clínica y Toxicología, Universidad de Costa Rica, Clínica Los Yoses, San José, Costa Rica
| | - Rosalia Padovani
- Irmandade da Santa Casa de Misericórdia de São PauloDivisão de EndocrinologiaDepartamento de MedicinaSão PauloSPBrasilDivisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Karen Palacios
- Clínica Diagnóstica Especializada VIDDivisión de EndocrinologíaMedellínColombiaDivisión de Endocrinología, Clínica Diagnóstica Especializada VID, Medellín, Colombia
| | - José Luis Paz
- Universidad Nacional Mayor de San MarcosHospital Nacional Edgardo Rebagliati MartinsFacultad de MedicinaLimaPerúDivisión de Endocrinología, Hospital Nacional Edgardo Rebagliati Martins, Departamento de Medicina, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Alejandro Roman
- Universidad de AntioquiaHospital Universitario San Vicente FundaciónFacultad de MedicinaMedellínColombiaSección de Endocrinología, Departamento de Medicina, Facultad de Medicina, Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Anabella Smulever
- Universidad de Buenos AiresHospital de ClínicasDivisión de EndocrinologíaBuenos AiresArgentinaDivisión de Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Fernanda Vaisman
- Universidade Federal do Rio de JaneiroInstituto Nacional do CâncerFaculdade de MedicinaRio de JaneiroRJBrasilServiço de Oncoendocrinologia, Serviço de Endocrinologia, Faculdade de Medicina, Instituto Nacional do Câncer (Inca), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Fabian Pitoia
- Universidad de Buenos AiresHospital de ClínicasDivisión de EndocrinologíaBuenos AiresArgentinaDivisión de Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
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Liu C, Zhao H, Lu Y, Xia Y, Cao Y, Zhang L, Zhao Y, Gao L, Liu Y, Liu H, Kuang Z, Liu S, Shao Q, Li X. A Long-Term Study Comparing the Quality of Life and Psychological Status of Patients with Highly Suspicious Thyroid Nodules ≤1 cm Undergoing Active Surveillance with Those Undergoing Immediate Surgery. Thyroid 2024; 34:611-625. [PMID: 38269424 DOI: 10.1089/thy.2023.0478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Background: Limited information is available on the long-term impact of active surveillance (AS) and immediate surgery (IS) on the quality of life (QoL) and psychological status of patients with highly suspicious subcentimeter thyroid nodules. Methods: A prospective study was conducted on 752 patients showing highly suspicious subcentimeter thyroid nodules, among whom 584 chose AS and 168 chose IS. All patients underwent at least two assessments regarding their QoL and psychological status, using three questionnaires: Thyroid Cancer-Specific Quality of Life (THYCA-QoL), Hospital Anxiety and Depression Scale (HADS), and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30). Propensity-score matching (PSM) at a ratio of 3:1 was utilized on patients in the AS and IS groups to mitigate selection bias (504 patients in the AS group and 168 in the IS group). Subsequently, the mixed linear model was used to analyze the QoL data. Results: The median time from the initial evaluation to the last follow-up in the AS and IS groups was 24.0 and 14.2 months, respectively. The AS group showed superior QoL outcomes compared to the IS group, mainly manifested in voice (p < 0.001), sympathetic (p = 0.008), throat/mouth (p < 0.001), and problems with scar (p < 0.001) domains, as per the THYCA-QoL questionnaire. Further, the EORTC QLQ-C30 questionnaire highlighted better outcomes in physical function (p = 0.029), role function (p < 0.001), social function (p < 0.001), global health status (p < 0.001), fatigue (p = 0.012), pain (p = 0.028), appetite loss (p = 0.017), and financial difficulties (p < 0.001). Compared to the initial assessment (1 week after surgery), the IS group showed progressive improvements in QoL, especially in voice (p = 0.024), throat/mouth (p < 0.001), physical function (p = 0.004), social function (p = 0.014), nausea and vomiting (p < 0.001), pain (p = 0.006), and appetite loss (p = 0.048) domains as per both questionnaires. Conclusion: Patients with highly suspicious subcentimeter thyroid nodules who choose IS tend to experience a poorer long-term QoL compared to those who choose AS. Although the situation may improve over time, certain issues might persist, making AS a favorable option for these patients.
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Affiliation(s)
- Chunhao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liyang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuewu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongfeng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zifeng Kuang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuzhou Liu
- Department of Otolaryngology Head and Neck Surgery, Hainan General Hospital, Haikou, China
| | - Qianqian Shao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Scappaticcio L, Trimboli P, Bellastella G, Ferrazzano P, Clery E, Cozzolino I, Montella M, Fasano M, Pirozzi M, Ferrandes S, Docimo G, Ciardiello F, Franco R, Esposito K. Prediction of classical versus non classical papillary thyroid carcinoma subtypes from cytology of nodules classified according to TIRADS. Endocrine 2024; 84:560-570. [PMID: 38001322 PMCID: PMC11076311 DOI: 10.1007/s12020-023-03604-3] [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: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE Our purposes were: 1) to estimate the prediction performance (PP) of cytology in identifying papillary thyroid carcinoma (PTC) subtypes; 2) to explore how the PTC subtypes distribute among the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) categories. METHODS Nodules were included if both the histology with the PTC subtype report and the cytology report with the possible PTC subtype were available. The PP was calculated by making the proportion of True positives/False positives+false negatives. RESULTS 309 cytologically "suspicious for malignancy" and "malignant" thyroid nodules with PTC histology were evaluated. ACR TI-RADS categorization for classical PTC was significantly different from non-classical PTC (p-value 0.02). For the whole cohort the PP of cytologically classical cases was 0.74, while that of cytologically non classical cases was 0.41. ACR TI-RADS categorization was not significantly different for aggressive vs non-aggressive PTC subtypes (p-value 0.1). When considering only aggressive or non-aggressive PTC subtypes, the PP of cytologically classical cases was respectively 0.86 and 0.87, while that of cytologically non classical cases was respectively 0.27 and 0.22. The PP of cytologically classical cases was 0.73 and 0.79, respectively for macroPTCs and microPTCs, while that of cytologically non classical cases was 0.55 and 0.33, respectively for macroPTCs and microPTCs. CONCLUSION Cytology examination reliably performed in predicting classical PTC versus non classical PTC subtypes. ACR TI-RADS categorization was significantly different among classical PTC versus non classical PTC subtypes.
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Affiliation(s)
- Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pierpaolo Trimboli
- Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy.
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Pamela Ferrazzano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Eduardo Clery
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Morena Fasano
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Pirozzi
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Sonia Ferrandes
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fortunato Ciardiello
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, AOU University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
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7
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Abelleira E, Jerkovich F. Dynamic risk assessment in patients with differentiated thyroid cancer. Rev Endocr Metab Disord 2024; 25:79-93. [PMID: 38015344 DOI: 10.1007/s11154-023-09857-7] [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] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
The current approach for patients with differentiated thyroid carcinoma should be individualized according to the risk of recurrence, and this stratification could be used to identify the risk of persistent/recurrent disease in three scenarios: preoperatively, immediately postoperatively, and during long-term follow-up. The initial risk of recurrence will tailor the management of the patient in the preoperative and immediate postoperative settings, while the dynamic risk, which considers the responses to treatment, could guide the decision-making process for remnant ablation and long-term management.This review provides a summary of the existing information regarding the dynamic risk of recurrence and recommended management for patients with differentiated thyroid cancer. The application of this approach is essential to avoid unnecessary treatments for most patients who will have a favorable prognosis. On the other hand, it allows specific therapeutic interventions for those patients at high risk of recurrence. In the future, analysis of tumor biology and prospective studies will surely improve the accuracy of recurrence risk prediction.
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Affiliation(s)
- Erika Abelleira
- Division of Endocrinology, Hospital de Clínicas José de San Martín (UBA), University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, C 1120, Argentina.
| | - Fernando Jerkovich
- Division of Endocrinology, Hospital de Clínicas José de San Martín (UBA), University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, C 1120, Argentina
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8
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Li Y, Wu F, Ge W, Zhang Y, Hu Y, Zhao L, Gou W, Shi J, Ni Y, Li L, Fu W, Lin X, Yu Y, Han Z, Chen C, Xu R, Zhang S, Zhou L, Pan G, Peng Y, Mao L, Zhou T, Zheng J, Zheng H, Sun Y, Guo T, Luo D. Risk stratification of papillary thyroid cancers using multidimensional machine learning. Int J Surg 2024; 110:372-384. [PMID: 37916932 PMCID: PMC10793787 DOI: 10.1097/js9.0000000000000814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Papillary thyroid cancer (PTC) is one of the most common endocrine malignancies with different risk levels. However, preoperative risk assessment of PTC is still a challenge in the worldwide. Here, the authors first report a Preoperative Risk Assessment Classifier for PTC (PRAC-PTC) by multidimensional features including clinical indicators, immune indices, genetic feature, and proteomics. MATERIALS AND METHODS The 558 patients collected from June 2013 to November 2020 were allocated to three groups: the discovery set [274 patients, 274 formalin-fixed paraffin-embedded (FFPE)], the retrospective test set (166 patients, 166 FFPE), and the prospective test set (118 patients, 118 fine-needle aspiration). Proteomic profiling was conducted by FFPE and fine-needle aspiration tissues from the patients. Preoperative clinical information and blood immunological indices were collected. The BRAFV600E mutation were detected by the amplification refractory mutation system. RESULTS The authors developed a machine learning model of 17 variables based on the multidimensional features of 274 PTC patients from a retrospective cohort. The PRAC-PTC achieved areas under the curve (AUC) of 0.925 in the discovery set and was validated externally by blinded analyses in a retrospective cohort of 166 PTC patients (0.787 AUC) and a prospective cohort of 118 PTC patients (0.799 AUC) from two independent clinical centres. Meanwhile, the preoperative predictive risk effectiveness of clinicians was improved with the assistance of PRAC-PTC, and the accuracies reached at 84.4% (95% CI: 82.9-84.4) and 83.5% (95% CI: 82.2-84.2) in the retrospective and prospective test sets, respectively. CONCLUSION This study demonstrated that the PRAC-PTC that integrating clinical data, gene mutation information, immune indices, high-throughput proteomics and machine learning technology in multicentre retrospective and prospective clinical cohorts can effectively stratify the preoperative risk of PTC and may decrease unnecessary surgery or overtreatment.
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Affiliation(s)
| | - Fan Wu
- Department of Oncological Surgery
| | - Weigang Ge
- bWestlake Omics (Hangzhou) Biotechnology Co., Ltd
| | - Yu Zhang
- Department of Oncological Surgery
| | - Yifan Hu
- bWestlake Omics (Hangzhou) Biotechnology Co., Ltd
| | - Lingqian Zhao
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University
| | - Wanglong Gou
- Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang
| | | | - Yeqin Ni
- Department of Oncological Surgery
| | - Lu Li
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University
- Research Centre for Industries of the Future, Westlake University
- Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang Province
| | - Wenxin Fu
- bWestlake Omics (Hangzhou) Biotechnology Co., Ltd
| | - Xiangfeng Lin
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong Province, People’s Republic of China
| | - Yunxian Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University
| | | | | | | | - Shirong Zhang
- Centre of Translational Medicine, Hangzhou First People’s Hospital
| | - Li Zhou
- Department of Oncological Surgery
| | - Gang Pan
- Department of Oncological Surgery
| | - You Peng
- Department of Oncological Surgery
| | | | - Tianhan Zhou
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University
| | - Jusheng Zheng
- Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, Zhejiang
| | - Haitao Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Shandong Province, People’s Republic of China
| | - Yaoting Sun
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University
- Research Centre for Industries of the Future, Westlake University
- Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang Province
| | - Tiannan Guo
- Key Laboratory of Structural Biology of Zhejiang Province, School of Life Sciences, Westlake University
- Research Centre for Industries of the Future, Westlake University
- Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang Province
| | - Dingcun Luo
- Department of Oncological Surgery
- The Fourth Clinical Medical College, Zhejiang Chinese Medical University
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9
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Kaliszewski K, Diakowska D, Miciak M, Jurkiewicz K, Kisiel M, Makles S, Dziekiewicz A, Biernat S, Ludwig M, Ludwig B, Sutkowska-Stępień K, Sebastian M, Domosławski P, Sutkowski K, Wojtczak B. The Incidence Trend and Management of Thyroid Cancer-What Has Changed in the Past Years: Own Experience and Literature Review. Cancers (Basel) 2023; 15:4941. [PMID: 37894308 PMCID: PMC10605595 DOI: 10.3390/cancers15204941] [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: 09/17/2023] [Revised: 09/30/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Because of ambiguous and widely debated observations concerning the incidence, trend, and management of TC, we performed this analysis. We drew attention to some events, such as "cancer screening activity", introduction of noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) to TC types, possibility of papillary thyroid microcarcinoma (PTMC) active surveillance (AS), occurrence of personalized medicine in TC management, and, finally, COVID-19 pandemic time. Because of the opinion that all changes have been made mostly by PTC, we compared it to the remaining types of TC in terms of incidence, clinical and pathological characteristics, and treatment. We analyzed patients treated in a single surgical center in eastern Europe (Poland). The prevalence of TC significantly increased from 5.15% in 2008 to 13.84% in 2015, and then significantly decreased to 1.33% in 2022 when the COVID-19 pandemic lasted (p < 0.0001). A similar trend was observed for PTC, when the incidence significantly increased to 13.99% in 2015 and then decreased to 1.38% in 2022 (p < 0.0001). At that time, the NIFTP category was introduced, and observation of PTMC began. The prevalence of FTC and MTC also increased until 2015 and then decreased. Significant differences in age, types of surgery, necessity of reoperation, and pTNM between PTCs and other types of TCs were observed. The average age was significantly lower in PTC patients than in patients with the remaining types of TC (p < 0.0001). Four milestones, including NIFTP introduction, the possibility of PTMC AS, personalized cancer medicine, and the COVID-19 pandemic, may have influenced the general statistics of TC.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Dorota Diakowska
- Department of Basic Sciences, Faculty of Health Science, Wroclaw Medical University, 50-367 Wrocław, Poland;
| | - Michał Miciak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Krzysztof Jurkiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Michał Kisiel
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Szymon Makles
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Anna Dziekiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Szymon Biernat
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Maksymilian Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Bartłomiej Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Karolina Sutkowska-Stępień
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Maciej Sebastian
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Paweł Domosławski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.M.); (K.J.); (M.K.); (S.M.); (A.D.); (S.B.); (B.L.); (K.S.-S.); (M.S.); (P.D.); (K.S.); (B.W.)
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10
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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: 0] [Impact Index Per Article: 0] [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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11
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Liu C, Zhao H, Xia Y, Cao Y, Zhang L, Zhao Y, Gao L, Liu R, Liu Y, Liu H, Meng Z, Liu S, Lu Y, Li X. Active surveillance versus immediate surgery: A comparison of clinical and quality of life outcomes among patients with highly suspicious thyroid nodules 1 cm or smaller in China. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106917. [PMID: 37137793 DOI: 10.1016/j.ejso.2023.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Active surveillance (AS) is considered an alternative to immediate surgery (IS) for low-risk papillary thyroid microcarcinoma (PTMC) patients. However, it is difficult to decide between AS and IS due to limited evidence regarding risks and benefits for patients in China. METHODS This study prospectively enrolled 485 patients with highly suspicious thyroid nodules = 1 cm who chose AS and 331 patients who underwent IS during the same period. The oncological outcomes, adverse events and quality of life, were compared between the two groups. RESULTS The oncological outcomes of the IS and AS groups were similarly excellent. The IS group had significantly higher rates of temporary vocal cord paralysis (VCP) and temporary hypoparathyroidism than the AS group (2.7% vs. 0.2%, p = 0.002; 13.6% vs.1.9%, p < 0.001, respectively). The IS group had significantly more patients on hormone replacement therapy (98.4% vs. 10.9%, p < 0.001) and a significantly higher incidence of neck scarring (94.3% vs. 9.1%, p < 0.001) compared to the AS group. In the early stages, the quality of life questionnaire showed significant differences with respect to three items: voice, throat/mouth, and surgical scarring, with more complaints in the IS group. However, one year or more after surgery, the main complaint was surgical scarring. CONCLUSION In China, AS can achieve similar short-term therapeutic effects as IS. As this approach can reduce the occurrence of unfavorable events, achieve better quality of life, it is a feasible option for patients with highly suspicious thyroid nodules.
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Affiliation(s)
- Chunhao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Liyang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Ya Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Ruifeng Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Yuewu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Hongfeng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Zhilan Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Shuzhou Liu
- Department of Otolaryngology Head and Neck Surgery, Hainan General Hospital, Hainan, 570311, China.
| | - Ying Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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12
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Koot A, Soares P, Robenshtok E, Locati LD, de la Fouchardiere C, Luster M, Bongiovanni M, Hermens R, Ottevanger P, Geenen F, Bartѐs B, Rimmele H, Durante C, Nieveen-van Dijkum E, Stalmeier P, Dedecjus M, Netea-Maier R. Position paper from the Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) on the management and shared decision making in patients with low-risk micro papillary thyroid carcinoma. Eur J Cancer 2023; 179:98-112. [PMID: 36521335 DOI: 10.1016/j.ejca.2022.11.005] [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: 09/23/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
The incidence of differentiated thyroid cancer (DTC) has been increasing worldwide, mostly, as an increase in the incidental detection of micro papillary thyroid carcinomas (microPTCs), many of which are potentially overtreated, as suggested by the unchanged mortality. Several international guidelines have suggested a less aggressive approach. More recently, it has been shown that active surveillance or minimally invasive treatments (MIT) are good alternatives for the management of these patients. In this context, patient participation in the decision-making process is paramount. The Endocrine Task Force of the European Organisation for Research and Treatment of Cancer (EORTC) has undertaken the task to establish consensus and define its position based on the scientific evidence concerning, 1) the current state of diagnostic and management options in microPTCs, including the current opinion of physicians about shared decision making (SDM), 2) the available evidence concerning patients' needs and the available decision instruments, and 3) to provide practical suggestions for implementation of SDM in this context. To improve SDM and patients' participation, knowledge gaps and research directions were highlighted.
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Affiliation(s)
- Anna Koot
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands.
| | - Paula Soares
- Institute for Research and Innovation in Health - i3S/Institute of Molecular Pathology and Immunology of the University of Porto-IPATIMUP, 4200-135 Porto, Portugal; Faculty of Medicine of the University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - Eyal Robenshtok
- Endocrinology and Metabolism Institute, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Laura D Locati
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Translational Oncology Unit, IRCCS Instituti Clinici Scientifici Maugeri, Pavia, Italy
| | | | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Massimo Bongiovanni
- Internal Medicine Unit, Department of Medicine, Ospedale di Circolo di Rho, ASST Rhodense, Milan, Italy
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
| | - Frans Geenen
- Schildklierorganisatie Nederland (SON), the Netherlands
| | | | - Harald Rimmele
- Bundesverband Schilddrüsenkrebs - Ohne Schilddrüse Leben e.V., Germany
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Els Nieveen-van Dijkum
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Cancer Center Amsterdam, the Netherlands
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, the Netherlands
| | - Marek Dedecjus
- Department of Endocrine Oncology and Nuclear Medicine, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
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13
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Tuttle RM, Fagin J, Minkowitz G, Wong R, Roman B, Patel S, Untch B, Ganly I, Shaha A, Shah J, Li D, Bach A, Girshman J, Lin O, Cohen M, Cohen JM, Cracchiolo J, Ghossein R, Sabra M, Boucai L, Fish S, Morris L. Active Surveillance of Papillary Thyroid Cancer: Frequency and Time Course of the Six Most Common Tumor Volume Kinetic Patterns. Thyroid 2022; 32:1337-1345. [PMID: 36178355 PMCID: PMC9700377 DOI: 10.1089/thy.2022.0325] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: The change in size of the papillary thyroid cancer (PTC) nodule during active surveillance has traditionally been characterized as either stable, increasing, or decreasing based on changes in maximal tumor diameter or tumor volume. More recently, it has been observed that the changes in tumor size observed during observation are more complex with tumor volume kinetic patterns that can be characterized either as stable (Pattern I), early increase in volume (Pattern II), later increase in volume (Pattern III), early increase in volume followed by stability (Pattern IV), stability followed by an increase in volume (Pattern V), or a decrease in tumor volume (Pattern VI). Methods: The frequency, time course, and clinical correlates of these six tumor volume kinetic patterns were analyzed in a cohort of 483 patients with low-risk PTC up to 1.5 cm in maximal diameter followed with active surveillance at our center for a median of 3.7 years. Results: The cumulative incidence of an increase in tumor volume for the entire cohort was 15.9% [confidence interval (CI) 11.8-20.0] at 5 years. At 5 years, most tumors demonstrated stability (78.8%, Pattern I) with 10.0% showing early growth (Pattern II), 4.1% late growth (Pattern III), 1.9% growth then stability (Pattern IV), 0.6% stability then growth (Pattern V), and 5.6% with a decrease in tumor volume (Pattern VI). Tumor volume doubling time during exponential growth significantly differed across the kinetic patterns, with median values of 2.4, 7.1, and 3.3 years for Patterns II, III, and IV, respectively (p < 0.01). Similarly, the time to a change in tumor volume was significantly different across the kinetic patterns, with median values of 1.5, 3, 1.6, 4.7, and 4.1 years for Patterns II, III, IV, V, and VI, respectively (analysis of variance, p < 0.01). Clinical correlates at baseline were not associated with tumor volume kinetic pattern. Conclusions: These six kinetic tumor volume patterns provide a comprehensive description of the changes in PTC tumor volume observed during the first 5 years of active surveillance.
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Affiliation(s)
- Robert Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - James Fagin
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gerald Minkowitz
- Department of Surgery Education, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard Wong
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Benjamin Roman
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal Patel
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brian Untch
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ashok Shaha
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin Shah
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Duan Li
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ariadne Bach
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jeffrey Girshman
- Radiology and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oscar Lin
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc Cohen
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jean-Marc Cohen
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer Cracchiolo
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ronald Ghossein
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mona Sabra
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Laura Boucai
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephanie Fish
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Luc Morris
- Head and Neck Service, Department of Surgery, Department of Memorial Sloan Kettering Cancer Center, New York, New York, USA
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14
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Liu C, Zhao H, Xia Y, Cao Y, Zhang L, Zhao Y, Gao L, Liu R, Liu Y, Liu H, Meng Z, Liu S, Li X. Active surveillance of highly suspicious thyroid nodules cohort in China shows a worse psychological status in younger patients. Front Oncol 2022; 12:981495. [PMID: 36091122 PMCID: PMC9458970 DOI: 10.3389/fonc.2022.981495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Active surveillance has been considered a safe alternative to surgery for low-risk papillary thyroid microcarcinoma. This study aimed to assess the oncological outcomes and psychological status of active surveillance of highly suspicious thyroid nodules ≤10 mm in China. Methods This prospective single-center cohort study enrolled 336 patients with highly suspicious thyroid nodules for active surveillance to assess oncological outcomes and psychological status. The psychological status of patients was assessed by two different questionnaires and compared among different patient groups. Results During a median follow-up period of 28.5 months, eight patients underwent delayed surgery for tumor enlargement and one for lymph node metastases. The cumulative incidence of disease progression at 5 and 10 years was 6.0% and 12.8%, respectively. Patients who underwent delayed surgery had no permanent complications, and no patient had distant metastasis or death. Patients ≤30 years old had a higher baseline anxiety score (4.9 vs. 3.8, p=0.024), a higher proportion of baseline anxiety score, i.e., ≥8 points (24.0% vs. 12.6%, p=0.033), and a worse baseline emotional function (62.7 vs. 70.7, p=0.013) than patients >30. During AS, patients ≤30 years of age had higher overall anxiety levels (p=0.005) and a worse overall emotional function (p=0.001). Conclusions Active surveillance in Chinese patients with highly suspicious subcentimetre thyroid nodules has good oncological outcomes and can be used as a safe alternative to surgery. Younger patients (≤30) show a worse psychological status; therefore, more attention should be paid to younger patients.
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Affiliation(s)
- Chunhao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liyang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruifeng Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuewu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongfeng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhilan Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuzhou Liu
- Department of Otolaryngology Head and Neck Surgery, Hainan General Hospital, Haikou, China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Xiaoyi Li,
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15
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Kim H, Oh YL, Chung JH, Hahn SY, Park KW, Kim TH, Shin JH. What is the difference between the tall cell variant and the classic type of papillary thyroid carcinoma on ultrasonography? Ultrasonography 2022; 41:493-501. [PMID: 35430786 PMCID: PMC9262674 DOI: 10.14366/usg.21200] [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: 09/23/2021] [Accepted: 02/21/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose The prevalence of the tall cell variant of papillary thyroid carcinoma (TCVPTC), which has a poor prognosis, has increased as its definition has been modified. We sought to investigate whether TCVPTC is different from the classic type on ultrasonography (US). Methods This study included 46 consecutive TCVPTC patients and 92 classic papillary thyroid carcinoma (PTC) patients who were confirmed surgically at the authors’ institution. The US findings and pathologic reports of these patients were retrospectively reviewed. US features based on the Korean Thyroid Imaging Reporting and Data System, preoperative US suspicion for lymph node metastasis, and the presence of capsular location were evaluated. Results Univariable and multivariable analyses identified that TCVPTC showed more frequent irregular tumor margin (odds ratio [OR], 6.62; 95% confidence interval [CI], 1.46 to 30.09; P=0.014) and capsular location (OR, 4.63; 95% CI, 1.49 to 14.41; P=0.008) than classic PTC. Capsular location was an independent predictor of TCVPTC for tumors less than or equal to 1.5 cm in size (OR, 4.23; 95% CI, 1.12 to 15.92; P=0.033). Irregular margin was an independent predictor of TCVPTC for tumors larger than 1.5 cm (OR, 10.46; 95% CI, 1.16 to 94.48; P=0.037). Extrathyroidal extension was not significantly different between the two groups. Conclusion The two key features of TCVPTC on US are frequent capsular location for tumors less than or equal to 1.5 cm in size and the higher likelihood of an irregular margin for tumors larger than 1.5 cm.
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Affiliation(s)
- Haejung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology and Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ko Woon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Arrigoni G, Crosetti E, Freddi M, Piovesan A, Rossetto Giaccherino R, Succo G, Palestini N. Comparison between 2015 ATA guidelines and Italian Consensus for DTC management. A commented report. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:41-54. [PMID: 35292787 PMCID: PMC9058931 DOI: 10.14639/0392-100x-n1572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022]
Abstract
The 2015 ATA guidelines and 2018 Italian Consensus have produced a series of generally concordant recommendations on clinical and therapeutic management of thyroid nodules and thyroid carcinoma. Currently, the goals of treatment are to achieve the highest disease-free survival rates through the best ratio between minimum invasiveness and cost/impact on quality of life. By analysis and comparison of the ATA Guidelines and Italian Consensus, we highlighted and commented upon the key points of differentiated thyroid cancer management. Furthermore, the aim of this work is to identify and promote uniform clinical approaches among all specialists who treat differentiated thyroid cancer and represent a starting point for a consensus drafted by the Italian Society of Otolaryngology - Head and Neck Surgery.
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Chen K, Wang Z, Sun W, Zhang D, Zhang T, He L, Zhang H. Bibliometric insights in advances of papillary thyroid microcarcinoma: Research situation, hot points, and global trends. Front Endocrinol (Lausanne) 2022; 13:949993. [PMID: 36004350 PMCID: PMC9393698 DOI: 10.3389/fendo.2022.949993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thyroid cancer has been on the rise over the last decade. Papillary thyroid microcarcinoma (PTMC) accounts for more than half of all thyroid cancers. Micropapillary carcinoma of the thyroid is a common but non-fatal form of thyroid cancer. To better comprehend, nearly two decades of scientific outputs were analyzed and summarized using bibliometric methods in this study. METHODS Approximately 1098 publications from 2000 and 2021 were included in WoS database through systematic retrieval. The general information was characterized, and developmental skeleton and research frontiers were explored. CiteSpace, VOSviewer, and R, Tableau were used to evaluate and visualize the results. RESULTS A total of 1098 publications from across 75 countries were identified. The annual number of publications showed an increasing trend in the past 21 years. China, Korea, the United States of America (USA), Italy, and Japan made remarkable contributions to the research of PTMC. Thyroid was the most productive journal. Miyauchi Akira published maximum articles. The utmost productive institution was the University of Ulsan. Risk stratification, active surveillance, and thermal ablation garnered the attention of researchers leading to novel approaches in the clinical diagnosis and treatment of micropapillary thyroid carcinoma. CONCLUSIONS This bibliometric study provides a comprehensive analysis of global productivity, collaboration, and research hotspots within PTMC field, which will aid in directing research toward PTMC in the coming years.
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Affiliation(s)
- Kefan Chen
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Zhongqing Wang
- Department of Information center, the First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Dalin Zhang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Ting Zhang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Liang He
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
- *Correspondence: Hao Zhang,
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18
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Shen K, Xiao S, Wu X, Zhang G. Preoperative prognostic risk stratification model for papillary thyroid carcinoma based on clinical and ultrasound characteristics. Front Endocrinol (Lausanne) 2022; 13:1025739. [PMID: 36277684 PMCID: PMC9585272 DOI: 10.3389/fendo.2022.1025739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The preoperative risk stratification for patients with papillary thyroid carcinoma (PTC) plays a crucial role in guiding individualized treatment. We aim to construct a predictive model that aids in distinguishing between patients with low-risk and high-risk PTC based on preoperative clinical and ultrasound characteristics. MATERIALS AND METHODS Patients who underwent open surgery and were diagnosed with PTC via a postoperative pathological report between January 2020 and December 2020 were retrospectively reviewed. Data including basic information, preoperative ultrasound characteristics, thyroid function, and postoperative pathology characteristics were obtained. Univariate logistic regression analysis and least absolute shrinkage and selection operator regression analysis were performed to screen candidate variables. Finally, the preoperative predictive model for PTC was established based on the results of the multivariate logistic regression analysis. RESULTS A total of 1,875 patients with PTC were enrolled. Eight variables (sex, age, number of foci, maximum tumor diameter on ultrasound, calcification, capsule, lymph node status on ultrasound, and thyroid peroxidase (TPO) antibody level) significantly associated with risk stratification were included in the predictive model. A nomogram was constructed for clinical utility. The model showed good discrimination, and the area under the curve was 0.777 [95% confidence interval (CI): 0.752-0.803] and 0.769 (95% CI: 0.729-0.809) in the training set and validation set, respectively. The calibration curve exhibited a rather good consistency with the perfect prediction. Furthermore, decision curve analysis and clinical impact curve showed that the model had good efficacy in predicting the prognostic risk of PTC. CONCLUSIONS The nomogram model based on preoperative indicators for predicting the prognostic stratification of PTC showed a good predictive value. This could aid surgeons in deciding on individualized precision treatments.
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Qian B, Hu L, Zhang S, Zhu J, Mei L, Huang T, Qu X. Comparison of clinicopathological features and prognosis of papillary thyroid carcinoma and microcarcinoma: A population-based propensity score matching analysis. Front Endocrinol (Lausanne) 2022; 13:944758. [PMID: 35992148 PMCID: PMC9389084 DOI: 10.3389/fendo.2022.944758] [Citation(s) in RCA: 2] [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: 05/15/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Overtreatment of papillary thyroid microcarcinoma (PTMC) has become a common concern. This study aimed to compare clinicopathological features between PTMC and papillary thyroid carcinoma (PTC) and to explore whether surgery can confer significant survival benefits in all patients with PTC or PTMC. METHODS Data of 145,951 patients with PTC registered in Surveillance, Epidemiology, and End Results (SEER) database and 8,751 patients with PTC in our institution were retrospectively collected. Patients with tumors less than 10 mm in diameter were classified as PTMC cohort and the rest as PTC cohort. Clinicopathological features between PTMC and PTC were compared on the basis of SEER cohort and validated with institutional data. Survival analysis was conducted to explore the effect of surgery on the prognosis of patients. To minimize potential confounders and selection bias, we performed propensity score matching (PSM) analysis to match more comparable cohorts. RESULTS Compared with PTC, PTMC exhibited the following characteristics: more common in women and whites, older age at diagnosis, lower proportion of follicular variants, intraglandular dissemination, extraglandular and capsular invasion, higher proportion of multifocality, fewer lymph node and distant metastases, and higher cancer-specific survival (CSS) and overall survival (OS) (all p-value < 0.05). Regarding treatment, patients with PTMC received a lower proportion of radiotherapy, chemotherapy, and total thyroidectomy but a higher proportion of lobectomy and/or isthmectomy. There was no significant difference in CSS for patients with PTMC at stage T1N0M0 with or without surgery (P = 0.36). CONCLUSION Generally, PTMC showed higher biological indolence than PTC, which meant a higher survival rate for patients in both OS and CSS. For patients with PTMC at staged T1N0M0, active surveillance (AS) may be a potentially feasible management strategy. However, the maintenance of good medical compliance and the management of psychological burden cannot be ignored for patients included in AS.
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Affiliation(s)
| | | | | | | | - Li Mei
- *Correspondence: Li Mei, ; Xincai Qu,
| | | | - Xincai Qu
- *Correspondence: Li Mei, ; Xincai Qu,
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20
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Sutherland R, Tsang V, Clifton-Bligh RJ, Gild ML. Papillary thyroid microcarcinoma: Is active surveillance always enough? Clin Endocrinol (Oxf) 2021; 95:811-817. [PMID: 34021503 DOI: 10.1111/cen.14529] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
The incidence of papillary thyroid carcinoma (PTC) has increased over recent decades. This apparent epidemic has been attributed to the overdiagnosis of small PTC ≤10 mm in diameter (papillary thyroid microcarcinoma [PTMC]) incidentally detected on imaging for unrelated presentations. Although most PTMCs follow an indolent disease course, there is a small but significant proportion of cases that display more biologically aggressive features such as early metastasis and lymph node involvement. Management of PTMC diagnosed preoperatively should be distinguished from managing those PTMCs incidentally discovered after thyroidectomy. Here, we will focus on the challenge of managing the preoperative patient. Current guidelines recommend against routine biopsy of nodules ≤10 mm, even if they display highly suspicious features on ultrasound; however, it is not known how to identify those PTMCs at higher risk of disease progression. In view of their good prognosis even without surgical resection, active surveillance has emerged as an alternative to operative management for low-risk PTMC without lymph node involvement or distant metastasis. This review aims to summarise active surveillance data for PTMC and identify clinical features that may differentiate the indolent majority from those PTMCs that exhibit early disease progression and metastasis.
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Affiliation(s)
- Rosie Sutherland
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
| | - Venessa Tsang
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Roderick J Clifton-Bligh
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Cancer Genetics Unit, Kolling Institute of Medical Research, Sydney, Australia
| | - Matti L Gild
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Cancer Genetics Unit, Kolling Institute of Medical Research, Sydney, Australia
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21
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Li R, Li G, Wang Y, Bao T, Lei Y, Tian L, Li Z, Zhu J, Lei J, Tang H. Psychological Distress and Sleep Disturbance Throughout Thyroid Nodule Screening, Diagnosis, and Treatment. J Clin Endocrinol Metab 2021; 106:e4221-e4230. [PMID: 33830242 DOI: 10.1210/clinem/dgab224] [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] [Received: 12/18/2020] [Indexed: 02/05/2023]
Abstract
CONTEXT Many controversies exist regarding screening and treatment of thyroid cancer (TC), especially papillary thyroid microcarcinoma (PTMC). OBJECTIVE The aim of this study was to evaluate patients' psychological distress and sleep disturbance throughout thyroid nodule (TN) screening, diagnosis, and treatment. METHODS A total of 2834 participants (1153 participants with TNs) were enrolled during the screening phase, and 1105 individuals with TNs (87 individuals with TC) were enrolled during the diagnosis phase. Of the 87 TC patients, 66 underwent immediate operation (OP), and 21 patients with PTMC opted for active surveillance (AS). Four validated scales were applied to quantify the outcome indicators at prescreening, postscreening, postdiagnosis, and posttreatment. RESULTS Higher psychological distress and sleep disturbance were found postscreening than prescreening in subjects with TNs, but no differences in those without nodules. Compared with postscreening, higher scores of psychological distress and sleep disturbance were identified in patients with suspicious TC treated with fine needle aspiration (FNA) or with AS. Lower psychological distress and sleep disturbance were noted for patients with benign nodules than for TC patients. OP for TC, especially PTMC, did not alleviate psychological distress or sleep disturbance compared with the same parameters in patients who underwent AS. CONCLUSION Based on the findings of impaired psychological health and sleep quality, screening for TNs in adults who show no symptoms should be performed with caution. Psychological distress and sleep disturbance should also be taken into consideration when FNA is performed for suspected TC or OP for papillary thyroid cancer, especially PTMC.
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Affiliation(s)
- Ruicen Li
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, China
- Business School, Sichuan University, Chengdu 610041, China
| | - Genpeng Li
- Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, 610041, China
- The laboratory of thyroid and parathyroid disease, Frontiers Science Center for Disease-related Molecular Network, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yuting Wang
- Department of Human Resources, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ting Bao
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yali Lei
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Liuyan Tian
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zhihui Li
- Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jingqiang Zhu
- Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Jianyong Lei
- Thyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Huairong Tang
- Health and Management Center, West China Hospital of Sichuan University, Chengdu 610041, China
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22
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Szász EA, Nechifor-Boilă AC, Zahan AE, Voidăzan TS, Borda A. Risk stratification of papillary thyroid microcarcinomas via an easy-to-use system based on tumor size and location: clinical and pathological correlations. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:1153-1162. [PMID: 34171064 PMCID: PMC8343526 DOI: 10.47162/rjme.61.4.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction: We aimed to determine whether two clinically accessible parameters, tumor size and location within the thyroid, correlate with clinicopathological features that are predictors of high risk in papillary thyroid microcarcinomas (PTMCs). Materials and Methods: PTMC cases were obtained from the database of the Department of Pathology, Emergency County Hospital, Târgu Mureş, Romania. Four tumor groups were created based on tumor size and location: Group I (≥5 mm, subcapsular), Group II (≥5 mm, nonsubcapsular), Group III (<5 mm, subcapsular), and Group IV (<5 mm, nonsubcapsular) PTMCs. Clinicopathological features and follow-up data were compared by univariate and multivariate analysis. Results: Our study included 164 PTMCs (n=70/20/19/55 in Groups I/II/III/IV, respectively). High-grade morphological features, such as plump pink cells (p=0.010), tumor desmoplasia (p=0.022) and sclerosis (p=0.001), infiltrative tumor borders (p=0.005), positive resection margins (p=0.005), invasion into the perithyroid adipose tissue (p=0.001), irregular nuclear membranes (p=0.004), and pseudoinclusions (p=0.001) were significantly more prevalent among Group I PTMCs. Group IV PTMCs were characterized by a paucity of the above-mentioned morphological features, while Group II and III PTMCs displayed intermediate morphological profiles. Conclusions: Group I PTMCs proved to be associated with more aggressive morphological features and might need a more careful clinical approach.
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Affiliation(s)
- Emőke Andrea Szász
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureş, Romania;
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Lv C, Sun W, Huang J, Qin Y, Ji X, Zhang H. Expression Profiles of Circular RNAs in Human Papillary Thyroid Carcinoma Based on RNA Deep Sequencing. Onco Targets Ther 2021; 14:3821-3832. [PMID: 34188490 PMCID: PMC8232851 DOI: 10.2147/ott.s316292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/05/2021] [Indexed: 01/11/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) is the most prevalent type of thyroid cancer. Herein, we purposed to explore the expression patterns of circRNAs in PTC with the overarching goal of improving early diagnosis rates for individuals with PTC. Methods We used RNA deep sequencing to determine the expression patterns of circRNAs in PTC. Besides, RT-qPCR was employed to confirm circRNAs. The diagnostic potential of the circRNAs was explored by constructing ROC curves. GO along with KEGG pathway analyses were utilized to elucidate the potential biological roles of differentially expressed circRNAs. Moreover, we predicted cross talks among circRNAs, miRNAs, and mRNAs, followed by establishment of a ceRNA network. Results Deep sequencing of four PTC pairs and neighboring nontumor tissues identified 16569 circRNAs, of which, 301 were upregulated and 419 were downregulated. The RT-qPCR data demonstrated that the expression of chr5: 38481299-38530666-, chr2: 159932176-159945082-, chr10: 179994-249088+, chr3: 121378716-121381532+, and chr1: 237423092-237445522+ was downregulated, while the expression of chr4: 25665378-25667298+, chr5: 161330883-161336769-, chr1: 12578718-12579412-, chr7: 116695750-116700284+, and chr7: 116699071-116700284+ was upregulated. The stability test exhibited that circRNAs were more tolerant to temperature, RNase R, and time. On the other hand, ROC curves illustrated that chr4: 25665378-25667298+, chr1: 12578718-12579412-, chr7: 116699071-116700284+, chr7: 116695750-116700284+, chr5: 161330883-161336769-, and chr10: 179994-249088+ were effective as diagnostic indicators. However, a logistic regression model combining the six indicators achieved a better combined prediction index, with 97.7% sensitivity and 95.3% specificity. Moreover, GO along with KEGG pathway analyses illustrated that differentially expressed circRNAs were linked to tumorigenesis. Furthermore, bioinformatics analyses established a promising ceRNAs network among mRNAs, circRNAs, and miRNAs. Conclusion Herein, we demonstrated that several circRNAs are promising PTC diagnostic biomarkers. Further study on the functions and mechanisms of these circRNAs may contribute to the understanding of PTC.
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Affiliation(s)
- Chengzhou Lv
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jiapeng Huang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Yuan Qin
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaoyu Ji
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, People's Republic of China
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Hegedüs L, Miyauchi A, Tuttle RM. Nonsurgical Thermal Ablation of Thyroid Nodules: Not if, but Why, When, and How? Thyroid 2020; 30:1691-1694. [PMID: 32777983 PMCID: PMC7757570 DOI: 10.1089/thy.2020.0659] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Address correspondence to: Laszlo Hegedüs, MD, DMSc, Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5th floor, Odense DK-5000 C, Denmark
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, Hyogo, Japan
| | - R. Michael Tuttle
- Department of Medicine, Endocrinology Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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25
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Expression of Class III Beta-Tubulin Is Associated with Invasive Potential and Poor Prognosis in Thyroid Carcinoma. J Clin Med 2020; 9:jcm9123830. [PMID: 33256003 PMCID: PMC7760790 DOI: 10.3390/jcm9123830] [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: 10/29/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Although American Thyroid Association guidelines offer a risk stratification scheme for thyroid cancer patients, there is a continuous need for more sophisticated biomarkers that can predict disease progression. In this study, we aim to evaluate the prognostic value of class III beta-tubulin (TUBB3) and uncover the relationship between TUBB3 and invasive potential in thyroid carcinoma. Immunohistochemistry (IHC) for TUBB3 and E-cadherin was performed on a total of 254 cases of thyroid cancer specimens. Tumor budding at the invasive margin was evaluated. In vitro functional studies were also performed; the protein and mRNA levels of TUBB3 were compared among the five cell types at baseline, with transwell invasion and after blocking of TUBB3 by shRNA. IHC revealed that the levels of TUBB3 were higher in conventional papillary carcinomas (cPTCs) and anaplastic thyroid carcinomas (ATCs). In univariate analysis, high tumor budding and TUBB3 expression were associated with inferior progression-free survival in cPTC. The results of a Western blot and RT-PCR agreed with the IHC finding. The results were further validated through data from The Cancer Genome Atlas database. Our results suggest that high expression of TUBB3 in thyroid carcinoma could predict invasive potential and possibly be linked with epithelial–mesenchymal transition.
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Colombo C, Giancola N, Fugazzola L. Personalized treatment for differentiated thyroid cancer: current data and new perspectives. Minerva Endocrinol (Torino) 2020; 46:62-89. [PMID: 33213119 DOI: 10.23736/s2724-6507.20.03342-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
More conservative and personalized treatment options have been developed in recent years to face the rising diagnosis of low-risk differentiated thyroid carcinoma (DTC). The present review describes the change towards a more risk-adapted management either in the treatment or in the follow-up of DTC. Particular attention is given to the innovations introduced by the latest guidelines for low-risk tumors, starting from the most appropriate extension of surgery up to the postoperative management. The emerging role of active surveillance for low-risk microcarcinoma is discussed, as well as the development of percutaneous strategies in the setting of malignant thyroid disease. The recent use of approved new systemic target therapies for advanced radioiodine refractory thyroid cancer is reported, together with the description of new compounds in trial. Finally, we provide some considerations to improve the risk evaluation in a presurgical setting, especially related to the rising role of genetics, to enable better risk-based cancer management and personalized treatment choices.
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Affiliation(s)
- Carla Colombo
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy -
| | - Noemi Giancola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Completion Total Thyroidectomy Is Not Necessary for Papillary Thyroid Microcarcinoma with Occult Central Lymph Node Metastasis: A Long-Term Serial Follow-Up. Cancers (Basel) 2020; 12:cancers12103032. [PMID: 33081050 PMCID: PMC7603084 DOI: 10.3390/cancers12103032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Simple Summary The necessity of completion total thyroidectomy is unclear in patients with papillary thyroid microcarcinoma (PTMC) with only pathological central lymph node metastasis (pCLNM). The aim of our study was to determine the necessity of completion total thyroidectomy after an initial surgery by comparing the prognosis according to the presence of pCLNM during a long-term follow-up. We retrospectively compared the pathological central lymph node (pCLN)-positive group of 165 patients who underwent thyroid lobectomy with the pCLN-negative group of 711 patients and found no difference between the two groups in the recurrence rate and disease-free survival rates. Therefore, PTMC patients who underwent thyroid lobectomy with prophylactic central compartment neck dissection and were diagnosed with pCLNM after surgery do not require completion total thyroidectomy. Abstract The necessity of completion total thyroidectomy in patients with papillary thyroid microcarcinoma (PTMC) and pathological central lymph node metastasis (pCLNM) who underwent thyroid lobectomy with central compartment neck dissection (CCND) is unclear. We determined the necessity of completion total thyroidectomy by retrospectively comparing the prognosis according to the presence of pCLNM during a long-term follow-up. We enrolled 876 patients with PTMC who underwent thyroid lobectomy with prophylactic CCND from January 1986 to December 2009. Patients were divided according to central lymph node (CLN) metastasis: 165 (18.8%) and 711 (81.2%) in the CLN-positive and CLN-negative groups, respectively. Medical records were reviewed retrospectively, and clinicopathologic characteristics and recurrence rates were analyzed. The CLN-positive group was associated with male sex (p = 0.001), larger tumor size (p < 0.001), and more microscopic capsular invasion (p < 0.001) compared with the CLN-negative group. There was no significant difference between the two groups’ recurrence (p = 0.133) or disease-free (p = 0.065) survival rates. Univariate and multivariate analyses showed no factors associated with tumor recurrence except male sex (hazard ratio = 3.043, confidence interval 1.117–8.288, p = 0.030). Patients who were diagnosed with pCLNM after undergoing thyroid lobectomy with prophylactic CCND do not require completion total thyroidectomy; however, frequent follow-up is necessary for patients with PTMC and pCLNM.
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Pusztaszeri MP, Tamilia M, Payne RJ. Active surveillance for low-risk small papillary thyroid cancer in North American countries: past, present and future (bridging the gap between North American and Asian practices). Gland Surg 2020; 9:1685-1697. [PMID: 33224846 DOI: 10.21037/gs-20-389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Papillary thyroid cancer (PTC) is increasingly being diagnosed worldwide; yet the mortality remains very low, suggesting widespread overdiagnosis. While traditional management of PTC includes thyroid surgery, sometimes followed by radioactive iodine treatment, there is a global trend towards more conservative approaches for patients who are considered as the lowest risk of recurrence or death from their disease. Active surveillance (AS), once called watchful waiting, involves close follow-up, with the intention to intervene if the cancer progresses, or on patient request. The Kuma Hospital in Japan was the first to introduce AS as an alternative to immediate thyroid surgery for low-risk papillary thyroid microcarcinomas (PTMC, <1 cm) in 1993. Accumulated evidence over the years has shown that AS is a safe and effective approach in select patients, with a low rate of cancer progression during AS. Consequently, the Japanese Clinical Guidelines for treatment of thyroid tumor approved AS as a first-line management for patients with asymptomatic PTMC in 2010. Subsequently, the latest 2015 American Thyroid Association guidelines endorsed AS as an alternative approach to immediate surgery for cytologically confirmed very low-risk PTC. However, the acceptance, feasibility and results of AS in patients with low-risk PTC outside of Japan are still largely unknown. Most guidelines recommend that thyroid nodules <1 cm should not be aspirated but instead monitored regardless of the ultrasonographic characteristics. In essence, these patients are also being subjected to AS. Specific recommendations and the role of molecular testing for the optimal selection of PTMC patients for an AS management approach are not well established. Furthermore, research is needed to assess the long-term clinical and psychosocial outcomes in patients with larger tumor sizes (>1 cm) who undergo screening and diagnosis according to the North American guidelines and practices. The first Canadian prospective observational study launched in 2016 is intended to complement the existing data for AS of small low-risk PTC (≤2 cm) and may provide insight into the different approaches in North American and Asian practices. This review intends to summarize the development and the rationale of AS for PTMC and highlights significant differences between North American and Japanese practices.
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Affiliation(s)
- Marc P Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, Canada
| | - Michael Tamilia
- Division of Endocrinology & Metabolism, Jewish General Hospital, McGill University, Montreal, Canada
| | - Richard J Payne
- Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Canada
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Abstract
In 1993, active surveillance of low-risk papillary thyroid microcarcinomas (PTMCs) started in Kuma Hospital, Kobe, Japan. It has spread globally after the publishing of American Thyroid Association (ATA) guidelines. During our hospital's active surveillance program, few patients (8.0%) showed tumor size enlargement ≥3 mm or the new appearance of node metastasis (3.8%) at 10-year follow-up. Conversion surgery was recommended for patients with disease progression. To date, no patients showed significant recurrence or metastasis or died with thyroid carcinoma when patients underwent active surveillance or after surgery due to PTMC progression. Unlike clinical papillary thyroid carcinoma (PTC), elderly patients' PTMCs were less progressive compared to those of young and middle-aged patients, indicating that elderly patients are strong candidates for the active surveillance of their PTMC. Although young patients' PTMCs are the most progressive, >50% and >75% of patients in their 20s and 30s would avoid conversion surgical treatment in their lifetime, respectively (according to estimated lifetime probability), indicating that such young patients are still candidates for active surveillance. It can thus be concluded that active surveillance is appropriate to be first management for PTMCs, based on the accumulation of favorable outcomes of PTMC patients who have undergone active surveillance, as well as the lower incidences of unfavorable events and lower medical cost than immediate surgery.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
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Abstract
The diagnostic modalities, stratification tools, and treatment options for patients with thyroid cancer have rapidly evolved since the development of the American Thyroid Association (ATA) guidelines in 2015. This review compiles newer concepts in diagnosis, stratification tools and treatment options for patients with differentiated thyroid cancer (DTC), medullary thyroid carcinoma (MTC) and anaplastic thyroid cancer (ATC). Newer developments apply precision medicine in thyroid cancer patients to avoid over-treatment in low risk disease and under-treatment in high risk disease. Among novel patient-tailored therapies are selective RET inhibitors that have shown efficacy in the treatment of MTC with limited systemic toxicity compared with non-specific tyrosine kinase inhibitors. The combination of BRAF and MEK inhibitors have revolutionized management of BRAF V600E mutant ATC. Several immunotherapeutic agents are being actively investigated in the treatment of all forms of thyroid cancer. In this review, we describe the recent advances in the diagnosis and management of DTC, MTC, and ATC, with an emphasis on novel treatment modalities.
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Affiliation(s)
- Katherine A. Araque
- Endocrinology Department, Pacific Neuroscience Institute, John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Sriram Gubbi
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Joanna Klubo-Gwiezdzinska
- Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
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Cheng SP, Lee JJ, Chien MN, Kuo CY, Jhuang JY, Liu CL. Lymphovascular invasion of papillary thyroid carcinoma revisited in the era of active surveillance. Eur J Surg Oncol 2020; 46:1814-1819. [PMID: 32732093 DOI: 10.1016/j.ejso.2020.06.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Lymphovascular invasion (LVI) is associated with disease recurrence and compromised survival in patients with thyroid cancer. Nonetheless, LVI is not identifiable on preoperative ultrasound or cytologic assessment. We aimed to explore the clinicopathological features associated with LVI. PATIENTS AND METHODS We conducted a retrospective review of our prospectively maintained database from 2009 to 2018. Multivariate analyses were performed to determine the associations between clinicopathological parameters and LVI. Generalized additive models were used to examine the nonlinear relationship between continuous variables and LVI. RESULTS A total of 795 patients were included in the analysis, and 174 (22%) had LVI. Patients' age (odds ratio [OR] = 0.982), tumor size (OR = 1.466), clinical lymphadenopathy (OR = 6.975), and advanced extrathyroidal extension (OR = 2.938) were independently associated with LVI. In the subset analysis of 198 patients with available genetic information, tumor size (OR = 1.599), clinical lymph node metastasis (OR = 3.657), and TERT promoter mutation (OR = 4.726) were predictive of LVI. Among 573 patients who had no clinical lymphadenopathy or advanced extrathyroidal extension, tumor size was the only predictor of LVI. Tumor size >1.5 cm had an increased risk of LVI based on the generalized additive model plot and receiver operating characteristic curve analysis. CONCLUSION Tumor size is positively associated with the risk of LVI in papillary thyroid cancer. To avoid delayed treatment in patients with LVI, a tumor size of 1.5 cm may be considered as the safe upper limit for active surveillance.
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Affiliation(s)
- Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jie-Jen Lee
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Ming-Nan Chien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Chi-Yu Kuo
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Jie-Yang Jhuang
- Department of Pathology, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Liang Liu
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan.
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Lohia S, Hanson M, Tuttle RM, Morris LGT. Active surveillance for patients with very low-risk thyroid cancer. Laryngoscope Investig Otolaryngol 2020; 5:175-182. [PMID: 32128446 PMCID: PMC7042648 DOI: 10.1002/lio2.356] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/07/2020] [Accepted: 01/25/2020] [Indexed: 01/03/2023] Open
Abstract
Over the past 30 years in the United States, increasing identification of small thyroid nodules has led to a dramatic rise in the detection of small thyroid cancers, many of which are unlikely to progress to overt clinical disease. Because autopsy studies reveal that up to 30% of people harbor clinically occult thyroid cancers, the growing use of diagnostic technologies has identified an increasing number of small, clinically low risk papillary thyroid cancers (PTCs). In recent years, clinical practice has evolved to de-intensify the treatment for PTCs, with fewer total thyroidectomy and nodal dissection procedures being performed, in favor of more limited operations. In addition, vigilant observation of selected low risk cancers has demonstrated outcomes comparable to those patients who undergo immediate surgical intervention. Active surveillance has emerged as a new option within the treatment algorithm of PTCs. There is now robust data from cancer centers in Japan and Korea which have reported excellent oncologic outcomes among patients undergoing active surveillance for PTC, as well as more recent, similar data from the United States. American Thyroid Association guidelines now include the option of active surveillance for appropriately selected patients with low-risk PTC. With active surveillance now one option within the standard of care for patients with certain thyroid cancers, surgeons have become critical to facilitating shared decision-making for patients facing this diagnosis.
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Affiliation(s)
- Shivangi Lohia
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Martin Hanson
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - R. Michael Tuttle
- Department of Medicine, Endocrine ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
| | - Luc G. T. Morris
- Department of Surgery, Head and Neck ServiceMemorial Sloan Kettering Cancer CenterNew YorkNew York
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Ito Y, Miyauchi A. Active surveillance of low-risk papillary thyroid microcarcinomas in Japan and other countries: a review. Expert Rev Endocrinol Metab 2020; 15:5-12. [PMID: 31902250 DOI: 10.1080/17446651.2020.1707078] [Citation(s) in RCA: 4] [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: 10/03/2019] [Accepted: 12/17/2019] [Indexed: 12/30/2022]
Abstract
Introduction: Active surveillance of low-risk papillary thyroid microcarcinomas (PTMCs) was initiated in Japan in 1993 and has since been adopted in many countries, especially after its approval by the American Thyroid Association in 2015.Areas covered: We performed a literature review in Medline/PubMed to identify studies that used active surveillance for PTMCs. Moreover, we performed a literature review about the increased incidence of thyroid microcarcinomas in relation to the relative stability of deaths due to thyroid carcinomas.Expert opinion: No patients showed life-threatening metastasis/recurrence or died of thyroid carcinoma during active surveillance or after conversion surgery following PTMC progression. Thus, active surveillance should be the first-line management of PTMCs without high-risk features. In the future, molecular testing of actively growing PTMCs using cytology specimens could be useful to guide the treatment plan.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Hyogo, Japan
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Tuttle RM, Alzahrani AS. Risk Stratification in Differentiated Thyroid Cancer: From Detection to Final Follow-Up. J Clin Endocrinol Metab 2019; 104:4087-4100. [PMID: 30874735 PMCID: PMC6684308 DOI: 10.1210/jc.2019-00177] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Modern management of differentiated thyroid cancer requires individualized care plans that tailor the intensity of therapy and follow-up to the estimated risks of recurrence and disease-specific mortality. DESIGN This summary is based on the authors' knowledge and extensive clinical experience, supplemented by review of published review articles, thyroid cancer management guidelines, published staging systems, and original articles identified through a PubMed search, which included terms such as risk stratification, staging, clinical outcomes, and differentiated thyroid cancer. MAIN OUTCOME MEASURES In the past, risk stratification in differentiated thyroid cancer usually referred to a static estimate of disease-specific mortality that was based on a small set of clinicopathological features available within a few weeks of completing initial therapy (thyroidectomy, with or without radioactive iodine). Today, risk stratification is a dynamic, active process used to predict the appropriateness for minimalistic initial therapy, disease-specific mortality, risk of recurrence, and the most likely response to initial therapy. Rather than being a static prediction available only after initial therapy, modern risk stratification is a dynamic, iterative process that begins as soon as a suspicious nodule is detected and continues through final follow-up. CONCLUSIONS Dynamic risk assessment should be used to guide all aspects of thyroid cancer management, beginning before a definitive diagnosis is made and continuing through the final follow-up visit.
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Affiliation(s)
- R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Chen J, Cao J, Qiu F, Huang P. The Efficacy and The Safety of Ultrasound-guided Ablation Therapy for Treating Papillary Thyroid Microcarcinoma. J Cancer 2019; 10:5272-5282. [PMID: 31602278 PMCID: PMC6775625 DOI: 10.7150/jca.36289] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
The prevalence of papillary thyroid microcarcinoma (PTMC) increases rapidly all around the world, but the management of PTMC hasn't reached a consensus. Recently, ultrasound-guided (US-guided) ablation therapy was introduced as a feasible treatment for low-risk PTMC. The clinical application of US-guided ablation therapy needs doctors' effort to investigate the efficacy and the safety of US-guided ablation in treating PTMC carefully. Although the present evidence showed some limitations, such as short-term study time spans and no randomized control design, in our perspective, US-guided thermal ablation therapy has good short-term efficacy and safety and is a promising PTMC's treatment in future clinical practice.
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Affiliation(s)
- Jifan Chen
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jing Cao
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fuqiang Qiu
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pintong Huang
- Department of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Jeon MJ, Lee YM, Sung TY, Han M, Shin YW, Kim WG, Kim TY, Chung KW, Shong YK, Kim WB. Quality of Life in Patients with Papillary Thyroid Microcarcinoma Managed by Active Surveillance or Lobectomy: A Cross-Sectional Study. Thyroid 2019; 29:956-962. [PMID: 31038017 DOI: 10.1089/thy.2018.0711] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Active surveillance (AS) is recommended as an alternative to immediate surgery in patients with papillary thyroid microcarcinoma (PTMC), but the impact of AS on quality of life has not been reported. The aim of this study was to compare quality-of-life parameters in patients with PTMC under AS versus those who underwent lobectomy (LB). Methods: In this cross-sectional study, patients with PTMC were prospectively enrolled between June 2016 and October 2017. All patients completed three questionnaires: the 12-item short-form health survey, thyroid cancer-specific quality of life, and fear of progression. The results were compared after adjusting for age, sex, and serum thyrotropin levels. Results: The AS group comprised 43 patients, and the LB group comprised 148 patients. According to the 12-item short-form health survey questionnaire, the score for role limitations due to emotional problems showed a significant negative association between the groups (coefficient [coef]: -7.71 [confidence interval (CI) -15.26 to -0.16], p = 0.045). The thyroid cancer-specific quality of life questionnaire also showed statistically significant differences between the groups with respect to three scores: neuromuscular problems (coef: 4.99 [CI 0.63-10.62], p = 0.020), throat/mouth problems (coef: 5.28 [CI 0.18-10.38], p = 0.043), and scar problems (coef: 9.34 [CI 4.38-14.29], p < 0.001), suggesting a higher level of complaint in the LB group than in the AS group. No significant differences in fear of progression scores were seen between the two groups. Conclusions: Patients with PTMC underwent LB experienced more health-related problems than those managed by AS. These findings support the role of AS as a reasonable management option for patients with PTMC.
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Affiliation(s)
- Min Ji Jeon
- 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu-Mi Lee
- 2Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Yon Sung
- 2Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Minkyu Han
- 3Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Wook Shin
- 4Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Gu Kim
- 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Yong Kim
- 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Wook Chung
- 2Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Bae Kim
- 1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Can Active Surveillance be an Alternative to Surgery in Papillary Thyroid Microcarcinoma?: The Current Situation Worldwide. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:233-243. [PMID: 32774084 PMCID: PMC7406552 DOI: 10.14744/semb.2018.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 11/20/2022]
Abstract
Papillary thyroid carcinoma is the most common endocrine malignancy. Papillary thyroid microcarcinomas (PTMCs) are tumors with a size of ≤1 cm. The biological behavior of these tumors differs due to the presence of their aggressive features. The prognosis of PTMCs with high-risk features, such as clinical node metastasis, distant metastasis, and significant extrathyroidal extension to the tracheal or recurrent laryngeal nerve invasion, is poor, even if a sufficient immediate surgery is performed at diagnosis. However, PTMCs without these aggressive features are low-risk tumors because of their indolent and slow growth behaviors. The increase in thyroid cancer incidence is mostly a result of overdiagnosis of small low-risk PTMCs with indolent clinical course. Despite the sudden increase in thyroid cancer incidence worldwide, cancer mortality did not increase. Although the traditional treatment strategy for PTMC is immediate surgery at diagnosis, because of the rather low disease-specific mortality rate, low recurrence rate, and potential risk for postoperative complications, active surveillance has been proposed recently as an alternative option for PTMCs without invasion, metastasis, or cytological or molecular characteristics. The recent data support that active surveillance of low-risk PTMC should be the initial treatment modality, because only a small percentage of low-risk PTMCs show signs of progression, and delayed surgery has not caused significant recurrence. However, recent management guidelines are shifting toward more conservative treatments, such as active surveillance. Although there is an increase in the number of studies related to active surveillance, prospective studies have been mostly from academic referral centers in Japan. The world still needs class 1 evidence extended prospective studies originating from different geographic regions. Active surveillance may be a good alternative to immediate surgery for appropriately selected patients with PTMC.
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