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Yao S, Shen P, Dai F, Deng L, Qiu X, Zhao Y, Gao M, Zhang H, Zheng X, Yu X, Bao H, Wang M, Wang Y, Yi D, Wang X, Zhang Y, Sang J, Fei J, Zhang W, Qian B, Lu H. Thyroid Cancer Central Lymph Node Metastasis Risk Stratification Based on Homogeneous Positioning Deep Learning. RESEARCH (WASHINGTON, D.C.) 2024; 7:0432. [PMID: 39165637 PMCID: PMC11334714 DOI: 10.34133/research.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 06/29/2024] [Indexed: 08/22/2024]
Abstract
Due to the absence of definitive diagnostic criteria, there remains a lack of consensus regarding the risk assessment of central lymph node metastasis (CLNM) and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer. The localization of thyroid nodules is a recognized predictor of CLNM; however, quantifying this relationship is challenging due to variable measurements. In this study, we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules, thereby predicting CLNM. We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node (CLN) surgery and utilized these images to train our predictive model, ACE-Net. Furthermore, we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions. ACE-Net demonstrated superior performance in 6 external multicenter tests (AUC = 0.826), surpassing the predictive accuracy of human experts (accuracy = 0.561). The risk heatmap enabled the identification of high-risk areas for CLNM, likely correlating with lymphatic metastatic pathways. Additionally, it was observed that the likelihood of metastasis exceeded 80% when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm. ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%, without missing positive cases, thus offering a valuable tool for clinical decision-making.
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Affiliation(s)
- Siqiong Yao
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, School of Life Sciences and Biotechnology,
Shanghai Jiao Tong University, Shanghai 200240, China
- SJTU-Yale Joint Center of Biostatistics and Data Science, National Center for Translational Medicine, MoE Key Lab of Artificial Intelligence,
AI Institute Shanghai Jiao Tong University, Shanghai 200240, China
| | - Pengcheng Shen
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, School of Life Sciences and Biotechnology,
Shanghai Jiao Tong University, Shanghai 200240, China
| | - Fang Dai
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, School of Life Sciences and Biotechnology,
Shanghai Jiao Tong University, Shanghai 200240, China
| | - Luojia Deng
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, School of Life Sciences and Biotechnology,
Shanghai Jiao Tong University, Shanghai 200240, China
| | - Xiangjun Qiu
- Department of Automation,
Tsinghua University, Beijing, China.
| | - Yanna Zhao
- Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming Gao
- Department of Head and Neck Tumor,
Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Huan Zhang
- Cancer Prevention Center,
Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Xiangqian Zheng
- Department of Head and Neck Tumor,
Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Xiaoqiang Yu
- Inner Mongolia Xing’an Meng People’s Hospital, Ulanhot, China
| | - Hongjing Bao
- Inner Mongolia Xing’an Meng People’s Hospital, Ulanhot, China
| | - Maofeng Wang
- Department of Biomedical Sciences Laboratory,
Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China
| | - Yun Wang
- Department of Oncological Surgery, Xuzhou City Central Hospital,
The Affiliated Hospital of the Southeast University Medical School (Xu zhou), The Tumor Research Institute of the Southeast University (Xu zhou), Xuzhou, Jiangsu, China
| | - Dandan Yi
- Division of Thyroid Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Xiaolei Wang
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, School of Life Sciences and Biotechnology,
Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yuening Zhang
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, School of Life Sciences and Biotechnology,
Shanghai Jiao Tong University, Shanghai 200240, China
| | - Jianfeng Sang
- Division of Thyroid Surgery, Department of General Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, China
| | - Jian Fei
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of General Surgery, Ruijin Hospital Lu Wan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Institute of Translational Medicine,
Shanghai Jiao Tong University, Shanghai, China
| | - Weituo Zhang
- Hong qiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Biyun Qian
- Hong qiao International Institute of Medicine, Shanghai Tong Ren Hospital and Clinical Research Institute,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Lu
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, School of Life Sciences and Biotechnology,
Shanghai Jiao Tong University, Shanghai 200240, China
- SJTU-Yale Joint Center of Biostatistics and Data Science, National Center for Translational Medicine, MoE Key Lab of Artificial Intelligence,
AI Institute Shanghai Jiao Tong University, Shanghai 200240, China
- Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, NHC Key Laboratory of Medical Embryogenesis and Developmental Molecular Biology & Shanghai Key Laboratory of Embryo and Reproduction Engineering, Shanghai 200020, China
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Chung SR, Baek JH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. Risk factors for metastasis in indeterminate lymph nodes in preoperative patients with thyroid cancer. Eur Radiol 2022; 32:3863-3868. [PMID: 34989848 DOI: 10.1007/s00330-021-08478-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate the relevance of clinical and sonographic features as indicators of metastasis in indeterminate lymph node (LN), to determine possible indications for fine-needle aspiration (FNA). METHODS Consecutive patients who underwent US-guided FNA for sonographic indeterminate LNs from differentiated thyroid carcinoma between January 2014 and December 2018 were retrospectively reviewed. Indeterminate LNs were defined as LNs which had neither an echogenic hilum nor hilar vascularity in the absence of any suspicious finding in accordance with the Korean Society of Thyroid Radiology (KSThR) guidelines. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors related to malignancy of indeterminate LNs. RESULTS Of the 236 LNs in 212 patients enrolled in this study, 67 LNs (28.3%) were metastatic. The multivariate logistic regression analysis showed that the long diameter of LNs has a negative association with metastasis in indeterminate LNs and the sonographic features of extrathyroidal extension (ETE) and nonparallel orientation of the primary tumor are associated with metastasis in indeterminate LNs. The sensitivity and positive predictive value were increased when FNA was performed for LNs with primary tumors showing ETE or nonparallel orientation than when FNA was performed for LNs larger than 5 mm (59.7% and 40.4% vs. 11.94% and 15.69%). CONCLUSIONS The size of LNs has a negative association with metastasis in indeterminate LNs. Performing FNA for indeterminate LNs in patients whose primary tumor shows ETE or a nonparallel orientation can improve the diagnostic performance and decrease the rate of unnecessary FNA. KEY POINTS • The size of lymph nodes was negatively related to the risk of metastasis in indeterminate lymph nodes. • Extrathyroidal extension and a nonparallel orientation of the primary tumor were suggested as sonographic features predicting metastasis in indeterminate lymph nodes. • The routine practice of FNA for large indeterminate lymph nodes detected during preoperative evaluation of thyroid cancer should be discouraged.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jung Hwan Baek
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Young Jun Choi
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 05505, South Korea
| | - Tae-Yon Sung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Tae Yong Kim
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jeong Hyun Lee
- Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 05505, South Korea
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Shimura H, Matsumoto Y, Murakami T, Fukunari N, Kitaoka M, Suzuki S. Diagnostic Strategies for Thyroid Nodules Based on Ultrasonographic Findings in Japan. Cancers (Basel) 2021; 13:4629. [PMID: 34572857 PMCID: PMC8464767 DOI: 10.3390/cancers13184629] [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: 07/28/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
In recent years, the incidence of thyroid cancer has been increasing worldwide, which is believed to be mainly due to the widespread use of imaging examinations, such as ultrasonography. In this context, ultrasonography has become increasingly important because it can evaluate not only the presence or absence of nodules, but also the detailed characteristics of the nodule, making it possible to diagnose benign or malignant nodules before cytology is performed. In Japan, the third edition of the sonographic diagnostic criteria for thyroid nodules is currently widely used, and its content is similar to that of recent meta-analyses and guidelines from medical societies in other countries. In addition, since overdiagnosis of very-low-risk thyroid cancer has recently become an issue, criteria for the implementation of fine needle aspiration cytology (FNAC) have been published by various countries. The Japan Society of Breast and Thyroid Sonology provides guidelines for FNAC implementation for solid and cystic nodules. In the United States, the ATA, NCCA, and ACR have published guidelines, whereas in Europe, the ESMO and ETA have done the same. All of these guidelines used to classify risk are based on nodule size and sonographic findings. This article outlines the diagnostic criteria and management guidelines in Japan in comparison with those published in other countries. Case studies using actual images were also performed to examine the differences in the FNAC guidelines.
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Affiliation(s)
- Hiroki Shimura
- Department of Laboratory Medicine, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yoshiko Matsumoto
- Department of Thyroid and Endocrinology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan; (Y.M.); (S.S.)
| | - Tsukasa Murakami
- Department of Endocrinology, Noguchi Thyroid Clinic and Hospital Foundation, Oita 874-0902, Japan;
| | - Nobuhiro Fukunari
- Thyroid Center, Showa University Northern Yokohama Hospital, Kanagawa 224-8503, Japan;
| | - Masafumi Kitaoka
- Department of Endocrinology and Metabolism Center, IMS Miyoshi General Hospital, Saitama 354-0041, Japan;
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, School of Medicine, Fukushima Medical University, Fukushima 960-1295, Japan; (Y.M.); (S.S.)
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Tong Y, Sun P, Yong J, Zhang H, Huang Y, Guo Y, Yu J, Zhou S, Wang Y, Wang Y, Ji Q, Wang Y, Chang C. Radiogenomic Analysis of Papillary Thyroid Carcinoma for Prediction of Cervical Lymph Node Metastasis: A Preliminary Study. Front Oncol 2021; 11:682998. [PMID: 34268116 PMCID: PMC8276635 DOI: 10.3389/fonc.2021.682998] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/09/2021] [Indexed: 12/19/2022] Open
Abstract
Background Papillary thyroid carcinoma (PTC) is characterized by frequent metastases to cervical lymph nodes (CLNs), and the presence of lymph node metastasis at diagnosis has a significant impact on the surgical approach. Therefore, we established a radiomic signature to predict the CLN status of PTC patients using preoperative thyroid ultrasound, and investigated the association between the radiomic features and underlying molecular characteristics of PTC tumors. Methods In total, 270 patients were enrolled in this prospective study, and radiomic features were extracted according to multiple guidelines. A radiomic signature was built with selected features in the training cohort and validated in the validation cohort. The total protein extracted from tumor samples was analyzed with LC/MS and iTRAQ technology. Gene modules acquired by clustering were chosen for their diagnostic significance. A radiogenomic map linking radiomic features to gene modules was constructed with the Spearman correlation matrix. Genes in modules related to metastasis were extracted for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, and a protein-protein interaction (PPI) network was built to identify the hub genes in the modules. Finally, the screened hub genes were validated by immunohistochemistry analysis. Results The radiomic signature showed good performance for predicting CLN status in training and validation cohorts, with area under curve of 0.873 and 0.831 respectively. A radiogenomic map was created with nine significant correlations between radiomic features and gene modules, and two of them had higher correlation coefficient. Among these, MEmeganta representing the upregulation of telomere maintenance via telomerase and cell-cell adhesion was correlated with ‘Rectlike’ and ‘deviation ratio of tumor tissue and normal thyroid gland’ which reflect the margin and the internal echogenicity of the tumor, respectively. MEblue capturing cell-cell adhesion and glycolysis was associated with feature ‘minimum calcification area’ which measures the punctate calcification. The hub genes of the two modules were identified by protein-protein interaction network. Immunohistochemistry validated that LAMC1 and THBS1 were differently expressed in metastatic and non-metastatic tissues (p=0.003; p=0.002). And LAMC1 was associated with feature ‘Rectlike’ and ‘deviation ratio of tumor and normal thyroid gland’ (p<0.001; p<0.001); THBS1 was correlated with ‘minimum calcification area’ (p<0.001). Conclusions The radiomic signature proposed here has the potential to noninvasively predict the CLN status in PTC patients. Merging imaging phenotypes with genomic data could allow noninvasive identification of the molecular properties of PTC tumors, which might support clinical decision making and personalized management.
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Affiliation(s)
- Yuyang Tong
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Department of Surgical Oncology, The Ohio State University, Columbus, OH, United States
| | - Peixuan Sun
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanjuan Yong
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongbo Zhang
- Pharmaceutical Sciences Laboratory, Åbo Akademi University, Turku, Finland.,Turku Biosciences Center, University of Turku and Åbo Akademi University, Turku, Finland
| | - Yunxia Huang
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi Guo
- Department of Electronic Engineering, Fudan University and Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China
| | - Jinhua Yu
- Department of Electronic Engineering, Fudan University and Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China
| | - Shichong Zhou
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yulong Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qinghai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yuanyuan Wang
- Department of Electronic Engineering, Fudan University and Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention of Shanghai, Shanghai, China
| | - Cai Chang
- Department of Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lim YS, Lee YS, Lee JC, Son SM, Shin DH, Kim SS, Kim IJ, Lee BJ. Ultrasound Echogenicity of Papillary Thyroid Cancer Is Affected by Tumor Growth Patterns and Tumor Fibrosis. In Vivo 2021; 35:1633-1640. [PMID: 33910846 DOI: 10.21873/invivo.12421] [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: 01/31/2021] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The association between preoperative ultrasound (US) echogenicity and histopathological characteristics of papillary thyroid cancer (PTC) has been rarely investigated is not well characterized. This study evaluated a relationship between the clinical characteristics of PTC, histopathological phenomena including tumor growth patterns (TGPs) and tumor fibrosis (TF), and US echogenicity. PATIENTS AND METHODS In total, 170 patients with PTC (<2 cm) underwent total thyroidectomy with central neck dissection. Demographics, US echogenicity, tumor size, extra-thyroidal extension (ETE), lymph node metastasis (LNM) within the central and lateral neck, TGPs, and TF percentage were reviewed. RESULTS Patients with TGP II (encapsulated growth with partial pericapsular extension) and III (infiltrative growth) were more frequently burdened by ETE and lateral neck LNM compared to patients with TGP I (encapsulated growth with a well-defined cystic or solid characteristic). Older age was significantly deterministic of TGP III, and male gender and higher TF percentage were independent risk factors for lateral neck LNM. TGP III and TF were independent determining factors for marked hypoechogenicity on US. CONCLUSION PTC with TGP II and III and higher tumor fibrosis exhibited more aggressive clinicopathologic behaviors. TGP III and TF were determinants for marked hypoechogenicity.
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Affiliation(s)
- Yun-Sung Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Republic of Korea
| | - Yoon Se Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Choon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Yangsan, Republic of Korea
| | - Seok-Man Son
- Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Yangsan, Republic of Korea
| | - Dong-Hoon Shin
- Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Yangsan, Republic of Korea;
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea
| | - In-Ju Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea
| | - Byung-Joo Lee
- Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea
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Risk factors for central lymph node metastasis in the cervical region in papillary thyroid carcinoma: a retrospective study. World J Surg Oncol 2021; 19:138. [PMID: 33941214 PMCID: PMC8091777 DOI: 10.1186/s12957-021-02247-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background To investigate the influence of different risk factors on central lymph node metastasis (CLNM) in the cervical region in patients with papillary thyroid carcinoma (PTC). Methods This retrospective study included 2586 PTC patients. Potential risk factors were identified by univariate analysis, and the relationships between these factors and CLNM were ascertained by multivariable analysis. A scoring system was constructed, and the optimal cut-off value was determined. Results On univariate analysis, sex, age, tumor diameter, multifocality, capsule invasion, vascular invasion, total number of lymph nodes in the central region, and serum thyroid peroxidase antibody (TPOAb) concentration were identified as potential risk factors for CLNM in the cervical region, whereas nerve invasion, thyroid-stimulating hormone concentration, and thyroglobulin antibody (TgAb) concentration were not. Multivariable analysis indicated that male sex, young age, large tumor diameter, multifocality, vascular invasion, a large number of central lymph nodes, and a low TPOAb concentration were significant risk factors. From these factors, a preoperative CLNM risk assessment scale was constructed for predicting CLNM in the cervical region for PTC patients. Conclusion Male sex, young age, large tumor diameter, multifocality, vascular invasion, a large number of central lymph nodes, and a low TPOAb concentration were positively correlated with CLNM in the cervical region in PTC patients. The preoperative CLNM risk assessment scale based on these risk factors is expected to offer accurate preoperative assessment of central lymph node status in PTC patients.
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Liu Y, Lv H, Zhang S, Shi B, Sun Y. The Impact of Coexistent Hashimoto's Thyroiditis on Central Compartment Lymph Node Metastasis in Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:772071. [PMID: 34867817 PMCID: PMC8635140 DOI: 10.3389/fendo.2021.772071] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) is the most prevalent inflammatory disorder of the thyroid gland. Current studies have reported the coexistence rate between HT and papillary thyroid carcinoma (PTC) is quite high. The objective of this study was to evaluate the impact of HT on the predictive factors of central compartment lymph node metastasis (CLNM) in PTC. METHODS A retrospective investigation was performed on PTC patients. They were subclassified into HT and non-HT groups. The results of preoperative neck ultrasound (US) examinations were reviewed. The clinical characteristics and the predictive value for CLNM were explored and compared between the two groups. RESULTS A total of 756 patients were included in this study. There were more female patients (86.1%) in the PTC coexistent with the HT group than non-HT group. The patients with HT group had higher preoperative serum level of TSH. There was statistically significant difference between the HT patients and non-HT patients in nodular vascularization. Univariate and multivariate analyses showed that male, age ≤45 years old, tumor diameter >1 cm, and presence of suspicious central compartment lymph node on US, irregular nodular shape, multifocal carcinoma were independent predictive factors of CLNM in PTC patients. It was showed that male, age ≤45 years old, tumor diameter >1 cm, multifocality, and presence of suspicious central lymph node on US were risk factors for CLNM in non-HT patients. Only tumor diameter >1 cm and presence of suspicious central lymph node on US were independently correlated with CLNM in HT patients. The sensitivity of the multivariate model was 63.5%, and specificity was 88.9% for prediction CLNM in HT patients. For non-HT patients, the AUC was 80.6%, the sensitivity of the multivariate model was 64.5%, and specificity was 85.2. CONCLUSION PTC combined with HT is more common in women, and TSH level in HT group is higher than that in patients with PTC alone. Regardless of that HT is not a related risk factor of CLNM in PTC, our result suggested that different predictive systems should be used for HT and non-HT patients respectively to have a more accurate evaluation of CLNM in clinic.
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Affiliation(s)
- Yang Liu
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Hongjun Lv
- Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shaoqiang Zhang
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yushi Sun
- Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Yushi Sun,
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Jianming L, Jibin L, Linxue Q. Suspicious ultrasound characteristics correlate with multiple factors that predict central lymph node metastasis of papillary thyroid carcinoma: Significant role of HBME-1. Eur J Radiol 2019; 123:108801. [PMID: 31918249 DOI: 10.1016/j.ejrad.2019.108801] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/04/2019] [Accepted: 12/15/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) is frequently associated with central lymph node metastasis (CLNM). In the present study, we aimed to identify possible risk factors for CLNM in PTC, including suspicious ultrasound (US) features coexisting with thyroid diseases, immunohistochemical markers, and BRAFV600E. These were used to establish a model to predict the risk of CLNM. METHODS From January 2016 to March 2018, we identified a cohort of patients with classic PTC who underwent cervical US and were diagnosed by postoperative pathology. Fine-needle aspiration biopsies were analyzed for the presence ofBRAFV600E, and immunohistochemistry was used to detect tumor markers. US imaging was performed in accordance with a standardized protocol. A model to determine the risk of CLNM was established using the outcomes of univariate and multivariate analyses. RESULTS Age of ≥45 years, male sex, mean tumor diameter of ≥1.0 cm, taller-than-wide tumor shape, multiple PTCs, capsule contact, and HBME-1 expression were significant independent risk predictors of CLNM. Hashimoto's thyroiditis, nodular goiter, andBRAFV600E were not significantly associated with CLNM. The cutoff value (area under the curve = 0.760) for predicting risk was determined from receiver operating characteristic curves (sensitivity, 75.6 %; specificity, 60.7 %). CONCLUSIONS Male sex, age of ≥45 years, mean tumor diameter of ≥1.0 cm, taller-than-wide shape, multiple tumors, capsule contact, and HBME-1 expression were independent predictors of the risk of CLNM in patients with PTC. The risk model may be useful for evaluating patients' prognoses and selecting optimal surgical strategies.
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Affiliation(s)
- Li Jianming
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
| | - Liu Jibin
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Qian Linxue
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Sun Y, Lv H, Zhang S, Bai Y, Shi B. Gender-Specific Risk of Central Compartment Lymph Node Metastasis in Papillary Thyroid Carcinoma. Int J Endocrinol 2018; 2018:6710326. [PMID: 29713344 PMCID: PMC5866883 DOI: 10.1155/2018/6710326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/12/2017] [Indexed: 02/07/2023] Open
Abstract
Our aim was to evaluate the impact of gender on the predictive factors of central compartment lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC). A retrospective study of 590 patients treated for PTC was performed. Univariate and multivariate analyses showed that gender (female; P = 0.001), age (≥45 y; P < 0.001), tumor size (>1 cm; P < 0.001), and multifocality (P = 0.004) were independent predictive factors of CLNM in PTC patients. Patients were divided into male group (n = 152) and female group (n = 438). Age (≥45 y; P = 0.001), T4 (P = 0.006) and multifocality (P = 0.024) were independent predictive risk factors of CLNM in male patients. As for female patients, age (≥45 y; P < 0.001), tumor size (>1 cm; P < 0.001), multifocality (P = 0.002), and microcalcification (P = 0.027) were independently correlated with CLNM. The sensitivity of the multivariate model for predicting CLNM in male patients was 64.9%, specificity was 82.9%, and area under the ROC curve (AUC) was 0.764. As for female patients, the sensitivity was 55.7%, specificity was 77.9%, and AUC was 0.73. This study showed that the predictive factors of CLNM indeed varied according to gender. To have a more accurate evaluation of CLNM, different predictive systems should be used for male and female patients.
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Affiliation(s)
- Yushi Sun
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hongjun Lv
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shaoqiang Zhang
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yanxia Bai
- Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Bingyin Shi
- Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Lee YS, Lee BJ, Hong HJ, Lee KD. Current trends of practical issues concerning micropapillary thyroid carcinoma: The Korean Society of Thyroid-Head and Neck Surgery. Medicine (Baltimore) 2017; 96:e8596. [PMID: 29137085 PMCID: PMC5690778 DOI: 10.1097/md.0000000000008596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Although several thyroid associations have published various guidelines, controversies especially in cases of micropapillary thyroid cancer (MPTC) still exist. This survey was designed to collect information about diagnostic tests and treatments performed on patients with MPTC and help identify current trends in thyroid surgery.We developed questionnaires about the management methods for MPTC, which were used to identify factors related to indications of fine needle aspiration (FNA), type of surgery, and central lymph node dissection (CLND). Active 60 members of the Korean Society of Thyroid-Head and Neck Surgery participated in the study in September 2016.Ultrasound-guided FNA was usually initiated when the tumor was at least 5 mm (60%). All respondents preferred ultrasound-guided FNA and surgery for nodules with extrathyroidal extension (ETE). The preferred treatment option for intraglandular MPTC was lobectomy (92%) rather than active surveillance (8%). Posterolateral ETE increased the respondents' preference for total thyroidectomy (61.7%). Active surveillance was preferred for tumors <5 mm, which was decreased by the presence of ETE. The presence of ETE (73.3%) and its proximity to critical organs (46.7%) were the main determining factors for prophylactic CLND. For multiple metastatic lymph nodes at level III, selective neck dissection including levels IIb (23.3%) and V (78.3%) was preferred in addition to levels IIa, III, VI, and V.Korean head and neck surgeons favored total thyroidectomy and CLND in cases wherein ETE, central lymph node metastasis, or critical organ involvement was suspected.
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Affiliation(s)
- Yoon Se Lee
- Department of Otorhinolaryngology—Head and Neck Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul
| | - Byung-Joo Lee
- Department of Otorhinolaryngology—Head and Neck Surgery, Pusan National University Hospital, Busan
| | - Hyun Joon Hong
- Department of Otolaryngology, Catholic Kwandong University International St. Mary's Hospital, Incheon
| | - Kang-Dae Lee
- Department of Otolaryngology, Kosin University Gospel Hospital, Busan, Korea
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Machado MRM, Tavares MR, Buchpiguel CA, Chammas MC. Ultrasonographic Evaluation of Cervical Lymph Nodes in Thyroid Cancer. Otolaryngol Head Neck Surg 2016; 156:263-271. [PMID: 28145839 DOI: 10.1177/0194599816676472] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective To determine what ultrasonographic features can identify metastatic cervical lymph nodes, both preoperatively and in recurrences after complete thyroidectomy. Study Design Prospective. Setting Outpatient clinic, Department of Head and Neck Surgery, School of Medicine, University of São Paulo, Brazil. Subjects and Methods A total of 1976 lymph nodes were evaluated in 118 patients submitted to total thyroidectomy with or without cervical lymph node dissection. All the patients were examined by cervical ultrasonography, preoperatively and/or postoperatively. The following factors were assessed: number, size, shape, margins, presence of fatty hilum, cortex, echotexture, echogenicity, presence of microcalcification, presence of necrosis, and type of vascularity. The specificity, sensitivity, positive predictive value, and negative predictive value of each variable were calculated. Univariate and multivariate logistic regression analyses were conducted. A receiver operator characteristic (ROC) curve was plotted to determine the best cutoff value for the number of variables to discriminate malignant lymph nodes. Results Significant differences were found between metastatic and benign lymph nodes with regard to all of the variables evaluated ( P < .05). Logistic regression analysis revealed that size and echogenicity were the best combination of altered variables (odds ratio, 40.080 and 7.288, respectively) in discriminating malignancy. The ROC curve analysis showed that 4 was the best cutoff value for the number of altered variables to discriminate malignant lymph nodes, with a combined specificity of 85.7%, sensitivity of 96.4%, and efficiency of 91.0%. Conclusion Greater diagnostic accuracy was achieved by associating the ultrasonographic variables assessed rather than by considering them individually.
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Affiliation(s)
- Maria Regina Marrocos Machado
- 1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marcos Roberto Tavares
- 2 Department of Head & Neck Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- 1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Maria Cristina Chammas
- 1 Department of Radiology and Oncology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Li JW, Chang C, Chen M, Zeng W, Gao Y, Zhou SC, Wang F, Hu N, Chen YL. Is Ultrasonography More Sensitive Than Computed Tomography for Identifying Calcifications in Thyroid Nodules? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2183-2190. [PMID: 27562974 DOI: 10.7863/ultra.15.10060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/18/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The primary objective of this study was to evaluate the difference and agreement between ultrasonography (US) and computed tomography (CT) for identifying calcifications in thyroid nodules. METHODS Data from the medical records of 20,248 patients were reviewed for preoperative diagnostic investigations and postoperative pathologic diagnoses. In total, 5247 records were selected for analysis based on the presence of calcifications reported in any of the following 3 modes: US, CT, and pathologic analysis. All 5247 patients underwent US examinations, whereas 3827 underwent cervical CT examinations. All patients had a postoperative pathologic diagnosis serving as a reference. The value of US for identification of calcifications and prediction of malignancy was analyzed on the basis of the entire cohort of 5247 records, whereas that of CT was based on 3827 records. The agreement between US and CT was analyzed on the basis of the 3827 common records. RESULTS Of the 5247 patients who underwent US, 4855 (92.5%) were found to have calcifications, whereas of the 3827 patients who underwent CT, 2040 (53.3%) were found to have calcifications (P < .0005). Among the 404 cases with calcifications reported by pathologic analysis, the agreement rate between US and pathologic findings was significantly higher than that between CT and pathologic findings (87.9% versus 81.9%, respectively; P = .018). CONCLUSIONS US is more sensitive and accurate than CT for detecting calcifications in thyroid nodules. Hence, US is recommended as the preferred imaging modality for calcification detection in thyroid nodules.
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Affiliation(s)
- Jia-Wei Li
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cai Chang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Chen
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Zeng
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi Gao
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Shi-Chong Zhou
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fen Wang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Na Hu
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Ling Chen
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai, China; and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Lin DZ, Qu N, Shi RL, Lu ZW, Ji QH, Wu WL. Risk prediction and clinical model building for lymph node metastasis in papillary thyroid microcarcinoma. Onco Targets Ther 2016; 9:5307-16. [PMID: 27601922 PMCID: PMC5004998 DOI: 10.2147/ott.s107913] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with risk factors. Multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for cervical nodes in PTMC.
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Affiliation(s)
- Dao-Zhe Lin
- Department of Surgical Oncology, Rui'an People's Hospital, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou
| | - Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Rong-Liang Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Zhong-Wu Lu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Wei-Li Wu
- Department of Surgical Oncology, Rui'an People's Hospital, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou
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Kocharyan D, Schwenter F, Bélair M, Nassif E. The relevance of preoperative ultrasound cervical mapping in patients with thyroid cancer. Can J Surg 2016; 59:113-7. [PMID: 27007092 DOI: 10.1503/cjs.011015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cervical lymph node involvement in thyroid cancer is associated with locoregional recurrence and decreased disease-free survival. Preoperative lymph node mapping helps in planning surgery for neck dissection and improves patient outcomes. We sought to perform a qualitative and quantitative analysis of ultrasound mapping for thyroid cancer and evaluate the clinical importance of this exam in terms of identifying the group of patients who would benefit most from subsequent surgical dissection. METHODS We retrospectively reviewed the cases of 263 patients who underwent thyroid surgery between 2009 and 2013. We calculated the positive predictive values (PPVs) of ultrasound mapping of both the lateral and central compartments together and the lateral or central compartment individually. A quantitative analysis was performed by comparing the number of positive lymph nodes at ultrasound imaging with histopathologic evaluation. RESULTS A total of 136 cases of thyroid cancer in 120 patients met the inclusion criteria for ultrasound mapping analysis. The PPVs (and 95% confidence intervals) were 83.82 (0.76-0.89) for the lateral and central compartments, 85.39% (0.76-0.91) for the lateral compartment, and 80.48% (0.7-0.87) for the central compartment. When comparing the positive lymph nodes at ultrasound imaging with histopathologic evaluation, the result was χ(2) = 10.33 (p = 0.006). CONCLUSION This single-institution study indicated that preoperative ultrasound mapping is an accurate imaging procedure for predicting lymphatic spread in differentiated and medullary thyroid cancer. Ultrasound mapping can be used as an efficient tool for surgical planning and prognosis determination, as well as for identifying the group of patients who would benefit most from subsequent surgical intervention.
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Affiliation(s)
- Davit Kocharyan
- From the Faculty of Medicine, Université de Montréal (Kocharyan); the departments of Surgery (Schwenter) and Surgical Oncology (Schwenter, Nassif), Centre Hospitalier de l'Université de Montréal; and the departments of Radiology (Bélair) and Surgical Oncology (Nassif), Université de Montréal, Montreal, Que
| | - Frank Schwenter
- From the Faculty of Medicine, Université de Montréal (Kocharyan); the departments of Surgery (Schwenter) and Surgical Oncology (Schwenter, Nassif), Centre Hospitalier de l'Université de Montréal; and the departments of Radiology (Bélair) and Surgical Oncology (Nassif), Université de Montréal, Montreal, Que
| | - Manon Bélair
- From the Faculty of Medicine, Université de Montréal (Kocharyan); the departments of Surgery (Schwenter) and Surgical Oncology (Schwenter, Nassif), Centre Hospitalier de l'Université de Montréal; and the departments of Radiology (Bélair) and Surgical Oncology (Nassif), Université de Montréal, Montreal, Que
| | - Edgard Nassif
- From the Faculty of Medicine, Université de Montréal (Kocharyan); the departments of Surgery (Schwenter) and Surgical Oncology (Schwenter, Nassif), Centre Hospitalier de l'Université de Montréal; and the departments of Radiology (Bélair) and Surgical Oncology (Nassif), Université de Montréal, Montreal, Que
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Ng M, Wiseman SM. Utility of sentinel lymph node biopsy for thyroid cancer: a comprehensive review. Expert Rev Endocrinol Metab 2015; 10:399-411. [PMID: 30293497 DOI: 10.1586/17446651.2015.1058153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sentinel lymph node biopsy (SLNB) is a minimally invasive lymphatic mapping technique, used to identify lymph node micrometastases and stage multiple cancer types. Despite the performance of SLNB for thyroid cancer having been under study since 1998, its role has remained controversial. The objective of this review is to summarize current research reporting on SLNB for thyroid cancer, focusing on recent studies of its application to differentiated thyroid cancer. The technique and potential benefits of SLNB are reviewed with regards to its ability to identify lymph node metastases, aid in cancer prognostication, and direct surgical and medical treatment.
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Affiliation(s)
- Melissa Ng
- a Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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