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Zhou X, Chang L, Liang Q, Zhao R, Xiao Y, Xu Z, Yu L. The m6A methyltransferase METTL3 drives thyroid cancer progression and lymph node metastasis by targeting LINC00894. Cancer Cell Int 2024; 24:47. [PMID: 38291427 PMCID: PMC10826051 DOI: 10.1186/s12935-024-03240-5] [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: 05/31/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Long noncoding RNAs (lncRNAs) are significant contributors to various human malignancies. The aberrant expression of lncRNA LINC00894 has been reported in various human malignancies. We aimed to illustrate the role of LINC00894 and its underlying mechanism in the development of papillary thyroid carcinoma (PTC). METHODS We performed bioinformatics analysis of differentially expressed RNAs from TCGA and GEO datasets and selected the target lncRNA LINC00894. SRAMP analysis revealed abundant M6A modification sites in LINC00894. Further analysis of StarBase, GEPIA, and TCGA datasets was performed to identify the related differentially expressed genes METTL3. Colony formation and CCK-8 assays confirmed the relationship between LINC00894, METTL3, and the proliferative capacity of PTC cells. The analysis of AnnoLnc2, Starbase datasets, and meRIP-PCR and qRT‒PCR experiments confirmed the influence of METTL3-mediated m6A modification on LINC00894. The study employed KEGG enrichment analysis as well as Western blotting to investigate the impact of LINC00894 on the expression of proteins related to the Hippo signalling pathway. RESULTS LINC00894 downregulation was detected in PTC tissues and cells and was even further downregulated in PTC with lymphatic metastasis. LINC00894 inhibits the lymphangiogenesis of vascular endothelial cells and the proliferation of cancer cells. METTL3 enhances PTC progression by upregulating LINC00894 by enhancing LINC00894 mRNA stability through the m6A-YTHDC2-dependent pathway. LINC00894 may inhibit PTC malignant phenotypes through the Hippo signalling pathway. CONCLUSION The METTL3-YTHDC2 axis stabilizes LINC00894 mRNA in an m6A-dependent manner and subsequently inhibits tumour malignancy through the Hippo signalling pathway.
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Affiliation(s)
- Xiang Zhou
- Head and neck surgery, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Lisha Chang
- Oncology department, The Second Affiliated Hospital of Nanjing Medical University, Nanjing City, People's Republic of China
| | - Qiaoqiao Liang
- Head and neck surgery, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Rongjie Zhao
- State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, People's Republic of China
| | - Yong Xiao
- Head and neck surgery, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Zheng Xu
- Head and neck surgery, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China
| | - Leitao Yu
- Head and neck surgery, The Second Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province, People's Republic of China.
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Shao L, Wang Z, Dong W, Sun W, Zhang H. Risk factors associated with preferential lateral lymph node metastasis in papillary thyroid carcinoma. Cancer Med 2023; 12:20670-20676. [PMID: 37905599 PMCID: PMC10709716 DOI: 10.1002/cam4.6567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Lateral lymph node metastasis (LLNM) is common in patients with papillary thyroid cancer (PTC), usually occurring after central lymph node metastasis (CLNM). However, some patients experience LLNM without first developing CLNM. This study aimed to identify the risk factors for developing LLNM without CLNM. METHODS We retrospectively reviewed 421 patients diagnosed with PTC who underwent lobectomy or total thyroidectomy with central and ipsilateral lateral lymph node dissection. We collected clinicopathological data and used univariate and multivariate logistic regression analyses to determine the risk factors associated with LLNM without CLNM. RESULTS The LLNM without CLNM frequency was 18.3% (77/421). Univariate analyses demonstrated that age over 55 years, primary tumor in the upper portion of the thyroid, the number of central lymph node (CLN) and LLNM, primary tumor size, and the summed size of multi-foci tumors smaller than 1 cm were significantly associated with LLNM without CLNM (p < 0.05). Multivariate analysis revealed that LLNM without CLNM was more likely to occur in patients aged ≥55 years (odds ratio [OR], 2.309; 95% confidence interval [CI], 1.133-4.704; p = 0.021), and primary tumor in the upper portion of the thyroid (OR, 0.524; 95% CI, 0.295-0.934; p = 0.028). CONCLUSION The lymph node metastasis pattern in patients with PTC is not constant. Therefore, surgeons should evaluate the lateral lymph nodes, especially in patients older than 55 years or when the primary tumor is in the upper portion of the thyroid.
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Affiliation(s)
- Liang Shao
- Department of Thyroid SurgeryThe First Hospital of China Medical UniversityShenyangLiaoning ProvinceP. R. China
| | - Zhihong Wang
- Department of Thyroid SurgeryThe First Hospital of China Medical UniversityShenyangLiaoning ProvinceP. R. China
| | - Wenwu Dong
- Department of Thyroid SurgeryThe First Hospital of China Medical UniversityShenyangLiaoning ProvinceP. R. China
| | - Wei Sun
- Department of Thyroid SurgeryThe First Hospital of China Medical UniversityShenyangLiaoning ProvinceP. R. China
| | - Hao Zhang
- Department of Thyroid SurgeryThe First Hospital of China Medical UniversityShenyangLiaoning ProvinceP. R. China
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Gaujoux S, Gharios J, Avisse C, Renard Y, Hartl D. Extent of cervical lymph node dissection: Recommendations from the Francophone Association for Endocrine Surgery, the French Society of Endocrinology and the French Society of Nuclear Medicine. J Visc Surg 2023:S1878-7886(23)00078-4. [PMID: 37169713 DOI: 10.1016/j.jviscsurg.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
When metastatic ipsilateral central lymph nodes from thyroid cancer are identified pre- or intraoperatively (cN1a), ipsilateral central lymph node dissection should be performed concomitantly with thyroidectomy. When the patient is N1a on one side, contralateral prophylactic central lymph node dissection can also be considered. Prophylactic ipsilateral lymph dissection is not recommended. Ipsilateral compartment lymph node dissection is recommended in the corresponding sector for treatment of thyroid cancer with lymph node involvement (cN1b). Lymph node dissection can be limited to sectors III and IV when one of these sectors (or both) is involved and ultrasound does not demonstrate involvement of the other lateral sectors. Associated prophylactic lymph node dissection of sectors IIA and IIB is not recommended, while lymph node dissection of sector V (and exceptionally sector I) is indicated only when metastatic lymph nodes are proven. Prophylactic lymph node dissection of sector VB can be considered when positive lymph nodes are identified in sectors II, III and IV. When isolated metastatic lateral lymph nodes are identified (cN1b), prophylactic central (sector VI) lymph node dissection is recommended on the same side as the lateral compartment in addition to ipsilateral lateral lymph node compartment dissection. The level of evidence is insufficient to recommend prophylactic lateral lymph node dissection on the contralateral side for unilateral cN1b tumors. This type of lymph node dissection can be discussed for tumors that are at high risk of recurrence, bilateral tumors, in case of ipsilateral lateral lymph nodes > 3cm or in presence of > 4 metastatic lymph nodes in the central compartment.
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Affiliation(s)
- Sébastien Gaujoux
- Service de chirurgie générale, viscérale et endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne université, 47-83, avenue de l'hôpital, 75013 Paris, France.
| | - Joseph Gharios
- Service de chirurgie générale, endocrinienne et métabolique, CHU La Conception, AP-HM, Aix Marseille université, Marseille, France
| | - Claude Avisse
- Service de chirurgie digestive et endocrinienne, hôpital Robert-Debré, université de Champagne Ardennes, Reims, France
| | - Yves Renard
- Service de chirurgie digestive et endocrinienne, hôpital Robert-Debré, université de Champagne Ardennes, Reims, France
| | - Dana Hartl
- Département d'anesthésie, de chirurgie et de radiologie interventionnelle, unité de chirurgie thyroïdienne, institut Gustave-Roussy, Villejuif, France
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Jiang Q, Zhai M, Lin X, Ren C, Li Y, Ye F, Gong Y, Liu S. Case Report: A papillary thyroid microcarcinoma patient with skip lymph node metastasis and multiple distant metastasis. Front Surg 2023; 9:1019846. [PMID: 36743898 PMCID: PMC9889854 DOI: 10.3389/fsurg.2022.1019846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Papillary thyroid microcarcinoma (PTMC) is defined as PTC with a diameter less than 1 centimeter. Most lymph nodes of PTC patients have metastasized to the central neck, and a few lymph nodes have metastasized to the lateral neck. Skip lymph node metastasis, that is, lateral cervical lymph node metastasis without central lymph node metastasis, is even less common. Additionally, distant metastasis of PTMC is also rare, mainly occurring in the lung and bone. Here, we reported a case of PTMC patient with skip lymph node metastasis and multiple distant metastasis. The patient presented with a huge shoulder mass and the primary tumor was found to originate from the thyroid. However, the patient only suffered with PTMC via postoperative pathological results, and interestingly, the patient only had skip lymph node metastasis. Thus, we should focus on PTMC patients with lateral cervical lymph nodes metastasis, especially those with skip metastasis. In addition, this case provides a new perspective for us to understand of skip lymph metastasis and distant metastasis of PTMC.
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Affiliation(s)
- Qin Jiang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mimi Zhai
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xiang Lin
- Department of General Surgery, Huaihua Second People’s Hospital, Huaihua, China
| | - Chutong Ren
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunxia Li
- Xiangya Nursing School, Central South University, Changsha, China
| | - Fei Ye
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Gong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sushun Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Correspondence: Sushun Liu ;
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Wu X, Li B, Zheng C, He X. Risk factors for skip metastasis in patients with papillary thyroid microcarcinoma. Cancer Med 2022; 12:7560-7566. [PMID: 36479912 PMCID: PMC10067130 DOI: 10.1002/cam4.5507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/19/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) is prevalent in papillary thyroid microcarcinoma (PTMC) and is essential when determining tumor stage and prognosis. Positive lateral LNM with negative central LNM is defined as skip metastasis. Thyroid carcinoma's risk factors for skip metastasis remain controversial, especially in PTMC. This study aimed to determine the clinical features as well as the risk factors of skip metastasis among patients with PTMC. METHODS We conducted retrospective research among patients with PTMC who were subjected to treatment at our Hospital between January 2018 and December 2019 by reviewing their medical records. A database containing demographic characteristics, ultrasonography features, blood test outcomes, operation information, pathology details, and follow-up information was constructed. The link between skip metastasis and clinicopathological features of PTMC was evaluated using univariate as well as multivariate analyses. RESULTS Overall, 293 patients diagnosed with PTMC and lateral LNM were included. There were 91 men (31.1%) and 202 women (68.9%). The median age was 38 (31-47) years. Fifty patients were diagnosed with skip metastases. Levels III and II + III were the most prevalent in single-level and two-level metastasis, correspondingly. Univariate and multivariate analyses detected two independent factors linked to skip metastasis in PTMC: female sex (odds ratio = 2.609, 95% confidence interval (CI): 1.135-6.000; p = 0.024) and location of the tumor (upper portion) (odds ratio = 2.959, 95% CI: 1.552-5.639; p = 0.001). CONCLUSIONS Skip metastasis is prevalent in thyroid carcinoma. Female sex and tumor location (upper portion) are independently linked to skip metastasis in PTMC. Patients who have these two risk factors should undergo a meticulous preoperative and intraoperative evaluation of lymph node status.
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Affiliation(s)
- Xin Wu
- Department of General Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Binglu Li
- Department of General Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Chaoji Zheng
- Department of General Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaodong He
- Department of General Surgery Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Bertin JB, Buffet C, Leenhardt L, Menegaux F, Chereau N. Effect of skip metastasis to lateral neck lymph nodes on outcome of patients with papillary thyroid carcinoma. Langenbecks Arch Surg 2022; 407:3025-3030. [PMID: 35819485 DOI: 10.1007/s00423-022-02604-7] [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: 01/31/2022] [Accepted: 07/03/2022] [Indexed: 11/26/2022]
Abstract
CONTEXT Lymph node metastasis (N1) is a prognostic factor for disease recurrence in papillary thyroid carcinoma (PTC) patients. Skip metastasis is defined as only lateral N1 with negative central lymph nodes (LNs). OBJECTIVE The aim of this study was to explore the outcome of PTC patients with skip N1. PATIENTS AND DESIGN All patients who underwent a total thyroidectomy with ipsilateral central and lateral LN dissection for PTC from 1999 to 2019 in a high-volume endocrine surgery centre were included in this study. MAIN OUTCOME MEASURE Demographic and outcomes-recurrence and disease-specific survival (DSS)-were compared between three groups: N1a (central N1 only), N1b-CL (central and lateral N1), and N1b-Skip (lateral N1 without central LN involvement). RESULTS During the study period, 3046 patients had surgery for PTC, including 1138 with N1 (37%, 860 women, mean age: 44.8 years) comprising 474 N1a (42%), 513 N1b-CL (45%), and 151 N1b-Skip (13%). The median follow-up was 74 months (range 12-216 months). The recurrence rate in the N1b-Skip group was 13% (20/151) and 10% (47/474) in the N1a group. This was significantly lower than that in the N1b-CL group (27%, 140/513) (p < 0.0001). DSS at 10 years was 99% for group N1a, 98% for the N1b-CL, and 99% in the N1b-Skip group. CONCLUSION The recurrence rate of N1b-Skip patients was lower than that of N1b-CL patients and similar to that of N1a patients. This result could be used as an indication for the modality of radioiodine therapy, and for the pattern of follow-up procedures.
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Affiliation(s)
- Jean Baptiste Bertin
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Camille Buffet
- Thyroid and Endocrine Tumor Unit, Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
| | - Laurence Leenhardt
- Thyroid and Endocrine Tumor Unit, Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
| | - Fabrice Menegaux
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France
| | - Nathalie Chereau
- Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
- Groupe de Recherche Clinique N°16 Thyroid Tumors, Sorbonne University, Paris, France.
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高 婕, 辛 运, 杨 立, 刘 亚, 田 泽, 尚 小. [Risk factors of skip lateral cervical lymph node metastasis in papillary thyroid carcinoma]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:528-539. [PMID: 35822381 PMCID: PMC10128391 DOI: 10.13201/j.issn.2096-7993.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Indexed: 06/15/2023]
Abstract
Objective:To investigate the incidence and risk factors of skip lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma(PTC). Methods:The clinical and pathological data of 85 patients with PTC who underwent total thyroidectomy plus central and lateral neck dissection in the Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University from January 2018 to January 2022 were analyzed retrospectively. SPSS 26.0 software was used to process the data, and univariate and multivariate analysis were performed to assess the relationships between skip lateral cervical lymph node metastasis and clinicopathological characteristics. Results:There were 31 cases(36.5%) of skipped lateral cervical lymph node metastasis. Univariate analysis showed that the largest tumor diameter ≤5 mm(P=0.006) and the tumor located in the upper pole of the thyroid(P=0.002) were associated with the occurrence of skip lateral cervical lymph node metastasis in patients with PTC. Most of the skip metastases involved a single area(18/31, 58.1%), of which area Ⅲ was most likely to be involved(10/31, 32.3%), followed by area Ⅱ(5/31, 16.1%). The results of binary logistic analysis showed that tumor diameter less than 5 mm(OR 7.800, 95%CI 1.710-21.394, P=0.005) and tumor at the upper pole of the gland(OR 4.060, 95%CI 1.468-11.235, P=0.007) were independent risk factors of skip lateral cervical lymph node metastasis in PTC patients. Conclusion:PTC patients with tumor diameter ≤5 mm and tumor located in the upper pole of the gland are more prone to skip lateral cervical lymph node metastasis. When the diameter of the tumor is less than 5 mm and the tumor is located at the upper pole of the gland, careful evaluation should be made before operation, even in the absence of central lymph node metastasis, attention should be paid to the possibility of lateral cervical lymph node metastasis.
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Affiliation(s)
- 婕 高
- 河北北方学院研究生院(河北张家口,075000)Graduate School of Hebei Northern University, Zhangjiakou, 075000, China
| | - 运超 辛
- 河北北方学院附属第一医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University
| | - 立航 杨
- 河北北方学院研究生院(河北张家口,075000)Graduate School of Hebei Northern University, Zhangjiakou, 075000, China
| | - 亚超 刘
- 河北北方学院附属第一医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University
| | - 泽东 田
- 河北北方学院附属第一医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University
| | - 小领 尚
- 河北北方学院附属第一医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University
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Muthuvel R, Maheswaran SK, Selvaraj TKV. Is Performance of Routine Central Compartment Neck Dissection in cN0 Papillary Thyroid Cancers Really Useful? 10-Year Prospective Observational Study. Indian J Surg Oncol 2022; 13:152-156. [PMID: 35462667 PMCID: PMC8986923 DOI: 10.1007/s13193-021-01408-3] [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: 01/27/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Central compartment nodes of neck are the first echelon nodes in papillary thyroid cancers (PTC). This study analyses the adverse parameters associated with central compartment nodal metastasis in cN0 PTC and also the usefulness of performing central compartment neck dissection routinely. A total of 236 patients with cNo PTC who underwent prophylactic central compartment neck dissection, from January 2008 to June 2017 in the Department of Oncology, Madurai Medical College, were included in study. Analysis of various adverse factors associated with central compartment nodal metastasis was made. Patients (46.18%) had metastatic nodes in the central compartment. Incidence of nodal metastasis increased with tumour size, capsular invasion, extrathyroidal extension, tracheal invasion and pulmonary metastasis. More than 50% patients did not have any of the statistically significant known adverse risk factors except for age and sex. Routine central compartment neck dissection has therapeutic value in PTC even in absence of known adverse factors and can be recommended in cases of clinically negative nodes. A meticulous dissection in experienced hands carries less complication rates as with thyroidectomy alone. In a resource limited country like ours, where the cost of re-surgery and radioiodine scans are high, a meticulous initial surgery incorporating central compartment neck dissection would really mean a difference.
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Affiliation(s)
- Ramesh Muthuvel
- Department of Surgical Oncology, Madurai Medical College, Tamilnadu, India
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Ni X, Xu S, Zhan W, Zhou W. A Risk Stratification Model for Metastatic Lymph Nodes of Papillary Thyroid Cancer: A Retrospective Study Based on Sonographic Features. Front Endocrinol (Lausanne) 2022; 13:942569. [PMID: 35937798 PMCID: PMC9355421 DOI: 10.3389/fendo.2022.942569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) has a high probability of cervical lymph node (LN) metastasis. The aim of the study was to develop an ultrasound risk stratification model to standardize the diagnosis of metastatic LNs of PTC. METHODS Patients with suspicious thyroid nodules who underwent US examination and US guided fine-needle aspiration for cervical LNs were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to assess the independent risk factor of metastatic LNs. According to the OR value of correlated indicators in logistic regression analysis, a risk stratification model was established. RESULTS A total of 653 LNs were included. The independent risk factors of metastatic LNs were long-axis diameter/short-axis ≤ 2 (OR=1.644), absence of hilum (OR=1.894), hyperechogenicity (OR=5.375), calcifications (OR=6.201), cystic change (OR=71.818), and abnormal flow (OR=3.811) (P<0.05 for all). The risk stratification model and malignancy rate were as follows: 0-2 points, malignancy rate of 10.61%, low suspicion; 3-5 points, malignancy rate of 50.49%, intermediate suspicion, ≥6 points, malignancy rate of 84.81%, high suspicion. The area under the receiver operating characteristic curve for the model was 0.827 (95% CI 0.795-0.859). CONCLUSIONS Our established risk stratification model can effectively evaluate metastatic LNs in the patients with suspicious thyroid nodules, and it might provide a new strategy choice for clinical practice.
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Affiliation(s)
- Xiaofeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shangyan Xu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Zhou, ; Weiwei Zhan,
| | - Wei Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ultrasound, RuiJin Hospital/Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Zhou, ; Weiwei Zhan,
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Zhu S, Wang Q, Zheng D, Zhu L, Zhou Z, Xu S, Shi B, Jin C, Zheng G, Cai Y. A Novel and Effective Model to Predict Skip Metastasis in Papillary Thyroid Carcinoma Based on a Support Vector Machine. Front Endocrinol (Lausanne) 2022; 13:916121. [PMID: 35865315 PMCID: PMC9295388 DOI: 10.3389/fendo.2022.916121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/01/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Skip metastasis, referred to as lymph node metastases to the lateral neck compartment without involvement of the central compartment, is generally unpredictable in papillary thyroid carcinoma (PTC). This study aims to establish an effective predictive model for skip metastasis in PTC. METERIALS AND METHODS Retrospective analysis was performed of clinical samples from 18192 patients diagnosed with thyroid cancer between 2016 to 2020. The First Affiliated Hospital of Wenzhou Medical University. The lateral lymph node metastasis was occureed in the training set (630 PTC patients) and validation set (189 PTC patients). The univariate and multivariate analyses were performed to detect the predictors of skip metastasis and the support vector machine (SVM) was used to establish a model to predict skip metastasis. RESULTS The rate of skip metastasis was 13.3% (84/631). Tumor size (≤10 mm), upper location, Hashimoto's thyroiditis, extrathyroidal extension, absence of BRAFV600E mutation, and less number of central lymph node dissection were considered as independent predictors of skip metastasis in PTC. For the training set, these predictors performed with 91.7% accuracy, 86.4% sensitivity, 92.2% specificity, 45.2% positive predictive value (PPV), and 98.9% negative predictive value (NPV) in the model. Meanwhile, these predictors showed 91.5% accuracy,71.4% sensitivity, 93.1% specificity, 45.5% PPV, and 97.6% NPV in validation set. CONCLUSION This study screened the predictors of the skip lateral lymph node metastasis and to establish an effective and economic predictive model for skip metastasis in PTC. The model can accurately distinguish the skip metastasis in PTC using a simple and affordable method, which may have potential for daily clinical application in the future.
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Affiliation(s)
- Shuting Zhu
- Department of Ultrasound, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Qingxuan Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Danni Zheng
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lei Zhu
- Thyroid Surgery Department, The Fifth Hospital Affiliated to Wenzhou Medical University, Lishui Central Hospital, Lishui, China
| | - Zheng Zhou
- Department of Head and Neck Surgery, Bengbu Medical College Graduate School, Anhui, China
| | - Shiying Xu
- Zhejiang Chinese Medical University, The Second Clinical Medical, Hangzhou, China
| | - Binbin Shi
- Department of Medical Ultrasound, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cong Jin
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guowan Zheng
- Department of Head and Neck Surgery, Otolaryngology & Head and Neck Center, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, China
- *Correspondence: Guowan Zheng, ; Yefeng Cai,
| | - Yefeng Cai
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Head and Neck Surgery, Otolaryngology & Head and Neck Center, Cancer Center, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Hangzhou, China
- *Correspondence: Guowan Zheng, ; Yefeng Cai,
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11
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Li Y, Gao W, Cai X, Jin A, Shen J, Zhang Y, Chen Y, Hu B, Zeng T, Yu X, Zheng Y, Wang Y. Exploring Somatic Alteration Associating With Aggressive Behaviors of Papillary Thyroid Carcinomas by Targeted Sequencing. Front Oncol 2021; 11:722814. [PMID: 34692499 PMCID: PMC8529196 DOI: 10.3389/fonc.2021.722814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/16/2021] [Indexed: 12/21/2022] Open
Abstract
Wisely differentiating high-risk papillary thyroid carcinoma (PTC) patients from low-risk PTC patients preoperatively is necessary when comes to making a personalized treatment plan. It is not easy to stratify the risk of patients according to sonography or lab results before surgery. This study aims to seek out potential mutation gene markers that may be helpful in stratifying the risk of PTC. A custom panel of 439 PTC relevant and classic tumor metabolic pathway relevant genes was designed. Targeted capture sequencing was performed on 35 pairs of samples from 35 PTC tumors and 35 para-tumor thyroid tissues obtained during surgery. Variant calling and detection of cancer gene mutations were identified by bio-information analysis. Ingenuity Pathway Analysis (IPA) was performed to do functional enrichment analysis of high-frequency mutant genes. Immunohistochemistry (IHC) was performed on 6 PTC patients to explore the expression of protein associated with interested genes. Event-free survival (EFS) was calculated to determine which genes might affect the prognosis of patients. We have identified 32 high-frequency mutant genes in PTC including BRAF. RBL2 was found to be significantly correlated to event-free survival, FOXO1, MUC6, PCDHB9, NOTCH1, FIZ1, and RTN1 were significantly associated with EFS, while BRAF mutant was not correlated to any of the prognosis indicators. Our findings in this study might open more choices when designing thyroid gene panels used in FNA samples to diagnose PTC and predict the potentially aggressive behavior of PTC.
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Affiliation(s)
- Yi Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Wei Gao
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Xiaojun Cai
- Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Anqi Jin
- Department of Ultrasound Medicine, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jian Shen
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Yichun Zhang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Yutong Chen
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Tao Zeng
- CAS Key Laboratory of Computational Biology, Bio-Med Big Data Center, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.,Key Laboratory of Systems Biology, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, China
| | - Xiangtian Yu
- Clinical Research Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai, China
| | - Yan Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Shanghai Sixth People's Hospital, Shanghai, China.,Shanghai Institute of Ultrasound in Medicine, Shanghai, China
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12
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Qiu Y, Xing Z, Fei Y, Qian Y, Luo Y, Su A. Role of the 2018 American Thyroid Association statement on postoperative hypoparathyroidism: a 5-year retrospective study. BMC Surg 2021; 21:334. [PMID: 34474672 PMCID: PMC8414735 DOI: 10.1186/s12893-021-01333-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/28/2021] [Indexed: 02/08/2023] Open
Abstract
Background Definitions of postoperative hypoparathyroidism (hypoPT) have never reached consent until the American Thyroid Association (ATA) statement was released, with new characteristics and challenges. Methods Patients with papillary thyroid carcinoma who underwent primary total thyroidectomy between January 2013 and June 2018 were retrospectively enrolled. Symptoms of hypocalcemia and their frequency were stringently followed. Patients were divided into groups according to the ATA statement. Incidence of postoperative hypoPT and serum parathyroid hormone levels accompanied by calcium levels, from 1-day to at least 24-month follow-up.
Results A total of 1749 patients were included: 458 (26.2%) had transient and 63 (3.6%) had permanent hypoPT. Transient hypoPT was found in 363 (20.7%) patients with biochemical hypoPT, 72 (4.1%) with clinical hypoPT, and 23 (1.3%) with relative hypoPT; permanent hypoPT was detected in 8 (0.5%) patients with biochemical hypoPT, 55 (3.1%) with clinical hypoPT, and none with relative hypoPT. Female sex, age ≥ 55 years, unintentional parathyroid gland resection, and autotransplantation of ≥ 2 parathyroid glands were independent risk factors for transient biochemical hypoPT. Age ≥ 55 years, bilateral central neck dissection, and isthmus tumor location were independent risk factors for transient clinical hypoPT. A postoperative 1-day percentage of parathyroid hormone (PTH) reduction of > 51.1% was an independent risk factor for relative hypoPT (odds ratio, 4.892; 95% confidence interval, 1.653–14.480; P = 0.004). No independent risk factor for permanent hypoPT was found. Conclusion ATA diagnostic criteria for postoperative hypoPT are of great value in differentiating patients by hypocalcemia symptoms and choosing corresponding clinical assistance; however, they may underestimate the actual incidence.
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Affiliation(s)
- Yuxuan Qiu
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.,Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China
| | - Zhichao Xing
- Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China
| | - Yuan Fei
- Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China
| | - Yuanfan Qian
- Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Anping Su
- Center of Thyroid and Parathyroid Surgery, Sichuan University West China Hospital, Sichuan Province, No. 37 Guo Xue Xiang, Chengdu, China.
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13
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Huang F, Wang L, Jia H. Research trends for papillary thyroid carcinoma from 2010 to 2019: A systematic review and bibliometrics analysis. Medicine (Baltimore) 2021; 100:e26100. [PMID: 34032748 PMCID: PMC8154384 DOI: 10.1097/md.0000000000026100] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thyroid carcinoma comprises the fastest rising incidence of carcinomas over the past decade. Papillary thyroid carcinoma (PTC) is the most predominant type of thyroid carcinoma. This study aimed to assess the research trends in the field of PTC. METHODS Publications from January 2010 to December 2019 were retrieved from the Web of Science Core Collection database using Thompson Reuters. Searching strategies were determined according to Medical Subject Heading terms. Different kinds of bibliometrics software, such as HistCite and VOSviewer, and online bibliometrics analysis platforms were utilized to evaluate and visualize the results. RESULTS A total of 8102 publications across 93 countries were identified, with the annual number of publications showing an increasing trend. The United States, China, and South Korea showed their dominant position in PTC publication outputs, H-index, total citations, and international collaborations. Thyroid was the most productive journal. Akira Miyauchi published the most articles, and the most productive institution was Yonsei University. The hotspots keywords proliferation, invasion and metastasis, diagnoses and prognoses, therapeutic resistance, recurrence, and microcarcinomas appeared earlier and were sustained over the last 3 years. CONCLUSIONS This bibliometric study provides a comprehensive analysis delineating the scientific productivity, collaboration, and research hotspots within the PTC field, which will be very helpful when focusing on the direction of research over the next few years.
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Affiliation(s)
- Fengyan Huang
- Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012
| | - Lihua Wang
- Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012
| | - Hongying Jia
- Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012
- The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Dajie, Jinan, Shandong 250033, PR China
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14
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Xing Z, Qiu Y, Fei Y, Xia B, Abuduwaili M, Zhu J, Su A. Protective strategy of parathyroid glands during thyroid lobectomy: A retrospective cohort and case-control study. Medicine (Baltimore) 2021; 100:e21323. [PMID: 33832057 PMCID: PMC8036091 DOI: 10.1097/md.0000000000021323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/17/2020] [Indexed: 02/05/2023] Open
Abstract
Parathyroid protection during thyroid lobectomy was not illustrated previously. Aim of this study was to find out the influence of parathyroid glands in situ preservation and autotransplantation on postoperative parathyroid function in thyroid lobectomy.Consecutive patients who underwent primary thyroid lobectomy with unilateral central neck dissection for papillary thyroid carcinoma in our center were included retrospectively. Postoperative hypoparathyroidism was defined as low parathyroid hormone (PTH) levels (<1.6 pmol/L) and keeping over 6 months was defined as permanent. Patients were divided into 3 groups: all identified parathyroid glands preserved in situ (preservation group); at least one parathyroid gland autotransplanted without accidental resection (autotransplantation group); at least one parathyroid gland accidental resected (resection group).A total of 425 patients were included. No permanent hypoparathyroidism was reported, and the rates of transient hypoparathyroidism were similar among all groups. Significantly lower serum PTH levels were found in autotransplantation group versus preservation group at postoperative 1-day (3.77 ± 1.61 vs 4.72 ± 2.31, P < .001). Transient hypoparathyroidism was significantly associated with reduced intraoperative carbon nanoparticles utilization (57.1% vs 77.4%, P = .039).Thyroid lobectomy was a safe surgical method for parathyroid protection no matter the practice to ipsilateral parathyroid glands. However, preservation of all parathyroid glands was still recommended considering relatively stable PTH levels.
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Affiliation(s)
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery
- Department of Ultrasound, West China Hospital, Sichuan University, PR China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery
| | | | | | | | - Anping Su
- Center of Thyroid & Parathyroid Surgery
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15
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Zou Y, Zhang H, Li W, Guo Y, Sun F, Shi Y, Gong Y, Lu X, Wang W, Xia S. Prediction of ipsilateral lateral cervical lymph node metastasis in papillary thyroid carcinoma: a combined dual-energy CT and thyroid function indicators study. BMC Cancer 2021; 21:221. [PMID: 33663422 PMCID: PMC7934388 DOI: 10.1186/s12885-021-07951-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Predicting the possibility of ipsilateral lateral cervical lymph node metastasis (ipsi-LLNM) was crucial to the operation plan for patients with papillary thyroid carcinoma (PTC). This study aimed to investigate the independent risk factors for ipsi-LLNM in PTC patients by combining dual-energy computed tomography (DECT) with thyroid function indicators. METHODS We retrospectively enrolled 406 patients with a pathological diagnosis of PTC from Jan 2016 to Dec 2019. Ensure the DECT images were clear and the thyroid function indicators were complete. Univariate and multivariate logistic analyses explored the independent risk factors for ipsi-LLNM. To evaluate the cutoff value of each risk factor by using receiver operating characteristic (ROC) curves. RESULTS A total of 406 patients with PTC were analyzed, including 128 with ipsi-LLNM and 278 without ipsi-LLNM. There were statistical differences of parameters between the two groups (P < .0001), including serum Tg, Anti-Tg, Anti-TPO, the volume of the primary lesion, calcification, extrathyroidal extension (ETE), and iodine concentration (IC) in the arterial and the venous phases. Independent risk factors for ipsi-LLNM included serum Tg, Anti-Tg, ETE, and IC in the arterial and the venous phases (P < .05). The combined application of the above independent risk factors can predict the possibility of ipsi-LLNM, with an AUC of 0.834. Ipsi-LLNM was more likely to occur when the following conditions were met: with ETE, Tg > 100.01 ng/mL, Anti-Tg > 89.43 IU/mL, IC in arterial phase > 3.4 mg/mL and IC in venous phase > 3.1 mg/mL. CONCLUSIONS The combined application of DECT quantitative parameters and thyroid function indicators can help clinicians accurately predict ipsi-LLNM before surgery, thereby assisting the individualized formulation of surgical procedures.
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Affiliation(s)
- Ying Zou
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin, 300193, China.,Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China
| | - Huanlei Zhang
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.,Department of Radiology, Yidu central hospital of Weifang, No. 4138 Linglongshan nan Road, Qing Zhou City, Shandong, 262500, China
| | - Wenfei Li
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.,Department of Radiology, The First Hospital of Qinhuangdao, No.258 Wenhua Road, Haigang District, Qinhuangdao, 066000, China
| | - Yu Guo
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China
| | - Fang Sun
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.,Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, 256603, Shandong, China
| | - Yan Shi
- Department of Ultrasonography, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou City, 256603, Shandong, China
| | - Yan Gong
- Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.,Department of Radiology, Tianjin Hospital of ITCWM Nan Kai Hospital, No.6 Changjiang Road, Nan Kai District, Tianjin, 300100, China
| | - Xiudi Lu
- Department of Radiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 314 Anshan West Road, Nan Kai District, Tianjin, 300193, China.,Department of Radiology, First Central Clinical College, Tianjin Medical University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China
| | - Wei Wang
- Department of Otorhinolaryngology, Tianjin First Central Hospital, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, No. 24 Fu Kang Road, Nan Kai District, Tianjin, 300192, China.
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16
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Xing Z, Qiu Y, Xia B, Abuduwaili M, Fei Y, Zhu J, Su A. Surgical strategy when identifying less than four parathyroid glands during total thyroidectomy: a retrospective cohort study. Gland Surg 2021; 10:10-22. [PMID: 33633958 DOI: 10.21037/gs-20-486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Parathyroid glands protection is still controversial in patients with less than 4 parathyroid glands during thyroidectomy. The aim of this study was to investigate the strategy of parathyroid autotransplantation or in situ preservation in patients with 3 parathyroid glands. Methods Consecutive patients who underwent primary total thyroidectomy with bilateral central neck dissection for papillary thyroid carcinoma (PTC) in our center were included retrospectively. Serum calcium and parathyroid hormone (PTH) levels (pg/mL), incidence of hypocalcemia and hypoparathyroidism during 24 months follow-up were compared grouping by the number of parathyroid glands both identified intraoperatively and confirmed postoperatively by pathology. Results A total of 1,424 patients were included. Serum PTH and calcium levels were lower and the incidence of hypocalcemia was higher in patients with 3 identified parathyroid glands. When excluding patients with accidental parathyroid resection, the results remained similar. Of the 212 patients with 3 identified parathyroid glands, PTH levels at postoperative 12-month in patients underwent autotransplantation were significantly lower than patients with all parathyroid glands preserved in situ (3.65±1.30 vs. 4.67±1.89, P=0.026). Conclusions The parathyroid function was weaker in patients with 3 parathyroid glands than patients with 4 before and after operation. Parathyroid glands preserved all in situ promoted better recovery of postoperative function in patients with 3 identified parathyroid glands.
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Affiliation(s)
- Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China.,Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China
| | - Baoying Xia
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Munire Abuduwaili
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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17
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Yang Z, Heng Y, Zhao Q, Cao Z, Tao L, Qiu W, Cai W. A Specific Predicting Model for Screening Skip Metastasis From Patients With Negative Central Lymph Nodes Metastasis in Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:743900. [PMID: 34659126 PMCID: PMC8515125 DOI: 10.3389/fendo.2021.743900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022] Open
Abstract
Skip metastasis is a specific type of papillary thyroid cancer lymph node metastasis (LNM). The present study aimed to clarify the typical clinical characteristics of skip metastasis and optimize the prediction model, so as to provide a more individual treatment mode for skip metastasis. We retrospectively analyzed 1075 PTC patients with different lymph node metastasis statuses from two clinical centers. Comparisons have been made between patients with skip metastasis and other types of LNM. Univariate and multivariate analyses were performed to detect the risk factors for skip metastasis with negative LNM, and a nomogram for predicting skip metastasis was established. The rate of skip metastasis was 3.4% (37/1075). Compared with other types of LNM, significant differences showed in tumor size, upper portion location, thyroid capsular invasion, and ipsilateral nodular goiter with the central lymph node metastasis (CLNM) group, and in age and gender with the lateral lymph node metastasis (LLNM) group. Four variables were found to be significantly associated with skip metastasis and were used to construct the model: thyroid capsular invasion, multifocality, tumor size > 1 cm, and upper portion. The nomogram had good discrimination with a concordance index of 0.886 (95% confidence interval [CI], 0.823 to 0.948). In conclusion, the significant differences between skip metastasis and other types of LNM indicated that the lymph node drainage pathway of skip metastasis is different from either CLNM or LLNM. Furthermore, we established a nomogram for predicting risk of skip metastasis, which was able to effectively predict the potential risk of skip metastasis in patients without preoperative LNM clue.
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Affiliation(s)
- Zheyu Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qiwu Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zichao Cao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
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18
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Wang W, Yang Z, Ouyang Q. A nomogram to predict skip metastasis in papillary thyroid cancer. World J Surg Oncol 2020; 18:167. [PMID: 32669128 PMCID: PMC7366301 DOI: 10.1186/s12957-020-01948-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022] Open
Abstract
Background Skip metastases are defined as lateral lymph node metastasis (LNM) without the involvement of central LNM in papillary thyroid cancer (PTC), and it is difficult to predict in clinical practice. Our study aimed to investigate the risk factors of skip metastasis and establish a nomogram for predicting the probability of skip metastasis in PTC patients. Patients and methods A total of 378 consecutive PTC patients with clinically suspected LNM who underwent modified radical neck dissection (MRND) from March 2018 to July 2019 in our hospital were enrolled. Univariate and multivariate analyses were used to examine risk factors of skip metastasis, and a nomogram prediction model was established and internally validated. Results The incidence of skip metastases was 11.6% (44/378). Primary tumor size of ≤ 1 cm (OR = 2.703; 95% CI, 1.342–5.464; P = 0.005), age (OR = 1.051; 95% CI, 1.017–1.805; P = 0.005), and primary tumor location in the upper portion (OR = 6.799; 95% CI, 2.710–17.060; P < 0.001) were found to be independent risk factors for skip metastasis in PTC patients. A nomogram based upon these predictors performed well. The area under the curve (AUC) was 0.806 (95% CI, 0.736–0.876), and the P value of the Hosmer-Lemeshow goodness of fit test was 0.66. Decision curve analysis revealed that the nomogram was clinically useful. Conclusion Based on the risk factors of skip metastasis, a high-performance nomogram was established, which can provide an individual risk assessment and can guide treatment decisions for patients.
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Affiliation(s)
- Wenlong Wang
- General Surgery Department, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, China
| | - Zhi Yang
- Department of Colorectal & Anal Surgery, Hepatobiliary & Enteric Surgery Rearch Center, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan Province, China.
| | - Qianhui Ouyang
- General Surgery Department, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, 410008, China
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19
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Xing Z, Qiu Y, Yang Q, Yu Y, Liu J, Fei Y, Su A, Zhu J. Thyroid cancer neck lymph nodes metastasis: Meta-analysis of US and CT diagnosis. Eur J Radiol 2020; 129:109103. [PMID: 32574937 DOI: 10.1016/j.ejrad.2020.109103] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE Ultrasound (US) is the first imaging technique in the assessment of cervical lymph nodes metastasis (LNM) of papillary thyroid cancer (PTC) patients preoperatively. Computed tomography (CT) exerts an influence on surgical strategy especially for patients with lateral cervical LNM. This meta-analysis aimed at assessing the diagnostic values of US and CT in detecting the cervical LNM in thyroid cancer patients. METHODS Medline, Embase and Cochrane Library (CENTRAL) were retrieved up to 16th Sep, 2019 for studies about comparison of the diagnostic performance between US and CT. The pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR and diagnostic odds ratio (DOR), with each's 95 % CI were calculated. RESULTS A total of 5656 thyroid cancer patients in 10 studies were included. CT had a higher sensitivity in central (0.400 [0.385, 0.416] vs 0.284 [0.270, 0.298], P < 0.001), lateral (0.811 [0.778, 0.416] vs 0.758 [0.722, 0.792], P = 0.029) and the whole (0.664 [0.633, 0.694] vs 0.593 [0.561, 0.625], P = 0.002) compartments regions. US had a higher specificity in central (0.895 [0.885,0.903] vs 0.950 [0.944, 0.956], P < 0.001), lateral (0.84 [0.813,0.864] vs 0.88 [0.856, 0.901], P = 0.012) and the whole (0.834 [0.804,0.862] vs 0.911 [0.887, 0.932], P < 0.001) compartments regions. CONCLUSIONS US and CT performed poorly when trying to identify the presence of central LNM. CT has a higher sensitivity while US has a higher specificity for the assessment of central, lateral and the whole cervical LNM. Performing CT to detect the lateral cervical LNM will effectively reduce the rate of missed diagnosis and improve surgical planning. Both US and CT are needed for neck lymph nodes staging preoperatively owning to low sensitivities.
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Affiliation(s)
- Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qianru Yang
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yang Yu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jingyan Liu
- Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Heng Y, Yang Z, Zhou L, Lin J, Cai W, Tao L. Risk stratification for lateral involvement in papillary thyroid carcinoma patients with central lymph node metastasis. Endocrine 2020; 68:320-328. [PMID: 31983029 DOI: 10.1007/s12020-020-02194-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To effectively predict lateral neck lymph nodes (LLN) metastasis in papillary thyroid carcinoma (PTC) patients with central lymph nodes (CLN) invasion, and devise targeted treatment strategies. METHODS Four hundred and thirty-four PTC patients with CLN metastasis from two medical centers were retrospectively analyzed. A new statistical model was established for predicting LLN involvement in these patients to guide lymph nodes management strategies. RESULTS Patients with more than five positive CLN metastasis appeared to have extremely high risk (83.0%) of LLN involvement. For patients with five or less positive CLN invasion, multivariate logistic analyses were applied. Independent risk factors for LLN involvement were determined to be: age over 40, maximum tumor diameter of no less than 1.0 cm, existence of thyroid capsular invasion, and tumor with ipsilateral nodular goiter (iNG). These factors were used to construct a predictive nomogram. The accuracy and validity of our newly built model were verified by C-index 0.761 (95% CI, 0.707-0.815) in development cohort and 0.759 (95% CI, 0.745-0.773) in validation cohort and calibration curve. The patients were stratified into three groups based on their nomogram risk scores. Possible LLN involvement rates for low-risk, moderate-risk, and relatively high-risk subgroups were 8.9%, 22.8%, and 48.2%, respectively. CONCLUSIONS Our newly established model can effectively predict possible LLN metastasis in PTC patients, and a new strategy selection flow chart was created for patients with positive CLN invasion. For patients in high-risk group, prophylactic LLN dissection is recommended, if not, adjuvant radioactive iodine or a closer follow-up scheme should at least be conducted. For those in low-risk group, surgical intervention is unnecessary and regular follow-up is recommended.
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Affiliation(s)
- Yu Heng
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Zheyu Yang
- Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China
| | - Liang Zhou
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Jianwei Lin
- Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China
| | - Wei Cai
- Department of General Surgery, School of medicine affiliated Ruijin Hospital, Shanghai Jiaotong University, 197 Ruijin 2nd Road, Shanghai, 200031, China.
| | - Lei Tao
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
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