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Samargandy SA, Qorban GN, Aljadani AK, Almufarji SS, Azab AM, Merdad MA, Al-Hajeili MR, Samargandy SJ. Course and predictors of excellent response to therapy in patients with differentiated thyroid cancer at long-term follow-up. Saudi Med J 2024; 45:139-146. [PMID: 38309729 PMCID: PMC11115420 DOI: 10.15537/smj.2024.45.2.20230596] [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: 08/15/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES To investigate the long-term outcomes of differentiated thyroid cancer (DTC) and the predictive factors for excellent and incomplete responses to therapy on long-term follow-up of patients. METHODS A retrospective chart review and analysis was carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Demographic, histological, and therapeutic data were collected from patients older than 13 years at the time of diagnosis, with a minimum follow-up of 18 months. Outcomes were divided into excellent, indeterminate, biochemically incomplete, and structurally incomplete responses. Odds ratios (ORs) for predictors of incomplete response at the last visit were determined. We first tested associations univariately with incomplete responses, and then variables with significant associations were included in a multivariable logistic model. RESULTS Among 230 patients with DTC, 61.7% had excellent responses to therapy on long-term follow-up, and 24.3% had incomplete biochemical and structural responses. The median follow-up was 4.6 years. Factors significantly associated with incomplete response to therapy in the multivariate analysis (p<0.05) were age >55 years (OR=5) and lymph node (OR=3.4) and distant metastases (OR=29). Older age did not affect the outcome in low-risk patients with DTC but was significantly associated with incomplete responses in those with intermediate risk (p=0.04) and high risk (p=0.003). CONCLUSION We strongly advocate incorporating age into recurrence risk assessment for patients with DTC.
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Affiliation(s)
- Shaza A. Samargandy
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Ghofran N. Qorban
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Arwa K. Aljadani
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Salihah S. Almufarji
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Abdulrahman M. Azab
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Mazin A. Merdad
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Marwan R. Al-Hajeili
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Saad J. Samargandy
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
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Kinet S, Cornette H, Van Den Heede K, Brusselaers N, Van Slycke S. Accuracy and diagnostic performance of the Bethesda system for reporting thyroid cytopathology in a tertiary endocrine surgical referral center in Belgium. World J Surg 2024; 48:386-392. [PMID: 38686788 DOI: 10.1002/wjs.12052] [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: 11/05/2023] [Accepted: 12/13/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology is a commonly used classification for fine needle aspiration (FNA) cytology of suspicious thyroid nodules. The risk of malignancy (ROM) for each category has recently been analyzed in three international databases. This paper compares the diagnostic performance of the Bethesda classification in a high-volume referral center in Belgium. METHODS All consecutive thyroid procedures were registered in a prospective database from January 2010 till August 2022. Patient and surgical characteristics, preoperative Bethesda categories, and postoperative pathology results were analyzed. RESULTS Out of 2219 consecutive thyroid procedures, 1226 patients underwent preoperative FNA. Papillary thyroid cancer was the most prevalent malignancy (N = 119, 70.4%), followed by follicular (N = 17, 10.1%) and medullary thyroid cancer (N = 15, 8.9%). Micropapillary thyroid cancer was incidentally found in 46 (3.8%) patients. Bethesda categories I, II, III, IV, V, and VI, respectively, represented 250 (20.4%; ROM 4.4%), 546 (44.5%; ROM 3.8%), 96 (7.8%; ROM 20.8%), 231 (18.8%; ROM 15.2%), 62 (5.1%; ROM 72.6%), and 41 (3.3%; ROM 90.2%) patients. Overall ROM was 13.8%. An negative predictive value (NPV) of 96.2% was found. Overall specificity was 64.2% with a positive predictive value (PPV) of 31.9%. Diagnostic accuracy was 67.8%. Compared to international databases (CESQIP, EUROCRINE, and UKRETS), ROM in this study appeared lower for Bethesda category IV (15.2 vs. 26.7% and p = 0.612). CONCLUSION Despite being validated in numerous studies, ROM based on preoperative FNA cytology classified according to the Bethesda classification may vary among surgical centers and countries as this study reveals a higher NPV and lower PPV.
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Affiliation(s)
- Sam Kinet
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Hendrik Cornette
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Nele Brusselaers
- Department of Microbiology, Tumour and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
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Pałyga I, Rumian M, Kosel A, Albrzykowski M, Krawczyk P, Kalwat A, Gąsior-Perczak D, Walczyk A, Kuchareczko A, Kopczyński J, Chrapek M, Góźdź S, Kowalska A. The Frequency of Differentiated Thyroid Cancer Recurrence in 2302 Patients With Excellent Response to Primary Therapy. J Clin Endocrinol Metab 2024; 109:e569-e578. [PMID: 37768152 DOI: 10.1210/clinem/dgad571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/18/2023] [Accepted: 09/27/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT Discrepant data on the recurrence rate of differentiated thyroid cancer (DTC) are reported. OBJECTIVE To evaluate the frequency and risk factors of true recurrence in DTC patients with excellent responses (ExR) to initial therapy. METHODS A retrospective analysis of the 2302 consecutive DTC patients with ExR to primary therapy, treated during 24 years at single center. The percentage of recurrence and cumulative recurrence rate (CRR) were analyzed. Risk factors for recurrence for patients with papillary thyroid cancer (PTC) were investigated and methods for establishing a diagnosis of recurrence were evaluated. RESULTS Of DTC patients, 32 (1.4%) experienced recurrence. PTC patients with recurrence were more likely to have younger age (P = .0182), larger tumor size (P = .0013), lymph node metastases (P = .0013), incomplete resection (P = .0446), higher ATA risk (P = .0002), and had more frequently been treated with 131I (P = .0203). CRRs at 5, 10, 15, 20, and 24 years after surgery were 1.2%, 1.9%, 2.5%, 2.9%, and 2.9%, respectively. The CRRs according to histological type were highest for poorly differentiated thyroid cancer (PDTC), lower for oncocytic (OTC) and follicular thyroid cancer (FTC), and lowest for PTC. Most recurrences occurred within the first 5 years of observation. The most effective method for detecting local recurrence was ultrasonography with fine needle aspiration cytology, and for distant metastases, 18F-FDG PET. CONCLUSION True recurrence is rare in DTC patients. PTC patients with ExR to primary therapy and N0/Nx can be dismissed from oncological follow-up. Despite ExR to primary therapy, DTC patients with N1, and PDTC, OTC, FTC should remain under oncological follow-up.
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Affiliation(s)
- Iwona Pałyga
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Maciej Rumian
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Alicja Kosel
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | | | - Paulina Krawczyk
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Agata Kalwat
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Danuta Gąsior-Perczak
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Agnieszka Walczyk
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Artur Kuchareczko
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Janusz Kopczyński
- Department of Pathology, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Magdalena Chrapek
- Department of Mathematics, Faculty of Natural Sciences, Jan Kochanowski University, Kielce 25-406, Poland
| | - Stanisław Góźdź
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Department of Clinical Oncology, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Aldona Kowalska
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
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O'Neill CJ, Carlson MA, Rowe CW, Fradgley EA, Paul C. Hearing the Voices of Australian Thyroid Cancer Survivors: Qualitative Thematic Analysis of Semistructured Interviews Identifies Unmet Support Needs. Thyroid 2023; 33:1455-1464. [PMID: 37335225 PMCID: PMC10734898 DOI: 10.1089/thy.2023.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background: Most thyroid cancer survivors regain their physical health-related quality of life, but psychological and social deficits persist. The nature of these detriments remains poorly understood and they are insufficiently captured by survey data alone. To address this, qualitative data exploring the breadth and depth of thyroid cancer survivors' experiences and priorities for supportive care are required. Methods: Twenty semistructured interviews were undertaken with a purposive, maximum variation sample of thyroid cancer survivors. Interviews were transcribed verbatim and coded independently by two researchers. A hybrid model of inductive and realistic codebook analysis was undertaken with themes developed. Results: Patient experiences centered around three themes: (1) impact of diagnosis and treatment, (2) thyroid cancer does not happen in isolation, and (3) role of clinicians and formalized support structures. The word "cancer" had negative connotations, but for many, the reality of their experience was more positive. Despite feeling "lucky" at the relative low-risk nature of thyroid cancer, many patients reported fatigue, weight gain, and difficulty returning to usual activities; concerns that were largely dismissed or minimized by clinicians. Few were offered any support beyond their treating doctors; where patients attempted to access formalized supportive care, little was available or appropriate. Life stage and concurrent family and social stressors greatly impacted patients' ability to cope with diagnosis and treatment. Addressing thyroid cancer in isolation felt inappropriate without appreciating the broader context of their lives. Interactions with clinicians were largely positive, particularly where information was communicated as a means of empowering patients to participate in shared decision-making and where clinicians "checked in" emotionally with patients. Information about initial treatments was largely adequate but information on longer term effects and follow-up was lacking. Many patients felt that clinicians focused on physical well-being and scan results, missing opportunities to provide psychological support. Conclusions: Thyroid cancer survivors can struggle to navigate their cancer journey, particularly with regard to psychological and social functioning. There is a need to acknowledge these impacts at the time of clinical encounters, as well as develop information resources and support structures that can be individualized to optimize holistic well-being for those in need.
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Affiliation(s)
- Christine J. O'Neill
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Melissa A. Carlson
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christopher W. Rowe
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
- Department of Endocrinology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Elizabeth A. Fradgley
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Slabaugh G, Beltran L, Rizvi H, Deloukas P, Marouli E. Applications of machine and deep learning to thyroid cytology and histopathology: a review. Front Oncol 2023; 13:958310. [PMID: 38023130 PMCID: PMC10661921 DOI: 10.3389/fonc.2023.958310] [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: 05/31/2022] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
This review synthesises past research into how machine and deep learning can improve the cyto- and histopathology processing pipelines for thyroid cancer diagnosis. The current gold-standard preoperative technique of fine-needle aspiration cytology has high interobserver variability, often returns indeterminate samples and cannot reliably identify some pathologies; histopathology analysis addresses these issues to an extent, but it requires surgical resection of the suspicious lesions so cannot influence preoperative decisions. Motivated by these issues, as well as by the chronic shortage of trained pathologists, much research has been conducted into how artificial intelligence could improve current pipelines and reduce the pressure on clinicians. Many past studies have indicated the significant potential of automated image analysis in classifying thyroid lesions, particularly for those of papillary thyroid carcinoma, but these have generally been retrospective, so questions remain about both the practical efficacy of these automated tools and the realities of integrating them into clinical workflows. Furthermore, the nature of thyroid lesion classification is significantly more nuanced in practice than many current studies have addressed, and this, along with the heterogeneous nature of processing pipelines in different laboratories, means that no solution has proven itself robust enough for clinical adoption. There are, therefore, multiple avenues for future research: examine the practical implementation of these algorithms as pathologist decision-support systems; improve interpretability, which is necessary for developing trust with clinicians and regulators; and investigate multiclassification on diverse multicentre datasets, aiming for methods that demonstrate high performance in a process- and equipment-agnostic manner.
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Affiliation(s)
- Greg Slabaugh
- Digital Environment Research Institute, Queen Mary University of London, London, United Kingdom
| | - Luis Beltran
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Hasan Rizvi
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Eirini Marouli
- Digital Environment Research Institute, Queen Mary University of London, London, United Kingdom
- Barts Health NHS Trust, The Royal London Hospital, London, United Kingdom
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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White E, Abbott B, Schembri G, Glover A, Clifton-Bligh R, Gild ML. Development of a novel clinical support tool for active surveillance of low risk papillary thyroid cancer. Front Endocrinol (Lausanne) 2023; 14:1160249. [PMID: 37766695 PMCID: PMC10520546 DOI: 10.3389/fendo.2023.1160249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Background Active surveillance (AS) is an alternative to surgery in select patients with very low risk papillary thyroid cancer (PTC). Many clinicians feel ill-equipped in selecting appropriate patients. We aimed to 1) Develop an evidence-based web delivered decision support tool to assist clinicians in identifying patients appropriate for AS; and 2) Evaluate the prevalence of patients suitable for AS in a tertiary high volume thyroid cancer centre. Method A REDCap web based clinical support tool was developed utilising evidence-based characteristics for AS suitability available to clinicals during initial assessment. A retrospective database was interrogated for patients who underwent hemithyroidectomy between 2012 - 2021 with final histopathology demonstrating PTC. Patients with PTCs>2cm, missing data, benign disease on surgical histopathology or incidental PTC were excluded. Results Between 2012 - 2021, 763 patients underwent hemithyroidectomy with final histopathology confirming PTC. Of these, 316 patients were excluded (missing data, incidental PTC, concomitant hyperparathyroidism were most common reasons for exclusion) and 114/447 remaining patients had a pre-operative fine needle aspirate (FNA) of Bethesda V or VI (high likelihood of malignancy). Using the tool, 59/114 (52%) met criteria for AS. The majority of patients were female (85% vs 15% male); median age 36 years (range 19 - 78). Following initial surgery, 10/59 patients had a completion thyroidectomy, with 4/10 demonstrating malignancy in contralateral lobe and eight of those patients undergoing I131 ablation. During a median follow up of over 3 years, 49/59 (83%) did not require further surgery or intervention with no patients developing recurrence. A subgroup analysis with second radiology assessment excluded 4/59 patients as meeting criteria for AS based on presence of ETE on preoperative ultrasound. None of these 4 patients had completion thyroidectomy. Conclusion Our clinical support tool identifies patients with PTC potentially suitable for AS which could be utilised during initial patient assessment. In a retrospective cohort of patients who had hemithyroidectomy for PTC with a pre-operative FNA diagnosis of Bethesda V or VI, 55/114 (48%) patients may have been suitable for AS. Prospective validation studies are required for implementation of the tool in clinical practice.
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Affiliation(s)
- Eleanor White
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Bridget Abbott
- Department of Radiology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Geoffrey Schembri
- Department of Radiology, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Anthony Glover
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Roderick Clifton-Bligh
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Matti L. Gild
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Van den Eynde F, Van Den Heede K, Brusselaers N, Van Slycke S. Thyroid surgery in the elderly: a surgical cohort. Langenbecks Arch Surg 2023; 408:254. [PMID: 37386199 DOI: 10.1007/s00423-023-02982-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE The need for thyroid surgery in the elderly is rising due to an ageing population, the liberal use of imaging studies, and the increasing prevalence of thyroid nodules and cancer with age. Data on surgical outcomes in this population are scarce and conflicting, but essential to assess safety of short-stay surgery. This study aims to compare surgical outcomes by age. METHODS All consecutive patients undergoing thyroid surgery from January 2010 to July 2021 in a large tertiary referral centre for endocrine surgery were included in this surgical cohort. The indication for surgery, surgical morbidity (hypocalcaemia, bleeding, recurrent laryngeal nerve (RLN) palsy), and length of hospital stay were assessed in three age groups (young: 18-64y, older: 65-74y, and the elderly: 75 years and older). RESULTS A total of 2,030 patients (1,499 young, 370 older, and 161 elderly) were included. The indication for surgery was significantly different, with the main indications in the elderly being multinodular goitre (70.2% vs. 47.7% in young patients) and thyroid cancer (9.9% vs. 7.0%). Reintervention for bleeding was more often required in the older (4.6%) and the elderly (2.5%) patients (vs. 1.4%). There was no difference in the proportion of hypocalcaemia or RLN palsy. The length of hospital stay was significantly longer in the elderly (length of stay longer than one day 43.5% vs. 9.8%). CONCLUSION Thyroid surgery in patients aged 75 years and older is a safe procedure with morbidity comparable to younger patients. However, the risk of reintervention for bleeding is higher, rendering ambulatory surgery not advisable. TRIAL REGISTRATION Researchregistry6182 on October 29th 2020, retrospectively registered.
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Affiliation(s)
- Fien Van den Eynde
- Group of Biomedical Sciences, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium.
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research Department of Microbiology, Tumour and Cell Biology, Karolinska Institute, Tomtebodavagen 16, 17165, Stockholm, Sweden
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Gouwelozestraat 100, 8400, Ostend, Belgium
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Balajam NZ, Mousavian AH, Sheidaei A, Gohari K, Tavangar SM, Ghanbari-Motlagh A, Ostovar A, Shafiee G, Heshmat R. The 15-year national trends of endocrine cancers incidence among Iranian men and women; 2005-2020. Sci Rep 2023; 13:7632. [PMID: 37164997 PMCID: PMC10172312 DOI: 10.1038/s41598-023-34155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/25/2023] [Indexed: 05/12/2023] Open
Abstract
Cancer is one of the important health problems in Iran, which is considered as the third cause of death. Endocrine cancers are rare but mostly curable. Thyroid cancer, the most common endocrine tumors, includes about one percent of malignant cancer. In this study, we examined the 15-year national trend of endocrine cancer incidence in Iranian men and women. The data in each province were evaluated based on age, gender, and cancer type according to International Classification of Disease Codes version 10 (ICD-10) from 2005 to 2020 in Iran. All data were obtained from the reports of the Statistics Center of Iran (SCI), 6 phases of the step-by-step approach to monitoring the risk factors of chronic diseases over 18 years old (STEPs), and 3 periods of the CASPIAN study (survey of non-communicable diseases in childhood and adolescence). Statistical analyzes and graph generation were done using R statistical software. Poisson regression with mixed effects was used for data modeling and incidence rate estimation. The incidence of thyroid gland malignancy is higher in women than in men. On the other hand, the incidence of adrenal gland cancer is slightly higher in men than in women. The same pattern is observed for other endocrine neoplasms and related structures. The incidence rate of these types of cancers has generally increased from 2005 to 2020 in Iran. This increase is more in women than in men. In addition, in the middle of the country, there is a strong region in terms of the occurrence of these types of cancers. The incidence rate in these provinces is relatively higher for both sexes and all studied periods. We conducted a study to observe the changing trends for various types of endocrine cancers over 15 years in men and women. Considering the increasing trend of thyroid cancers in Iran, therefore, creating essential policies for the management of these types of cancers for prevention, rapid diagnosis, and, timely treatment is particularly important.
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Affiliation(s)
- Narges Zargar Balajam
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir-Hossein Mousavian
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kimiya Gohari
- Department of Biostatistics, Faculty of Medicine Sciences, Tarbiat Modares University, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari-Motlagh
- Department of Radiotherapy, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Messias H, Sequeira ML, Nogueira R, Zagalo C, Martins M, Gomes P. Pyramidal lobe-dominant papillary thyroid carcinoma-A rare entity with important clinical implications. Clin Case Rep 2023; 11:e7189. [PMID: 37207085 PMCID: PMC10188893 DOI: 10.1002/ccr3.7189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/16/2023] [Accepted: 03/23/2023] [Indexed: 05/21/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) primarily located in the pyramidal lobe of the thyroid gland is extremely rare, therefore the clinical and pathological features are not well understood. The authors describe a case of PTC of the pyramidal lobe, in a 77-year-old woman who underwent en bloc total thyroidectomy with pyramidal lobe, hyoid bone and cervical lymph node excision. In line with the present case, current literature reports a greater presence of worse prognostic factors, namely extrathyroidal extension, advanced T stage or presence of cervical lymph node metastasis. Recently, a new classification has been suggested-Upper Neck Papillary Thyroid Cancer (UPTC)-which encompasses these carcinomas, Delphi ganglion metastases and thyroglossal duct cyst carcinomas, with potential clinical and therapeutic implications, particularly the need for orthotopic thyroidectomy. Also, the complete excision of the pyramidal lobe during thyroidectomy may influence the success of radioactive iodine therapy and the patient's follow-up surveillance.
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Affiliation(s)
- Henrique Messias
- Head and Neck Surgery DepartmentPortuguese Institute of Oncology Francisco GentilLisbonPortugal
- Division of Health SciencesUniversity of EdinburghEdinburghUK
| | - Maria Luísa Sequeira
- Head and Neck Surgery DepartmentPortuguese Institute of Oncology Francisco GentilLisbonPortugal
| | - Ricardo Nogueira
- Head and Neck Surgery DepartmentPortuguese Institute of Oncology Francisco GentilLisbonPortugal
| | - Carlos Zagalo
- Head and Neck Surgery DepartmentPortuguese Institute of Oncology Francisco GentilLisbonPortugal
| | - Mariluz Martins
- Head and Neck Surgery DepartmentPortuguese Institute of Oncology Francisco GentilLisbonPortugal
| | - Pedro Gomes
- Head and Neck Surgery DepartmentPortuguese Institute of Oncology Francisco GentilLisbonPortugal
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10
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McMurtry V, Canberk S, Deftereos G. Molecular testing in fine-needle aspiration of thyroid nodules. Diagn Cytopathol 2023; 51:36-50. [PMID: 36480743 DOI: 10.1002/dc.25035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Thyroid nodules are commonly faced by clinicians as palpable nodules or incidentally identified on imaging. Nodules that are found to be suspicious by imaging can be biopsied by fine needle aspiration, which can yield material for molecular testing to refine the diagnosis. METHODS The current literature concerning molecular testing in thyroid nodules including available commercial assays was reviewed and summarized. RESULTS/CONCLUSIONS Commonly encountered alterations include mutations in RAS, BRAF, TERT promoter, PTEN, and DICER1 as well as fusions of RET, ALK, PAX8-PPARγ, and NTRK. This article provides a summary of these molecular alterations, commercially available molecular assays, and general considerations for thyroid epithelial malignancies and benign thyroid nodules.
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Affiliation(s)
- Valarie McMurtry
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA.,ARUP Institute for Experimental Pathology, Salt Lake City, Utah, USA
| | - Sule Canberk
- Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (Ipatimup), Porto, Portugal.,Abel Salazar Biomedical Sciences Institute (ICBAS), University of Porto, Porto, Portugal
| | - Georgios Deftereos
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA.,ARUP Institute for Experimental Pathology, Salt Lake City, Utah, USA
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11
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The Initial ATA Risk Classification, but Not the AJCC/TNM Stage, Predicts the Persistence or Relapse of Differentiated Thyroid Cancer in Long-Term Surveillance. ENDOCRINES 2022. [DOI: 10.3390/endocrines3030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The American Joint Commission on Cancer on Tumor Node Metastasis (AJCC/TNM) staging system provides adequate information on the risk of differentiated thyroid cancer (DTC)-specific mortality in totally thyroidectomized patients, but its role in predicting persistence and relapse of disease is uncertain. The relatively new 2015 American Thyroid Association (ATA) guidelines recommend stratifying patients at the time of DTC diagnosis with its own risk classification system, in order to identify those at high risk of residual or recurrent morbidity who may benefit from post-operative radioiodine (RAI) administration and/or need additional work-up. Methods: To verify the prevalence proportion of persistence or relapse of disease, a consecutive cohort of 152 patients with a diagnosis of DTC, subjected to total thyroidectomy (+/− post-operative RAI administration as per guidelines indication) and to neck ultrasonography (US), as well as biochemical surveillance for a minimum of 2 years at the Endocrinology Unit of Mater-Domini Hospital (Catanzaro, Italy), was enrolled. The prognostic role of the AJCC/TNM stage and ATA risk classification system was analyzed by logistic regression. Results: At a mean of 9 years after surgical treatment, DTC was found to persist or relapse in 19 (12.5%) participants. The initial risk for these outcomes, based on the ATA classification, was mostly low (53.9%) or intermediate (39.5%). AJCC/TNM stages were predominantly stage I or stage II. Despite a small representation in this cohort, high-risk patients according to the ATA classification had 8-fold higher odds of persistence or relapse of disease than those of low-risk participants, while controlling for potential risk modifiers, including age at DTC diagnosis, male gender, and post-operative RAI administration (p = 0.008). In contrast, the AJCC/TNM stage was not associated with the disease status at the last follow-up visit (p = 0.068 for the 7th Edition; p = 0.165 for the 8th Edition). Furthermore, low-risk participants subjected to post-operative RAI administration had the same probability of persistence or relapse of DTC when compared to those who had undergone total thyroidectomy only. Conclusions: There is a need for the endocrine community to revise the current work-up of DTC. The initial ATA risk classification is a reliable tool for predicting the persistence or relapse of disease in long-term surveillance.
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12
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Feasibility and Safety of Ambulatory Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA). World J Surg 2022; 46:2678-2686. [PMID: 35854011 PMCID: PMC9295883 DOI: 10.1007/s00268-022-06666-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
Background In search of an ideal cosmesis, transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has recently been introduced to avoid a visible scar. Although ambulatory thyroid surgery is considered safe in carefully selected patients, this remains unclear for TOETVA. Methods All consecutive adult patients who underwent ambulatory TOETVA or open thyroid surgery at a French university hospital were prospectively enrolled from 12/2020 until 11/2021. The primary outcome was postoperative morbidity (recurrent laryngeal nerve (RLN) palsy, re-intervention for bleeding, wound morbidity, or hospital readmission). The secondary outcome was quality of life (QoL), measured by a survey including a validated questionnaire (SF-12) and a modified thyroid surgery questionnaire six weeks after surgery. Results Throughout the study period, 374 patients underwent a unilateral lobectomy or isthmectomy in ambulatory setting, of which 34 (9%) as TOETVA (including 21 (62%) for a possible malignancy). In the TOETVA group, younger age (median 40 (IQR 35–50) vs. 51 (40–60) years, P < 0.001) and lower BMI (median 23.1 (20.9–25.4) vs. 24.9 (22.1–28.9) kg/m2, P = 0.001) were noted. No cases were converted to open cervicotomy. TOETVA was at least as good as open cervicotomy with nil versus four (1%) re-interventions for bleeding, one temporary (5%) versus 13 (4%) (temporary) RLN palsies, and one (<1%) wound infection (open cervicotomy group). No hospital readmissions occurred in all ambulatory surgery patients. No differences were found in physical (P = 0.280) and mental (P = 0.569) QoL between TOETVA and open surgery. Conclusions In carefully selected patients, the feasibility and safety of ambulatory TOETVA are comparable to open surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06666-y.
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13
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Bulfamante AM, Lori E, Bellini MI, Bolis E, Lozza P, Castellani L, Saibene AM, Pipolo C, Fuccillo E, Rosso C, Felisati G, De Pasquale L. Advanced Differentiated Thyroid Cancer: A Complex Condition Needing a Tailored Approach. Front Oncol 2022; 12:954759. [PMID: 35875142 PMCID: PMC9300941 DOI: 10.3389/fonc.2022.954759] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Differentiated thyroid cancers (DTCs) are slow-growing malignant tumours, including papillary and follicular carcinomas. Overall, prognosis is good, although it tends to worsen when local invasion occurs with bulky cervical nodes, or in the case of distant metastases. Surgery represents the main treatment for DTCs. However, radical excision is challenging and significant morbidity and functional loss can follow the treatment of the more advanced forms. Literature on advanced thyroid tumours, both differentiated and undifferentiated, does not provide clear and specific guidelines. This emerges the need for a tailored and multidisciplinary approach. In the present study, we report our single-centre experience of 111 advanced (local, regional, and distant) DTCs, investigating the rate of radical excision, peri-procedural and post-procedural complications, quality of life, persistence, recurrence rates, and survival rates. Results are critically appraised and compared to the existing published evidence review.
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Affiliation(s)
- Antonio Mario Bulfamante
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eleonora Lori
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Eleonora Lori,
| | | | | | - Paolo Lozza
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Castellani
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Emanuela Fuccillo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Cecilia Rosso
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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14
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Imam S, Paparodis RD, Rafiqi SI, Ali S, Niaz A, Kanzy A, Tovar YE, Madkhali MA, Elsherif A, Khogeer F, Zahid ZA, Sarwar H, Karim T, Salim N, Jaume JC. Thyroid Cancer Screening Using Tumor-Associated DN T Cells as Immunogenomic Markers. Front Oncol 2022; 12:891002. [PMID: 35692772 PMCID: PMC9186057 DOI: 10.3389/fonc.2022.891002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThyroid nodules are an extremely common entity, and surgery is considered the ultimate diagnostic strategy in those with unclear malignant potential. Unfortunately, strategies aiming to predict the risk of malignancy have inadequate specificity. Our group recently found that the microenvironment of thyroid cancer is characterized by an enhanced immune invasion and activated immune response mediated by double-negative T lymphocytes (DN T) (CD3+CD4-CD8-), which are believed to enable or promote tumorigenesis. In the present work, we try to use the DN T cells’ proportion in thyroid fine-needle aspiration (FNA) material as a predictor of the risk of malignancy.MethodsWe recruited 127 patients and obtained ultrasound-guided FNA samples from subjects with cytology-positive or suspicious for malignancy and from those with benign nodular goiter associated with compressive symptoms (such as dysphagia, shortness of breath, or hoarseness), Hashimoto thyroiditis, and Graves’ disease. Out of 127, we investigated 46 FNA samples of patients who underwent total thyroidectomy and for which postoperative histological diagnosis by the academic pathologists was available. We specifically measured the number of cells expressing CD3+CD4-CD8- (DN T) as a function of total CD3+ cells in FNA samples using flow cytometry. We correlated their FNA DN T-cell proportions with the pathological findings.ResultsThe DN T cells were significantly more abundant in lymphocytic infiltrates of thyroid cancer cases compared to benign nodule controls (p < 0.0001). When the DN T-cell population exceeded a threshold of 9.14%, of total CD3+ cells, the negative likelihood ratio of being cancer-free was 0.034 (96.6% sensitivity, 95% CI, 0.915–1.000, p < 0.0001). DN T cells at <9.14% were not found in any subject with benign disease (specificity 100%). The high specificity of the test is promising, since it abolishes a false-positive diagnosis and in turn unnecessary surgical procedures.ConclusionThe present study proposes DN T cells’ proportion as a preoperative diagnostic signature for thyroid cancer that with integration of RNA transcriptomics can provide a simplified technology based on the PCR assay for the ease of operation.
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Affiliation(s)
- Shahnawaz Imam
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
- *Correspondence: Shahnawaz Imam, ; Juan C. Jaume,
| | - Rodis D. Paparodis
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
- Private Practitioner, Patras, Greece
| | - Shafiya Imtiaz Rafiqi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Sophia Ali
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Azra Niaz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Abed Kanzy
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Yara E. Tovar
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Mohammed A. Madkhali
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Ahmed Elsherif
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Feras Khogeer
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Zeeshan A. Zahid
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Haider Sarwar
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
- Windsor University School of Medicine, Cayon St. Kitts West Indies, Saint Kitts and Nevis
| | - Tamanna Karim
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Nancy Salim
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
| | - Juan C. Jaume
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
- Center for Diabetes and Endocrine Research (CeDER), University of Toledo, Toledo, OH, United States
- *Correspondence: Shahnawaz Imam, ; Juan C. Jaume,
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15
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Zhang Z, Sun B, Ouyang H, Cong R, Xia F, Li X. Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Thyroid Surgery. Front Endocrinol (Lausanne) 2021; 12:796984. [PMID: 35002974 PMCID: PMC8728058 DOI: 10.3389/fendo.2021.796984] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background Endoscopic thyroidectomy and robotic thyroidectomy are effective and safe surgical options for thyroid surgery, with excellent cosmetic outcomes. However, in regard to lateral neck dissection (LND), much effort is required to alleviate cervical disfigurement derived from a long incision. Technologic innovations have allowed for endoscopic LND, without the need for extended cervical incisions and providing access to remote sites, including axillary, chest-breast, face-lift, transoral, and hybrid approaches. Methods A comprehensive review of published literature was performed using the search terms "lateral neck dissection", "thyroid", and "endoscopy OR endoscopic OR endoscope OR robotic" in PubMed. Results This review provides an overview of the current knowledge regarding endoscopic LND, and it specifically addresses the following points: 1) the surgical procedure, 2) the indications and contraindications, 3) the complications and surgical outcomes, and 4) the technical advantages and limitations. Robotic LND, totally endoscopic LND, and endoscope-assisted LND are separately discussed. Conclusions Endoscopic LND is a feasible and safe technique in terms of complete resection of the selected neck levels, complications, and cosmetic outcomes. However, it is recommended to strictly select criteria when expanding the population of eligible patients. A formal indication for endoscopic LND has not yet been established. Thus, a well-designed, multicenter study with a large cohort is necessary to confirm the feasibility, long-term outcomes, oncological safety, and influence of endoscopic LND on patient quality of life (QoL).
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Affiliation(s)
| | | | | | | | - Fada Xia
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
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