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Wei A, Tang YL, Tang SC, Zhang XY, Ren JY, Shi L, Cui XW, Zhang CX. A model based on C-TIRADS combined with SWE for predicting Bethesda I thyroid nodules. Front Oncol 2024; 14:1421088. [PMID: 39281385 PMCID: PMC11393783 DOI: 10.3389/fonc.2024.1421088] [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: 04/21/2024] [Accepted: 08/06/2024] [Indexed: 09/18/2024] Open
Abstract
Objectives This study aimed to explore the performance of a model based on Chinese Thyroid Imaging Reporting and Data Systems (C-TIRADS), clinical characteristics, and shear wave elastography (SWE) for the prediction of Bethesda I thyroid nodules before fine needle aspiration (FNA). Materials and methods A total of 267 thyroid nodules from 267 patients were enrolled. Ultrasound and SWE were performed for all nodules before FNA. The nodules were scored according to the 2020 C-TIRADS, and the ultrasound and SWE characteristics of Bethesda I and non-I thyroid nodules were compared. The independent predictors were determined by univariate analysis and multivariate logistic regression analysis. A predictive model was established based on independent predictors, and the sensitivity, specificity, and area under the curve (AUC) of the independent predictors were compared with that of the model. Results Our study found that the maximum diameter of nodules that ranged from 15 to 20 mm, the C-TIRADS category <4C, and E max <52.5 kPa were independent predictors for Bethesda I thyroid nodules. Based on multiple logistic regression, a predictive model was established: Logit (p) = -3.491 + 1.630 × maximum diameter + 1.719 × C-TIRADS category + 1.046 × E max (kPa). The AUC of the model was 0.769 (95% CI: 0.700-0.838), which was significantly higher than that of the independent predictors alone. Conclusion We developed a predictive model for predicting Bethesda I thyroid nodules. It might be beneficial to the clinical optimization of FNA strategy in advance and to improve the accurate diagnostic rate of the first FNA, reducing repeated FNA.
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Affiliation(s)
- An Wei
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Ultrasound, Hunan Provincial People's Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yu-Long Tang
- Department of Thyroid Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi-Chu Tang
- Department of Medical Ultrasound, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xian-Ya Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia-Yu Ren
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Long Shi
- Department of Medical Ultrasound, Jingmen People's Hospital, Jingmen, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao-Xue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Yi Y, Zhu Y, Wu Y, Hu F. Investigation on low-iodine diet implementation by medical staff before radioactive iodine treatment for differentiated thyroid carcinoma. Ann Nucl Med 2024; 38:639-646. [PMID: 38874877 DOI: 10.1007/s12149-024-01952-2] [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: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To explore the implementation of low-iodine diets by medical staff caring for patients with differentiated thyroid carcinoma prior to 131I therapy across 58 hospitals, and offer valuable insights for the development of guidelines on low-iodine diets. METHODS Convenience sampling was utilized to conduct a survey among 163 medical staff members working in nuclear medicine departments across 58 tertiary hospitals using a self-designed questionnaire. RESULTS Concerning the duration of the low-iodine diet prior to treatment, the medical staff's recommendations were as follows: 58.28% suggested 2-4 weeks, 31.29% recommended more than 4 weeks, 9.2% opted for 7-13 days, and 1.23% favored less than 1 week. Regarding the timing of resuming a normal diet, the respondents' recommendations ranged from immediately after treatment (1.84%) to 3 months post-treatment (8.58%), with intermediate recommendations of 2 h (8.58%), 24-48 h (14.11%), post-discharge (12.26%), and 1 month (42.94%). Furthermore, the surveyed medical staff unanimously recommended abstaining from seafood, with 90.8% also advising against the consumption of iodized salt, 91.41% recommending avoidance of iodine-containing medications, and 71.17% advising caution with moderately high-iodine foods. Notably, 75.46% of the medical staff evaluated patient compliance with the low-iodine diet. When patients failed to adhere to the diet preparation, 33.74% of healthcare workers chose to proceed with treatment. In terms of guidance sources, 96.93% of respondents relied on relevant guidelines, 66.26% referred to the literature, and 49.69% drew upon their clinical experience. During hospitalization, 58.28% of the medical staff continued to guide patients on the low-iodine diet, while only 8.59% provided such guidance after discharge. Notably, only 20.25% of the staff considered consulting the nutrition department. CONCLUSION This study underscored substantial variations in the duration and selection criteria for low-iodine diets, which were linked to a scarcity of standardized evaluations. Consequently, there is an urgent need for further research to establish detailed, practical, accessible, comprehensive, and dependable implementation programs for low-iodine diets.
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Affiliation(s)
- Yupin Yi
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, China
| | - Yuquan Zhu
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, China
| | - Youfeng Wu
- Department of Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, China.
| | - Fengqiong Hu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, 1st Youyi Road, Chongqing, 400016, China.
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Zhou B, Liu J, Yang Y, Ye X, Liu Y, Mao M, Sun X, Cui X, Zhou Q. Ultrasound-based nomogram to predict the recurrence in papillary thyroid carcinoma using machine learning. BMC Cancer 2024; 24:810. [PMID: 38972977 PMCID: PMC11229345 DOI: 10.1186/s12885-024-12546-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 06/20/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND AND AIMS The recurrence of papillary thyroid carcinoma (PTC) is not unusual and associated with risk of death. This study is aimed to construct a nomogram that combines clinicopathological characteristics and ultrasound radiomics signatures to predict the recurrence in PTC. METHODS A total of 554 patients with PTC who underwent ultrasound imaging before total thyroidectomy were included. Among them, 79 experienced at least one recurrence. Then 388 were divided into the training cohort and 166 into the validation cohort. The radiomics features were extracted from the region of interest (ROI) we manually drew on the tumor image. The feature selection was conducted using Cox regression and least absolute shrinkage and selection operator (LASSO) analysis. And multivariate Cox regression analysis was used to build the combined nomogram using radiomics signatures and significant clinicopathological characteristics. The efficiency of the nomogram was evaluated by receiver operating characteristic (ROC) curves, calibration curves and decision curve analysis (DCA). Kaplan-Meier analysis was used to analyze the recurrence-free survival (RFS) in different radiomics scores (Rad-scores) and risk scores. RESULTS The combined nomogram demonstrated the best performance and achieved an area under the curve (AUC) of 0.851 (95% CI: 0.788 to 0.913) in comparison to that of the radiomics signature and the clinical model in the training cohort at 3 years. In the validation cohort, the combined nomogram (AUC = 0.885, 95% CI: 0.805 to 0.930) also performed better. The calibration curves and DCA verified the clinical usefulness of combined nomogram. And the Kaplan-Meier analysis showed that in the training cohort, the cumulative RFS in patients with higher Rad-score was significantly lower than that in patients with lower Rad-score (92.0% vs. 71.9%, log rank P < 0.001), and the cumulative RFS in patients with higher risk score was significantly lower than that in patients with lower risk score (97.5% vs. 73.5%, log rank P < 0.001). In the validation cohort, patients with a higher Rad-score and a higher risk score also had a significantly lower RFS. CONCLUSION We proposed a nomogram combining clinicopathological variables and ultrasound radiomics signatures with excellent performance for recurrence prediction in PTC patients.
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Affiliation(s)
- Binqian Zhou
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Jianxin Liu
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Yaqin Yang
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xuewei Ye
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Yang Liu
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Mingfeng Mao
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xiaofeng Sun
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| | - Qin Zhou
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
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Cao ZX, Huang JS, Wang MM. Application and subgroup analysis of competing risks model based on different lymph node staging systems in differentiated thyroid cancer. Updates Surg 2024:10.1007/s13304-024-01851-1. [PMID: 38691331 DOI: 10.1007/s13304-024-01851-1] [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: 12/14/2023] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, with a rising incidence worldwide. Accurate prognostic models are essential for effective patient management. This study evaluates the prognostic value of various lymph node staging systems in DTC using a competing risks model. We used SEER database records (1998-2016) of 16,527 DTC patients, analyzing N stage, positive lymph node numbers (PLNNs), metastatic lymph node ratio (MLNR), log odds of positive lymph nodes (LODDS), and log odds of the negative lymph node (NLN)/T stage ratio (LONT). Univariate and multivariate analyses in a competing risks model were performed, along with subgroup analyses based on demographic and clinical characteristics. In this study of 16,527 patients with DTC, different lymph node staging systems showed different prognostic correlations in univariate and multivariate analyses. In particular, PLNNs showed significant prognostic correlations in several subgroups. Additionally, PLNNs were more suitable as a lymph node staging system for DTC than LODDS and MLNR in N1 stage subgroups, with an optimal cut-off of 13. Receiver operating characteristic curves, calibration curves and nomograms improved the clinical utility of the prognostic model based on PLNNs. Using competing risks model and subgroup analyses, we found that PLNNs had the best prognostic discriminatory efficacy for patients with DTC, especially those with N1 stage disease, and had an optimal cut-off value of 13.
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Affiliation(s)
- Zhe Xu Cao
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha City, Hunan Province, China
| | - Jiang Sheng Huang
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha City, Hunan Province, China
| | - Ming Ming Wang
- Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha City, Hunan Province, China.
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Pan L, Zhang L, Fu J, Shen K, Zhang G. Integrated transcriptome sequencing and weighted gene co-expression network analysis reveals key genes of papillary thyroid carcinomas. Heliyon 2024; 10:e27928. [PMID: 38560266 PMCID: PMC10981042 DOI: 10.1016/j.heliyon.2024.e27928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid cancers and has a high recurrence rate. We aimed to screen key genes involved in PTC to provide novel insights into the mechanisms of PTC. Methods Seven microarray datasets of PTC were downloaded from gene expression omnibus database. Differentially expressed genes (DEGs) between PTC and normal samples were screened in the merged dataset. Then, protein-protein interaction (PPIs) functional modules analysis and weighted gene co-expression network analysis (WGCNA) were utilized to identify PTC-associated key genes. The identified key genes were then characterized from various aspects, including gene set enrichment analysis (GSEA) and the associations with immune infiltration, methylation levels and prognosis. Results A large numbers of DEGs were identified, and these DEGs are involved in several cancer pathways. Nine key genes (including down-regulated genes GNA14, AVPR1A, and WFS1, and up-regulated genes LAMB3, PLAU, MET, MFGE8, PRSS23, and SERPINA1) were identified. Patients in the AVPR1A and GNA14 high expression groups had better disease-free survival (DFS) than those in the low expression group. Key genes were mainly involved in P53 pathway, estrogen response, apoptosis, glycolysis, NOTCH signaling, epithelial mesenchymal transition, WNT_beta catenin signaling, and inflammatory response. The expression of key genes was associated with immune cell infiltration and corresponding methylation levels. The verification results of key gene proteins and mRNA expression levels using external validation datasets were consistent with our expectations, implying the involvements of key genes in PTC. Conclusion The key genes may serve as potential therapeutic targets for PTC. This study provides novel insights into the mechanisms underlying PTC development.
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Affiliation(s)
- Lingfeng Pan
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130033, China
| | - Lianbo Zhang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130033, China
| | - Jingyao Fu
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130033, China
| | - Keyu Shen
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130033, China
| | - Guang Zhang
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130033, China
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Althoubaiti SA, Alharthi AS, Al Kahtani RM, Algrni MA, Alshorm AG, Mahfouz MEM. Post-thyroidectomy Depression and Associated Factors in Saudi Arabia. Cureus 2024; 16:e55328. [PMID: 38559523 PMCID: PMC10981879 DOI: 10.7759/cureus.55328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Background Thyroidectomy is a common surgical procedure used to treat thyroid gland illnesses. The surgery has many outcomes, and one of them may show an association with depression. This study aims to assess the factors associated with depression after thyroidectomy in Saudi Arabia. Methodology A cross-sectional study was conducted among 414 Saudi participants. The target population included patients more than 18 years old and who had undergone thyroidectomy, whereas patients 18 years or younger were excluded. The data were collected between December 2023 and January 2024 using an electronic self-administered questionnaire that included demographics, clinical characteristics, and the nine-item Patient Health Questionnaire. The questionnaire was distributed randomly throughout social media, and patient consent was obtained. The descriptive and inferential analyses were performed using SPSS software version 27 (IBM Corp., Armonk, NY, USA). Results The study showed that of the 414 participants, 306 were females and 108 were males. Depression affected 335 (80.92%) participants and was mostly mild (120, 28.99%), followed by moderate (109, 26.33%), moderately severe (55, 13.29%), and severe (51, 12.32%). Depression symptoms were more common in females than males. The participants who underwent total thyroidectomy (217, 52.41%) were more than those who underwent partial thyroidectomy (197, 47.58%). Temporary complications were more prevalent in the participants exhibiting symptoms of depression. Both educational level and surgery time were significant factors. Conclusions The study revealed a significant prevalence of post-thyroidectomy depression. The associated factors in post-thyroidectomy depression included educational level, with more depression symptoms noted with high education. In addition, surgery time showed an increased risk of developing depression that still existed two years postoperatively.
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Affiliation(s)
| | - Amirah S Alharthi
- Department of Surgery, College of Medicine, Taif University, Taif, SAU
| | | | - Mayar A Algrni
- Department of Surgery, College of Medicine, Taif University, Taif, SAU
| | - Amal G Alshorm
- Department of Surgery, College of Medicine, Taif University, Taif, SAU
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Bogdanova T, Rogounovitch TI, Zurnadzhy L, Mitsutake N, Tronko M, Ito M, Bolgov M, Chernyshov S, Gulevatyi S, Masiuk S, Yamashita S, Saenko VA. Characteristics and immune checkpoint status of radioiodine-refractory recurrent papillary thyroid carcinomas from Ukrainian Chornobyl Tissue Bank donors. Front Endocrinol (Lausanne) 2024; 14:1343848. [PMID: 38260161 PMCID: PMC10800488 DOI: 10.3389/fendo.2023.1343848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction The radioiodine-refractory (RAI-R) recurrent papillary thyroid carcinomas (PTCs) are more frequent in elderly patients and have an unfavorable prognosis. Data on the prevalence and characteristics of RAI-R recurrent PTCs in patients of young and middle age with or without a history of radiation exposure in childhood are poorly described. The aim of the current study was: i) to determine the frequency of RAI-R recurrent PTCs among donors of the Chornobyl Tissue Bank (CTB) and analyze the clinicopathological features of primary tumors (PTs), primary metastases (PMTSs), recurrent metastases (RMTSs) and risk factors for RMTS, and ii) to determine the immune checkpoint status (ICS) of the RAI-R recurrent PTCs and to assess the factors associated with ICS positivity. Methods Sixty RAI-R recurrent PTCs (46 exposed to radiation and 14 non-exposed, 2.5% of all cases registered with the CTB) from the Ukrainian patients aged up to 48 years were identified. Results The clinicopathological characteristics of the PTs moderately to weakly resembled those of the PMTS and RMTS from the same patients while the metastatic tissues were highly similar. The multivariate model of RMTS included the dominant solid-trabecular growth pattern of the PT, cystic changes, N1b metastases, and the probability of a causation (POC) of PTC by radiation as risk factors. Among these factors, the lateral PMTS (N1b) had the strongest effect. The longer period of latency (a POC component) was the second statistically significant characteristic. ICS percent agreement between the PT and RAI-R RMTS was 91.5%; 23.7% of PTs and 28.8% of RMTSs had positive ICS (positive PD-L1 tumor epithelial cells (TECs) and positive PD-L1/PD1 tumor-associated immune cells). ICS positivity of PTs was associated with pronounced oncocytic changes and high density of the p16INK4A-positive TECs in the invasive areas of PTs. In RMTSs, ICS positivity was associated with pronounced oncocytic changes and Ki-67 labeling index ≥ 4.5% of PTs, and the dominant solid-trabecular growth pattern, Ki-67 labeling index ≥ 7.6% and p16INK4A-positivity of RMTS. Discussion The findings are of clinical relevance and may be useful for developing individual treatment approaches for patients with RAI-R recurrent PTCs possibly involving immunotherapy.
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Affiliation(s)
- Tetiana Bogdanova
- Laboratory of Morphology of Endocrine System, State Institution “VP Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Tatiana I. Rogounovitch
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Liudmyla Zurnadzhy
- Laboratory of Morphology of Endocrine System, State Institution “VP Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Norisato Mitsutake
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Mykola Tronko
- Department of Fundamental and Applied Problems of Endocrinology, State Institution “VP Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
| | - Masahiro Ito
- Department of Diagnostic Pathology, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Michael Bolgov
- Department of Surgery of Endocrine Glands, State Institution “VP Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
| | - Serhii Chernyshov
- Department of Surgery of Endocrine Glands, State Institution “VP Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
| | - Serhii Gulevatyi
- Laboratory of Radiology and Radiobiology, State Institution “VP Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine”, Kyiv, Ukraine
| | - Sergii Masiuk
- Radiation Protection Laboratory, State Institution “National Research Center of Radiation Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine
| | - Shunichi Yamashita
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
- Global Exchange Center, Fukushima Medical University, Fukushima, Japan
| | - Vladimir A. Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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Staubitz-Vernazza JI, Schwind S, Lozan O, Musholt TJ. A 16-Year Single-Center Series of Trachea Resections for Locally Advanced Thyroid Carcinoma. Cancers (Basel) 2023; 16:163. [PMID: 38201590 PMCID: PMC10778257 DOI: 10.3390/cancers16010163] [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: 10/16/2023] [Revised: 12/20/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Infiltration of the aerodigestive tract in advanced thyroid carcinoma determines the prognosis and quality of life. Different stages of tracheal tumor invasion require customization of the surgical concept. (2) Methods: In the period from January 2007 to January 2023, patients who underwent surgery for advanced thyroid carcinomas with trachea resections were included in a retrospective observational study. The surgical resection concepts and operation-associated complications were documented. The overall survival and post-resection survival were analyzed. (3) Results: From 2007 to 2023, at the single-center UMC Mainz, 33 patients (15 female and 18 male) underwent neck surgery with trachea resections for locally advanced thyroid carcinomas. Of these, 14 were treated with non-transmural (trachea shaving) and 19 transmural trachea resections (9 "window" resections, 6 near-circular resections, 3 sleeve resections and 1 total laryngectomy with extramucosal esophageal resection). The two-year postoperative survival rate was 82.0 percent. The two-year recurrence-free survival rate was 75.0 percent (mean follow-up period: 29.2 months). (4) Conclusions: Tracheal resections for locally advanced tumor infiltration are feasible as an element of highly individualized treatment concepts.
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Affiliation(s)
| | | | | | - Thomas J. Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany; (J.I.S.-V.); (S.S.); (O.L.)
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Huang NS, Li Q, Gao XY, Xiang SY, Ji QH, Xiang J, Wang YL, Wei WJ, Chen JY, Yu Q, Cao YM, Guan Q, Gu YJ, Wang Y. Using a CT-based scale to evaluate disease extension and the resectability of locally advanced thyroid cancer. Eur Radiol 2023; 33:9063-9073. [PMID: 37439940 DOI: 10.1007/s00330-023-09799-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES To establish a computed tomography (CT)-based scale to evaluate the resectability of locally advanced thyroid cancer. METHODS This twin-centre retrospective study included 95 locally advanced thyroid cancer patients from the 1st centre as the training cohort and 31 patients from the 2nd centre as the testing cohort, who were categorised into the resectable and unresectable groups. Three radiologists scored the CT scans of each patient by evaluating the extension to the recurrent laryngeal nerve (RLN), trachea, oesophagus, artery, vein, soft tissue, and larynx. A 14-score scale (including all comprised structures) and a 12-score scale (excluding larynx) were developed. Receiver-operating characteristic (ROC) analysis was used to evaluate the performance of the scales. Stratified fivefold cross-validation and external verification were used to validate the scale. RESULTS In the training cohort, compromised RLN (p < 0.001), trachea (p = 0.001), oesophagus (p = 0.002), artery (p < 0.001), vein (p = 0.005), and soft tissue (p < 0.001) were predictors for unresectability, while compromised larynx (p = 0.283) was not. The 12-score scale (AUC = 0.882, 95%CI: 0.812-0.952) was not inferior to the 14-score scale (AUC = 0.891, 95%CI: 0.823-0.960). In subgroup analysis, the AUCs of the 12-score scale were 0.826 for treatment-naïve patients and 0.976 for patients with prior surgery. The 12-score scale was further validated with a fivefold cross-validation analysis, with an overall accuracy of 78.9-89.4%. Finally, external validation using the testing cohort showed an AUC of 0.875. CONCLUSIONS The researchers built a CT-based 12-score scale to evaluate the resectability of locally advanced thyroid cancer. Validation with a larger sample size is required to confirm the efficacy of the scale. CLINICAL RELEVANCE STATEMENT This 12-score CT scale would help clinicians evaluate the resectability of locally advanced thyroid cancer. KEY POINTS • The researchers built a 12-score CT scale (including recurrent laryngeal nerve, trachea, oesophagus, artery, vein, and soft tissue) to evaluate the resectability of locally advanced thyroid cancer. • This scale has the potential to help clinicians make treatment plans for locally advanced thyroid cancer.
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Affiliation(s)
- Nai-Si Huang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiao Li
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
| | - Xin-Yi Gao
- Shanghai Institute of Medical Imaging, 180 Fenglin Road, Shanghai, 200032, China
- Department of Radiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China
| | - Shi-Yu Xiang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Jun Xiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Long Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Jun Wei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jia-Ying Chen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing Yu
- Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 1 Banshan East Road, Hangzhou, 310022, Zhejiang, China
- Department of Thyroid Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Key Laboratory of Head & Neck Cancer, Translational Research of Zhejiang Province, Hangzhou, China
| | - Yi-Ming Cao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qing Guan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ya-Jia Gu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
- Department of Radiology, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China.
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270 Dongan Rd, Shanghai, China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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10
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Yang Y, Gan M, Yi K, Han S, Lin Z, Shi Y, Ming J. Guiding the postoperative radioactive iodine-131 therapy for patients with papillary thyroid carcinoma according to the prognostic risk groups: a SEER-based study. J Cancer Res Clin Oncol 2023; 149:17147-17157. [PMID: 37782329 DOI: 10.1007/s00432-023-05299-5] [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: 04/19/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE The effectiveness of iodine-131(131I) therapy in patients with papillary thyroid cancer (PTC) of various stage is controversial. This study aimed to use prognostic risk groups to guide 131I therapy in patients with PTC after radical thyroidectomy. METHODS Data of 53,484 patients with PTC after radical thyroidectomy were collected from the Epidemiology and End Results (SEER) database. Patients were divided into subgroups according to MACIS system and regional lymph node involvement. The prognostic role of 131I therapy was investigated by comparing Kaplan-Meier survival analysis and Cox proportional hazard models in different subgroups. RESULTS Sex, age, tumor size, invasion, regional lymph node involvement, and distant metastasis was related to the survival of patients with PTC. If MACIS < 7, 131I treatment didn't affect the cancer-specific survival (CSS) rate. If MACIS ≥ 7, 131I therapy didn't work on CSS rate for patients with N0 or N1a < 5 status; 131I therapy had improved CSS rate for patients in the N1a ≥ 5 or N1b status. If patients with distant metastasis, invasion, or large tumor, 131I therapy didn't improve CSS rate for patients in N0 or N1a < 5 stage. CONCLUSION After radical thyroidectomy, if MACIS < 7, patients with PTC could avoid 131I therapy. If MACIS ≥ 7, patients in the N0 or N1a < 5 could avoid 131I therapy; those in the N1a ≥ 5 or N1b stage should be given 131I therapy. Among them, all patients with distant metastasis should be given 131I therapy.
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Affiliation(s)
- Yuping Yang
- Department of Breast and Thyroid Surgery, Army Specialty Medical Center, Chongqing, China
| | - Mingyu Gan
- Department of Basic Medicine, Shanxi Medical University, Taiyuan, China
| | - Kun Yi
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shanshan Han
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zijing Lin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanling Shi
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Ming
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Balakirouchenane D, Seban R, Groussin L, Puszkiel A, Cottereau AS, Clerc J, Vidal M, Goldwasser F, Arrondeau J, Blanchet B, Huillard O. Pharmacokinetics/Pharmacodynamics of Dabrafenib and Trametinib for Redifferentiation and Treatment of Radioactive Iodine-Resistant Mutated Advanced Differentiated Thyroid Cancer. Thyroid 2023; 33:1327-1338. [PMID: 37725566 DOI: 10.1089/thy.2023.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Background: BRAF and MEK inhibitors are cornerstones of the redifferentiation strategy in metastatic radioactive iodine (RAI)-resistant mutant thyroid cancers. We explored the exposure-toxicity relationship for dose-limiting toxicity (DLT) onset in patients treated with dabrafenib and/or trametinib and investigated whether plasma exposure was associated with RAI reuptake. Methods: We conducted a retrospective monocentric study in which we reviewed the electronic medical records of patients treated in our institution with a tumor redifferentiation strategy, for whom plasma concentration of dabrafenib, its active metabolite hydroxy-dabrafenib, and trametinib was measured. Trough concentrations (Cminpred) and total plasma drug exposure (area under the curve, AUC) of dabrafenib (AUCDAB), hydroxy-dabrafenib (AUCOHD), and trametinib (AUCTRA) were estimated. Results: Of the 22 patients treated in a redifferentiation strategy between March 2014 and December 2021, 15 were included in this study. A dabrafenib- or trametinib-related DLT was experienced by 8 (62%) and 9 (64%) patients, respectively. Patients who experienced a trametinib-related DLT exhibited a significantly higher last AUCTRA than the average AUCTRA of patients who had no DLT (390, IQR: 67 vs. 215, IQR: 91 ng/mL·h-1, respectively; p = 0.008). Patients who experienced a dabrafenib-related DLT had a higher AUCDAB than observed in other patients (9265 ng/mL·h-1 vs. 6953 ng/mL·h-1, respectively; p = 0.09). No clinical and demographical characteristic was associated with the DLT onset. Overall, 9 of 15 (60%) patients demonstrated tumor redifferentiation. Patients in whom RAI reuptake was achieved had significant lower AUCDAB (6990 ng/mL·h-1 vs. 9764 ng/mL·h-1, p = 0.014; respectively) compared with patients who did not. Moreover, the relative exposure ratio of AUCOHD/DAB was significantly higher in patients who achieved RAI reuptake (1.11 vs. 0.71, respectively; p = 0.0047). Conclusions: Our data suggest a relationship between DLT onset and trametinib plasma exposure, as well as an association between achievement of RAI reuptake and dabrafenib plasma exposure (AUC and ratio of AUCOHD/DAB). These data imply that the use of plasma drug monitoring could be helpful in guiding clinical practice in redifferentiation treatment.
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Affiliation(s)
- David Balakirouchenane
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, CARPEM, Paris, France
- UMR8038 CNRS, U1268 INSERM, Faculté de Pharmacie, Université Paris Cité, PRES Sorbonne Paris Cité, CARPEM, Paris, France
| | - Romain Seban
- Department of Medical Oncology, Hôpital Cochin, CARPEM, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Lionel Groussin
- Department of Endocrinology, Hopital Cochin, Assistance Publique-Hopitaux de Paris, Université Paris Cité, Paris, France
| | - Alicja Puszkiel
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, CARPEM, Paris, France
| | - Anne Ségolène Cottereau
- Department of Nuclear Medicine, Hopital Cochin, DMU Imagina, Assistance Publique-Hopitaux de Paris, Université Paris Cité, Paris, France
| | - Jerome Clerc
- Department of Nuclear Medicine, Hopital Cochin, DMU Imagina, Assistance Publique-Hopitaux de Paris, Université Paris Cité, Paris, France
| | - Michel Vidal
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, CARPEM, Paris, France
- UMR8038 CNRS, U1268 INSERM, Faculté de Pharmacie, Université Paris Cité, PRES Sorbonne Paris Cité, CARPEM, Paris, France
| | - Francois Goldwasser
- Department of Medical Oncology, Hôpital Cochin, CARPEM, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Jennifer Arrondeau
- Department of Medical Oncology, Hôpital Cochin, CARPEM, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Benoît Blanchet
- Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, CARPEM, Paris, France
- UMR8038 CNRS, U1268 INSERM, Faculté de Pharmacie, Université Paris Cité, PRES Sorbonne Paris Cité, CARPEM, Paris, France
| | - Olivier Huillard
- Department of Medical Oncology, Hôpital Cochin, CARPEM, Assistance Publique-Hopitaux de Paris, Paris, France
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12
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Duan SL, Wu M, Zhang ZJ, Chang S. The potential role of reprogrammed glucose metabolism: an emerging actionable codependent target in thyroid cancer. J Transl Med 2023; 21:735. [PMID: 37853445 PMCID: PMC10585934 DOI: 10.1186/s12967-023-04617-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
Although the incidence of thyroid cancer is increasing year by year, most patients, especially those with differentiated thyroid cancer, can usually be cured with surgery, radioactive iodine, and thyroid-stimulating hormone suppression. However, treatment options for patients with poorly differentiated thyroid cancers or radioiodine-refractory thyroid cancer have historically been limited. Altered energy metabolism is one of the hallmarks of cancer and a well-documented feature in thyroid cancer. In a hypoxic environment with extreme nutrient deficiencies resulting from uncontrolled growth, thyroid cancer cells utilize "metabolic reprogramming" to satisfy their energy demand and support malignant behaviors such as metastasis. This review summarizes past and recent advances in our understanding of the reprogramming of glucose metabolism in thyroid cancer cells, which we expect will yield new therapeutic approaches for patients with special pathological types of thyroid cancer by targeting reprogrammed glucose metabolism.
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Affiliation(s)
- Sai-Li Duan
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Min Wu
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Zhe-Jia Zhang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, 410008, Hunan, People's Republic of China.
| | - Shi Chang
- Department of General Surgery, Xiangya Hospital Central South University, Changsha, 410008, Hunan, People's Republic of China.
- Xiangya Hospital, National Clinical Research Center for Geriatric Disorders, Changsha, 410008, Hunan, People's Republic of China.
- Clinical Research Center for Thyroid Disease in Hunan Province, Changsha, 410008, Hunan, People's Republic of China.
- Hunan Provincial Engineering Research Center for Thyroid and Related Diseases Treatment Technology, Changsha, 410008, Hunan, People's Republic of China.
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13
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Xiao W, Hu X, Zhang C, Qin X. Ultrasonic Feature Prediction of Large-Number Central Lymph Node Metastasis in Clinically Node-Negative Solitary Papillary Thyroid Carcinoma. Endocr Res 2023; 48:112-119. [PMID: 37606889 DOI: 10.1080/07435800.2023.2249090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/12/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the preoperative prediction of large-number central lymph node metastasis (CLNM) in single thyroid papillary carcinoma (PTC) with negative clinical lymph nodes. METHODS A total of 634 patients with clinically lymph node-negative single PTC who underwent thyroidectomy and central lymph node dissection at the First Affiliated Hospital of Anhui Medical University and the Nanchong Central Hospital between September 2018 and September 2021 were analyzed retrospectively. According to the CLNM status, the patients were divided into two groups: small-number (≤5 metastatic lymph nodes) and large-number (>5 metastatic lymph nodes). Univariate and multivariate analyses were used to determine the independent predictors of large-number CLNM. Simultaneously, a nomogram based on risk factors was established to predict large-number CLNM. RESULTS The incidence of large-number CLNM was 7.7%. Univariate and multivariate analyses showed that age, tumor size, and calcification were independent risk factors for predicting large-number CLNM. The combination of the three independent predictors achieved an AUC of 0.806. Based on the identified risk factors that can predict large-number CLNM, a nomogram was developed. The analysis of the calibration map showed that the nomogram had good performance and clinical application. CONCLUSION In patients with single PTC with negative clinical lymph nodes large-number CLNM is related to age, size, and calcification in patients with a single PTC with negative clinical lymph nodes. Surgeons and radiologists should pay more attention to patients with these risk factors. A nomogram can help guide the surgical decision for PTC.
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Affiliation(s)
- Weihan Xiao
- Department of Ultrasound, Nanchong Central Hospital The second Clinical Medical College, North Sichuan Medical College, Nan Chong, Sichuan, China
| | - Xiaomin Hu
- Department of Ultrasound, Nanchong Central Hospital The second Clinical Medical College, North Sichuan Medical College, Nan Chong, Sichuan, China
| | - Chaoxue Zhang
- Department of Ultrasound, The first affiliated hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiachuan Qin
- Department of Ultrasound, Nanchong Central Hospital The second Clinical Medical College, North Sichuan Medical College, Nan Chong, Sichuan, China
- Department of Ultrasound, The first affiliated hospital of Anhui Medical University, Hefei, Anhui, China
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14
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Chen L, He Q, Tian H, Zhu Q, Shen Y, Fang Y, Zhu F, Zhu L, Chen L, Pan J, Du Y, Yan X, Zhang Q, Zhou X, Tian W, Wu Y. Sternomastoid intermuscular approach has better postoperative cosmesis and less neck discomfort than linea alba cervicalis approach in hemithyroidectomy: a randomized clinical trial. Int J Surg 2023; 109:2672-2679. [PMID: 37379168 PMCID: PMC10498877 DOI: 10.1097/js9.0000000000000505] [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: 08/29/2022] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Surgery is still the most important treatment method for thyroid cancer. The classic linea alba cervicalis approach caused obvious neck scarring. This study explored an alternative open operative approach with concealed incision for hemithyroidectomy, and demonstrated whether it was non-inferior to traditional approach in postoperative complications and operation efficiency. METHODS Patients ( n =220) from November 2019 to November 2020 willing to undergo hemithyroidectomy because of differentiated thyroid cancer were randomly divided into the sternocleidomastoid intermuscular approach (SMIA) group ( n =110), and the linea alba cervicalis approach (LACA) group ( n =110). The incidence of postoperative complications within 3 months and operation efficiency indicator R0 resection rate were recorded as primary endpoint, while scar apperance was assessed as secondary endpoint. The data were statistically analyzed. RESULTS The baseline data of these two groups were comparable, with no significant difference ( P >0.05). As primary endpoint, R0 resection rate was 100% in both groups. In the 1-month follow-up period, the SMIA group had a lower score for neck discomfort compared with that of the LACA group (1.01±0.1648 vs. 0.5657±0.0976, P =0.0217). The SMIA group's scar had better results from the observer scar assessment compared to that of the LACA group as secondary endpoint. Within the 3-month follow-up, the total complications were calculated, and it was demonstrated that SMIA was non-inferior to traditional LACA operation ( P of non-inferiority=0.0048). CONCLUSIONS Compared with LACA group, surgery through the SMIA is safe, effective, and has non-inferior postoperative complications. SMIA can be considered an alternative approach to classic LACA in hemithyroidectomy.
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Affiliation(s)
- Linghui Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qiwen He
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Hedi Tian
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qinsheng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yibin Shen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yun Fang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Feng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Lixian Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Liang Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jun Pan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yehui Du
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiaochuan Yan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qijun Zhang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xueyu Zhou
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, P.R. China
| | - Yijun Wu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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15
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Abstract
Background: Before the development of antithyroid drugs in the 1940s, treatment of Graves' hyperthyroidism was primarily surgical. Surgical mortality was quite variable, but a significant minority of patients died during or after surgery. Summary: In 1936, Karl Compton, President of the Massachusetts Institute of Technology, in a lecture attended by Massachusetts General Hospital physicians, suggested that artificially radioactive isotopes might be useful for studying metabolism. By 1942, Hertz and Roberts reported on the successful use of radioactive iodine (RAI) to treat Graves' hyperthyroidism. RAI uptake was subsequently demonstrated in well-differentiated thyroid cancer metastases. In 1948, Seidlin demonstrated stimulation of uptake in thyroid cancer metastases by thyrotropin (TSH). By 1990, 69% of endocrinologists in North America recommended RAI for Graves' hyperthyroidism. Currently RAI is less frequently used for Graves' hyperthyroidism, related to concerns about exacerbation of thyroid eye disease, about radiation exposure, and about potential adverse consequences of permanent hypothyroidism. Similarly, RAI was administered to the majority of patients with thyroid cancer for decades, but its use is now more selective. Conclusions: RAI is a remarkable example of interinstitutional cooperation between physicians and scientists to transition from bench to bedside in only three years. It is the model for a theranostic approach to disease (the simultaneous use of a radioactive drug for diagnosis and therapy). The future of RAI is less certain; inhibition of TSH receptor stimulating antibodies in Graves' disease and more precise targeting of genes that drive thyroid oncogenesis may diminish the use of RAI. Alternatively, redifferentiation techniques may improve the efficacy of RAI in RAI-refractory thyroid cancer.
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Affiliation(s)
- Gilbert H Daniels
- Thyroid Unit, Endocrine Tumor Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas S Ross
- Thyroid Unit, Endocrine Tumor Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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16
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Yang Z, Heng Y, Zhao Q, Hao D, Tao L, Deng X, Cai W, Qiu W. The proposed modification of TNM staging and therapeutic strategy for skip metastasis in papillary thyroid carcinoma: A multicenter retrospective cohort study. Cancer Med 2023. [PMID: 37140212 DOI: 10.1002/cam4.6018] [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: 11/29/2022] [Revised: 03/18/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Skip metastasis is a special type of lateral lymph node metastasis, which is not classified definitely by the eighth edition of the AJCC TNM staging system. The aim of the research was to study the prognosis of skip metastasis in PTC patients, and carry out a more appropriate N staging for skip metastasis. METHODS Study subjects were 3167 patients with papillary thyroid carcinoma (PTC), who underwent thyroidectomy at three clinical centers from 2016 to 2019. We identified two well-balanced cohorts matched on the basis of propensity score. RESULTS During a median follow-up of 42 months, recurrence occurred in 68 (4.3%) patients with lymph node metastasis. 34 cases recurred in 1120 patients with central lymph node metastasis (N1a), and 34 recurred in 461 patients with lateral lymph node metastasis (N1b), among which 73 patients were diagnosis with skip metastasis. The RFS of N1a was significantly lower than that of N1b (p < 0.001). After propensity-score matching, recurrence rate was significantly lower in the skip metastasis group than in the LLNM group (p = 0.039), whereas the rate was similar in the skip metastasis groups and the CLNM group (p = 0.29). CONCLUSIONS In conclusion, our study indicated that, among patients with LLNM, those with positive skip metastasis showed significantly lower recurrence, exhibiting a similar rucurrence tendency as patients with CLNM. Thus, skip metastasis could be categorized into N1a stage rather than N1b stage based on the AJCC TNM staging system. The downstaging of skip metastasis may reveal more conservative treatment strategy.
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Affiliation(s)
- Zheyu Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu Heng
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Qiwu Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ding Hao
- Department of General Surgery, Civil Aviation Shanghai Hospital, Shanghai, China
| | - Lei Tao
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Xiaxing Deng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of General Surgery, Civil Aviation Shanghai Hospital, Shanghai, China
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17
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Li Q, Feng T, Zhu T, Zhang W, Qian Y, Zhang H, Zheng X, Li D, Yun X, Zhao J, Li Y, Yu H, Gao M, Qian B. Multi-omics profiling of papillary thyroid microcarcinoma reveals different somatic mutations and a unique transcriptomic signature. J Transl Med 2023; 21:206. [PMID: 36941725 PMCID: PMC10026500 DOI: 10.1186/s12967-023-04045-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/08/2023] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND Papillary thyroid microcarcinoma (PTMC) incidence has significantly increased, and some cases still exhibit invasive traits. The entire molecular landscape of PTMC, which can offer hints for the etiology of cancer, is currently absent. METHODS We compared our findings with those for PTMC in the TCGA by analyzing the largest study at the current stage of whole exome sequencing and RNA-sequencing data from 64 patients with PTMC. Then, we systematically demonstrated the differences between the two PTMC subtypes based on multi-omics analyses. Additionally, we created a molecular prediction model for the PTMC subtypes and validated them among TCGA patients for individualized integrative assessment. RESULTS In addition to the presence of BRAF mutations and RET fusions in the TCGA cohort, we also discovered a new molecular signature named PTMC-inflammatory that implies a potential response to immune intervention, which is enriched with AFP mutations, IGH@-ext fusions, elevated immune-related genes, positive peroxidase antibody, and positive thyroglobulin antibody. Additionally, a molecular prediction model for the PTMC-inflammatory patients was created and validated among TCGA patients, while the prognosis for these patients is poor. CONCLUSIONS Our findings comprehensively define the clinical and molecular features of PTMC and may inspire new therapeutic hypotheses.
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Affiliation(s)
- Qiang Li
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, 277 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - Tienan Feng
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, 277 South Chongqing Road, Huangpu District, Shanghai, 200025, China
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tengteng Zhu
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, 277 South Chongqing Road, Huangpu District, Shanghai, 200025, China
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Weituo Zhang
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, 277 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - Ying Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, 277 South Chongqing Road, Huangpu District, Shanghai, 200025, China
| | - Huan Zhang
- Cancer Prevention Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xiangqian Zheng
- Cancer Prevention Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Dapeng Li
- Cancer Prevention Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xinwei Yun
- Cancer Prevention Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Jingzhu Zhao
- Cancer Prevention Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Yangyang Li
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Herbert Yu
- Cancer Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Ming Gao
- Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, Tianjin, Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, Tianjin, 300121, China.
- Department of Head and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China.
| | - Biyun Qian
- Hongqiao International Institute of Medicine, Shanghai Tongren Hospital and School of Public Health, Shanghai Jiao Tong University School of Medicine, 277 South Chongqing Road, Huangpu District, Shanghai, 200025, China.
- Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, 200072, China.
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Expanding the Spectrum of BRAF Non-V600E Mutations in Thyroid Nodules: Evidence-Based Data from a Tertiary Referral Centre. Int J Mol Sci 2023; 24:ijms24044057. [PMID: 36835466 PMCID: PMC9958561 DOI: 10.3390/ijms24044057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
The BRAF p.V600E mutation represents the most specific marker for papillary thyroid carcinoma and is potentially related to aggressive behavior and persistent disease. BRAF alterations other than the p.V600E are less common in thyroid carcinoma and represent an alternative mechanism of BRAF activation with unclear clinical significance. The study aims to describe the frequency and clinicopathologic characteristics of BRAF non-V600E mutations in a large cohort (1654 samples) of thyroid lesions characterized by next-generation sequencing. BRAF mutations have been found in 20.3% (337/1654) of thyroid nodules, including classic (p.V600E) mutation in 19.2% (317/1654) of samples and non-V600E variants in 1.1% of cases (19/1654). BRAF non-V600E alterations include 5 cases harboring p.K601E, 2 harboring p.V600K substitutions, 2 with a p.K601G variant, and 10 cases with other BRAF non-V600E alterations. BRAF non-V600E mutations have been reported in one case of follicular adenoma, three cases of conventional papillary thyroid carcinoma, eight cases of follicular variant of papillary carcinomas, one case of columnar cell variant papillary thyroid carcinoma, one case of oncocytic follicular carcinoma, and two bone metastasis of follicular thyroid carcinoma. We confirm that BRAF non-V600E mutations are uncommon and typically found in indolent follicular-patterned tumors. Indeed, we show that BRAF non-V600E mutations can be found in tumors with metastatic potential. However, in both aggressive cases, the BRAF mutations were concomitant with other molecular alterations, such as TERT promoter mutation.
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Krajewska J, Kukulska A, Samborski K, Czarniecka A, Jarzab B. Lobo-isthmectomy in the management of differentiated thyroid cancer. Thyroid Res 2023; 16:4. [PMID: 36775829 PMCID: PMC9923929 DOI: 10.1186/s13044-022-00145-1] [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: 01/16/2022] [Accepted: 12/21/2022] [Indexed: 02/14/2023] Open
Abstract
We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-term survival prompted researchers and experts to an ongoing discussion on the adequacy of DTC management to avoid, on the one hand, the overtreatment of low-risk cases and, on the other hand, the undertreatment of highly aggressive ones.The most recent guidelines of the American Thyroid Association (ATA GL) moved primary thyroid surgery in DTC towards a less aggressive approach by making lobectomy an option for patients with intrathyroidal low-risk DTC tumors up to 4 cm in diameter without evidence of extrathyroidal extension or lymph node metastases. It was one of the key changes in DTC management proposed by the ATA in 2015.Following the introduction of the 2015 ATA GL, the role of thyroid lobectomy in DTC management has slowly become increasingly important. The data coming from analyses of the large databases and retrospective studies prove that a less extensive surgical approach, even if in some reports it was related to a slight increase of the risk of recurrence, did not show a negative impact on disease-specific and overall survival in T1T2N0M0 low-risk DTC. There is no doubt that making thyroid lobectomy an option for low-risk papillary and follicular carcinomas was an essential step toward the de-escalation of treatment in thyroid carcinoma.This review summarizes the current recommendations and evidence-based data supporting the necessity of de-escalation of primary thyroid surgery in low-risk DTC. It also discusses the controversies raised by introducing new ATA guidelines and tries to resolve some open questions.
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Affiliation(s)
- Jolanta Krajewska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102, Gliwice, Poland.
| | - Aleksandra Kukulska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland ,Radiotherapy Department, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Konrad Samborski
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland
| | - Agnieszka Czarniecka
- Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland
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Kiss A, Szili B, Bakos B, Ármós R, Putz Z, Árvai K, Kocsis-Deák B, Tobiás B, Balla B, Pikó H, Dank M, Kósa JP, Takács I, Lakatos P. Comparison of surgical strategies in the treatment of low-risk differentiated thyroid cancer. BMC Endocr Disord 2023; 23:23. [PMID: 36703169 PMCID: PMC9881362 DOI: 10.1186/s12902-023-01276-8] [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: 10/15/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
CONTEXT Increasing diagnostic sensitivity in the detection of thyroid cancer has led to uncertainties in the optimal surgical approach of the smaller, low risk tumors. Current ATA guidelines consider lobectomy safe between 1 and 4 cm, while ETA advocates for primary total thyroidectomy to avoid reoperation, as final risk stratification is based on the histological results. OBJECTIVE Our aim was to compare the differences in outcomes that are potentially achievable with adherence to the different guidelines, and also to examine the predictive value of clinical parameters on the incidence of postoperative risk factors. METHODS We performed a retrospective cohort database analysis to identify the different surgical outcomes (based on postoperative risk factors) using ATA and ETA guidelines; the hypothetical rate of completion thyroidectomy when ATA or ETA recommends lobectomy; the accuracy of our preoperative evaluation; the utility of preoperative findings in predicting the optimal surgical strategy using binary logistic regression. RESULTS Out of 248 patients, 152 (ATA) and 23 (ETA) cases would have been recommended for initial lobectomy. Following the guidelines, a postoperative risk factor would have been present in 61.8, and 65.2% of the cases, respectively. Except for angioinvasion, tumor size was not a significant predictor for the presence of postoperative risk factors. CONCLUSION Current pre-operative criteria are inadequate to accurately determine the extent of initial surgery and our postoperative findings verify the frequent need for completion thyroidectomy using both guidelines. As a consequence, in the absence of effective pre-operative set of criteria, we advocate primary total thyroidectomy in most cases.
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Affiliation(s)
- András Kiss
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary.
| | - Balázs Szili
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Bence Bakos
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Richárd Ármós
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Zsuzsanna Putz
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Kristóf Árvai
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Barbara Kocsis-Deák
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Bálint Tobiás
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Bernadett Balla
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Henriett Pikó
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Magdolna Dank
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - János Pál Kósa
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - István Takács
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
| | - Péter Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary
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Song Z, Li Q, Zhang D, Li X, Yu J, Liu Q, Li Z, Huang J, Zhang X, Tang Z. Nomogram based on spectral CT quantitative parameters and typical radiological features for distinguishing benign from malignant thyroid micro-nodules. Cancer Imaging 2023; 23:13. [PMID: 36703218 PMCID: PMC9878766 DOI: 10.1186/s40644-023-00525-2] [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: 09/25/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To analyse the predictive effect of a nomogram combining dual-layer spectral computed tomography (DSCT) quantitative parameters with typical radiological features in distinguishing benign micro-nodule from thyroid microcarcinoma (TMC). METHODS Data from 342 instances with thyroid micro-nodules (≤1 cm) who underwent DSCT (benign group: n = 170; malignant group: n = 172) were reviewed. Typical radiological features including micro-calcification and enhanced blurring, and DSCT quantitative parameters including attenuation on virtual monoenergetic images (40 keV, 70 keV and 100 keV), the slope of the spectral HU curve (λHU), normalized iodine concentration (NIC), and normalized effective atomic number (NZeff) in the arterial phase (AP) and venous phase (VP), were measured and compared between the benign and malignant groups. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of significant quantitative DSCT parameters or the models combining DSCT parameters respectively and typical radiological features based on multivariate logistic regression (LR) analysis. A nomogram was developed using predictors with the highest diagnostic performance in the above model, as determined by multivariate LR analysis. RESULTS The DSCT parameter APλHU showed the greatest diagnostic efficiency in identifying patients with TMC, with an area under the ROC curve (AUC) of 0.829, a sensitivity and specificity of 0.738 and 0.753, respectively. Then, APλHU was combined with the two radiological features to construct the DSCT-Radiological nomogram, which had an AUC of 0.858, a sensitivity of 0.791 and a specificity of 0.800. The calibration curve of the nomogram demonstrated that the prediction result was in good agreement with the actual observation. The decision curve revealed that the nomogram can result in a greater net benefit than the all/none-intervention strategy for all threshold probabilities. CONCLUSION As a valid and visual noninvasive prediction tool, the DSCT-Radiological nomogram incorporating DSCT quantitative parameters and radiological features shows favourable predictive efficiency for identifying benign and malignant thyroid micro-nodules.
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Affiliation(s)
- Zuhua Song
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Qian Li
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Qian Liu
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Zongwen Li
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Jie Huang
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
| | - Xiaodi Zhang
- Philips Healthcare, Chengdu branch, Chengdu, China
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, No.118, Xingguang Avenue, Liangjiang New Area, Chongqing, 401147 China
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Dralle H, Weber F, Machens A, Brandenburg T, Schmid KW, Führer-Sakel D. [Hemithyroidectomy or total thyroidectomy for low-risk papillary thyroid cancer? : Surgical criteria for primary and secondary choice of treatment in an interdisciplinary treatment concept]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:79-92. [PMID: 36121448 DOI: 10.1007/s00104-022-01726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/21/2023]
Abstract
The increase in small intrathyroid papillary thyroid cancer (PTC) observed worldwide over the past two decades, with no increase in cancer-specific mortality, has challenged the previous concept of total thyroidectomy as a one-size-fits-all panacea. After exclusion of papillary microcarcinomas, a systematic review of 20 clinical studies published since 2002, which compared hemithyroidectomy (HT) to total thyroidectomy (TT), found comparable long-term oncological outcomes for low-risk papillary thyroid cancer (LRPTC) 1-4 cm in diameter, whereas postoperative complication rates were markedly lower for HT. To refine individual treatment plans, HT should be combined with ipsilateral central lymph node dissection and intraoperative frozen section analysis for staging. Based on recent evidence from studies and in consideration of individual risk factors, patients with LRPTC can be offered the concept of HT as an alternative to the standard TT. A prerequisite for the treatment selection and decision is a comprehensive patient clarification of the possible advantages and disadvantages of both approaches.
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Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - F Weber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Machens
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - T Brandenburg
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - K W Schmid
- Institut für Pathologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Führer-Sakel
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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Lymph node thyroglobulin in the diagnosis of metastases of thyroid carcinoma with the thyroid in situ: A prospective intraoperative study. Eur J Surg Oncol 2022; 49:760-763. [PMID: 36564333 DOI: 10.1016/j.ejso.2022.12.007] [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: 11/11/2022] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The use of thyroglobulin concentration in washout fluid of fine-needle aspiration (FNA-Tg) is a procedure advocated by international guidelines to diagnose metastatic LN in papillary thyroid cancer. With the increasing use of active follow-up or lobectomy alone for low-risk thyroid cancers, the determination of the diagnostic performance of FNA-Tg in the detection of metastatic PTC when the thyroid is in situ is paramount. MATERIALS AND METHODS Prospective study with measurement of Tg in washout fluid obtained from intraoperative fine needle aspiration (FNA) cytology in order to avoid contamination from thyroid tissue and rigorously isolated punctured nodes. Receiver-operating characteristic (ROC) curve and area under the curve (AUC), optimal threshold to discriminate benign and malignant LN, sensitivity and specificity were provided. RESULTS a total of 58 lymph nodes from 32 patients were analyzed. ROC analysis defined the optimal cutoff values of FNA-Tg at 60 ng/ml for the diagnosis of malignant LNs in patients with a thyroid in situ. Sensitivity and specificity were 75% (95% confidence interval 57.89-86.75) and 87.5% (95%CI: 69-95.66), respectively. CONCLUSION Our results support the hypothesis that the Tg-FNA threshold for a safe diagnosis of LN metastasis in PTC is higher in presence of a thyroid gland in situ. The use of lower thresholds could result in false positive results and lead to unnecessary surgery.
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Stramazzo I, Capriello S, Antonelli A, Fallahi P, Centanni M, Virili C. Seeking optimization of LT4 treatment in patients with differentiated thyroid cancer. Hormones (Athens) 2022; 21:537-543. [PMID: 35655116 PMCID: PMC9712340 DOI: 10.1007/s42000-022-00376-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/19/2022] [Indexed: 12/25/2022]
Abstract
Levothyroxine sodium (LT4) is the mainstay treatment to replace thyroid hormonal production in thyroidectomized patients, but, depending on the aggressiveness of the cancer and on the risk of recurrence, patients with differentiated thyroid cancer may also be treated in a TSH-suppressive or semi-suppressive mode. The pathophysiological rationale for this LT4 treatment stems from the role of TSH, considered to be a growth factor for follicular cells, potentially inducing initiation or progression of follicular cell-derived thyroid cancer. Therefore, accurate tailoring of treatment, taking into account both patient characteristics (age and comorbidities) and risk of persistent/recurrent disease, is highly recommended. Furthermore, adjustments to traditional LT4 treatment should be made in thyroidectomized patients due to the lack of thyroidal contribution to whole body triiodothyronine (T3) concentration. Since LT4 exhibits a narrow therapeutic index and the side effects of over- and under-treatment could be deleterious, particularly in this category of patients, caution is required in dose individualization, in the mode of ingestion, and in potential pharmacological and other types of interference as well. Our aim was to analyze the current knowledge concerning LT4 dose requirements in patients with thyroid cancer according to different therapeutic approaches, taking into account a number of factors causing interference with LT4 efficacy. Specific mention is also made about the use of the novel LT4 formulations.
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Affiliation(s)
- Ilaria Stramazzo
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy
- Endocrine Unit, AUSL Latina, Latina, Italy
| | | | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy.
- Endocrine Unit, AUSL Latina, Latina, Italy.
| | - Camilla Virili
- Department of Medico-Surgical Sciences and Biotechnologies, ''Sapienza'' University of Rome, Latina, Italy
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Chen Z, Guo ML, Li YY, Yan K, Li L, Shen F, Guan H, Liu QZ, Xu B, Lian ZX. Immune profiling identifies CD8+ T-cell subset signatures as prognostic markers for recurrence in papillary thyroid cancer. Front Immunol 2022; 13:894919. [PMID: 36420264 PMCID: PMC9676940 DOI: 10.3389/fimmu.2022.894919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Background Thyroid tissue has a special immune microenvironment that is not well characterized. Whether immune cells have a prognostic value in the recurrence of papillary thyroid cancer (PTC) needs further investigation. Methods Multinodular non-toxic goiter (MNG) was taken as normal tissue for the difficulty in obtaining completely normal thyroid tissue (normal thyroid function, no thyroiditis, and no nodules). We compared the composition of mononuclear cells (MNCs) in peripheral blood and thyroid tissues from MNG and PTC patients by high-dimensional flow cytometry profiling and verified the results by multiplex immunohistochemistry. The recurrence rates of PTC patients with different CD8+T cell subset signatures were compared using TCGA database. Results We observed that the immune cell composition of MNG was different from that in peripheral blood. Thyroid tissue contains higher percentages of T cells and NK cells. Moreover, the percentages of memory T cells and Treg cells were higher in thyroid than in peripheral blood and increased in PTC tumors. We further focused on the antitumoral CD8+T cells and found that the expression patterns of PD-1, CD39, and CD103 on CD8+T cells were different between MNG and PTC. Importantly, we found higher percentages of PD-1+CD39+CD103+CD8+T and PD-1+CD39+CD103-CD8+T cells in PTC tumor tissues from recurrent patients than non-recurrent patients. By analyzing PTC data from TCGA database, we found that the expression patterns of these molecules were associated with different pathologic types and genders among PTC patients. Moreover, patients with PD-1hiCD39loCD103hiCD8hi, PD-1hiCD39hiCD103loCD8hi, and PD-1loCD39hiCD103hiCD8hi expression patterns have a higher 10-year recurrence-free survival. Conclusion The immune microenvironment in MNG tissue is distinct from that in peripheral blood and paratumor tissue. More memory CD8+T cells were detected in PTC, and expression patterns of PD-1, CD39, and CD103 on CD8+T cells were significantly different in physiology and gender and associated with the recurrence rate of PTC. These observations indicate that CD8+T cell signatures may be useful prognostic markers for PTC recurrence.
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Affiliation(s)
- Zhen Chen
- Department of Thyroid Surgery, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Meng-Li Guo
- Department of Thyroid Surgery, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Ya-Yi Li
- Department of Thyroid Surgery, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Kai Yan
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Liang Li
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Fei Shen
- Department of Thyroid Surgery, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Qing-Zhi Liu
- Chronic Disease Laboratory, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- *Correspondence: Bo Xu, ; Qing-Zhi Liu,
| | - Bo Xu
- Department of Thyroid Surgery, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Bo Xu, ; Qing-Zhi Liu,
| | - Zhe-Xiong Lian
- Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Prediction of Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma by CT Radiomics. Acad Radiol 2022:S1076-6332(22)00493-7. [PMID: 36220726 DOI: 10.1016/j.acra.2022.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/22/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To explore the feasibility of the preoperative prediction of pathological central lymph node metastasis (CLNM) status in patients with negative clinical lymph node (cN0) papillary thyroid carcinoma (PTC) using a computed tomography (CT) radiomics signature. MATERIALS AND METHODS A total of 97 PTC cN0 nodules with CLNM pathology data (pN0, with CLNM, n = 59; pN1, without CLNM, n = 38) in 85 patients were divided into a training set (n = 69) and a validation set (n = 28). For each lesion, 321 radiomic features were extracted from nonenhanced, arterial and venous phase CT images. Minimum redundancy and maximum relevance and the least absolute shrinkage and selection operator were used to find the most important features with which to develop a radiomics signature in the training set. The performance of the radiomics signature was evaluated by receiver operating characteristic curves, calibration curves and decision curve analysis . RESULTS Three nonzero the least absolute shrinkage and selection operator coefficient features were selected for radiomics signature construction. The radiomics signature for distinguishing the pN0 and pN1 groups achieved areas under the curve of 0.79 (95% CI 0.67, 0.91) in the training set and 0.77 (95% CI 0.55, 0.99) in the validation set. The calibration curves demonstrated good agreement between the radiomics score-predicted probability and the pathological results in the two sets (p= 0.399, p = 0.191). The decision curve analysis curves showed that the model was clinically useful. CONCLUSION This radiomic signature could be helpful to predict CLNM status in cN0 PTC patients.
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Hassan MAE, El-Gharieb HA, Nasr M, Abdelhay WM, Yousef TSM, El-Zamek HMF, Zidan AM, Nady M, Abdel-Kareem MA, Hasan A. Potential Association between Subclinical Hypothyroidism and Childhood Migraine. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101346. [PMID: 36295508 PMCID: PMC9610765 DOI: 10.3390/medicina58101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Migraine is caused by genetic susceptibility that is triggered by environmental as well as biological factors, and it is also linked to many somatic comorbidities, including clinical and subclinical hypothyroidism. We aimed to estimate the potential association between subclinical hypothyroidism (ScH) and migraine in children at our tertiary hospital. Materials and Methods: Using a case−control strategy, 200 children and adolescents were assigned to two equal groups: a case group (patients with migraine) of 100 patients and a control group of 100 patients without migraine. Clinical and biochemical parameters (TSH, FT4) were compared between the groups using statistical analysis. Results: Thyroid function comparison between the groups showed higher TSH but normal FT4 among children with migraine headache compared to the control group, which means more frequent ScH cases among the migraine group relative to the control (17% vs. 2%, p < 0.001). Obesity and overweight were more frequent among patients with migraine than the control group (8 and 5% vs. 2 and 1%, respectively). The (overweight/obese) patients with migraine had about 77% ScH and 15.4% overt hypothyroidism compared to 8% ScH and no overt hypothyroidism among normal body weight migraine patients (p < 0.001). No significant difference in the prevalence of nodular goiter between patients with migraine and controls was found. Conclusions: Based on our results, subclinical hypothyroidism is significantly linked to childhood migraine. Obesity and being overweight are more frequent among patients with migraine. Therefore, it may be logical to test the thyroid function in migraineur children, especially those with high BMI. Further studies are recommended to discover the mechanism of this association in children.
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Affiliation(s)
| | | | - Mohamed Nasr
- Histology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Wagih M. Abdelhay
- Histology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | | | | | - Ahmed M. Zidan
- Radio-diagnosis Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mohamed Nady
- Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
| | - Mona A. Abdel-Kareem
- Anatomy Department, Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh 33516, Egypt
| | - Abdulkarim Hasan
- Departments of Pathology, Faculty of Medicine, Al-Azhar University, Cairo 11884, Egypt
- Correspondence: or ; Tel.: +20-002-022-4012-932
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Alexander EK, Cibas ES. Diagnosis of thyroid nodules. Lancet Diabetes Endocrinol 2022; 10:533-539. [PMID: 35752200 DOI: 10.1016/s2213-8587(22)00101-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 12/22/2022]
Abstract
Thyroid nodules are common, usually asymptomatic, and often pose minimal risk to the affected patient. However, 10-15% prove malignant and serve as the rationale for diagnostic assessment. Safely identifying and treating a relevant thyroid cancer through a cost-effective process is the primary goal of the treating practitioner. Ultrasound is the principal means of initial nodule assessment and should be performed when any thyroid nodule is suspected. Fine-needle aspiration provides further cytological determination of benign or malignant disease and is generally applied to nodules larger than 1-2 cm in diameter, on the basis of holistic risk assessment. The Bethesda System for Reporting Thyroid Cytopathology provides standardised terminology, which enhances communication among health-care providers and patients. Benign cytology is highly accurate, whereas indeterminate cytology could benefit from further application of molecular testing. The ultimate goal of diagnostic assessment of thyroid nodules is to accurately identify malignancy while avoiding overtreatment. Low-risk thyroid nodules can be safely monitored in many patients with minimal diagnostic intervention.
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Affiliation(s)
- Erik K Alexander
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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29
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Reinecke MJ, Ahlers G, Burchert A, Eilsberger F, Flux GD, Marlowe RJ, Mueller HH, Reiners C, Rohde F, van Santen HM, Luster M. Second primary malignancies induced by radioactive iodine treatment of differentiated thyroid carcinoma - a critical review and evaluation of the existing evidence. Eur J Nucl Med Mol Imaging 2022; 49:3247-3256. [PMID: 35320386 PMCID: PMC9250458 DOI: 10.1007/s00259-022-05762-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/11/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE Concern is growing about long-term side effects of differentiated thyroid cancer treatment, most notably radioactive iodine (RAI) therapy. However, published studies on the subject have had heterogeneous cohorts and conflicting results. This review seeks to provide an updated evaluation of published evidence, and to elucidate the risk of second primary malignancies (SPMs), especially secondary hematologic malignancies (SHMs), attributable to RAI therapy. METHODS An extensive literature search was performed in Ovid MEDLINE, Ovid MEDLINE and In-Process & Other Non-Indexed Citations, Ovid MEDLINE Epub Ahead of Print, Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed. Studies regarding RAI-induced SPMs or a dose-response relationship between RAI therapy and SPMs were identified, 10 of which were eligible for the analysis. We evaluated risk of bias in each study and judged quality of evidence (QOE) across all studies using the Grading of Recommendations, Assessment, Development and Evaluations approach. RESULTS For the outcome "SPM", the relative effect (relative risk, hazard ratio, or odds ratio) of RAI vs. no RAI ranged from 1.14 to 1.84 across studies, but most results were not statistically significant. For the outcome "SHM", reported relative effects ranged from 1.30 to 2.50, with 2/3 of the studies presenting statistically significant results. In 7/8 of the studies, increased risk for SPM was shown with increasing cumulative RAI activity. QOE was "very low" regarding SPM after RAI and regarding a dose-response relationship, and "low" for SHM after RAI. CONCLUSION Based on low quality evidence, an excess risk for the development of SPM cannot be excluded but is expected to be small.
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Affiliation(s)
| | - Gerrit Ahlers
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Andreas Burchert
- Department of Internal Medicine, Hematology, Oncology and Immunology, University Hospital Marburg, Marburg, Germany
| | | | - Glenn D Flux
- Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | | | - Hans-Helge Mueller
- Institute for Medical Bioinformatics and Biostatistics, Philipps University of Marburg, Marburg, Germany
| | - Christoph Reiners
- Department of Nuclear Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Fenja Rohde
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Hanneke M van Santen
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany.
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30
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Shi ZY, Zhang SX, Fan D, Li CH, Cheng ZH, Xue Y, Wu LX, Lu KY, Yang SY, Cheng Y, Wu ZF, Gao C, Li XF, Liu HY, Li SJ. Dynamic Immune Function Changes Before and After the First Radioactive Iodine Therapy After Total Resection of Differentiated Thyroid Carcinoma. Front Immunol 2022; 13:901263. [PMID: 35844520 PMCID: PMC9280633 DOI: 10.3389/fimmu.2022.901263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
The effects of total thyroidectomy or radioactive iodine therapy on immune activation and suppression of the tumor microenvironment remain unknown. We aimed to investigate the effects of these treatments on the immune function in patients with differentiated thyroid carcinoma (DTC). Our cohort included 45 patients with DTC treated with total thyroidectomy and radioactive iodine therapy (RAIT). Immune function tests were performed by flow cytometry at 0, 30, and 90 days post-RAIT. Both the percentage and absolute number of circulating regulatory T cells were significantly lower in the postoperative DTC compared to the healthy controls. Notably, the absolute number of multiple lymphocyte subgroups significantly decreased at 30 days post-RAIT compared to those pre-RAIT. The absolute counts of these lymphocytes were recovered at 90 days post-RAIT, but not at pre-RAIT levels. Additionally, the Th17 cell percentage before RAIT was positively correlated with thyroglobulin (Tg) levels after RAIT. The tumor burden might contribute to increased levels of circulating Tregs. In conclusion, RAIT caused transient radiation damage in patients with DTC and the percentage of Th17 cells before RAIT could be a significant predictor of poor prognosis in patients with DTC.
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Affiliation(s)
- Zhi-Yong Shi
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Sheng-Xiao Zhang
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, China
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Di Fan
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Cai-Hong Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhe-Hao Cheng
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Xue
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Li-Xiang Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ke-Yi Lu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Su-Yun Yang
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Cheng
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhi-Fang Wu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Chong Gao
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Xiao-Feng Li
- Department of Rheumatology, Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hai-Yan Liu
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Hai-Yan Liu, ; Si-Jin Li,
| | - Si-Jin Li
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Collaborative Innovation Center for Molecular Imaging of Precision Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, China
- *Correspondence: Hai-Yan Liu, ; Si-Jin Li,
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31
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van Velsen EFS, Leung AM, Korevaar TIM. Diagnostic and Treatment Considerations for Thyroid Cancer in Women of Reproductive Age and the Perinatal Period. Endocrinol Metab Clin North Am 2022; 51:403-416. [PMID: 35662449 DOI: 10.1016/j.ecl.2021.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Thyroid cancer is one of the most common cancers diagnosed in women of reproductive age and during pregnancy. This leads to important questions about thyroid cancer prognosis and treatment, but also fertility and risk for adverse obstetric and/or fetal and neonatal outcomes. The benefits of thyroid cancer treatment should be weighed against its harms, as various options may adversely impact maternal and fetal health. In the current review, the authors focus on perinatal-specific clinical considerations related to the care of patients with thyroid cancer.
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Affiliation(s)
- Evert F S van Velsen
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Dr Molewaterplein 40, 3015 CE, Rotterdam, The Netherlands.
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, 100 Medical Plaza, Suite 310, Los Angeles, CA 90095, USA; Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (111D), Los Angeles, CA 90073, USA
| | - Tim I M Korevaar
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Dr Molewaterplein 40, 3015 CE, Rotterdam, The Netherlands
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32
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Health Anxiety and Its Relationship to Thyroid-Hormone-Suppression Therapy in Patients with Differentiated Thyroid Cancer. Cancers (Basel) 2022; 14:cancers14102349. [PMID: 35625954 PMCID: PMC9140054 DOI: 10.3390/cancers14102349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Differentiated thyroid cancer (DTC) has a good prognosis; however, patients often need lifelong follow up, and they face potential side effects. The aim of this study was to investigate health anxiety among DTC patients and its relationship to TSH suppression. In 2020, patients from a previous cohort who were from Stockholm completed the 14-item Short Health Anxiety Inventory (SHAI-14; 0−42; 18 being the threshold for clinical significance) and a study-specific questionnaire. Clinical information was also retrieved from medical records. Linear regression was used to investigate the relationship between the TSH levels and the SHAI-14, while adjusting for potential confounders. In total, 146 (73%) patients were included. A total of 24 respondents (16%) scored 18 or more on the SHAI-14, and the mean score was 11.3. Patients with TSH levels of 0.1−0.5 (mE/L) scored, on average, 3.28 points more (p-value 0.01) on the SHAI-14 compared to patients with TSH levels > 0.5. There was no statistically significant difference between patients with TSH levels < 0.1 and TSH levels > 0.5. Thus, we found no linear relationship between the TSH values and health anxiety. Clinically significant levels of health anxiety are slightly higher than those in the general population, but do not appear to be a major psychiatric comorbidity among patients with DTC.
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Schmidt M, Bartenstein P, Bucerius J, Dietlein M, Drzezga A, Herrmann K, Lapa C, Lorenz K, Musholt TJ, Nagarajah J, Reiners C, Sahlmann CO, Kreissl MC. Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy - A German position paper from Surgery and Nuclear Medicine. Nuklearmedizin 2022; 61:87-96. [PMID: 35299276 DOI: 10.1055/a-1783-8154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A consensus statement about indications for post-surgical radioiodine therapy (RIT) in differentiated thyroid cancer patients (DTC) was recently published by the European Thyroid Association (ETA) 1. This publication discusses indications for RIT on the basis of an individual risk assessment. Many of the conclusions of this consensus statement are well founded and accepted across the disciplines involved. However, especially from the perspective of nuclear medicine, as the discipline responsible for indicating and executing RIT, some of the recommendations may require further clarification with regard to their compatibility with established best practice and national standards of care. Assessment of the indications for RIT is strongly dependent on the weighing up of benefits and risks. On the basis of longstanding clinical experience in nuclear medicine, RIT represents a highly specific precision medicine procedure of proven efficacy with a favorable side-effect profile. This distinguishes RIT significantly from other adjuvant oncological therapies and has resulted in the establishment of this procedure as a usually well-tolerated, standard safety measure. With regard to its favorable risk/benefit ratio, this procedure should not be unnecessarily restricted, in the interest of offering reassurance to the patients. Both patients' interests and regional/national differences need to be taken into account. We would therefore like to comment on the recent consensus from the perspective of authors and to provide recommendations based on the respective published data.
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Affiliation(s)
- Matthias Schmidt
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.).,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Jan Bucerius
- Department of Nuclear Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany.,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Constantin Lapa
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Member of the Board, German Society of Nuclear Medicine (DGN e. V.)
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University of Halle Wittenberg, Faculty of Medicine, Halle, Germany.,Member of the surgical working group for endocrinology (CAEK) of the German society for general and visceral surgery (DGAV)
| | - Thomas J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.,Member of the surgical working group for endocrinology (CAEK) of the German society for general and visceral surgery (DGAV)
| | - James Nagarajah
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherland.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.).,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Christoph Reiners
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Carsten O Sahlmann
- Department of Nuclear Medicine, University Medical Center Göttingen, Göttingen, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.)
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Effect of Levothyroxine Sodium Tablets on Pregnancy Outcome and Offspring Development Quotient of SCH during Pregnancy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9001881. [PMID: 35388329 PMCID: PMC8979691 DOI: 10.1155/2022/9001881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/19/2022] [Accepted: 01/22/2022] [Indexed: 11/17/2022]
Abstract
Objective. To investigate the effect of levothyroxine sodium tablets (L-T4) on pregnancy outcome and offspring development quotient in patients with subclinical hypothyroidism (SCH) during pregnancy. Material and Methods. Pregnant women with gestational age less than 12 weeks who underwent the first prenatal examination in our hospital from January 2019 to December 2019 were prospectively selected as subjects. According to the level of thyroid hormone in pregnant women, they were divided into the treatment group (n = 63) and received L-T4 treatment, untreated group (n = 64), and control group (n = 54). Three groups of pregnancy outcomes, children’s physical development, and the development of offspring were compared at when one full year of life. Results. After treatment, the contrast difference of the three groups about abortion and gestational diabetes mellitus (GDM) was statistically significant (
). The abortion rate and gestational diabetes mellitus (GDM) in the untreated group were higher than those in the control group (
). The contrast difference of the treatment group and control group about abortion and gestational diabetes mellitus (GDM) is not statistically significant (
); The contrast difference of the three groups about a filial generation at birth and one-year-old body length is not statistically significant (
). The contrast difference between the three groups of individual children who are one-year old having the individual action energy, material ability, speech ability, and human ability is statistically significant (
). One-year-old developmental quotient (DQ) of the treatment group and control group was higher than that of the untreated group (
); the Pearson correlation analysis showed that the treatment group TSH levels have no correlation between the offspring developmental quotient (DQ) level of one-year-old children (
). Conclusion. Levothyroxine sodium tablets (L-T4) can not only improve the pregnancy outcome of patients with SCH during pregnancy but also play a positive role in improving the neurointellectual development of their offspring.
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Lai L, Liu Z, Zhang J, Ni X, Liu J, Luo T, Dong Y, Zhou J. Effect of Hashimoto's thyroiditis on the extent of the ablation zone in early stages of ultrasound-guided radiofrequency ablation for papillary thyroid microcarcinoma: a large cohort study of 772 patients. Int J Hyperthermia 2022; 39:397-404. [PMID: 35209788 DOI: 10.1080/02656736.2022.2041736] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the effect of Hashimoto's thyroiditis (HT) on the extent of ablation zone in ultrasound (US)-guided radiofrequency ablation (RFA) for early stages of papillary thyroid microcarcinoma (PTMC). METHOD We selected 772 patients with 797 PTMCs who underwent with RFA from August 2017 to August 2020. They were subdivided into two groups as follows: (i) 216 patients (224 PTMCs) with HT in the 'HT + PTMC' group and (ii) 556 patients (573 PTMCs) with healthy thyroid in the 'PTMC' group. We assessed the extent (maximum diameter and volume) of the ablation zone by contrast-enhanced ultrasound (CEUS) immediately, one day, and 1 week following RFA. RESULTS The ablation zone of the 'HT + PTMC' group was smaller than that of the 'PTMC' group at 1 week of RFA (maximum diameter: 14.6 ± 3.1 mm vs. 15.2 ± 3.2 mm and volume: 0.932 ± 0.498 mL vs. 1.028 ± 0.540 mL, respectively, p < .05). However, there were no differences before, immediately, and one day post-RFA (p > .05). Life-threatening complications did not develop in any of the patients. CONCLUSION RFA-treated PTMCs were smaller in size in patients with HT than in those with a healthy thyroid at 1 week of RFA. However, the exact mechanism underlying this phenomenon and its clinical significance warrant further investigation.
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Affiliation(s)
- Limei Lai
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhenhua Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jingwen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaofeng Ni
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Juan Liu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Luo
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yijie Dong
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianqiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Tang T, Zhi J, Zhang W, Hu L, Ruan X, Chen X, Wang Z, Zheng X, Gao M. Surgery and Radioactive Iodine Therapeutic Strategy for Patients Greater Than 60 Years of Age with Differentiated Thyroid Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4348396. [PMID: 35178227 PMCID: PMC8846970 DOI: 10.1155/2022/4348396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of the current study was to determine whether older patients with differentiated thyroid cancer (DTC) who received surgical treatment had a better cause-specific survival (CSS) than patients who were recommended surgery, but declined, and whether patients who underwent postoperative RAI-131 therapy had an impact on CSS based on TNM staging and number of lymph node metastases for all total or near-total thyroidectomy patients. Patients and Methods: This retrospective, population-based study analyzed the clinical data of 162 DTC patients from signal institution in China and 26,487 cases from the Surveillance, Epidemiology, and End Results (SEER) program registry. The patients were divided into two groups (underwent surgery and surgery recommended, but not performed) in the SEER cohort. Furthermore, patients were grouped as follows: T4; N1b; M1; T1-3N0-1a; specific number of lymph node metastases; and total or near-total thyroidectomy. Results: The 120-month cause-specific survival (CSS) rate of women and men showed a gradual declining trend from 60-64 to ≥80 years of age in the group that underwent surgery. The CSS rate of women and men showed a marked downward and irregular trend with an increase in age in the recommended, but no surgery group in the SEER cohort. Univariate analysis indicated that the surgery group had a higher 120-month CSS in women in most stages and men, compared with the no surgery group in the SEER cohort. The analysis of the SEER cohort showed that RAI-131 therapy was associated with an improved 80-month CSS in T4/N1b/M1 women (P < 0.0183) and men (P < 0.0011). However, there were no CSS differences between the RAI-131 therapy and the no-RAI-131 group for the patients with T4/N1b/M1 (AJCC 7th) thyroid cancer in the Chinese cohort. There was no CSS difference in women or men between the T1-3N0 and T1-3N1a patients in the SEER cohort. And similar findings were observed in T1-3N1a patients in the Chinese cohort. There was no statistical difference between the two subgroups. Conclusions: Surgical treatment should be recommended for elderly DTC patients because surgery can lead to a better CSS. High-risk patients achieve a higher benefit-to-risk ratio with RAI-131 therapy. To avoid the adverse effects associated with RAI-131 therapy, a multidisciplinary discussion should be arranged for intermediate- and low-risk patients.
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Affiliation(s)
- Tao Tang
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- The First Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College, Nanchong, China
| | - Jingtai Zhi
- Department of Otolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
| | - Wei Zhang
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Linfei Hu
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xianhui Ruan
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiaoyu Chen
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Zhaohui Wang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, China
| | - Xiangqian Zheng
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ming Gao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
- Department of Breast and Thyroid Surgery, Tianjin Union Medical Center, Tianjin, China
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Arrigoni G, Crosetti E, Freddi M, Piovesan A, Rossetto Giaccherino R, Succo G, Palestini N. Comparison between 2015 ATA guidelines and Italian Consensus for DTC management. A commented report. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:41-54. [PMID: 35292787 PMCID: PMC9058931 DOI: 10.14639/0392-100x-n1572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022]
Abstract
The 2015 ATA guidelines and 2018 Italian Consensus have produced a series of generally concordant recommendations on clinical and therapeutic management of thyroid nodules and thyroid carcinoma. Currently, the goals of treatment are to achieve the highest disease-free survival rates through the best ratio between minimum invasiveness and cost/impact on quality of life. By analysis and comparison of the ATA Guidelines and Italian Consensus, we highlighted and commented upon the key points of differentiated thyroid cancer management. Furthermore, the aim of this work is to identify and promote uniform clinical approaches among all specialists who treat differentiated thyroid cancer and represent a starting point for a consensus drafted by the Italian Society of Otolaryngology - Head and Neck Surgery.
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Zhu C, Zhong L, Lin M, Tian C, Wang C. The value of TI-RADS combined with superb micro-vascular imagine in distinguishing benign and malignant thyroid nodules: A meta-analysis. PLoS One 2022; 17:e0261521. [PMID: 35041691 PMCID: PMC8765637 DOI: 10.1371/journal.pone.0261521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/24/2021] [Indexed: 01/07/2023] Open
Abstract
This meta-analysis aimed to evaluate the value of thyroid imaging report and data system (TI-RADS) combined with superb micro-vascular imagine technique(SMI) in distinguishing benign and malignant thyroid nodules. We searched PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from inception through February 31, 2021. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 softwares. We calculated the summary statistics for sensitivity(Sen), specificity(Spe), and receiver operating characteristic (SROC) curve. Six studies that met all inclusion criteria were included in this meta-analysis. A total of 408 thyroid malignant nodules and 496 thyroid benign nodules were assessed. All thyroid nodules were histologically confirmed after SMI. The pooled Sen and Spe of TI-RADS were 0.80(95%CI = 0.71-0.87) and 0.82(95%CI = 0.75-0.87); The pooled Sen and Spe of TI-RADS combined with SMI were 0.88 (95%CI = 0.80-0.91) and 0.89 (95%CI = 0.85-0.92). The areas under the SROC curve of TI-RADS and TI-RADS combined with SMI were 0.8874(SE = 0.0165) and 0.9415(SE = 0.0102), between which there was significant difference(Z = 2.789; SE = 0.0194; p = 0.0053). Our meta-analysis indicates that TI-RADS combined with SMI may have high diagnostic accuracy, and is more effective than single TI-RADS in distinguishing benign and malignant thyroid nodules.
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Affiliation(s)
- Changfu Zhu
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lin Zhong
- Pathology Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mingxin Lin
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Congliang Tian
- Pediatrics Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Wang
- Ultrasound Department of the First Affiliated Hospital of Dalian Medical University, Dalian, China
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Zhang Q, Xin X, Wang L. A Bibliometric Analysis of 8271 Publications on Thyroid Nodules From 2000 to 2021. Front Endocrinol (Lausanne) 2022; 13:845776. [PMID: 35528005 PMCID: PMC9068984 DOI: 10.3389/fendo.2022.845776] [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: 12/30/2021] [Accepted: 03/17/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Thyroid nodules (TNs) are a common clinical condition. The probability of thyroid nodules being malignant is 7-15%. However, in recent decades, a number of publications on TNs have not been well summarized and discussed. The aim of this study was to summarize and sort out medical publications on TNs over the past 2 decades using a bibliometric method. MATERIALS AND METHODS Medical publications from January 1st, 2000, to November 1st, 2021, were searched in the Web of Science Core Collection database using the Medical Subject Heading (MeSH) term "thyroid nodule". Full associated data were downloaded, and detailed information was extracted using the bibliometric analysis platform VOSviewer. RESULTS A total of 8271 publications related to TNs from the last 2 decades were found and included in this study. An increasing trend was presented in the annual number of publications. The United States, China and Italy contributed the most publications. Carcinoma, management, ultrasound, and fine-needle aspiration were the most popular subjects in the field of TNs. The topics of the studies could be stratified into four clusters. The first cluster was using ultrasound to evaluate the nodules, including the thyroid imaging reporting and data system (TI-RADS), elastography and benign features. The second cluster was the fine-needle aspiration method, including the Bethesda system, cytology and BRAF mutations. The third cluster was the management of nodules, including radiofrequency and thermal ablation, surgery, and consensus statements. The last cluster was carcinoma, which is correlated with all three clusters described above. The preoperative diagnosis of cytologically indeterminate nodules was particularly highlighted in the top 10 most cited publications in recent years. CONCLUSION How to diagnose thyroid nodules as malignant or benign, especially in cytologically indeterminate nodules, is still the most concerning topic in TN research. Although the fine-needle aspiration method and gene-expression classifiers show promising results, there is still a crucial need for translations from fundamental studies to clinical applications.
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Affiliation(s)
- Qianqian Zhang
- Department of Endocrine and Metabolism, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Xiaoyan Xin
- Department of Endocrine and Metabolism, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
| | - Li Wang
- Department of Endocrine and Metabolism, Zhuhai People’s Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, China
- Department of Health Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Li Wang,
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Yihao L, Shuo L, Pu X, Zipeng W, Hanlin S, Qungang C, Yongfei W, Detao Y. Risk Factors for Contralateral Occult Papillary Thyroid Carcinoma in Patients with Clinical Unilateral Papillary Thyroid Carcinoma: A Case-Control Study. Int J Endocrinol 2022; 2022:5112985. [PMID: 35800226 PMCID: PMC9256461 DOI: 10.1155/2022/5112985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Papillary thyroid cancer (PTC) is one of the most prevalent endocrine malignancies that has increased in recent decades around the world. Although the indicator for navigating the surgical extent in PTC patients is still in debate, a key issue is how to predict that there are undetected preoperative tumors in the contralateral thyroid lobe. This study aims to find risk factors for contralateral occult papillary thyroid cancer (COPTC) to facilitate more accurate surgical decisions made for patients with PTC. MATERIALS AND METHODS In our study, we included 229 patients who underwent total thyroidectomy plus central and ipsilateral lateral lymph nodes dissection from January 1, 2019, to September 1, 2021. Univariate and multivariate logistic regression analyses were conducted to assess the association between COPTC and clinical-pathological characteristics, as well as the relation between the diameter of the occult lesions and predictors. The forest plot was plotted to visualize the prediction factors from the output of the multivariate regression analysis. A ROC curve was used to evaluate the combining potency of all the risk factors. RESULTS Of the 229 patients included in our study, 46 with COPTC were assigned to the case group, representing 20.1% in this study. Multifocality in one lobe (OR = 2.21, P=0.03), intact capsule (OR = 2.54, P=0.01), central lymph node metastasis (OR = 3.00, P=0.02), and Hashimoto's thyroiditis (OR = 2.08, P = 0.04) are more prone to present contralateral occult papillary thyroid carcinoma. The ROC curve of the aggregate potency of the risk factors presents AUC = 0.701 (P < 0.001), and the best cutoff value was 2.02, with a sensitivity of 78.3% and specificity of 55.2%. Furthermore, there was no statistical correlation between the diameter of the occult tumor and the four obtained variables. CONCLUSION Patients with multifocality in one lobe, intact capsule, central lymph node metastasis, and HT may harbor contralateral papillary thyroid carcinoma. It is essential to be prudent to make a surgical or follow-up decision on these patients. In addition, more clinical rather than postoperative pathological indicators need to be revealed in the future.
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Affiliation(s)
- Liu Yihao
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Li Shuo
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xi Pu
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wang Zipeng
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sun Hanlin
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chang Qungang
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wang Yongfei
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yin Detao
- Thyroid Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Zhengzhou, China
- Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou, China
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Campennì A, Giovanella L. Nuclear medicine therapy of thyroid cancer post-thyroidectomy. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Gao XQ, Ma Y, Peng XS, Wang LL, Li HX, Zheng XL, Liu Y. Diagnostic performance of C-TIRADS combined with SWE for the diagnosis of thyroid nodules. Front Endocrinol (Lausanne) 2022; 13:939303. [PMID: 36147579 PMCID: PMC9486702 DOI: 10.3389/fendo.2022.939303] [Citation(s) in RCA: 6] [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: 05/09/2022] [Accepted: 08/10/2022] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVE To explore the value of the optimal parameters of shear wave elastography (SWE) to enhance the identification of benign and malignant thyroid nodules by C-TIRADS. METHODS The two-dimensional ultrasonography images and SWE images of 515 patients with a total of 586 thyroid nodules were retrospectively analyzed. The nodules were divided into the D ≤10 mm and D >10 mm groups according to size and were graded by C-TIRADS. With the pathological results as the gold standard, the receiver operating characteristic (ROC) curves were drawn, and the area under the curve (AUC) was calculated to compare the diagnostic performances of C-TIRADS, SWE, and the combination of the two on the benign and malignant thyroid nodules. RESULTS The ROC showed that the AUC of the maximum elastic modulus (0.875) was higher than that of the mean elastic modulus (0.798) and elasticity ratio (0.772), with an optimal cutoff point of 51 kPa, which was the optimal parameter to distinguish the malignant from the benign nodules (P < 0.001). In the D ≤10 mm group, the AUC of TIRADS combined with SWE (0.955) was elevated by 0.172 compared with the application of C-TIRADS alone (0.783), and the difference was statistically significant (P < 0.05). In the D >10 mm group, the AUC of TIRADS combined with SWE (0.904) was elevated by 0.076 compared with the application of C-TIRADS alone (0.828), and the difference was statistically significant (P < 0.05). Among all nodules, the application of C-TIRADS alone had a sensitivity of 88.14%, a specificity of 74.56%, and an accuracy of 85.50% in diagnosing benign and malignant thyroid nodules, while the sensitivity, specificity, and accuracy were 93.22%, 90.35%, and 92.66%, respectively, in combination with SWE. CONCLUSION The diagnostic performance of SWE in combination with TIRADS was better than that of SWE or C-TIRADS alone. Here, SWE enhanced the diagnostic performance of C-TIRADS for the benign and malignant thyroid nodules, most significantly for nodules with D ≤10 mm.
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Wang XS, Wu SL, Peng Z, Zhu HH. SLCO4A1 is a Prognosis-Associated Biomarker Involved in Neutrophil-Mediated Immunity in Thyroid Cancer. Int J Gen Med 2021; 14:9615-9628. [PMID: 34924768 PMCID: PMC8674671 DOI: 10.2147/ijgm.s339921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The study aimed to investigate the value of solute carrier organic anion transporter family member 4A1 (SLCO4A1) in thyroid cancer mainly from three aspects: expression, prognosis, and biological function analyses. Methods Based on various bioinformatic approaches, genes co-expressed with vascular endothelial growth factor C (VEGFC) in thyroid cancer were used for further survival and expression analyses to identify the target gene. After evaluation of the SLCO4A1 expression levels in thyroid cancer, Cox regression analysis was utilized to predict the risk factors for survival of thyroid cancer patients. And receiving operating characteristic curve analysis was performed to validate the prognostic value of SLCO4A1. Additionally, WebGestalt was employed for enrichment analysis of SLCO4A1 and its co-expressed genes. Further, the relation between SLCO4A1 and neutrophil was analyzed, followed by exploring the association of SLCO4A1 with immunomodulators. Results A total of 38 consistent VEGFC co-expressed genes were generated, and SLCO4A1 was selected as the target gene due to its oncogenic characteristics. SLCO4A1 was highly expressed in thyroid cancer at both gene and protein levels, and SLCO4A1 mRNA expression was significantly associated with the cancer stage (all P <0.05). Besides, high SLCO4A1 expression led to unfavorable progression-free survival (PFS) of thyroid cancer patients (P =0.0066). Further, Cox regression analysis indicated that high SLCO4A1 expression was an independent predictor of poor PFS in patients with papillary thyroid cancer, particularly in patients at stage 1 and female patients (all P <0.001). The enrichment analysis results showed that SLCO41A was involved in the neutrophil-mediated immunity pathway. Moreover, SLCO4A1 had a positive relation with neutrophils (all P <0.05). Finally, a significant correlation between SLCO4A1 and immunomodulators was observed (all P <0.001). Conclusion SLCO4A1 was a potential prognostic biomarker for papillary thyroid cancer patients. And SLCO4A1 might affect PFS in thyroid cancer patients by positive regulation of neutrophil-mediated immunity pathway.
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Affiliation(s)
- Xin-Sheng Wang
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, Qinghai, People's Republic of China
| | - Shi-Le Wu
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, Qinghai, People's Republic of China
| | - Zhe Peng
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, Qinghai, People's Republic of China
| | - Hai-Hong Zhu
- Department of General Surgery, Qinghai Provincial People's Hospital, Xining, Qinghai, People's Republic of China
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Cao J, Huang W, Huang P, Huang Y. ACR TI-RADS and ATA ultrasound classifications are helpful for the management of thyroid nodules located in the isthmus. Clin Hemorheol Microcirc 2021; 80:463-471. [PMID: 34864651 DOI: 10.3233/ch-211304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare the application value of the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) and the American Thyroid Association (ATA) guidelines in the risk stratification of thyroid isthmic nodules. METHODS A total of 315 patients with thyroid isthmic nodules (315 nodules) confirmed by surgical pathology or fine-needle aspiration biopsy (FNAB) were selected in this retrospective study. The nodules were evaluated and classified according to ACR TI-RADS and the ATA guidelines. Taking pathological results as the reference, receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic capabilities of the ACR TI-RADS and the ATA guidelines for the risk stratification of thyroid isthmic nodules. The unnecessary biopsy rates and false-negative rates were compared. RESULTS Multivariate analysis of ultrasonographic features of suspicious malignancies showed that an aspect ratio > 1 was not an independent risk factor for malignant thyroid nodules located in the isthmus (odds ratio: 3.193, 95%confidence interval: 0.882-11.552) (P = 0.077). The area under the ROC curves for diagnosing malignant thyroid nodules located in the isthmus in by the ACR TI-RADS and the ATA guidelines were 0.853 and 0.835, respectively. Under the management recommendations of the ACR TI-RADS and ATA guidelines, the false-negative rates of malignant thyroid nodules were 66.2%(ATA intermediate suspicion), 62.3%(ACR TR 4), 81.8%(ATA high suspicion) and 86.5%(ACR TR 5). CONCLUSION Both the ACR TI-RADS and the ATA guidelines have high diagnostic capabilities for the risk stratification of thyroid isthmic nodules. For ACR TR 4 and 5 and ATA intermediate- and high-suspicion thyroid isthmic nodules with a maximum diameter < 1 cm, the criteria for puncture should be lowered, and FNAB should be done to clarify their diagnosis.
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Affiliation(s)
- Jianhui Cao
- Department of Ultrasound, the Jiashan County First People's Hospital, Jiashan County, Zhejiang Province, China
| | - Weiwei Huang
- Department of Ultrasound, the Jiashan County First People's Hospital, Jiashan County, Zhejiang Province, China
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yunlin Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
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Markantes GK, Karakioulaki M, Papanikolopoulou S, Theodoropoulou A, Markou KB, Vagenakis AG, Spyridonidis T, Goulis DG, Michalaki MA. Improving the prediction of persistent and recurrent differentiated thyroid cancer using the American Thyroid Association 2015 risk stratification system. Hormones (Athens) 2021; 20:761-768. [PMID: 34383288 DOI: 10.1007/s42000-021-00313-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The 2015 American Thyroid Association risk stratification system (ATA RSS) is used in patients with differentiated thyroid carcinoma (DTC) to assess their risk of persistent/recurrent disease. Our aims were to validate the 2015 ATA RSS in a registry of DTC patients and to examine whether the addition of factors not included in it, such as pre-radioactive iodine therapy stimulated thyroglobulin (pre-RAI sTg), gender, and age could increase its predictive ability. METHODS We studied 403 patients with DTC, treated at a tertiary center from 1990 to 2018 and subjected to total thyroidectomy. All patients had received RAI therapy, except those with low-risk papillary microcarcinoma. RESULTS Of our patients, 81.9% were women and 91.1% had papillary thyroid carcinoma. After a median follow-up of 5.0 years, 53 cases of persistent and 21 cases of recurrent disease were recorded. The proportion of variance explained (PVE) regarding the outcome (presence or absence of recurrent/persistent disease) using the 2015 ATA RSS alone was 18.3% (persistence) and 16.9% (recurrence), increasing to 74.4% and 52.0%, respectively, when pre-RAI sTg was added to the logistic regression model. Gender and age were not associated with the disease outcome. In ROC analysis, pre-RAI sTg had a high predictive value for persistent (AUC 0.983, 95% CI 0.962-1.000) and recurrent disease (AUC 0.856, 95% CI 0.715-0.997). The optimal cut-offs and sensitivity, specificity, and positive and negative predictive value for pre-RAI sTg were the following: for persistence 12.75 ng/ml, 100%, 90.5%, 64%, and 100%, and for recurrence 8.05 ng/ml, 77.8%, 85.5%, 36.8%, and 97%. CONCLUSIONS The 2015 ATA RSS displayed moderate performance in predicting recurrent/persistent disease in patients with DTC, which improved with the inclusion of pre-RAI sTg values; pre-RAI sTg was an independent predictor of the disease outcome, with high negative prognostic value.
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Affiliation(s)
- Georgios K Markantes
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Meropi Karakioulaki
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula Papanikolopoulou
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Theodoropoulou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Kostas B Markou
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Apostolos G Vagenakis
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece
| | - Trifon Spyridonidis
- Department of Nuclear Medicine, University Hospital of Patras, Patras, Greece
| | - Dimitrios G Goulis
- 1st Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marina A Michalaki
- Department of Internal Medicine, Division of Endocrinology, University of Patras Medical School, Patras, Greece.
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Grani G, Cera G, Conzo G, Del Gatto V, di Gioia CRT, Maranghi M, Lucia P, Cantisani V, Metere A, Melcarne R, Borcea MC, Scorziello C, Menditto R, Summa M, Biffoni M, Durante C, Giacomelli L. Preoperative Ultrasonography in the Evaluation of Suspected Familial Non-Medullary Thyroid Cancer: Are We Able to Predict Multifocality and Extrathyroidal Extension? J Clin Med 2021; 10:jcm10225277. [PMID: 34830559 PMCID: PMC8624166 DOI: 10.3390/jcm10225277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
Family history of thyroid cancer increases the risk of harboring thyroid malignancies that end up having extrathyroidal extension (ETE) and multifocality on histology; some authors suggest a more aggressive surgical approach. Their pre-operative identification could allow more conservative surgical procedures if none of these features are suspected. Our aim was to assess if neck ultrasonography could identify or exclude multifocality or ETE in these patients to tailor the extent of surgery. This retrospective study included patients with previous thyroid surgery, ≥1 first-grade relative with thyroid cancer, and who had undergone pre-surgical ultrasound. ETE was suspected in the case of thyroid border interruption or gross invasion of perithyroidal tissues. Multiple suspicious nodules were defined as suspicion of multifocal cancer. The cohort consisted of 45 patients (median age 49 years, 40 with thyroid cancer, 30 females). The positive predictive value of ultrasonography in predicting multifocality and ETE was 57.14% (25.25–84.03) and 41.67% (21.5–65.1%), respectively, while the negative predictive values were 63.2% (56.4–69.4%) and 72.7% (63.3–80.5%). Pre-operative ultrasound examination is unable to reliably identify or exclude multifocal disease or extrathyroidal extension. In patients scheduled for surgery and with a first-degree relative affected by DTC, a “negative” pre-operative US report does not exclude the potential finding of multifocality and ETE at final histopathology.
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Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Gianluca Cera
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Giovanni Conzo
- Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, I-80131 Naples, Italy;
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Cira Rosaria Tiziana di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (C.R.T.d.G.); (V.C.)
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Piernatale Lucia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Vito Cantisani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (C.R.T.d.G.); (V.C.)
| | - Alessio Metere
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Rossella Melcarne
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Maria Carola Borcea
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Chiara Scorziello
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Rosa Menditto
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Marco Summa
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
- Correspondence: ; Tel.: +39-0-649-975-130
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
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47
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Mantsopoulos K, Mueller SK, Pavel M, Kuwert T, Meidenbauer N, Fietkau R, Sievert M, Iro H. [Treatment strategy by radioiodine refractory differentiated thyroid cancer]. Laryngorhinootologie 2021; 101:298-303. [PMID: 34583388 DOI: 10.1055/a-1580-7327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traditionally, the multimodal therapy concept for differentiated thyroid carcinomas consists of thyroidectomy with neck dissection (for cN + neck) and adjuvant radioiodine ablation with subsequent risk-adapted TSH suppression. The extent of radioiodine uptake in metastatic thyroid carcinomas plays a significant role is significant in terms of prognosis. Radioiodine refractory lesions are characterized by the lack of radioiodine uptake in combination with the lack of decrease in the tumor marker thyroglobulin as well as signs of progression on imaging. Due to the mostly indolent course over a long period of time, a wait-and-see strategy in combination with local management of distant metastase symptom relief appears to be primarily sufficient. By evidence for change in tumor dynamics, the need for a multi-tyrosine kinase inhibitor (sorafenib, lenvatinib)-based systemic therapy should be thoroughly evaluated. These substances are mostly associated with an unfavorable side-effect profile (diarrhea, rash, arterial hypertension, local wound healing disorders), which leads to a non-negligible rate of treatment-associated morbidity and a high number of treatment interruptions. For this reason, two selective RET inhibitors (selpercatinib, pralsetinib) for differentiated thyroid carcinomas were approved by the FDA in 2020. A new perspective for the future would be the variable re-differentiation strategies, which aim to increase the sensitivity of tumor cells to radioiodine.
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Affiliation(s)
- Konstantinos Mantsopoulos
- Otolaryngology, Head and Neck surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarina K Mueller
- Otolaryngology, Head and Neck surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marianne Pavel
- Department of Medicine I, Lead Division of Endocrinology & Neuroendocrine Tumors, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Torsten Kuwert
- Nuclear Medicine, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Norbert Meidenbauer
- Department of Medicine V, Haematology and Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Rainer Fietkau
- Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matti Sievert
- Otolaryngology, Head and Neck surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Otolaryngology, Head and Neck surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Fenton ME, Wade SA, Pirrili BN, Balogh ZJ, Rowe CW, Bendinelli C. Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review. J Clin Med 2021; 10:4150. [PMID: 34575260 PMCID: PMC8470818 DOI: 10.3390/jcm10184150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommendations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted.
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Affiliation(s)
- Mark E. Fenton
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
| | - Sarah A. Wade
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
| | - Bibi N. Pirrili
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
| | - Zsolt J. Balogh
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Christopher W. Rowe
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Endocrinology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Cino Bendinelli
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW 2305, Australia
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49
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Juweid ME, Rabadi NJ, Tulchinsky M, Aloqaily M, Al-Momani A, Arabiat M, Abu Ain G, Al Hawari H, Al-Momani M, Mismar A, Abulaban A, Taha I, Alhouri A, Zayed A, Albsoul N, Al-Abbadi MA. Assessing potential impact of 2015 American Thyroid Association guidelines on community standard practice for I-131 treatment of low-risk differentiated thyroid cancer: case study of Jordan. Endocrine 2021; 73:633-640. [PMID: 33772746 DOI: 10.1007/s12020-021-02698-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The 2015 American Thyroid Association (ATA) guidelines called for significantly more selective 131I therapy in patients with low-risk differentiated thyroid cancer (DTC). We hypothesized that application of these guidelines would significantly reduce the 131I activity utilized by an academic tertiary hospital in Jordan. METHODS All DTC patients managed at Jordan University Hospital (JUH) between 1/2009 and 6/2019 were classified according to the 2015 ATA risk category and 131I activity was assigned accordingly. The actual 131I activity administered was compared with that recommended by the 2015 ATA guidelines. RESULTS In total, 135/182 DTC patients (74.2%) managed at JUH underwent 131I therapy. Of those, 58 (43%) had ATA low-, 58 (43%) intermediate-, and 19 (14%) high-risk disease. The low-, intermediate-, and high-risk DTC patients received an average (±SD) initial 131I activity of 3.53 ± 0.95, 4.40 ± 1.49, and 5.06 ± 2.52 GBq, respectively. Withholding 131I therapy altogether in the 2015 ATA low-risk patients would result in decreasing the 131I activity in the overall patient population by 37%. Withholding 131I therapy only in low-risk papillary thyroid microcarcinomas while administering 1.11 GBq of 131I to other low-risk patients would result in 28% reduction of 131I. CONCLUSION This study demonstrates a significant reduction in 131I therapeutic activity that would be given to DTC patients in an academic tertiary setting in Jordan, following acceptance of the 2015 ATA recommendations. Institutions that adopted the 2015 ATA guidance should measure outcomes in comparison to their historical controls and report those findings, while long-term results of randomized controlled trials are forthcoming.
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Affiliation(s)
- Malik E Juweid
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Nidal J Rabadi
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Mark Tulchinsky
- Department of Radiology, Penn State Health, Hershey, PA, USA.
| | - Mohammed Aloqaily
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Ahmad Al-Momani
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Majd Arabiat
- Division of Endocrinology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Gassem Abu Ain
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Hussam Al Hawari
- Division of Endocrinology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Munther Al-Momani
- Division of Endocrinology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Ayman Mismar
- Department of Special Surgery, University of Jordan, Amman, Jordan
| | - Amr Abulaban
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Ibrahim Taha
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Abdullah Alhouri
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Ayman Zayed
- Division of Endocrinology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Nader Albsoul
- Department of Special Surgery, University of Jordan, Amman, Jordan
| | - Mousa A Al-Abbadi
- Department of Histopathology, Microbiology and Forensic Medicine, University of Jordan, Amman, Jordan
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50
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Rashid FA, Khan MS, Tabassum S, Aiman A, Jadoon MH. Discrepancies of RET gene and risk of differentiated thyroid carcinoma. Cancer Biomark 2021; 33:111-121. [PMID: 34366324 DOI: 10.3233/cbm-210088] [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: 11/15/2022]
Abstract
BACKGROUND Somatic variations in rearranged during transfection (RET) proto-oncogene acts to influence Thyroid cancer (TC) in a low penetrance manner, but their effects tend to vary between different populations. OBJECTIVE This case-control study was aimed to evaluate effect of RET G691S, S904S and L769L single nucleotide polymorphisms (SNPs) on the risk for differentiated thyroid carcinoma (DTC). METHODS A total of 180 patients and 220 controls were genotyped by Polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP). Di-Deoxy Sanger sequencing was performed on 100 samples with variations and 20 wild samples for each amplified exon. In addition, In Silico tools were used to evaluate structural and functional impact of individual SNPs in disease progression. RESULTS In RET G691S/L769L/S904S SNPs, frequency of variant genotypes in DTC cases was 61.1%, 54.4% and 76.6% as compared to 45.9%, 43.6% and 89.09% in controls respectively (P⩽ 0.05). In Silico analysis revealed that different protein formed due to G691S substitution decreases the stability of 3D structure of protein. The RET G691S and L769L SNP followed "Dominant" but RET S904S SNP confirmed an "Additive" mode of inheritance. CONCLUSION RET G691S/L769L/S904S SNPs are significantly associated with DTC with G691S SNP declining the stability of final protein product.
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Affiliation(s)
- Faiza A Rashid
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan
| | - Mosin S Khan
- Government Medical College Srinagar and Associated Hospitals, Srinagar, India
| | - Sobia Tabassum
- Department of Biological Sciences, International Islamic University, Islamabad, Pakistan
| | - Aiffa Aiman
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Maharij H Jadoon
- Research Centre for Modeling and Simulation, National University of Science and Technology, Islamabad, Pakistan
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