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Chiapponi C, Kasajima A. [Frozen section in oncologic endocrine surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2025; 96:385-393. [PMID: 40131405 DOI: 10.1007/s00104-025-02266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/11/2025] [Indexed: 03/27/2025]
Abstract
BACKGROUND The aim of the present study is to discuss the benefits of intraoperative frozen sections (FS) for the surgical management of endocrine tumors. METHODS A systematic search of the literature of the last ten years on FS in the field of oncologic endocrine surgery was carried out and a discussion based on the available evidence and experience of the authors is provided. RESULTS A group of publications focused on the role of intraoperative FS in thyroid surgery in identifying the malignant potential of thyroid nodules. The detection of lymph node metastasis and extrathyroidal growth in differentiated thyroid cancer (DTC) were also two other topical groups as well as the diagnosis of lymph node involvement based on stromal desmoplasia in medullary thyroid cancer (MTC). A further group investigated the possibilities of deep learning to overcome technical problems and another investigated the cost-benefit analyses. There is no relevant literature on the role of FS in the surgical treatment of parathyroid and adrenal cancers. DISCUSSION The synthesis of the available evidence suggests that FS investigations of the thyroid glands should be restricted to Bethesda V nodules. The technical limitations in the exclusion of vascular and capsular invasion make the FS unsuitable for follicular neoplasms and oncocytic lesions. The Delphi lymph node seems to be suitable for investigation using FS and when positive represents an indication for lymphadenectomy in cN0 patients. Larger studies are necessary in the future to confirm if the absence of desmoplasia with an intact tumor capsule can reliably justify omitting lymph node resection in MTC, independent of the calcitonin level. The costs and benefits depend on the individual context so that generalization is difficult. Deep learning models could generally improve the performance of FS analysis in the future. CONCLUSION In thyroid surgery awareness of the technical limitations of FS is crucial for correct implementation and thus to optimize its performance. A preoperative fine needle biopsy and surgical experience help in selecting the nodules that can benefit from FS. Deep image learning could help to overcome current problems in the future. In adrenal and parathyroid oncologic surgery FS do not play a relevant role.
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Affiliation(s)
- Costanza Chiapponi
- Klinik und Poliklinik für Chirurgie, TUM School of Medicine and Health, TUM Klinikum rechts der Isar, München, Deutschland.
| | - Atsuko Kasajima
- Institut für Pathologie, TUM School of Medicine and Health, TUM Klinikum rechts der Isar, München, Deutschland
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Lin Y, Wu Y. Trends in incidence and overdiagnosis of thyroid cancer in China, Japan, and South Korea. Cancer Sci 2023; 114:4052-4062. [PMID: 37488752 PMCID: PMC10551580 DOI: 10.1111/cas.15909] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 07/26/2023] Open
Abstract
We used data from 13 cancer registries in China, Japan, and South Korea to analyze time trends in overdiagnosis of thyroid cancer between 1998 and 2012. Age-standardized and age-specific incidence and annual percentage changes were calculated. The number of thyroid cancers diagnosed and the proportion attributable to overdiagnosis were estimated, with calculations stratified by sex and age group. The Spearman method was used to analyze the correlation between thyroid cancer incidence and overdiagnosis. From 1998 to 2012, both the incidence and proportions of overdiagnoses of thyroid cancer in China, Japan, and South Korea showed an increasing trend, with higher rates in women than men. South Korea had both the highest incidence for men (10.1/105 ) and women (46.7/105 ) and the highest proportions of overdiagnosis (men, 90.3%; women, 94.9%). The fastest growth in overdiagnosis was in Chinese men and women (annual percentage changes 6.1 and 4.6, respectively). We found significant positive correlations between age-standardized incidence and proportions of overdiagnosis for both men (Spearman r = 0.98, p < 0.05) and women (Spearman r = 0.99, p < 0.05) in the three countries. Age-specific incidence curves in Chinese and South Korean individuals were of an inverted U-shape. Overdiagnosis of thyroid cancer in Japan was mainly concentrated in middle-aged and older patients, whereas in China and South Korea, it occurred primarily in the middle-aged. The incidence and overdiagnosis of thyroid cancer in China, Japan, and South Korea are increasing, necessitating the implementation of comprehensive measures to reduce these overdiagnoses.
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Affiliation(s)
- Yongtian Lin
- Department of EpidemiologyClinical Oncology School of Fujian Medical University, Fujian Cancer HospitalFuzhouChina
| | - Yu Wu
- Department of Head and Neck SurgeryClinical Oncology School of Fujian Medical University, Fujian Cancer HospitalFuzhouChina
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Liu C, Zhao H, Xia Y, Cao Y, Zhang L, Zhao Y, Gao L, Liu R, Liu Y, Liu H, Meng Z, Liu S, Li X. Active surveillance of highly suspicious thyroid nodules cohort in China shows a worse psychological status in younger patients. Front Oncol 2022; 12:981495. [PMID: 36091122 PMCID: PMC9458970 DOI: 10.3389/fonc.2022.981495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Active surveillance has been considered a safe alternative to surgery for low-risk papillary thyroid microcarcinoma. This study aimed to assess the oncological outcomes and psychological status of active surveillance of highly suspicious thyroid nodules ≤10 mm in China. METHODS This prospective single-center cohort study enrolled 336 patients with highly suspicious thyroid nodules for active surveillance to assess oncological outcomes and psychological status. The psychological status of patients was assessed by two different questionnaires and compared among different patient groups. RESULTS During a median follow-up period of 28.5 months, eight patients underwent delayed surgery for tumor enlargement and one for lymph node metastases. The cumulative incidence of disease progression at 5 and 10 years was 6.0% and 12.8%, respectively. Patients who underwent delayed surgery had no permanent complications, and no patient had distant metastasis or death. Patients ≤30 years old had a higher baseline anxiety score (4.9 vs. 3.8, p=0.024), a higher proportion of baseline anxiety score, i.e., ≥8 points (24.0% vs. 12.6%, p=0.033), and a worse baseline emotional function (62.7 vs. 70.7, p=0.013) than patients >30. During AS, patients ≤30 years of age had higher overall anxiety levels (p=0.005) and a worse overall emotional function (p=0.001). CONCLUSIONS Active surveillance in Chinese patients with highly suspicious subcentimetre thyroid nodules has good oncological outcomes and can be used as a safe alternative to surgery. Younger patients (≤30) show a worse psychological status; therefore, more attention should be paid to younger patients.
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Affiliation(s)
- Chunhao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liyang Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Luying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruifeng Liu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuewu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hongfeng Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhilan Meng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shuzhou Liu
- Department of Otolaryngology Head and Neck Surgery, Hainan General Hospital, Haikou, China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Chiapponi C, Alakus H, Schmidt M, Faust M, Bruns CJ, Büttner R, Eich ML, Schultheis AM. Lymphatic Vessel Invasion in Routine Pathology Reports of Papillary Thyroid Cancer. Front Med (Lausanne) 2022; 9:841550. [PMID: 35265646 PMCID: PMC8899077 DOI: 10.3389/fmed.2022.841550] [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: 12/22/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose It is not mandatory to report lymphatic vessel invasion in pathology reports of papillary thyroid cancer (PTC) according to the current Union for International Cancer Control (UICC) TNM (tumor, nodes, and metastases) classification. However, there is some evidence for its correlation with lymph node metastasis (LNM) and prognosis. The aim of this study was to explore the clinical implication of lymphatic vessel invasion documentation of PTC because pathology reports play a pivotal role in postsurgical clinical decision-making in endocrine tumor boards. Methods Patients undergoing postoperative radioiodine treatment for PTC at the University Hospital of Cologne, Germany between December 2015 and March 2020 were identified. Pathology reports were screened for documentation of lymphatic vessel invasion. Demographics and clinicopathologic data of patients documented, including lymphatic vessel invasion and lymph nodal involvement were analyzed. Results A total of 578 patients were identified and included. Lymphatic vessel invasion was reported in pathology reports of 366 (63.3%) and omitted in 112 (36.7%) patients. Positive lymphatic vessel invasion (L1) was diagnosed in 67 (18.3%) of 366 patients and was documented as absent (L0) in 299 (81.7%) patients. Lymph nodal (N) status was positive (N+) in 126 (45.6%) and negative (N0) in 150 (54.3%) of these patients. In 54 (80.6%) L1 cases N+ status and in 137 (65.6%) L0 cases N0 status was diagnosed. In 13 (19.4%) cases with L1 status, there were no LNMs (L1 N0). In total, 72 (34.4%) patients had LNM despite L0 status (L0 N+). The sensitivity and specificity of LVI reporting for LNM were 0.42 and 0.91, respectively. Conclusion In routine pathology reports of PTC used for indication to postoperative radioiodine treatment by a German endocrine tumor board, lymphatic vessel invasion was found to be reported inconsistently and mostly as L0. L1 diagnoses, however, reliably correlated with reported LNM and might, thus, be relevant for clinical decision-making. For this reason, we advocate for standardized pathologic reassessment of lymphatic vessel invasion, in particular for cases where lymph nodes are not included in the pathologic specimen and if L0 is documented.
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Affiliation(s)
- Costanza Chiapponi
- Department of General, Visceral, Cancer and Transplant Surgery, University Clinic of Cologne, Cologne, Germany
| | - Hakan Alakus
- Department of General, Visceral, Cancer and Transplant Surgery, University Clinic of Cologne, Cologne, Germany
| | - Matthias Schmidt
- Department for Nuclear Medicine, University Clinic of Cologne, Cologne, Germany
| | - Michael Faust
- Policlinic for Endocrinology, Diabetes and Prevention Medicine, University Clinic of Cologne, Cologne, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplant Surgery, University Clinic of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Institute for Pathology, University Clinic of Cologne, Cologne, Germany
| | - Marie-Lisa Eich
- Institute for Pathology, University Clinic of Cologne, Cologne, Germany
| | - Anne M Schultheis
- Institute for Pathology, University Clinic of Cologne, Cologne, Germany
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