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Yu ST, Lei ST. Letter to the Editor: Comment on: "BRAF V600E Mutation Lacks Association with Poorer Clinical Prognosis in Papillary Thyroid Carcinoma". Ann Surg Oncol 2024; 31:3737-3738. [PMID: 38512604 DOI: 10.1245/s10434-024-15225-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Shi-Tong Yu
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
| | - Shang-Tong Lei
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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Ren A, Zhu J, Wu Z, Ming J, Ruan S, Xu M, Huang T. Machine learning algorithms for identifying contralateral central lymph node metastasis in unilateral cN0 papillary thyroid cancer. Front Endocrinol (Lausanne) 2024; 15:1385324. [PMID: 38800481 PMCID: PMC11116582 DOI: 10.3389/fendo.2024.1385324] [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: 02/12/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose The incidence of thyroid cancer is growing fast and surgery is the most significant treatment of it. For patients with unilateral cN0 papillary thyroid cancer whether to dissect contralateral central lymph node is still under debating. Here, we aim to provide a machine learning based prediction model of contralateral central lymph node metastasis using demographic and clinical data. Methods 2225 patients with unilateral cN0 papillary thyroid cancer from Wuhan Union Hospital were retrospectively studied. Clinical and pathological features were compared between patients with contralateral central lymph node metastasis and without. Six machine learning models were constructed based on these patients and compared using accuracy, sensitivity, specificity, area under the receiver operating characteristic and decision curve analysis. The selected models were then verified using data from Differentiated Thyroid Cancer in China study. All statistical analysis and model construction were performed by R software. Results Male, maximum diameter larger than 1cm, multifocality, ipsilateral central lymph node metastasis and younger than 50 years were independent risk factors of contralateral central lymph node metastasis. Random forest model performed better than others, and were verified in external validation cohort. A web calculator was constructed. Conclusions Gender, maximum diameter, multifocality, ipsilateral central lymph node metastasis and age should be considered for contralateral central lymph node dissection. The web calculator based on random forest model may be helpful in clinical decision.
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Affiliation(s)
- Anwen Ren
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqing Zhu
- First Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenghao Wu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Ming
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengnan Ruan
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Xu
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yu ST, Ge JN, Sun BH, Wei ZG, Zhang ZC, Chen WS, Li TT, Lei ST. A modified, single-incision, gasless, endoscopic thyroidectomy and bilateral central neck dissection via axillary approach technique for bilateral papillary thyroid microcarcinoma: A preliminary report. Heliyon 2024; 10:e24802. [PMID: 38318059 PMCID: PMC10839888 DOI: 10.1016/j.heliyon.2024.e24802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
Background Our objective was to assess the viability and oncological security of a gasless, transaxillary single-incision endoscopic procedure for performing total thyroidectomy and bilateral central neck dissection (TT + BCND). This study focused on patients diagnosed with bilateral papillary thyroid microcarcinoma (PTMC). Method Between April 2020 and November 2021, 22 patients with bilateral PTMC underwent single-incision, gasless, transaxillary endoscopic TT + BCND. The patients' clinicopathologic characteristics, surgical completeness and complications were analyzed. Result Single-incision, gasless, transaxillary endoscopic TT + BCND was successful performed in all patients. The median (IQR) total surgical time was 143 (85-160) min. Only two patients experienced transient unilateral RLN palsy or transient hypocalcemia. All these complications resolved within 1 month after surgery. The median duration of hospital stay after surgery was 4 (3-4.5) days. The median hospitalization expense for these patients was 3848 (3781-4145) USD. The median number of lymph node yielded was 10.5 (8-15). The cosmetic outcomes were well-received by all individuals. Conclusion In certain cases, gasless, transaxillary endoscopic TT + BCND procedure performed through a single incision proved to be a secure alternative for managing bilateral PTMC.
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Affiliation(s)
- Shi-Tong Yu
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jun-Na Ge
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Bai-Hui Sun
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhi-Gang Wei
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhi-Cheng Zhang
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Wei-Sheng Chen
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Ting-Ting Li
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Shang-Tong Lei
- Department of General Surgery, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
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Ge JN, Yu ST, Tan J, Sun BH, Wei ZG, Zhang ZC, Chen WS, Li TT, Lei ST. A propensity score matching analysis of gasless endoscopic transaxillary thyroidectomy with five-settlement technique versus conventional open thyroidectomy in patients with papillary thyroid microcarcinoma. Surg Endosc 2023; 37:9255-9262. [PMID: 37875693 DOI: 10.1007/s00464-023-10473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/17/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND In a previous study, we proposed a novel anatomy-based five-settlement method for transaxillary endoscopic thyroidectomy (fs-TAT) for patients with papillary thyroid carcinoma. The safety of this new method has been reported in a retrospective study of a single cohort. The safety and short-term oncological outcome of this method was confirmed by comparing it with conventional open surgery (COT) in patients with papillary thyroid microcarcinoma. METHODS The medical records of patients who underwent fs-TAT or COT by a single surgeon from February 2019 to December 2021 were reviewed retrospectively. All patients were diagnosed with papillary thyroid microcarcinoma and underwent lobectomy and ipsilateral central compartment neck dissection. Propensity score matching was used to compare the technical safety and short-term oncologic outcomes of fs-TAT and COT for the purpose of reducing potential selection bias. Reporting was consistent with the STROCSS 2021 guidelines. RESULT After propensity score matching, 460 (fs-TAT: 230; COT: 230) patients remained in the study population. There were no significant differences in sex, age, tumor size, Hashimoto's thyroiditis, or tumor multifocality between the groups. The operative time was longer [104.5 (90.3, 120.0) vs. 62.0 (52.0, 76.0), P < 0.001] and the total postoperative drainage volume [135(90, 210) vs. 75 (55, 115), P < 0.001] was greater in the fs-TAT group than in the COT group. However, intraoperative bleeding [3.0 (2.0, 5.0) vs. 5.0 (5.0, 7.5), P < 0.001] was greater, and the median number of lymph nodes yielded [5.0 (2.3, 8.0) vs. 7.0 (5.0, 11.0), P < 0.001] was greater in the COT group than in the fs-TAT group. The groups exhibited no significant difference in the rate of complications (fs-TAT: 2.2% vs. COT: 2.6%, P = 0.856), rate of positive lymph nodes (fs-TAT: 32.2% vs. COT: 36.5%, P = 0.377), length of postoperative hospital stay (3 days vs. 3 days, P = 0.305) or total medical costs (26,936 vs. 26,549, P = 0.144). CONCLUSION Compared to conventional open surgery, fs-TAT offered excellent safety and acceptable short-term oncological outcomes in a selected cohort of patients with papillary thyroid microcarcinoma.
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Affiliation(s)
- Jun-Na Ge
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China
| | - Shi-Tong Yu
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China
| | - Jie Tan
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China
| | - Bai-Hui Sun
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China
| | - Zhi-Gang Wei
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China
| | - Zhi-Cheng Zhang
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China
| | - Wei-Sheng Chen
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China
| | - Ting-Ting Li
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China
| | - Shang-Tong Lei
- Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, Guangdong, China.
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Pang J, Yang M, Li J, Zhong X, Shen X, Chen T, Qian L. Interpretable machine learning model based on the systemic inflammation response index and ultrasound features can predict central lymph node metastasis in cN0T1-T2 papillary thyroid carcinoma. Gland Surg 2023; 12:1485-1499. [PMID: 38107491 PMCID: PMC10721554 DOI: 10.21037/gs-23-349] [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: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023]
Abstract
Background It is arguable whether individuals with T1-T2 papillary thyroid cancer (PTC) who have a clinically negative (cN0) diagnosis should undergo prophylactic central lymph node dissection (pCLND) on a routine basis. Many inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic immune-inflammatory index (SII), have been reported in PTC. However, the associations between the systemic inflammation response index (SIRI) and the risk of central lymph node metastasis (CLNM) remain unclear. Methods Retrospective research involving 1,394 individuals with cN0T1-T2 PTC was carried out, and the included patients were randomly allocated into training (70%) and testing (30%) subgroups. The preoperative inflammatory indices and ultrasound (US) features were used to train the models. To assess the forecasting factors as well as drawing nomograms, the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were utilized. Then eight interpretable models based on machine learning (ML) algorithms were constructed, including decision tree (DT), K-nearest neighbor (KNN), support vector machine (SVM), artificial neural network (ANN), random forest (RF), extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and categorical boosting (CatBoost). The performance of the models was evaluated by incorporating the area under the precision-recall curve (auPR) and the area under the receiver operating characteristic curve (auROC), as well as other conventional metrics. The interpretability of the optimum model was illustrated via the shapley additive explanations (SHAP) approach. Results Younger age, larger tumor size, capsular invasion, location (lower and isthmus), unclear margin, microcalcifications, color Doppler flow imaging (CDFI) blood flow, and higher SIRI (≥0.77) were independent positive predictors of CLNM, whereas female sex and Hashimoto thyroiditis were independent negative predictors, and nomograms were subsequently constructed. Taking into account both the auROC and auPR, the RF algorithm showed the best performance, and superiority to XGBoost, CatBoost and ANN. In addition, the role of key variables was visualized in the SHAP plot. Conclusions An interpretable ML model based on the SIRI and US features can be used to predict CLNM in individuals with cN0T1-T2 PTC.
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Affiliation(s)
- Jin Pang
- Department of Breast and Thyroid Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Mohan Yang
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Jun Li
- Department of Breast and Thyroid Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Zhong
- Department of General Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiangyu Shen
- Department of Breast and Thyroid Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ting Chen
- Department of Breast and Thyroid Surgery, Third Xiangya Hospital, Central South University, Changsha, China
| | - Liyuan Qian
- Department of Breast and Thyroid Surgery, Third Xiangya Hospital, Central South University, Changsha, China
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Zheng G, Zhang H, Lin F, Zafereo M, Gross N, Sun P, Liu Y, Sun H, WU G, Wei S, Wu J, Mao N, Li G, Wu G, Zheng H, Song X. Performance of CT-based deep learning in diagnostic assessment of suspicious lateral lymph nodes in papillary thyroid cancer: a prospective diagnostic study. Int J Surg 2023; 109:3337-3345. [PMID: 37578434 PMCID: PMC10651261 DOI: 10.1097/js9.0000000000000660] [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: 06/15/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Preoperative evaluation of the metastasis status of lateral lymph nodes (LNs) in papillary thyroid cancer is challenging. Strategies for using deep learning to diagnosis of lateral LN metastasis require additional development and testing. This study aimed to build a deep learning-based model to distinguish benign lateral LNs from metastatic lateral LNs in papillary thyroid cancer and test the model's diagnostic performance in a real-world clinical setting. METHODS This was a prospective diagnostic study. An ensemble model integrating a three-dimensional residual network algorithm with clinical risk factors available before surgery was developed based on computed tomography images of lateral LNs in an internal dataset and validated in two external datasets. The diagnostic performance of the ensemble model was tested and compared with the results of fine-needle aspiration (FNA) (used as the standard reference method) and the diagnoses made by two senior radiologists in 113 suspicious lateral LNs in patients enrolled prospectively. RESULTS The area under the receiver operating characteristic curve of the ensemble model for diagnosing suspicious lateral LNs was 0.829 (95% CI: 0.732-0.927). The sensitivity and specificity of the ensemble model were 0.839 (95% CI: 0.762-0.916) and 0.769 (95% CI: 0.607-0.931), respectively. The diagnostic accuracy of the ensemble model was 82.3%. With FNA results as the criterion standard, the ensemble model had excellent diagnostic performance ( P =0.115), similar to that of the two senior radiologists ( P =1.000 and P =0.392, respectively). CONCLUSION A three-dimensional residual network-based ensemble model was successfully developed for the diagnostic assessment of suspicious lateral LNs and achieved diagnostic performance similar to that of FNA and senior radiologists. The model appears promising for clinical application.
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Affiliation(s)
| | | | - Fusheng Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, People’s Republic of China
| | | | | | - Peng Sun
- Department of Otorhinolaryngology, The First Affiliated Hospital of Soochow University, Suzhou
- Department of Head and Neck Surgery
| | | | | | | | | | - Jia Wu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ning Mao
- Big Data and Artificial Intelligence Laboratory
- Department of Radiology
| | | | - Guoyang Wu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, People’s Republic of China
| | | | - Xicheng Song
- Big Data and Artificial Intelligence Laboratory
- Department of Otorhinolaryngology, Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong
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