1
|
Baloch Z, Fadda G. Remembering Dr. Virginia A. LiVolsi (July 29, 1943-March 7, 2024): The lady of the "Butterfly Gland". Endocrine 2024; 85:1096-1099. [PMID: 39003436 DOI: 10.1007/s12020-024-03894-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 05/26/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Zubair Baloch
- Professor of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Perelman School of Medicine, Philadelphia, PA, 19146, USA
| | - Guido Fadda
- Professor of Pathology, Department of Human Pathology of the Adulthood and of the Developing Age "Gaetano Barresi", "Gaetano Martino" University Hospital, University of Messina, Messina, Italy.
| |
Collapse
|
2
|
Yuan Y, Pan B, Mo H, Wu X, Long Z, Yang Z, Zhu J, Ming J, Qiu L, Sun Y, Yin S, Zhang F. Deep learning-based computer-aided diagnosis system for the automatic detection and classification of lateral cervical lymph nodes on original ultrasound images of papillary thyroid carcinoma: a prospective diagnostic study. Endocrine 2024; 85:1289-1299. [PMID: 38570388 DOI: 10.1007/s12020-024-03808-1] [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: 11/25/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE This study aims to develop a deep learning-based computer-aided diagnosis (CAD) system for the automatic detection and classification of lateral cervical lymph nodes (LNs) on original ultrasound images of papillary thyroid carcinoma (PTC) patients. METHODS A retrospective data set of 1801 cervical LN ultrasound images from 1675 patients with PTC and a prospective test set including 185 images from 160 patients were collected. Four different deep leaning models were trained and validated in the retrospective data set. The best model was selected for CAD system development and compared with three sonographers in the retrospective and prospective test sets. RESULTS The Deformable Detection Transformer (DETR) model showed the highest diagnostic efficacy, with a mean average precision score of 86.3% in the retrospective test set, and was therefore used in constructing the CAD system. The detection performance of the CAD system was superior to the junior sonographer and intermediate sonographer with accuracies of 86.3% and 92.4% in the retrospective and prospective test sets, respectively. The classification performance of the CAD system was better than all sonographers with the areas under the curve (AUCs) of 94.4% and 95.2% in the retrospective and prospective test sets, respectively. CONCLUSIONS This study developed a Deformable DETR model-based CAD system for automatically detecting and classifying lateral cervical LNs on original ultrasound images, which showed excellent diagnostic efficacy and clinical utility. It can be an important tool for assisting sonographers in the diagnosis process.
Collapse
Affiliation(s)
- Yuquan Yuan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Bin Pan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Hongbiao Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Xing Wu
- College of Computer Science, Chongqing University, Chongqing, China
| | - Zhaoxin Long
- College of Computer Science, Chongqing University, Chongqing, China
| | - Zeyu Yang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Junping Zhu
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Jing Ming
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Lin Qiu
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Yiceng Sun
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Supeng Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China.
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China.
- Graduate School of Medicine, Chongqing Medical University, Chongqing, China.
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China.
| |
Collapse
|
3
|
Grani G, Sponziello M, Filetti S, Durante C. Thyroid nodules: diagnosis and management. Nat Rev Endocrinol 2024:10.1038/s41574-024-01025-4. [PMID: 39152228 DOI: 10.1038/s41574-024-01025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/19/2024]
Abstract
Thyroid nodules, with a prevalence of almost 25% in the general population, are a common occurrence. Their prevalence varies considerably depending on demographics such as age and sex as well as the presence of risk factors. This article provides a comprehensive overview of the prevalence, risk stratification and current management strategies for thyroid nodules, with a particular focus on changes in diagnostic and therapeutic protocols that have occurred over the past 10 years. Several sonography-based stratification systems (such as Thyroid Imaging Reporting and Data Systems (TIRADS)) might help to predict the malignancy risk of nodules, potentially eliminating the need for biopsy in many instances. However, large or suspicious nodules necessitate cytological evaluation following fine-needle aspiration biopsy for accurate classification. In the case of cytology yielding indeterminate results, additional tools, such as molecular testing, can assist in guiding the management plan. Surgery is no longer the only treatment for symptomatic or malignant nodules: active surveillance or local ablative treatments might be beneficial for appropriately selected patients. To enhance clinician-patient interactions and discussions about diagnostic options, shared decision-making tools have been developed. A personalized, risk-based protocol promotes high-quality care while minimizing costs and unnecessary testing.
Collapse
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Sebastiano Filetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| |
Collapse
|
4
|
Tjendra Y, Zuo Y, Velez Torres JM. Follicular neoplasms with nuclear atypia versus other types of atypia: Should follicular neoplasms be stratified according to the presence of nuclear atypia? Cancer Cytopathol 2024. [PMID: 39097785 DOI: 10.1002/cncy.22889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/17/2024] [Accepted: 07/02/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND The third edition of The Bethesda System (TBS) subclassifies the atypia of undetermined significance (AUS) category on the basis of the presence of nuclear atypia (AUS-Nuclear). This approach is supported by studies showing significant differences in the risk of malignancy (ROM) between AUS-Nuclear and those without (AUS-Other). Although aspirates of follicular neoplasms (FNs) are characterized by marked architectural atypia, TBS recognizes the infrequent occurrence of FNs with mild nuclear atypia (FN-Nuclear). Furthermore, limited studies have shown significant differences in ROM between FN-Nuclear and those without (FN-Other). This study explored potential differences in ROM, molecular-derived risk of malignancy (MDROM), and molecular alterations between FN-Nuclear and FN-Other. METHODS A retrospective database search identified 93 FN aspirates. Cytology slides, molecular reports, and histologic follow-ups were reviewed. Both groups' benign call rate (BCR), positive call rate (PCR), MDROM, and ROM were computed and compared. RESULTS Eighty-six percent of aspirates (80 of 93) comprised FN-Other, whereas 14% (13 of 93) were FN-Nuclear. The BCR and PCR for FN-Other were 51% and 49%, respectively. In contrast, they were 23% and 77% for FN-Nuclear, respectively. The MDROM significantly differed between FN-Other (30%) and FN-Nuclear (56%) (p < .05). HRAS mutation was the most common molecular alteration in FN-Nuclear, whereas mutations in NRAS/KRAS and copy number alterations were more common in FN-Other. The ROM1/ROM2 in FN-Other and FN-Nuclear were 16%/31% and 54%/88%, respectively. CONCLUSIONS These results reveal that FN-Nuclear exhibits significantly higher MDROM and ROM than FN-Other, which provides support for a subclassification scheme for FNs based on the presence of nuclear atypia.
Collapse
Affiliation(s)
- Youley Tjendra
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Yiqin Zuo
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
5
|
Raffaelli M, Voloudakis N, Barczynski M, Brauckhoff K, Durante C, Gomez-Ramirez J, Koutelidakis I, Lorenz K, Makay O, Materazzi G, Pandev R, Randolph GW, Tolley N, Vriens M, Musholt T. European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. Br J Surg 2024; 111:znae199. [PMID: 39158073 PMCID: PMC11331340 DOI: 10.1093/bjs/znae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità (CREO), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joaquin Gomez-Ramirez
- Endocrine Surgery Unit, General Surgery Department, Hospital Universitario La Paz, IdiPaz Madrid, Madrid, Spain
| | - Ioannis Koutelidakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ozer Makay
- Centre for Endocrine Surgery, Ozel Saglik Hospital, Izmir, Turkey
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Rumen Pandev
- Department of General Surgery, University Hospital St Marina, Medical University Pleven, Pleven, Bulgaria
| | - Gregory W Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Tolley
- Endocrine Surgery Service, Imperial College NHS Healthcare Trust, London, UK
| | - Menno Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thomas Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Mainz, Germany
| |
Collapse
|
6
|
Abraham PJ, Lindeman BM. Management of Incidental Thyroid Nodules. Surg Clin North Am 2024; 104:711-723. [PMID: 38944493 DOI: 10.1016/j.suc.2024.02.002] [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] [Indexed: 07/01/2024]
Abstract
Thyroid nodules are widely prevalent, and often discovered incidentally. Malignancy rates are low for incidental thyroid nodules, and overall outcomes are favorable regardless of diagnosis. Patients with thyroid nodules should be evaluated with TSH levels followed by ultrasound of the thyroid and cervical lymph nodes. It is important to recognize sonographic features suspicious for thyroid malignancy and obtain biopsies when indicated according to major society guidelines. The Bethesda System for Reporting Thyroid Cytopathology along with molecular testing can help guide management decisions regarding thyroid nodules. Surgical resection and other emerging technologies are safe and effective for the treatment of thyroid nodules needing intervention.
Collapse
Affiliation(s)
- Peter J Abraham
- Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue S, Boshell Diabetes Building, Birmingham, AL 35233, USA
| | - Brenessa M Lindeman
- Department of Surgery, University of Alabama at Birmingham, 1808 7th Avenue S, Boshell Diabetes Building, Birmingham, AL 35233, USA.
| |
Collapse
|
7
|
Sada A, Yip L. The Role of Molecular Markers in Thyroid Cancer Diagnostics and Treatment. Surg Clin North Am 2024; 104:741-749. [PMID: 38944495 DOI: 10.1016/j.suc.2024.02.004] [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] [Indexed: 07/01/2024]
Abstract
Molecular testing for cytologically indeterminate thyroid nodules has demonstrated benefit by reducing the need for diagnostic thyroidectomies and reducing costs. Its use is currently recommended in practice guidelines from the American Thyroid Association and the American Association of Endocrine Surgeons when clinically appropriate. Moreover, there is growing evidence that molecular testing may provide prognostic information and can detect targetable genetic alterations which may expand treatment options for refractory advanced thyroid cancers.
Collapse
Affiliation(s)
- Alaa Sada
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Building, Suite 101, Pittsburgh, PA 15213, USA.
| | - Linwah Yip
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Building, Suite 101, Pittsburgh, PA 15213, USA. https://twitter.com/l_yip123
| |
Collapse
|
8
|
Salih AM, Muhialdeen AS, Ismaeil DA, Saeed YA, Dhahir HM, Baba HO, Kakamad FH, Qadir AA, Hassan MN, Hassan SH, Abdalla BA, Mohammed MS. Thyroid nodulectomy: A promising approach to the management of solitary thyroid nodules. Biomed Rep 2024; 21:118. [PMID: 38938739 PMCID: PMC11209868 DOI: 10.3892/br.2024.1805] [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: 01/14/2024] [Accepted: 05/13/2024] [Indexed: 06/29/2024] Open
Abstract
The choice between nodulectomy and lobectomy for managing thyroid nodules is a subject of debate in the field of thyroid surgery. The present study aims to share the experience of a single center in managing solitary thyroid nodules through nodulectomy from January 2023 to October 2023. The inclusion criteria encompassed symptomatic or suspicious solitary nodules and medically necessitated cases. The extracted data included patient demographics, medical history, symptoms, diagnostic details, surgery indication, procedure outcome and histopathological findings. The follow-up included clinic visits and phone calls. The mean age of the patients was 36.64±11.63 years, with 85.0% females and 15.0% males. Predominantly, patients were housewives (58.5%). Neck swelling (62.3%) was the most common presentation. Ultrasound examination revealed mixed nodules in more than half of the cases (54.7%). Right nodulectomy was performed in 26 cases (49.1%) and left nodulectomy in 23 (43.4%), and four cases (7.5%) underwent isthmusectomy. The mean operation time was 36.04±9.37 min and no drainage tube was used in any of the cases. One case (1.9%) of seroma was the only observed complication during the observational period. Nodulectomy may be a suitable choice for managing benign, large, solitary thyroid nodules, small suspicious nodules or microcarcinomas.
Collapse
Affiliation(s)
- Abdulwahid M. Salih
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Aso S. Muhialdeen
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Deari A. Ismaeil
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Yadgar A. Saeed
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Hardi M. Dhahir
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Hiwa O. Baba
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
| | - Fahmi H. Kakamad
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
| | - Abdullah A. Qadir
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Marwan N. Hassan
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Shko H. Hassan
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Berun A. Abdalla
- Scientific Affairs Department, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization for Scientific Research, Sulaimani, Kurdistan 46001, Iraq
| | | |
Collapse
|
9
|
Huang BL, Carneiro-Pla D. Intraoperative Adjuncts in Thyroid Surgery. Surg Clin North Am 2024; 104:767-777. [PMID: 38944497 DOI: 10.1016/j.suc.2024.02.006] [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] [Indexed: 07/01/2024]
Abstract
Thyroidectomy is relatively safe and often can be done as a minimally invasive procedure. Although they may be associated with a learning curve, thoughtful use of intraoperative adjuncts such as energy devices, recurrent laryngeal nerve monitoring, and parathyroid autofluorescence have the potential to make incremental improvements in the safety and efficiency of thyroid surgery. Perhaps many of these adjuncts may be of greatest benefit when used routinely by less experienced surgeons or selectively in higher-risk operations, although their adoption in practice continues to increase overall.
Collapse
Affiliation(s)
- Bernice Liying Huang
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery at the Medical University of South Carolina, 30 Courtenay Drive, Suite 240, MSC 295, Charleston, SC 29425, USA
| | - Denise Carneiro-Pla
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery at the Medical University of South Carolina, 30 Courtenay Drive, Suite 240, MSC 295, Charleston, SC 29425, USA.
| |
Collapse
|
10
|
Fields TD, Underwood HJ, Pitt SC. Management of Small Papillary Thyroid Cancers. Surg Clin North Am 2024; 104:725-740. [PMID: 38944494 DOI: 10.1016/j.suc.2024.02.003] [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] [Indexed: 07/01/2024]
Abstract
Thyroid cancer is the most common endocrine malignancy. With increasing imaging utilization, there has been an increase in the recognition of small, indolent cancers that would otherwise go undiagnosed. Historically, the surgical recommendation for all patients with thyroid cancer was a total thyroidectomy. However, over the last 20 years, there have been numerous studies evaluating the de-escalation of interventions for low-risk thyroid cancers, transitioning from total thyroidectomy to thyroid lobectomy or active surveillance when indicated. Here, we review the current literature and recommendations with each of these treatment options.
Collapse
Affiliation(s)
- Tyler D Fields
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Hunter J Underwood
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. https://twitter.com/HJUnderwoodMD
| | - Susan C Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Michigan, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. https://twitter.com/susieQP8
| |
Collapse
|
11
|
Gillis A, Zmijewski P, Mcleod MC, Lindeman B, Fazendin J, Chen H, Bhatia S. Racial implications of time to surgery in disparities in thyroid cancer survival. Am J Surg 2024; 234:85-91. [PMID: 38519403 DOI: 10.1016/j.amjsurg.2024.02.002] [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: 07/25/2023] [Revised: 02/01/2024] [Accepted: 02/01/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION The influence of time to surgery on racial/ethnic disparities in papillary thyroid carcinoma (PTC) survival remains unstudied. MATERIALS AND METHODS The National Cancer Database (2004-2017) was queried for patients with localized PTC. Survival data was compared by time to surgery, patient demographics, and multivariable Cox regression was performed. RESULTS Of 126,708 patients included, 5% were Black, 10% Hispanic. Of all patients, 85% had no comorbidities. Non-Hispanic White (NHW) patients had a shorter median time to surgery than Black and Hispanic patients (36 vs. 43 vs. 42 days, respectively p < 0.001). In multivariable analysis, longer time to surgery (>90 days vs < 30 days) and Black race vs NHW, were associated with worse survival (HR: 1.56, (95%CI, 1.43-1.70), p < 0.001 and HR: 1.21, (1.08-1.36), p = 0.001), respectively. CONCLUSION Delaying surgery for thyroid cancer is associated with worse survival. However, independent of time to surgery and other confounders, there remains a disparity as black patients have poorer outcomes.
Collapse
Affiliation(s)
- Andrea Gillis
- University of Alabama At Birmingham, Department of General Surgery, USA.
| | - Polina Zmijewski
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - M Chandler Mcleod
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - Brenessa Lindeman
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - Jessica Fazendin
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - Herbert Chen
- University of Alabama At Birmingham, Department of General Surgery, USA
| | - S Bhatia
- University of Alabama At Birmingham, Department of General Pediatrics, USA
| |
Collapse
|
12
|
Zhu J, Guo T, Guo S, Chang L, Zhao J, Wang X, Wei X. A practical nomogram for preoperatively predicting lateral cervical lymph node metastasis in medullary thyroid carcinoma: a dual-center retrospective study. Front Endocrinol (Lausanne) 2024; 15:1349853. [PMID: 39129917 PMCID: PMC11310050 DOI: 10.3389/fendo.2024.1349853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose Lateral lymph node metastasis (LLNM) is very common in medullary thyroid carcinoma (MTC), but there is still controversy about how to manage cervical lateral lymph nodes, especially for clinically negative MTC. The aim of this study is to develop and validate a nomogram for predicting LLNM risk in MTC. Materials and methods A total of 234 patients from two hospitals were retrospectively enrolled in this study and divided into LLNM positive group and LLNM negative group based on the pathology. The correlation between LLNM and preoperative clinical and ultrasound variables were evaluated by univariable and multivariable logistic regression analysis. A nomogram was generated to predict the risk of the LLNM of MTC patients, validated by external dataset, and evaluated in terms of discrimination, calibration, and clinical usefulness. Results The training, internal, and external validation datasets included 152, 51, and 31 MTC patients, respectively. According to the multivariable logistic regression analysis, gender (male), relationship to thyroid capsule and serum calcitonin were independently associated with LLNM in the training dataset. The predictive nomogram model developed with the aforementioned variables showed favorable performance in estimating risk of LLNM, with the area under the ROC curve (AUC) of 0.826 in the training dataset, 0.816 in the internal validation dataset, and 0.846 in the external validation dataset. Conclusion We developed and validated a model named MTC nomogram, utilizing available preoperative variables to predict the probability of LLNM in patients with MTC. This nomogram will be of great value for guiding the clinical diagnosis and treatment process of MTC patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| |
Collapse
|
13
|
Hirokawa M, Suzuki A. "Immunocytochemistry in Cytology: Myth or Reality": Unraveling the Myth - Immunocytochemistry Applications in Thyroid Lesions. Acta Cytol 2024:1-9. [PMID: 39004076 DOI: 10.1159/000540366] [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: 04/30/2024] [Accepted: 07/10/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Fine-needle aspiration cytology serves as an important preoperative diagnostic tool for thyroid nodules. Despite its excellent diagnostic accuracy, diagnoses based solely on morphological observation can be challenging. Therefore, various ancillary diagnostic techniques have been applied, including immunocytochemistry (ICC). This review discusses the application and evaluation of ICC in thyroid fine needle aspiration. SUMMARY Currently, three immunostaining preparation methods are available for cytological materials: liquid-based cytology, cell block, and cell transfer. ICC proves valuable in scenarios such as tumour diagnosis, assessment of differentiation and grading of carcinomas, estimation of primary organs in metastatic carcinomas, and detection of gene abnormalities. However, ICC, while useful, is not as accurate as immunohistochemistry and is more difficult to evaluate. KEY MESSAGES If the pitfalls and limitations are understood and effectively navigated, ICC could play a significant role in decreasing the non-diagnostic rate, thus leading to more accurate and valuable diagnoses and reductions in the re-aspiration rate.
Collapse
Affiliation(s)
| | - Ayana Suzuki
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| |
Collapse
|
14
|
Jensen CB, Pitt SC. Letter to the Editor: Molecular Testing: Adoption and Disparities in Utilization Across the United States. Thyroid 2024. [PMID: 38919133 DOI: 10.1089/thy.2024.0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Affiliation(s)
- Catherine B Jensen
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Susan C Pitt
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
15
|
Hedberg F, Falhammar H, Calissendorff J, Bränström R. Surgical outcome after thyroidectomy due to Graves' disease and Lugol iodine treatment: a retrospective register-based cohort study. Endocrine 2024; 85:272-278. [PMID: 38306008 PMCID: PMC11246264 DOI: 10.1007/s12020-024-03708-4] [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: 12/27/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE This study aimed to investigate the relationship between Lugol iodine treatment in a rescue setting and surgical outcomes in Graves' disease patients. METHODS The retrospective register-based cohort study included 813 patients who had undergone primary total thyroidectomy with a primary diagnosis of Graves' disease (ICD-code E05.0) at Karolinska University Hospital in Stockholm, Sweden, between January 2008 and December 2015. Of 813 patients, 33 (4.1%) were given Lugol iodine before surgery and the remaining, the non-Lugol group, did not. The study's primary outcomes were post-operative calcium treatment day 1, calcium and vitamin D supplements at discharge and follow-up. Secondary outcomes were laryngeal nerve damage and bleeding (defined as re-operation). RESULTS Differences were found between the Lugol and non-Lugol groups in the treatment of calcium day 1 (45.5% vs 26.7%, p = 0.018), at discharge (36.4% vs. 16.2%, p = 0.002) and vitamin D supplements at discharge (36.4% vs. 19.1%, p = 0.015) as surrogate variables for hypocalcemia post-operatively. No differences could be seen at 4-6 weeks and six-months follow-up. There were no differences between the Lugol and non-Lugol groups in terms of operation time, laryngeal nerve damage, and bleeding. CONCLUSION Patients in our cohort undergoing thyroidectomy due to Graves' disease pre-operatively treated with Lugol iodine as a rescue therapy had a higher risk of experiencing short term post-operative hypocalcemia.
Collapse
Affiliation(s)
- Fredric Hedberg
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jan Calissendorff
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Robert Bränström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
16
|
Hazout C, Daniel A, Ziv O, Yoel U, Kiderman D, Shukrun R, Cohen O. Do extremely large goiters carry a higher risk of malignancy or complications? A case control study. Am J Otolaryngol 2024; 45:104283. [PMID: 38626601 DOI: 10.1016/j.amjoto.2024.104283] [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: 12/31/2023] [Accepted: 04/01/2024] [Indexed: 04/18/2024]
Abstract
INTRODUCTION The definition of thyroid goiter remains ambiguous, yet size may impact both malignancy rate and surgical complications' rate. METHODS All patients with thyroid goiter who underwent thyroidectomy between 1/2015-1/2023 were included. Goiter was defined as lobe ≥4 cm. For analysis purpose, goiters measuring 4-8 cm and ≥8 cm were defined as large and extremely large goiters, respectively. For malignancy definition, tumor<1 cm in their largest diameter were excluded from study. Collected data included demographics, cytology, histology and postoperative complication. RESULTS 144 goiters from 111 patients were included. The most common indication for surgery was symptoms (55 %). Compared with large goiter, extremely large goiters demonstrated a trend for tracheal narrowing on pre-operative CT findings (23 % vs. 45 %, p = 0.07 respectively). Overall differentiated thyroid carcinoma (DTC) rate was 17 % (25/144) without statistical difference between groups (p = 0.89). Within goiters with pre-operative benign cytology, the DTC rate was 17 % (7/43). Follicular variant of papillary thyroid cancer was the most common type for both groups. Nodular hyperplasia was significantly associated with extremely large goiters (53 % vs. 73 %, p = 0.03). No significant difference was found in transient hypocalcemia (48 % [15/31] vs. 41 % [5/12], p = 0.6) and other complications' rate between extremely large goiters and the control group. CONCLUSION When discussing management options for patients with goiters, the size of the goiter should not regarded as a higher risk for complications or malignancy, yet the relatively high malignancy rate found should be taken under consideration for resection.
Collapse
Affiliation(s)
- Chen Hazout
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Israel; Faculty of Health sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Aviv Daniel
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Israel; Faculty of Health sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Oren Ziv
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Israel; Faculty of Health sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Uri Yoel
- Faculty of Health sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Unit of Endocrinology, Soroka University Medical Center, Beer Sheva, Israel
| | - David Kiderman
- Department of Otolaryngology Head and Neck Surgery, Kaplan Medical Center, Israel; Hebrew University in Jerusalem, Rehovot, Israel
| | - Rami Shukrun
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Israel; Faculty of Health sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Oded Cohen
- Department of Otolaryngology Head and Neck Surgery, Soroka University Medical Center, Israel; Faculty of Health sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| |
Collapse
|
17
|
Machens A, Lorenz K, Weber F, Dralle H. Anatomical Patterns of Nodal Spread in Unilateral Papillary and Medullary Thyroid Cancer. Thyroid 2024; 34:871-879. [PMID: 38717955 DOI: 10.1089/thy.2024.0076] [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: 05/22/2024]
Abstract
Background: Skip metastases, node metastases in the lateral neck sparing the ipsilateral central neck, challenge the current concept of central-to-lateral lymphatic spread. This study sought to delineate patterns of central and lateral neck involvement in unilateral papillary thyroid cancer (PTC) and medullary thyroid cancer (MTC). Methods: This was a retrospective correlative analysis of nodal patterns in surgical specimens from patients with unilateral PTC or MTC who had undergone thyroidectomy with at least ipsilateral central neck dissection between November 1994 and January 2024 at a tertiary referral center. Results: Included were 833 patients with unilateral PTC and 640 patients with unilateral MTC. Simultaneous presence or absence of node metastases was noted in ipsilateral central and lateral neck compartments in 76.6-78.1% of patients with PTC (both node positive in 27.0-54.7% and both node negative in 23.4-49.6%) and 77.3-80.0% of patients with MTC (both node positive in 26.6-33.2% and both node negative in 44.1-53.4%). Only one ipsilateral neck compartment was node positive in 21.9-23.4% of patients with PTC and 20.0-22.7% of patients with MTC. The ipsilateral central, but not the ipsilateral lateral compartment, was node positive in 8.8-16.9% with PTC and 8.6-8.8% of patients with MTC, whereas the ipsilateral lateral, but not the ipsilateral central compartment, was node positive in 6.5-13.1% with PTC and 11.3-14.1% with MTC. Ipsilateral lateral neck involvement sparing the ipsilateral central neck was 1.5-2 times more frequent in patients with node positive MTC than patients with node positive PTC (24.2-25.2% vs. 12.9-17.1%). Greater numbers of node metastases in the ipsilateral central neck compartment were associated with more frequent involvement of the ipsilateral lateral, contralateral central, and contralateral lateral neck compartments. Thyroid tumor diameter intensified nodal spread without changing nodal spread patterns. Conclusions: These histopathological findings, which need to be interpreted in light of the respective tumor biology, offer an unprecedented glimpse at the metastatic patterns of unilateral PTC and MTC. Customizing neck dissection to the patterns of nodal spread, considering operative status (initial vs. reoperative surgery) and experience with neck dissection, may require more frequent concomitant dissections of ipsilateral central and ipsilateral lateral neck compartments.
Collapse
Affiliation(s)
- Andreas Machens
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Henning Dralle
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
18
|
Lukyanov SA, Titov SE, Kozorezova ES, Demenkov PS, Veryaskina YA, Korotovskii DV, Ilyina TE, Vorobyev SL, Zhivotov VA, Bondarev NS, Sleptsov IV, Sergiyko SV. Prediction of the Aggressive Clinical Course of Papillary Thyroid Carcinoma Based on Fine Needle Aspiration Biopsy Molecular Testing. Int J Mol Sci 2024; 25:7090. [PMID: 39000197 PMCID: PMC11241318 DOI: 10.3390/ijms25137090] [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] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024] Open
Abstract
Molecular genetic events are among the numerous factors affecting the clinical course of papillary thyroid carcinoma (PTC). Recent studies have demonstrated that aberrant expression of miRNA, as well as different thyroid-related genes, correlate with the aggressive clinical course of PTC and unfavorable treatment outcomes, which opens up new avenues for using them in the personalization of the treatment strategy for patients with PTC. In the present work, our goal was to assess the applicability of molecular markers in the preoperative diagnosis of aggressive variants of papillary thyroid cancer. The molecular genetic profile (expression levels of 34 different markers and BRAF mutations) was studied for 108 cytology specimens collected by fine-needle aspiration biopsy in patients with PTC having different clinical manifestations. Statistically significant differences with adjustment for multiple comparisons (p < 0.0015) for clinically aggressive variants of PTC were obtained for four markers: miRNA-146b, miRNA-221, fibronectin 1 (FN1), and cyclin-dependent kinase inhibitor 2A (CDKN2A) genes. A weak statistical correlation (0.0015 < p < 0.05) was observed for miRNA-31, -375, -551b, -148b, -125b, mtDNA, CITED1, TPO, HMGA2, CLU, NIS, SERPINA1, TFF3, and TMPRSS4. The recurrence risk of papillary thyroid carcinoma can be preoperatively predicted using miRNA-221, FN1, and CDKN2A genes.
Collapse
Affiliation(s)
- Sergei A Lukyanov
- Department of General and Pediatric Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia
| | - Sergei E Titov
- Department of the Structure and Function of Chromosomes, Institute of Molecular and Cellular Biology, SB RAS, Novosibirsk 630090, Russia
- PCR Laboratory, AO Vector-Best, Novosibirsk 630117, Russia
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk 630090, Russia
| | - Evgeniya S Kozorezova
- National Center of Clinical Morphological Diagnostics, Saint Petersburg 192283, Russia
| | - Pavel S Demenkov
- Department of Natural Sciences, Novosibirsk State University, Novosibirsk 630090, Russia
- Institute of Cytology and Genetics, SB RAS, Novosibirsk 630090, Russia
| | - Yulia A Veryaskina
- Department of the Structure and Function of Chromosomes, Institute of Molecular and Cellular Biology, SB RAS, Novosibirsk 630090, Russia
- Institute of Cytology and Genetics, SB RAS, Novosibirsk 630090, Russia
| | - Denis V Korotovskii
- Department of General and Pediatric Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia
| | - Tatyana E Ilyina
- Department of General and Pediatric Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia
| | - Sergey L Vorobyev
- National Center of Clinical Morphological Diagnostics, Saint Petersburg 192283, Russia
| | - Vladimir A Zhivotov
- Department of Surgery, National Medical and Surgical Center Named after N.I. Pirogov, Moscow 105203, Russia
| | - Nikita S Bondarev
- Department of Surgery, National Medical and Surgical Center Named after N.I. Pirogov, Moscow 105203, Russia
| | - Ilya V Sleptsov
- Department of Faculty Surgery, Saint Petersburg State University, Saint Petersburg 199034, Russia
| | - Sergei V Sergiyko
- Department of General and Pediatric Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia
| |
Collapse
|
19
|
Graceffa G, Lopes A, Orlando G, Mazzola S, Vassallo F, Curione F, Richiusa P, Radellini S, Melfa G, Scerrino G. Risk Factors for Transient Hypoparathyroidism after Total Thyroidectomy: Insights from a Cohort Analysis. J Clin Med 2024; 13:3326. [PMID: 38893037 PMCID: PMC11173213 DOI: 10.3390/jcm13113326] [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: 04/22/2024] [Revised: 06/01/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Transient hypoparathyroidism (TH) is the main post-thyroidectomy complication, significantly impacting surgical outcomes, hospitalization length, and perceived perceived quality of life understood as mental and physical well-being. This study aims to identify possible associated risk factors. Methods: We analyzed 238 thyroidectomies (2020-2022), excluding instances of partial surgery, primary hyperparathyroidism, neck irradiation history, and renal failure. The variables considered were as follows: demographics, histology, autoimmunity, thyroid function, pre- and postoperative Vitamin D levels (where available), type of surgery, number of incidentally removed parathyroid glands (IRP), and surgeons' experience (>1000 thyroidectomies, <500, in training). Univariate analysis applied: χ2, Fisher's exact test for categorical variables, and Student's t-test for continuous variables. Subsequently, logistic multivariate analysis with stepwise selection was performed. Results: Univariate analysis did not yield statistically significant results for the considered variables. The 'No Complications' group displayed a mean age of 55 years, whereas the TH group showed a mean age of 51 (p-value = 0.055). We considered this result to be marginally significant. Subsequently, we constructed a multivariate logistic model. This model (AIC = 245.02) indicated that the absence of incidental parathyroidectomy was associated with the age class >55 years, presenting an odds ratio (OR) of 9.015 (p-value < 0.05). Simultaneously, the age class >55 years exhibited protective effects against TH, demonstrating an OR of 0.085 (p-value < 0.01). Similarly, the absence of incidental parathyroidectomy was found to be protective against TH, with an OR of 0.208 (p-value < 0.01). Conclusions: Multivariate analysis highlighted that having "No IRP" was protective against TH, while younger age was a risk factor. Surgeon experience does not seem to correlate with IRP or outcomes, assuming there is adequate tutoring and a case volume close to 500 to ensure good results. The effect of reimplantation has not been evident in transient hypoparathyroidism.
Collapse
Affiliation(s)
- Giuseppa Graceffa
- Unit of General and Oncology Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.G.); (A.L.)
| | - Antonella Lopes
- Unit of General and Oncology Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (G.G.); (A.L.)
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (F.V.); (F.C.); (G.M.)
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy;
| | - Fabrizio Vassallo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (F.V.); (F.C.); (G.M.)
| | - Francesco Curione
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (F.V.); (F.C.); (G.M.)
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Stefano Radellini
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (P.R.); (S.R.)
| | - Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy; (F.V.); (F.C.); (G.M.)
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy;
| |
Collapse
|
20
|
Ren X, Zhang J, Song Z, Li Q, Zhang D, Li X, Yu J, Li Z, Wen Y, Zeng D, Zhang X, Tang Z. Detection of malignant lesions in cytologically indeterminate thyroid nodules using a dual-layer spectral detector CT-clinical nomogram. Front Oncol 2024; 14:1357419. [PMID: 38863637 PMCID: PMC11165073 DOI: 10.3389/fonc.2024.1357419] [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: 12/18/2023] [Accepted: 05/02/2024] [Indexed: 06/13/2024] Open
Abstract
Purpose To evaluate the capability of dual-layer detector spectral CT (DLCT) quantitative parameters in conjunction with clinical variables to detect malignant lesions in cytologically indeterminate thyroid nodules (TNs). Materials and methods Data from 107 patients with cytologically indeterminate TNs who underwent DLCT scans were retrospectively reviewed and randomly divided into training and validation sets (7:3 ratio). DLCT quantitative parameters (iodine concentration (IC), NICP (IC nodule/IC thyroid parenchyma), NICA (IC nodule/IC ipsilateral carotid artery), attenuation on the slope of spectral HU curve and effective atomic number), along with clinical variables, were compared between benign and malignant cohorts through univariate analysis. Multivariable logistic regression analysis was employed to identify independent predictors which were used to construct the clinical model, DLCT model, and combined model. A nomogram was formulated based on optimal performing model, and its performance was assessed using receiver operating characteristic curve, calibration curve, and decision curve analysis. The nomogram was subsequently tested in the validation set. Results Independent predictors associated with malignant TNs with indeterminate cytology included NICP in the arterial phase, Hashimoto's Thyroiditis (HT), and BRAF V600E (all p < 0.05). The DLCT-clinical nomogram, incorporating the aforementioned variables, exhibited superior performance than the clinical model or DLCT model in both training set (AUC: 0.875 vs 0.792 vs 0.824) and validation set (AUC: 0.874 vs 0.792 vs 0.779). The DLCT-clinical nomogram demonstrated satisfactory calibration and clinical utility in both training set and validation set. Conclusion The DLCT-clinical nomogram emerges as an effective tool to detect malignant lesions in cytologically indeterminate TNs.
Collapse
Affiliation(s)
- Xiaofang Ren
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayan Zhang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zuhua Song
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Qian Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zhang
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Jiayi Yu
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Zongwen Li
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Youjia Wen
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Dan Zeng
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| | - Xiaodi Zhang
- Department of Clinical and Technical Support, Philips Healthcare, Chengdu, China
| | - Zhuoyue Tang
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Radiology, Chongqing General Hospital, Chongqing, China
| |
Collapse
|
21
|
Lévesque F, Payne RJ, Beaudoin D, Boucher A, Fortier PH, Massicotte MH, Pusztaszeri M, Rondeau G, Corriveau E, El Malt F, Brassard M. A Prospective Study of Publicly Funded Molecular Testing of Indeterminate Thyroid Nodules: Canada's Experience. J Clin Endocrinol Metab 2024:dgae355. [PMID: 38779881 DOI: 10.1210/clinem/dgae355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/25/2024] [Accepted: 05/21/2024] [Indexed: 05/25/2024]
Abstract
CONTEXT Indeterminate thyroid nodules (ITNs) lead to diagnostic surgeries in many countries. Use of molecular testing (MT) is endorsed by several guidelines, but costs are limitative, especially in public healthcare systems like in Canada. OBJECTIVES Primary objective: evaluate the clinical value of Thyroseq® v3 (TSv3) using benign call rate (BCR) in a real-world practice. Secondary objective: assess cost-effectiveness of MT. DESIGN This is a multicentric prospective study. SETTING This study was conducted in 5 academic centers in Quebec, Canada. PATIENTS OR OTHER PARTICIPANTS 500 consecutive patients with Bethesda III (on 2 consecutive cytopathologies) or IV and TIRADS 3 or 4 nodules measuring 1 to 4 cm were included. INTERVENTION MT was performed between November 2021 and November 2022. Patients with a positive TSv3 were referred to surgery. Patients with a negative TSv3 were planned for follow-up by ultrasonography for a minimum of 2 years. MAIN OUTCOME MEASURE The BCR, corresponding to the proportion of ITNs with negative TSv3 results, was assessed. RESULTS 500 patients underwent TSv3 testing, with a BCR of 72.6% (95% CI: 68.5-76.5; p<0.001). 99.7% of patients with a negative result avoided surgery. The positive predictive value of TSv3 was 68.2% (95% CI: 58.5-76.9). The cost-benefit analysis identified that the implementation of MT would yield cost savings of $6.1 million over the next 10 years. CONCLUSIONS Use of MT (TSv3) in a well-selected population with ITNs led to a BCR of 72.6%. It is cost-effective and prevents unnecessary surgeries in a public healthcare setting.
Collapse
Affiliation(s)
- Florence Lévesque
- Division of Oncology, Department of Medicine, Centre Hospitalier universitaire de Québec, Université Laval, Quebec City, Canada
| | - Richard J Payne
- Department of Otolaryngology, Head and Neck Surgery, Jewish General Hospital and McGill University Health Centre, Montreal, Canada
| | - Danielle Beaudoin
- Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier universitaire de Québec, Université Laval, Quebec City, Canada
| | - Andrée Boucher
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Pierre-Hugues Fortier
- Department of Otolaryngology, Head and Neck Surgery, Centre Hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Hélène Massicotte
- Division of Endocrinology, Department of Medicine, Centre Hospitalier universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital and McGill University Health Centre, Montreal, Canada
| | - Geneviève Rondeau
- Division of Endocrinology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | | | - Farida El Malt
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Maryse Brassard
- Division of Endocrinology, Department of Medicine, Centre Hospitalier universitaire de Québec, Université Laval, Quebec City, Canada
| |
Collapse
|
22
|
Conradie W, Baatjes K, Luvhengo T, Buitendag J, Razack R, Davies J, Crabbia F, Afrogheh A, Lübbe J. Performance of Thyroid Fine-Needle Aspiration Biopsy in a Low- and Middle-Income Country. Acta Cytol 2024:1-8. [PMID: 38735277 DOI: 10.1159/000539153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION The 6 categories of the Bethesda System for Reporting Thyroid Cytology (TBSRTC) with associated risk of malignancy (ROM) provide evidence-based clinical management guidelines. This study aimed to determine the ROM and accuracy of FNAB in South Africa (SA). METHODS Thyroid specimens from 3 pathology laboratories registered between January 2015 and December 2019 were considered for inclusion. ROM was obtained per TBSRTC category by cytohistological correlation and dividing the total number of specimens with malignant histology by the total number of cases operated. Accuracy was calculated based on the Bethesda category and eventual malignant histology. RESULTS Seventeen thousand seven hundred and seventy-three histology and 4,791 cytology cases were identified. Of the 4,791 cytology cases, 931 (19%) underwent surgery. More than a third (333, 35.8%) of cases were confirmed as malignant following histological assessment, with the majority being benign (584, 62.7%). The ROM for the nondiagnostic and benign categories was 24.3% and 20.5%. The highest ROM was for category VI (91.5%), followed by categories V (69.5%), IV (51.9%), and III (38.8%). Thyroid FNAB had a sensitivity of 73%, specificity of 74%, and overall accuracy of 74%. CONCLUSION Bethesda categories II and IV have a relatively higher ROM in SA compared to findings from other developed countries. The diagnostic accuracy of thyroid FNAB in SA and the high rate of nondiagnostic diagnoses (38%) require further investigation. A national thyroid registry could provide location-specific data to aid the implementation of appropriate local policies and national guidelines for practicing thyroid surgeons.
Collapse
Affiliation(s)
- Wilhelmina Conradie
- Tygerberg Hospital, Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| | - Karin Baatjes
- Tygerberg Hospital, Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| | | | - Johannes Buitendag
- Tygerberg Hospital, Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| | - Rubina Razack
- Division of Anatomical Pathology, National Health Laboratory Service, University of Stellenbosch, Cape Town, South Africa
| | | | - Fabio Crabbia
- Pathcare Laboratory (Dietrich, Voigt, Mia and Partners), Cape Town, South Africa
| | - Amir Afrogheh
- National Health Laboratory Service, Department of Oral and Maxillofacial Pathology, University of Western Cape, Cape Town, South Africa
| | - Jeanne Lübbe
- Tygerberg Hospital, Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| |
Collapse
|
23
|
Ivanovic-Zuvic D, Chelebifski S, Uribe B, Quintana C, Domínguez JM, Olmos R, Florenzano P. Impaired Quality of Life in Patients with Post-Surgical Hypoparathyroidism. J Bone Metab 2024; 31:140-149. [PMID: 38886971 PMCID: PMC11184150 DOI: 10.11005/jbm.2024.31.2.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/14/2024] [Accepted: 05/04/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Hypoparathyroidism is characterized by chronic hypocalcemia with low or abnormal parathyroid hormone levels. Thyroid surgery remains a predominant cause of hypoparathyroidism, often preventable by partial thyroidectomy. Although hypoparathyroidism can impair quality of life (QOL), data remain limited for Latin America. We aimed to characterize clinical manifestations and QOL in patients with postsurgical hypoparathyroidism. METHODS This case-control study included patients (>18 years) who underwent total thyroidectomy (TT) for differentiated thyroid cancer (DTC) with postsurgical hypoparathyroidism (Group 1, Cases) and those with DTC who underwent TT without postsurgical hypoparathyroidism (Group 2, Controls). Clinical records were collected, and the SF-36v2 QOL survey and a structured symptom survey were applied. A logistic multivariate regression analysis was performed. RESULTS This study included 106 subjects (Group 1, N=41; Group 2, N=65). Group 1 patients were younger, had a higher frequency of lymph node resection, and more frequently received Ι-131 than Group 2 patients (p<0.05). In the SF-36v2 survey, Group 1 had fewer physical-functioning scores (odds ratio, 3.8; 95% confidence interval, 1.2-11.7) and lower scores in mental and physical components than Group 2 and national records. Commonly reported symptoms include paresthesia, daily fatigue, and memory alterations. Treatment adherence rates were 56% and 71% for calcium and calcitriol, respectively. Furthermore, 24% of patients experienced one or more hypoparathyroidism drug-related adverse effects. CONCLUSIONS Patients with postsurgical hypoparathyroidism had an impaired QOL, a high frequency of disease-associated symptoms, and limited treatment adherence. These results should be considered when deciding the best surgical alternative for DTC.
Collapse
Affiliation(s)
| | - Slavka Chelebifski
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Benjamin Uribe
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Camila Quintana
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - José Miguel Domínguez
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Centro Traslacional de Endocrinología (CETREN-UC), School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Roberto Olmos
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Centro Traslacional de Endocrinología (CETREN-UC), School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Pablo Florenzano
- Department of Endocrinology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Centro Traslacional de Endocrinología (CETREN-UC), School of Medicine, Pontificia Universidad Católica de Chile, Santiago,
Chile
| |
Collapse
|
24
|
Shearn-Nance G, Politano S, Cabrera CI, Tamaki A, Li S, Lavertu P, Thuener JE. Development of hypothyroidism following hemithyroidectomy: A population-based study. Am J Otolaryngol 2024; 45:104239. [PMID: 38430841 DOI: 10.1016/j.amjoto.2024.104239] [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: 12/27/2023] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Hypothyroidism is a known possibility after hemithyroidectomy, with a highly variable incidence in the literature ranging from 8 to 60 %. Incidence of hypothyroidism after hemithyroidectomy was evaluated with a secondary aim to assess incidence in patients with Hashimoto's disease. MATERIALS & METHODS A retrospective study using the TriNetX global federated research network was performed. We included patients within the last 15 years that were ≥18 years of age and had Current Procedural Terminology codes for hemithyroidectomy. Patients were excluded if they had a total or completion thyroidectomy at any time, a history of thyroid cancer, were preoperatively either on levothyroxine, diagnosed with hypothyroidism, or had a Thyroid Stimulating Hormone ≥ 4 m[IU]/L. We assessed the 3 month incidence of hypothyroidism postoperatively based on the International Classification of Diseases code, TSH ≥ 4 m[IU]/L, or taking levothyroxine after surgery. RESULTS 6845 patients met the inclusion criteria. Most of the cohort was female (67 %) and white (63 %). The mean age at surgery for this population was 54 ± 14.8 years. During the 15 years of data, we found the 3-month incidence of hypothyroidism following hemithyroidectomy to be 23.58 %. The median time to develop the disease was 41.8 months. A subgroup analysis of those with Hashimoto's revealed a 3-month incidence of 31.1 % of patients developing hypothyroidism after surgery. CONCLUSIONS This population-based study gives additional insight into the incidence of hypothyroidism after hemithyroidectomy. This will help improve perioperative patient counseling and management.
Collapse
Affiliation(s)
| | - Stephen Politano
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Claudia I Cabrera
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Akina Tamaki
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Shawn Li
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Pierre Lavertu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jason E Thuener
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology - Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| |
Collapse
|
25
|
Bakuła-Zalewska E, Długosińska J, Stanek-Widera A, Góralski P, Gałczyński J, Żyłka A, Durzyńska M, Dedecjus M. Fine needle aspiration biopsy of parathyroid; is it meaningful? A cytologic study of 81 cases with histological and clinical correlations. Cytopathology 2024; 35:362-370. [PMID: 38213192 DOI: 10.1111/cyt.13356] [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: 07/27/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Recognizing the parathyroid gland and distinguishing the parathyroid from thyroid lesions in fine needle aspiration (FNA) is challenging. This study aimed to identify cytomorphologic features suggestive of parathyroid origin and to assess the utility of cytopathology in conjunction with ancillary tests in the identification of parathyroid glands. MATERIALS AND METHODS Ultrasound (US) guided FNA of parathyroid gland and lesions in 81 patients were reviewed concerning clinical history and correlated to histopathologic findings in available cases. FNA smears were evaluated for cellularity, architectural patterns, cellular and nuclear features, and background of the smears. In 78 cases, FNA was supplemented by a measurement of parathormone (PTH) levels in the needle washout fluid (FNA-PTH assay) and/or GATA3/PTH/chromogranin-A immunostainings. RESULTS Sixty-four cases were diagnosed cytologically as parathyroid lesions in conjunction with FNA-PTH assay and/or immunocytochemical examinations. In an additional nine cases, a diagnosis of parathyroid lesions was rendered after repeated FNA with FNA-PTH assay. The histolopathologic diagnosis of surgically excised cases (n = 75) included parathyroid adenoma (60 cases), atypical parathyroid adenoma (4 cases), parathyroid hyperplasia (10 cases), and parathyroid carcinoma (1 case). Major cytological findings of parathyroid tissue included high cellularity, scattered naked nuclei, cribriform and three-dimensional clusters, stippled chromatin, and oxyphilic cytoplasm while papillary pattern or colloid-like material was identified in three cases respectively. No nuclear grooves or inclusions were seen in any case. CONCLUSIONS High cellularity scattered naked nuclei, cribriform and three-dimensional patterns, stippled chromatin and oxyphilic cytoplasm are cytomorphologic features that favour parathyroid origin. A combination of these features with FNA-PTH assay and/or GATA3, PTH, and chromogranin-A immunostainings on cytologic specimens aid in the identification of parathyroid glands and the distinguishing of parathyroid from thyroid lesions.
Collapse
Affiliation(s)
- Elwira Bakuła-Zalewska
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Warsaw, Poland
| | - Joanna Długosińska
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Warsaw, Poland
| | | | - Piotr Góralski
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Warsaw, Poland
| | - Jacek Gałczyński
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Warsaw, Poland
| | - Agnieszka Żyłka
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Warsaw, Poland
| | - Monika Durzyńska
- Department of Pathology and Laboratory Diagnostics, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Warsaw, Poland
| | - Marek Dedecjus
- Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Warsaw, Poland
| |
Collapse
|
26
|
Wang R, Disharoon M, Song Z, Gillis A, Fazendin J, Lindeman B, Chen H, McMullin JL. Incidental but Not Insignificant: Thyroid Cancer in Patients with Graves Disease. J Am Coll Surg 2024; 238:751-758. [PMID: 38230856 DOI: 10.1097/xcs.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
BACKGROUND Graves disease is the most common cause of hyperthyroidism in the US. Treatment with antithyroid drugs and radioactive iodine is more commonly used than surgical management with total thyroidectomy (TTx). However, incidentally discovered thyroid cancer (TC) has been described on surgical pathology from patients who underwent surgical treatment of Graves disease, which would be missed with these other treatment strategies. We sought to determine the incidence rate of TC among patients with surgically treated Graves disease. STUDY DESIGN We retrospectively reviewed patients with Graves disease who underwent TTx at a single institution from 2011 to 2023. Pathology reports were reviewed for TC. Patient demographics, preoperative laboratory and radiological evaluations, preoperative medical management, and surgical outcomes were compared between patients with and without incidental TC. RESULTS There were 934 patients, of whom 60 (6.4%) patients had incidentally discovered TC on pathology. The majority (58.3%) of patients had papillary thyroid carcinoma, followed by 33.3% with papillary microcarcinoma. Preoperative ultrasound (US) was obtained in 564 (60.4%) of patients, with 44.3% with nodules, but only 34 (13.7%) of those with nodules had TC on final pathology. Preoperative fine needle aspiration was obtained in 15 patients with TC, and 8 patients (53.3%) were reported as benign lesions, which ultimately had TC on final pathology. There was no difference in sex, race or ethnicity, preoperative medical management, and postoperative outcomes between the 2 groups. CONCLUSIONS Incidental TC was found on surgical pathology in 6.4% of patients undergoing TTx for Graves disease. Preoperative imaging with US and fine needle aspiration were often unreliable at predicting TC. The incidence of TC should not be underestimated when counseling patients on definitive management for Graves disease.
Collapse
Affiliation(s)
- Rongzhi Wang
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Mitchell Disharoon
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Zhixing Song
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Andrea Gillis
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Jessica Fazendin
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Brenessa Lindeman
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Herbert Chen
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
| | - Jessica Liu McMullin
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL (Wang, Disharoon, Song, Gillis, Fazendin, Lindeman, Chen, McMullin)
- Department of Surgery, University of Utah, Salt Lake City, UT (McMullin)
| |
Collapse
|
27
|
Wang SH, Chao WP, Lo TY, Ng SC, Chen YH. Comparison of Surgical Outcomes of Transoral Versus Open Thyroidectomy for Graves Disease. Surg Laparosc Endosc Percutan Tech 2024; 34:150-155. [PMID: 38359355 DOI: 10.1097/sle.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/21/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a safe alternative to thyroidectomy for thyroid goiter and provides the benefit of being scarless. However, the data on the use of TOETVA in patients with Graves disease are limited. This retrospective study compared the outcomes of Graves disease patients who underwent TOETVA versus those who underwent open thyroidectomy (OT). MATERIALS AND METHODS Patients with Graves disease who received TOETVA or OT for bilateral total thyroidectomy between September 2017 and October 2022 were included. Patient demographics and surgical outcomes, including operation time, blood loss, length of stay, and complications, were compared. RESULTS There were 15 patients in each group. The mean age in the TOETVA group was 35.80±8.13 years, which was significantly younger than that in the OT group, which was 51.53±14.22 years. Females predominated in both groups. The other demographic characteristics were similar in both groups. The operation time and intraoperative blood loss were also comparable. The postoperative stay and complications, including hypoparathyroidism, recurrent laryngeal nerve injury, surgical site infection, postoperative hemorrhage, and recurrence of hyperthyroidism, were not different between the 2 groups. There were 11 patients in the TOETVA group and 10 in the OT group who had thyroglobulin levels <0.1 ng/dL, indicating the completeness of total thyroidectomy in the 2 groups. There was no conversion of TOETVA to an open procedure. CONCLUSIONS For carefully selected Graves patients, TOETVA offers a safe, scarless, and feasible alternative to conventional open thyroidectomy.
Collapse
Affiliation(s)
- Suo-Hsien Wang
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wu-Po Chao
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ta-You Lo
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taiwan
| | - Soh-Ching Ng
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Chang Gung University, Taiwan
| | - Yu-Hsien Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| |
Collapse
|
28
|
Zhao ZL, Wang SR, Dong G, Liu Y, He JF, Shi LL, Guo JQ, Wang ZH, Cong ZB, Liu LH, Yang BB, Qu CP, Niu WQ, Wei Y, Peng LL, Li Y, Lu NC, Wu J, Yu MA. Microwave Ablation versus Surgical Resection for US-detected Multifocal T1N0M0 Papillary Thyroid Carcinoma: A 10-Center Study. Radiology 2024; 311:e230459. [PMID: 38563669 DOI: 10.1148/radiol.230459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Microwave ablation (MWA) is currently under preliminary investigation for the treatment of multifocal papillary thyroid carcinoma (PTC) and has shown promising treatment efficacy. Compared with surgical resection (SR), MWA is minimally invasive and could preserve thyroid function. However, a comparative analysis between MWA and SR is warranted to draw definitive conclusions. Purpose To compare MWA and SR for preoperative US-detected T1N0M0 multifocal PTC in terms of overall and 1-, 3-, and 5-year progression-free survival rates and complication rates. Materials and Methods In this retrospective study, 775 patients with preoperative US-detected T1N0M0 multifocal PTC treated with MWA or SR across 10 centers between May 2015 and December 2021 were included. Propensity score matching (PSM) was performed for patients in the MWA and SR groups, followed by comparisons between the two groups. The primary outcomes were overall and 1-, 3-, and 5-year progression-free survival (PFS) rates and complication rates. Results After PSM, 229 patients (median age, 44 years [IQR 36.5-50.5 years]; 179 female) in the MWA group and 453 patients (median age, 45 years [IQR 37-53 years]; 367 female) in the SR group were observed for a median of 20 months (range, 12-74 months) and 26 months (range, 12-64 months), respectively. MWA resulted in less blood loss, shorter incision length, and shorter procedure and hospitalization durations (all P < .001). There was no evidence of differences in overall and 1-, 3-, or 5-year PFS rates (all P > .05) between MWA and SR (5-year rate, 77.2% vs 83.1%; P = .36) groups. Permanent hoarseness (2.2%, P = .05) and hypoparathyroidism (4.0%, P = .005) were encountered only in the SR group. Conclusion There was no evidence of a significant difference in PFS rates between MWA and SR for US-detected multifocal T1N0M0 PTC, and MWA resulted in fewer complications. Therefore, MWA is a feasible option for selected patients with multifocal T1N0M0 PTC. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Georgiades in this issue.
Collapse
Affiliation(s)
- Zhen-Long Zhao
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Shu-Rong Wang
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Gang Dong
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Ying Liu
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Jun-Feng He
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Li-Li Shi
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Jian-Qin Guo
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Zhong-Hua Wang
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Zhi-Bin Cong
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Li-Hong Liu
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Bei-Bei Yang
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Chun-Ping Qu
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Wen-Quan Niu
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Ying Wei
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Li-Li Peng
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Yan Li
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Nai-Cong Lu
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Jie Wu
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| | - Ming-An Yu
- From the Department of Interventional Medicine, China-Japan Friendship Hospital, Beijing, China (Z.L.Z., Y.W., L.L.P., Y. Li, N.C.L., J.W., M.A.Y.); Department of Ultrasound, Yantai Hospital of Shandong Wendeng Orthopaedics and Traumatology, Yantai, China (S.R.W., Y. Liu); Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (G.D.); Department of Ultrasound, the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China (J.F.H.); Department of Ultrasound, Laixi Municipal Hospital, Laixi, China (L.L.S.); Department of Interventional Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China (J.Q.G.); Department of Special Inspection, Wendeng District People's Hospital, Weihai, China (Z.H.W.); Department of Electrodiagnosis, the Affiliated Hospital to Changchun University of Traditional Chinese Medicine, Changchun, China (Z.B.C.); Department of Medical Ultrasound, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China (L.H.L., B.B.Y.); Department of Special Inspection, Muping Zhongyi Hospital, Yantai, China (C.P.Q.); Department of Clinical Medical Sciences, Capital Institute of Pediatrics, Beijing, China (W.Q.N.)
| |
Collapse
|
29
|
Chilkoti GT, Gupta A, Bhandari P, Mohta M. Techniques of detecting recurrent laryngeal nerve palsy in patients undergoing thyroid surgery: Pearls and pitfalls. J Anaesthesiol Clin Pharmacol 2024; 40:199-205. [PMID: 38919442 PMCID: PMC11196049 DOI: 10.4103/joacp.joacp_346_22] [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: 09/21/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 06/27/2024] Open
Abstract
Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.
Collapse
Affiliation(s)
- Geetanjali Tolia Chilkoti
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Anju Gupta
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Pallav Bhandari
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Medha Mohta
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| |
Collapse
|
30
|
Hu Y, Xu S, Dong L, Pan Z, Zhang L, Zhan W. Clinical features combined with ultrasound characteristics to predict TERT promoter mutations in papillary thyroid carcinoma: a single-center study over the past 5 years. Front Endocrinol (Lausanne) 2024; 15:1322731. [PMID: 38562417 PMCID: PMC10982409 DOI: 10.3389/fendo.2024.1322731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Telomerase reverse transcriptase (TERT) has been reported in papillary thyroid carcinoma (PTC). This study aimed to investigate the correlation of TERT promoter mutations with clinical and ultrasound (US) features in PTC and to develop a model to predict TERT promoter mutations. Methods Preoperative US images, postoperative pathological features, and TERT promoter mutation information were evaluated in 365 PTC patients confirmed by surgery. Univariate and multivariate factor analyses were performed to identify risk factors for TERT promoter mutations. A predictive model was established to assess the clinical predictive value. Results Of the 365 patients with PTC (498 nodules), the number of those with TERT promoter mutations was 67 cases (75 nodules), and the number of those without mutations was 298 cases (423 nodules). The median age was 40 years in the wild-type group and 60 years in the mutant group. Male patients made up 35.82% of the mutant group and 22.82% of the wild-type group. Multivariate analysis revealed that the independent risk factors associated with the occurrence of TERT promoter mutation in PTC were as follows: older age (odds ratio (OR) = 1.07; p = 0.002), maximum diameter of ≥ 10 mm (OR = 3.94; p < 0.0001), unilateral (OR = 4.15; p < 0.0001), multifocal (OR = 7.69; p < 0.0001), adjacent to the thyroid capsule (OR = 1.94; p = 0.044), and accompanied by other benign nodules (OR = 1.94, p = 0.039). A predictive model was established, and the area under the curve (AUC) of the receiver operating characteristic was 0.839. TERT promoter mutations were associated with high-risk US and clinical features compared with the wild-type group. Conclusion TERT promoter mutations were associated with older ages. They were also found to be multifocal, with a maximum diameter of ≥ 10 mm, unilateral, adjacent to the thyroid capsule, and accompanied by other benign nodules. The predictive model was of high diagnostic value.
Collapse
Affiliation(s)
- Yan Hu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shangyan Xu
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lei Dong
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zuxian Pan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lu Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiwei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
31
|
Balbaloglu H, Karadeniz E, Erkek A, Yilmaz C, Ugurlu MU, Cakmak GK. Utilizing Surgeon-Performed Intraoperative Translaryngeal Ultrasound for Verifying Vocal Fold Function: A Troubleshooting Approach for Intraoperative Neuromonitoring in Neck Surgery. J Voice 2024:S0892-1997(24)00062-6. [PMID: 38493015 DOI: 10.1016/j.jvoice.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION We investigated transcutaneous laryngeal ultrasonography (TLUS) for assessing vocal fold (VF) mobility during thyroid and parathyroid surgeries, emphasizing its precision and utility in signal loss scenarios. METHODS Between October 2020 and January 2023, we performed TLUS, Doppler sonography, laryngeal twitch response (LTR) palpation, and electromyography (EMG) to monitor recurrent laryngeal nerve function during neck surgeries. Postoperatively, the VF activity was verified using fiberoptic video laryngoscopy (FL). Concordance with FL was categorized based on VF activity. RESULTS Of the 443 VF evaluations, no instances of permanent bilateral paralysis were noted. Temporary unilateral palsy was found in 3.38% and permanent in 0.45%. TLUS displayed 97.8% agreement with EMG and was diagnostically superior (99.7% vs 98.2%) and more affordable ($68 vs $300) compared to analogous operative durations. CONCLUSION TLUS rivals EMG in terms of intraoperative neuromonitoring accuracy and outperforms LTR. Being cost-effective, TLUS can effectively address signal loss situations, thereby averting additional surgeries.
Collapse
Affiliation(s)
- Hakan Balbaloglu
- Department of General Surgery, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey.
| | - Emre Karadeniz
- Department of General Surgery, Bulent Ecevit University, School of Medicine, Zonguldak, Turkey
| | - Ahmet Erkek
- Department of General Surgery, Bahcesehir University, School of Medicine, Istanbul, Turkey
| | | | - Mustafa Umit Ugurlu
- Department of General Surgery, Marmara University, School of Medicine, Istanbul, Turkey
| | | |
Collapse
|
32
|
Biffoni M, Grani G, Melcarne R, Geronzi V, Consorti F, Ruggieri GD, Galvano A, Razlighi MH, Iannuzzi E, Engel TD, Pace D, Di Gioia CRT, Boniardi M, Durante C, Giacomelli L. Drawing as a Way of Knowing: How a Mapping Model Assists Preoperative Evaluation of Patients with Thyroid Carcinoma. J Clin Med 2024; 13:1389. [PMID: 38592234 PMCID: PMC10931768 DOI: 10.3390/jcm13051389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Effective pre-surgical planning is crucial for achieving successful outcomes in endocrine surgery: it is essential to provide patients with a personalized plan to minimize operative and postoperative risks. Methods: Preoperative lymph node (LN) mapping is a structured high-resolution ultrasonography examination performed in the presence of two endocrinologists and the operating surgeon before intervention to produce a reliable "anatomical guide". Our aim was to propose a preoperative complete model that is non-invasive, avoids overdiagnosis of thyroid microcarcinomas, and reduces medical expenses. Results: The use of 'preoperative echography mapping' has been shown to be successful, particularly in patients with suspected or confirmed neoplastic malignancy. Regarding prognosis, positive outcomes have been observed both post-surgery and in terms of recurrence rates. We collected data on parameters such as biological sex, age, BMI, and results from cytologic tests performed with needle aspiration, and examined whether these parameters predict tumor malignancy or aggressiveness, calculated using a multivariate analysis (MVA). Conclusions: A standard multidisciplinary approach for evaluating neck lymph nodes pre-operation has proven to be an improved diagnostic and preoperative tool.
Collapse
Affiliation(s)
- Marco Biffoni
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Rossella Melcarne
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Valerio Geronzi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Fabrizio Consorti
- Department of General Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy;
| | - Giuseppe De Ruggieri
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Alessia Galvano
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Maryam Hosseinpour Razlighi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Eva Iannuzzi
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Tal Deborah Engel
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| | - Daniela Pace
- Department of Endocrinology, Valmontone Hospital, 00038 Valmontone, Italy;
| | - Cira Rosaria Tiziana Di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy;
| | - Marco Boniardi
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy;
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (G.G.); (C.D.)
| | - Laura Giacomelli
- Department of General and Specialist Surgery, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy; (M.B.); (V.G.); (G.D.R.); (A.G.); (M.H.R.); (E.I.); (T.D.E.); (L.G.)
| |
Collapse
|
33
|
Bastien AJ, Ho AS. Surgical Management of Substernal Thyroid Goiters. Otolaryngol Clin North Am 2024; 57:39-52. [PMID: 37652811 DOI: 10.1016/j.otc.2023.07.008] [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] [Indexed: 09/02/2023]
Abstract
Substernal thyroid goiters can present with progressive symptoms involving compression of vital structures such as the esophagus, trachea, or large vessels. A multidisciplinary approach is critical when diagnosing and treating these patients. This article discusses patient presentation, workup, and management options for patients with substernal goiter as well as surgical pearls to minimize risk of complications.
Collapse
Affiliation(s)
- Amanda J Bastien
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Allen S Ho
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| |
Collapse
|
34
|
Sura GH, Thrall MJ, Rogers J, Hodjat P, Christensen P, Cubb TD, Khadra HS, Thomas JS, Jacobi EM. A retrospective analysis of molecular testing in cytologically indeterminate thyroid nodules with histologic correlation: Experience at a heterogenous multihospital system. Diagn Cytopathol 2024; 52:82-92. [PMID: 37950548 DOI: 10.1002/dc.25250] [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: 08/10/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Thyroid malignancy is one of the most common types of cancer in developed nations. Currently, fine-needle aspiration cytology (FNAC) is the most practical screening test for thyroid nodules. However, cytologically indeterminate samples comprise approximately 15%-30% of cases. These include cases classified as atypia of undetermined significance (AUS), follicular neoplasm (FN), and suspicious for malignancy (SFM). Indeterminate cases can be sent for molecular testing for more definitive classification to help guide management and prevent overtreatment of benign thyroid nodules. We conducted a retrospective review on molecular testing of indeterminate thyroid FNAC and reviewed subsequent histologic diagnoses in resection specimens to assess how molecular testing supported a diagnosis and its effect on clinical management of patients at our institution. METHODS A retrospective chart review was performed on all thyroid FNAC specimens, corresponding molecular testing, and subsequent surgical resection specimens over a 6-year period. RESULTS A total of 10,253 thyroid FNAC were performed in our hospital system during our study period, of which 10% (n = 1102/10,253) had indeterminate FNAC results. Molecular testing was performed in 16% (n = 178/1102) of indeterminate cytology cases. Genetic alterations were identified in 39% (n = 69/178) of the cases sent for molecular testing. The majority of cytologically indeterminate cases sent for molecular testing were follicular-patterned lesions and their corresponding resection specimens revealed mostly low grade follicular derived neoplasms (i.e., follicular adenoma, non-invasive follicular thyroid neoplasm with papillary-like nuclear features, and follicular variant of papillary thyroid carcinoma). Of the cases with identified genetic alterations, 75% (n = 52/69) were treated surgically. In cases with no genetic alterations identified, only 18% (n = 20/109) were treated surgically. DISCUSSION/CONCLUSION Molecular testing on cytologically indeterminate thyroid nodules can help provide a more accurate risk of malignancy assessment in patients with lesions that are difficult to diagnosis based solely on FNAC morphology. The types of genetic alterations identified in the resected thyroid lesions were consistent with what has been previously described in the literature. Additionally, we found that in the patients with indeterminate thyroid FNAC with adjunct molecular testing, more than half did not undergo surgical resection. This finding emphasizes the value of adding molecular testing in patients, particularly when attempting to reduce unnecessary surgical intervention.
Collapse
Affiliation(s)
- Gloria H Sura
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Thrall
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - John Rogers
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Parsa Hodjat
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Paul Christensen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Trisha D Cubb
- Department of Endocrinology, Houston Methodist Hospital, Houston, Texas, USA
| | - Helmi S Khadra
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Jessica S Thomas
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Elizabeth M Jacobi
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
35
|
Scott B, Wong RJ. Step-by-Step Thyroidectomy-Incision, Nerve Identification, Parathyroid Preservation, and Gland Removal. Otolaryngol Clin North Am 2024; 57:25-37. [PMID: 37748983 DOI: 10.1016/j.otc.2023.08.007] [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] [Indexed: 09/27/2023]
Abstract
Thyroidectomy is a surgical procedure to remove part or all of the thyroid gland. Although the general tenets of surgery have remained the same, improvements in techniques, diagnostics, understanding of anatomy, and technology have allowed thyroid surgery to become a standard, effective, and safe surgery. For surgeons undertaking this procedure, it is imperative to have an in-depth knowledge of critical anatomy and a comprehensive understanding of surgical techniques to perform safe and effective surgery. This article aims to provide an overview of surgical techniques that may be applied in both benign and malignant disease settings.
Collapse
Affiliation(s)
- Britney Scott
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
| |
Collapse
|
36
|
Brocke TK, Martens GR, Awad MM, Sacks JM, Olson JA. Combined Thyroid-Parathyroid Organ Transplantation: Demonstration of Technical Feasibility in a Perfused Cadaver Model. J Am Coll Surg 2024; 238:e1-e5. [PMID: 37921360 DOI: 10.1097/xcs.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Affiliation(s)
- Tiffany K Brocke
- From the Department of Surgery, Washington University in St Louis, St Louis, MO
| | | | | | | | | |
Collapse
|
37
|
Yu F, Sang T, Kang J, Deng X, Guo B, Yang H, Chen X, Fan Y, Ding X, Wu B. An automatic parathyroid recognition and segmentation model based on deep learning of near-infrared autofluorescence imaging. Cancer Med 2024; 13:e7065. [PMID: 38457206 PMCID: PMC10923035 DOI: 10.1002/cam4.7065] [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: 07/25/2023] [Revised: 01/18/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Near-infrared autofluorescence imaging (NIFI) can be used to identify parathyroid gland (PG) during surgery. The purpose of the study is to establish a new model, help surgeons better identify, and protect PGs. METHODS Five hundred and twenty three NIFI images were selected. The PGs were recorded by NIFI and marked with artificial intelligence (AI) model. The recognition rate for PGs was calculated. Analyze the differences between surgeons of different years of experience and AI recognition, and evaluate the diagnostic and therapeutic efficacy of AI model. RESULTS Our model achieved 83.5% precision and 57.8% recall in the internal validation set. The visual recognition rate of AI model was 85.2% and 82.4% on internal and external sets. The PG recognition rate of AI model is higher than that of junior surgeons (p < 0.05). CONCLUSIONS This AI model will help surgeons identify PGs, and develop their learning ability and self-confidence.
Collapse
Affiliation(s)
- Fan Yu
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian Sang
- School of Computer Engineering and Science, Shanghai University, Shanghai, China
| | - Jie Kang
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianzhao Deng
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Guo
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hangzhou Yang
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyi Chen
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Youben Fan
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuehai Ding
- School of Computer Engineering and Science, Shanghai University, Shanghai, China
| | - Bo Wu
- Department of Thyroid, Breast and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
38
|
Ohori NP, Cuda JM, Bastacky SI, Yip L, Karslioglu-French E, Morariu EM, Ullal J, Ramonell KM, Carty SE, Nikiforov YE, Schoedel KE, Seethala RR. Molecular-derived risk of malignancy and the related positive call rate of indeterminate thyroid cytology diagnoses as quality metrics for individual cytopathologists. Cancer Cytopathol 2024; 132:109-118. [PMID: 37849056 DOI: 10.1002/cncy.22772] [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: 08/08/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Indeterminate thyroid cytopathology diagnoses represent differing degrees of risk that are corroborated by follow-up studies. However, traditional cytologic-histologic correlation may overestimate the risk of malignancy (ROM) because only a subset of cases undergo resection. Alternatively, some molecular tests provide probability of malignancy data to calculate the molecular-derived risk of malignancy (MDROM) and the positive call rate (PCR). The authors investigated MDROMs and PCRs of indeterminate diagnoses for individual cytopathologists as quality metrics. METHODS This study was approved by the Department of Pathology Quality Improvement Program. Thyroid cytopathology diagnoses and ThyroSeq v3 results were retrieved for each cytopathologist for a 2-year period with at least 3 years of follow-up for the atypia of undetermined significance (AUS), follicular neoplasia (FN), and follicular neoplasia, oncocytic-type (ONC) cytopathologic diagnoses. MDROMs and PCRs were compared with reference ROMs and cytologic-histologic correlation outcomes. RESULTS The overall MDROMs (and ranges for cytopathologists) for the AUS, FN, and ONC categories were 13.4% (range, 5.8%-20.8%), 28.1% (range, 22.1%-36.7%), and 27.0% (range, 19.5%-41.5%), respectively, and most individual cytopathologists' MDROMs were within reference ROM ranges. However, PCRs more effectively parsed the differences in cytopathologists' ROM performance. Although the overall PCRs were not significantly different across cytopathologists (p = .06), the AUS PCRs were quite different (p = .002). By cytologic-histologic correlation, six of 55 resected cases (10.9%) were falsely negative, and there were no false-positive cases. CONCLUSIONS MDROMs and PCRs evaluate concordance with reference ROMs and with one another and provide individual feedback, which potentially facilitates quality improvement.
Collapse
Affiliation(s)
- N Paul Ohori
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Jacqueline M Cuda
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Sheldon I Bastacky
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Esra Karslioglu-French
- Division of Endocrinology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Elena M Morariu
- Division of Endocrinology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Jagdeesh Ullal
- Division of Endocrinology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Kimberly M Ramonell
- Division of Endocrine Surgery, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Sally E Carty
- Division of Endocrine Surgery, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Karen E Schoedel
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
39
|
Liu Y, Wang J, Chen S, Lv H, Yu S, Ran X, Gao N, Sun Y, Cao G. Preliminary report on a novel technique for endoscopic transaxillary thyroidectomy: a case-control study. Int J Surg 2024; 110:654-659. [PMID: 37983762 PMCID: PMC10871656 DOI: 10.1097/js9.0000000000000885] [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: 07/09/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Endoscopic transaxillary approaches to thyroidectomy have been well described and gasless transaxillary endoscopic thyroidectomy (GTET) is the most popular method. However, this require a single long axillary incision which is longer than most remote access thyroidectomy procedures. The authors improved the GTET and provided a novel way to access the thyroid. The purpose of this study was to test the feasibility of our novel transaxillary thyroidectomy procedure and to attempt to reduce the size of the scar and reduce the flap creation area. METHODS One hundred sixteen patients who underwent our novel transaxillary thyroidectomy procedure were compared with the patients who underwent open and GTET procedures. The patients' demographics, outcomes, and complications were analyzed. RESULTS Although the operation time (121.48±23.91 mins) was longer in the novel endoscopic group compare to the open group, it was shorter than GTET group. Intraoperative blood loss was similar between the groups. However, the novel procedure group had more drainage volume within 48 postoperative hours compare to other two groups. Despite the VAS pain score did not reveal a difference between the open and novel endoscopic procedure, it was lower in the novel procedure than GTET. The hospital stay days did not show a difference between the two groups. The number of resected central lymph nodes was similar between the groups. Differences did not reveal between the groups regarding to the complications rate. CONCLUSION Our results showed that our novel transaxillary thyroidectomy procedure is feasible and safe. This procedure can be an alternative endoscopic transaxillary method for thyroidectomy.
Collapse
Affiliation(s)
- Yang Liu
- Department of General Surgery, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, People’s Republic of China
| | | | | | | | | | | | | | | | - Gang Cao
- Department of General Surgery, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, People’s Republic of China
| |
Collapse
|
40
|
Ma Y, Zhang X, Yi Z, Ding L, Cai B, Jiang Z, Liu W, Zou H, Wang X, Fu G. A study of machine learning models for rapid intraoperative diagnosis of thyroid nodules for clinical practice in China. Cancer Med 2024; 13:e6854. [PMID: 38189547 PMCID: PMC10904961 DOI: 10.1002/cam4.6854] [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: 04/14/2023] [Revised: 11/06/2023] [Accepted: 12/10/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND In China, rapid intraoperative diagnosis of frozen sections of thyroid nodules is used to guide surgery. However, the lack of subspecialty pathologists and delayed diagnoses are challenges in clinical treatment. This study aimed to develop novel diagnostic approaches to increase diagnostic effectiveness. METHODS Artificial intelligence and machine learning techniques were used to automatically diagnose histopathological slides. AI-based models were trained with annotations and selected as efficientnetV2-b0 from multi-set experiments. RESULTS On 191 test slides, the proposed method predicted benign and malignant categories with a sensitivity of 72.65%, specificity of 100.0%, and AUC of 86.32%. For the subtype diagnosis, the best AUC was 99.46% for medullary thyroid cancer with an average of 237.6 s per slide. CONCLUSIONS Within our testing dataset, the proposed method accurately diagnosed the thyroid nodules during surgery.
Collapse
Affiliation(s)
- Yan Ma
- Department of Pathology, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Xiuming Zhang
- Department of PathologyThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouZhejiangChina
| | - Zhongliang Yi
- Department of PathologyHang Zhou Dian Medical LaboratoryHangzhouZhejiangP. R. China
| | - Liya Ding
- Department of Pathology, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Bojun Cai
- Hangzhou PathoAI Technology Co., LtdHangzhouZhejiangChina
| | - Zhinong Jiang
- Department of Pathology, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Wangwang Liu
- Department of Pathology, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Hong Zou
- Department of PathologyThe Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Xiaomei Wang
- Hangzhou PathoAI Technology Co., LtdHangzhouZhejiangChina
| | - Guoxiang Fu
- Department of Pathology, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| |
Collapse
|
41
|
Lacoste-Collin L, Decaussin-Petrucci M, Buffet C. [Molecular and other ancillary tests proposed by The Bethesda system for reporting thyroid cytopathology 2023]. Ann Pathol 2024; 44:36-46. [PMID: 37953129 DOI: 10.1016/j.annpat.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
For the first time the 2023 version of The Bethesda System for Reporting Thyroid Cytology dedicates a whole chapter (chapter 14) to ancillary studies almost exclusively represented by molecular testing. The latest data reported bring some evidence that molecular testing could help to optimize the diagnostic performance of « indeterminate » categories (AUS and NF). Other studies suggest a promising role to guide the management of suspicious of malignancy and malignant categories. Indeed, the recognition of prognostic and predictive biomarkers analyzed on cytological samples, regardless of how it is collected, has progressed thanks to advances in our knowledge of molecular abnormalities of thyroid tumors. The chapter 14 is presented here highlighting the current and emerging roles of « in-house » and commercialized molecular testing as presented by TSBRTC.
Collapse
Affiliation(s)
| | - Myriam Decaussin-Petrucci
- Service d'anatomie pathologique, centre hospitalier Lyon Sud, hospices civils de Lyon, EA 3738, université Lyon 1, Lyon, France
| | - Camille Buffet
- Service des pathologies thyroïdiennes et tumorales endocrines, hôpital Pitié-Salpêtrière, AP-HP, Sorbonne université, GRC n(o) 16, GRC tumeurs thyroïdiennes, 75013 Paris, France; Laboratoire d'Imagerie Biomédicale, CNRS, Inserm, 75006 Paris, France
| |
Collapse
|
42
|
Kinet S, Cornette H, Van Den Heede K, Brusselaers N, Van Slycke S. Accuracy and diagnostic performance of the Bethesda system for reporting thyroid cytopathology in a tertiary endocrine surgical referral center in Belgium. World J Surg 2024; 48:386-392. [PMID: 38686788 DOI: 10.1002/wjs.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/13/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND The Bethesda System for Reporting Thyroid Cytopathology is a commonly used classification for fine needle aspiration (FNA) cytology of suspicious thyroid nodules. The risk of malignancy (ROM) for each category has recently been analyzed in three international databases. This paper compares the diagnostic performance of the Bethesda classification in a high-volume referral center in Belgium. METHODS All consecutive thyroid procedures were registered in a prospective database from January 2010 till August 2022. Patient and surgical characteristics, preoperative Bethesda categories, and postoperative pathology results were analyzed. RESULTS Out of 2219 consecutive thyroid procedures, 1226 patients underwent preoperative FNA. Papillary thyroid cancer was the most prevalent malignancy (N = 119, 70.4%), followed by follicular (N = 17, 10.1%) and medullary thyroid cancer (N = 15, 8.9%). Micropapillary thyroid cancer was incidentally found in 46 (3.8%) patients. Bethesda categories I, II, III, IV, V, and VI, respectively, represented 250 (20.4%; ROM 4.4%), 546 (44.5%; ROM 3.8%), 96 (7.8%; ROM 20.8%), 231 (18.8%; ROM 15.2%), 62 (5.1%; ROM 72.6%), and 41 (3.3%; ROM 90.2%) patients. Overall ROM was 13.8%. An negative predictive value (NPV) of 96.2% was found. Overall specificity was 64.2% with a positive predictive value (PPV) of 31.9%. Diagnostic accuracy was 67.8%. Compared to international databases (CESQIP, EUROCRINE, and UKRETS), ROM in this study appeared lower for Bethesda category IV (15.2 vs. 26.7% and p = 0.612). CONCLUSION Despite being validated in numerous studies, ROM based on preoperative FNA cytology classified according to the Bethesda classification may vary among surgical centers and countries as this study reveals a higher NPV and lower PPV.
Collapse
Affiliation(s)
- Sam Kinet
- Faculty of Medicine, KU Leuven, Leuven, Belgium
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Hendrik Cornette
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Klaas Van Den Heede
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
| | - Nele Brusselaers
- Department of Microbiology, Tumour and Cell Biology, Centre for Translational Microbiome Research, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Global Health Institute, University of Antwerp, Wilrijk, Belgium
| | - Sam Van Slycke
- Department of General and Endocrine Surgery, Onze-Lieve-Vrouw (OLV) Hospital Aalst-Asse-Ninove, Aalst, Belgium
- Department of Head and Skin, University Hospital Ghent, Ghent, Belgium
- Department of General Surgery, AZ Damiaan, Ostend, Belgium
| |
Collapse
|
43
|
Sartori PV, Andreani S, De Pasquale L, Pauna I, Bulfamante AM, Aiello PSL, Melcarne R, Giacomelli L, Boniardi M. How to Manage Advanced Differentiated Thyroid Cancer: Step-by-Step Analysis from Two Italian Tertiary Referral Centers. J Clin Med 2024; 13:708. [PMID: 38337400 PMCID: PMC10856418 DOI: 10.3390/jcm13030708] [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: 11/28/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) has an excellent prognosis; however, advanced disease is associated with a worse prognosis and is relatively common. Surgery followed by RAI treatment remains the mainstream treatment for a large majority of patients with high- and intermediate-risk DTC, but its benefits should be carefully weighed against the potential for harm. The aim of this paper is to critically review the experience in treating advanced DTC at two tertiary referral centers in Italy. METHODS Retrospective analysis of 300 patients who underwent surgery for ADTC over 30 years. RESULTS The complication rate was 50.33%. A total of 135 patients (45%) remained at regular follow-up, 118 (87.4%) were alive, while 17 (12.6%) were deceased. The mean overall survival at 12 years was 84.8% with a mean of 238 months. Eleven patients (8.1%) experienced a relapse after a median of 13 months. CONCLUSIONS ADTC patients adequately treated can achieve prolonged survival even in the case of metastasis or disease relapse. Patients with ADTC should be referred to high-volume centers with the availability of an extended multidisciplinary team to receive tailored treatment.
Collapse
Affiliation(s)
| | - Sara Andreani
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy;
| | - Iuliana Pauna
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Antonio Mario Bulfamante
- Pediatric Otolaryngology Unit, ASST Fatebenefratelli-Sacco, Buzzi Children Hospital, 20162 Milan, Italy;
| | | | - Rossella Melcarne
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Laura Giacomelli
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Marco Boniardi
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| |
Collapse
|
44
|
Tumati A, Egan CE, Lee-Saxton YJ, Marshall TE, Lee J, Jain K, Heymann JJ, Gokozan H, Azar SA, Schwarz J, Keutgen XM, Laird AM, Beninato T, Zarnegar R, Fahey TJ, Finnerty BM. Clinical utility of a microRNA classifier in cytologically indeterminate thyroid nodules with RAS mutations: A multi-institutional study. Surgery 2024; 175:234-240. [PMID: 37907382 DOI: 10.1016/j.surg.2023.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Molecular testing guides the management of cytologically indeterminate thyroid nodules. We evaluated the real-world clinical benefit of a commercially available thyroid mutation panel plus microRNA risk classifier in classifying RAS-mutated nodules. METHODS We performed a subgroup analysis of the results of molecular testing of Bethesda III/IV nodules using the ThyGenX/ThyGeNEXT-ThyraMIR platform at 3 tertiary-care centers between 2017 and 2021, defining a positive result as 10% or greater risk of malignancy. RESULTS We identified 387 nodules from 375 patients (70.7% female, median age 59.3 years) who underwent testing. Positive nodules (32.3%) were associated with increased surgical intervention (74.4% vs 14.9%, P < .0001) and carcinoma on surgical pathology (46.4% vs 3.4%, P < .0001) compared to negative modules. RAS mutations were the most common mutations, identified in 71 of 380 (18.7%) nodules, and were classified as ThyraMIR- (28 of 71; 39.4%) or ThyraMIR+ (43 of 71; 60.6%). Among RAS-mutated nodules, there was no significant difference in operative rate (P = .2212) or carcinoma diagnosis (P = .6277) between the ThyraMIR+ and ThyraMIR- groups, and the sensitivity, specificity, negative predictive value, and positive predictive value of ThyraMIR were 64.7%, 34.8%, 40.0%, and 59.5%, respectively. CONCLUSION Although testing positive is associated with malignancy in surgical pathology, the ThyraMIR classifier failed to differentiate between benign and malignant RAS-mutated nodules. Diagnostic lobectomy should be considered for RAS-mutated nodules, regardless of microRNA expression status.
Collapse
Affiliation(s)
- Abhinay Tumati
- Department of Surgery, Weill Cornell Medicine, New York, NY.
| | - Caitlin E Egan
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/CaitlinEgan18
| | - Yeon J Lee-Saxton
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/YeonJooLeeMD
| | - Teagan E Marshall
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/TeaganEMarshall
| | - Joyce Lee
- Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Kavita Jain
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY. https://twitter.com/HeymannJonas
| | - Hamza Gokozan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY. https://twitter.com/GokozanMD
| | - Sara Abou Azar
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL. https://twitter.com/SaraAbouAzar
| | - Jason Schwarz
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL
| | - Xavier M Keutgen
- Department of Surgery, Section of Endocrine Surgery, The University of Chicago Medicine, Chicago, IL. https://twitter.com/XKeutgen
| | - Amanda M Laird
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. https://twitter.com/amlaird
| | - Toni Beninato
- Department of Surgery, Rutgers-Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. https://twitter.com/BeninatoToni
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/RasaZarnegarMD
| | - Thomas J Fahey
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/tjf3endosurg
| | - Brendan M Finnerty
- Department of Surgery, Weill Cornell Medicine, New York, NY. https://twitter.com/FinnertyMD
| |
Collapse
|
45
|
Lin AC, Liu Z, Lee J, Ranvier GF, Taye A, Owen R, Matteson DS, Lee D. Generating a multimodal artificial intelligence model to differentiate benign and malignant follicular neoplasms of the thyroid: A proof-of-concept study. Surgery 2024; 175:121-127. [PMID: 37925261 DOI: 10.1016/j.surg.2023.06.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 06/18/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Machine learning has been increasingly used to develop algorithms that can improve medical diagnostics and prognostication and has shown promise in improving the classification of thyroid ultrasound images. This proof-of-concept study aims to develop a multimodal machine-learning model to classify follicular carcinoma from adenoma. METHODS This is a retrospective study of patients with follicular adenoma or carcinoma at a single institution between 2010 and 2022. Demographics, imaging, and perioperative variables were collected. The region of interest was annotated on ultrasound and used to perform radiomics analysis. Imaging features and clinical variables were then used to create a random forest classifier to predict malignancy. Leave-one-out cross-validation was conducted to evaluate classifier performance using the area under the receiver operating characteristic curve. RESULTS Patients with follicular adenomas (n = 7) and carcinomas (n = 11) with complete imaging and perioperative data were included. A total of 910 features were extracted from each image. The t-distributed stochastic neighbor embedding method reduced the dimension to 2 primary represented components. The random forest classifier achieved an area under the receiver operating characteristic curve of 0.76 (clinical only), 0.29 (image only), and 0.79 (multimodal data). CONCLUSION Our multimodal machine learning model demonstrates promising results in classifying follicular carcinoma from adenoma. This approach can potentially be applied in future studies to generate models for preoperative differentiation of follicular thyroid neoplasms.
Collapse
Affiliation(s)
- Ann C Lin
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Zelong Liu
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Justine Lee
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York City, NY
| | | | - Aida Taye
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Randall Owen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - David S Matteson
- Department of Statistics and Data Science, Cornell University, Ithaca, NY
| | - Denise Lee
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY.
| |
Collapse
|
46
|
Bae HL, Ahn JH, Kwak J, Kim HS, Yoon SG, Yi JW, Kim SJ, Lee KE. Intraoperative pathologic evaluation of central compartment lymph nodes in patients undergoing lobectomy for unilateral papillary thyroid carcinoma. Asian J Surg 2024; 47:360-366. [PMID: 37891110 DOI: 10.1016/j.asjsur.2023.08.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/03/2023] [Accepted: 08/30/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND/OBJECTIVE Although papillary thyroid carcinoma (PTC) has an excellent prognosis, it can cause central lymph node metastasis (CLNM) which can increase local recurrence. Intraoperative pathologic evaluation (IOPE) can provide evidence regarding CLNM and help surgeons determine the appropriate surgical approach. The aim of this study was to evaluate the efficacy of IOPE and to determine risk factors associated with CLNM in unilateral PTC without preoperative clinical evidence of CLNM. METHODS Medical charts of 227 patients who had unilateral PTC without clinical lymph node metastasis preoperatively were reviewed retrospectively. They were scheduled for thyroid lobectomy and prophylactic central lymphadenectomy (CND) from January 1, 2017 to December 31, 2017. RESULTS Total follow-up period was 47.6 ± 10.6 months. CLNM was identified in 57 (25.1%) patients during IOPE and in 72 (31.7%) patients during final pathological analysis. The sensitivity and specificity of IOPE were 76.4% and 98.7%, respectively. IOPE through central lymph node dissection was safely performed with low complications (vocal cord palsy, 5.7%; hypoparathyroidism, 22.8%). Age < 55 years, echogenic foci on preoperative ultrasonography, and extrathyroidal extension at final pathological report were significantly associated with an increased risk of CLNM (p = 0.006, p < 0.001, and p < 0.001, respectively). In terms of oncological outcomes, there was no significant difference between the true negative and false negative results in IOPE. CONCLUSION IOPE can safely provide accurate information for determining disease status and surgical extent. Further long-term studies are needed to evaluate clinical benefits of IOPE.
Collapse
Affiliation(s)
- Hye Lim Bae
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong-Hyuk Ahn
- Department of Surgery, Chungbuk National University Hospital, Chungbuk, South Korea; Department of Surgery, Inha University College of Medicine, Incheon, South Korea
| | - JungHak Kwak
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Soo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Seoul National University Seoul Surgery Clinic, Seoul, South Korea
| | - Sang Gab Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Surgery, Young Do Hospital, Busan, South Korea
| | - Jin Wook Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Department of Surgery, Inha University College of Medicine, Incheon, South Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul, South Korea; Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Integrated Major in Innovative Medical Science, Seoul National University Graduate School, South Korea.
| |
Collapse
|
47
|
Visenio MR, Reddy S, Sturgeon C, Elaraj DM, Ritter HE, McDow AD, Merkow RP, Bilimoria KY, Yang AD. Emergency department use after outpatient thyroidectomy across three states. Surgery 2024; 175:41-47. [PMID: 37945478 DOI: 10.1016/j.surg.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/27/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Although outpatient thyroidectomy has become common, few large-scale studies have examined post-thyroidectomy emergency department use, readmission, and encounters not resulting in readmission, known as "treat-and-release" encounters. We evaluated post-outpatient thyroidectomy emergency department use and readmission and characterized associated factors. METHODS Using the Healthcare Cost and Utilization Project databases, we identified adult outpatient (same-day or <24-hour discharge) thyroidectomies performed in Florida, Maryland, and New York from 2016 to 2017. We identified the procedures linked with emergency department treat-and-release encounters and readmissions within 30 days postoperatively and the factors associated with post-thyroidectomy emergency department use and readmission. RESULTS Of the 17,046 patients who underwent outpatient thyroidectomy at 374 facilities, 7.5% had emergency department treat-and-release encounters and 2.3% readmissions. The most common reasons for emergency department treat-and-release encounters (9.9%) and readmissions (22.2%) were hypocalcemia-related diagnoses. Greater odds of treat-and-release were associated with identifying as non-Hispanic Black (adjusted odds ratio: 1.5, 95% confidence interval: 1.3-1.8) or Hispanic race/ethnicity (adjusted odds ratio: 1.4, 95% CI: 1.1-1.6), having Medicaid insurance (adjusted odds ratio: 2.7, 95% CI: 2.3-3.2), and living in non-metropolitan areas (adjusted odds ratio: 1.6, 95% CI: 1.1-2.2). We observed no associations between these factors and the odds of readmission. CONCLUSION Emergency department use after outpatient thyroidectomy is common. Racial, ethnic, socioeconomic, and geographic disparities are associated with treat-and-release encounters but not readmissions. Standardization of perioperative care pathways, focusing on identifying and addressing specific issues in vulnerable populations, could improve care, reduce disparities, and improve patient experience by avoiding unnecessary emergency department visits after outpatient thyroidectomy.
Collapse
Affiliation(s)
- Michael R Visenio
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL
| | - Susheel Reddy
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cord Sturgeon
- Department of Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL
| | - Dina M Elaraj
- Department of Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL
| | - Hadley E Ritter
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Alexandria D McDow
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN; Department of Surgery, Northwestern University Feinberg School of Medicine. Chicago, IL
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Anthony D Yang
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
| |
Collapse
|
48
|
Riju J, Thomas N, Paul TV, Abraham DT, Pai R, Prabhu AJ, Jacob PM, Rajan R, Michael RC, Tirkey AJ, Ramalingam N, Asha HS, Kapoor N. Role of Genetic Testing in the Management of Indeterminate Thyroid Nodules in the Indian Setting. Indian J Endocrinol Metab 2024; 28:3-10. [PMID: 38533287 PMCID: PMC10962768 DOI: 10.4103/ijem.ijem_415_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/15/2023] [Accepted: 01/20/2024] [Indexed: 03/28/2024] Open
Abstract
The increased detection of thyroid nodules in the human population has led to an increase in the number of thyroid surgeries without an improvement in survival outcomes. Though the choice for surgery is straightforward in malignant thyroid nodules, the decision is far more complex in those nodules that get categorized into indeterminate thyroid nodules (ITN) by fine needle aspiration. Therefore, there is a pressing need to develop a tool that will aid in decision-making among the ITN. In this context, the development of various molecular testing (MT) panels has helped to confirm or rule out malignancy, reducing unnecessary surgeries and potentially guiding the extent of surgery as well. Currently, such tests are widely used among the Western population but these MT panels are not used by the South Asian population because of non-availability of validated panels and the high cost involved. There is a need to develop a suitable panel which is population-specific and validate the same. In this review, we would focus on current trends in the management of ITN among the South Asian population and how to develop a novel MT panel which is cost-effective, with high diagnostic accuracy obviating the need for expensive panels that already exist.
Collapse
Affiliation(s)
- Jeyashanth Riju
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas V. Paul
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepak Thomas Abraham
- Department of Endocrine Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anne J. Prabhu
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Remya Rajan
- Department of Endocrinology Diabetes and Metabolism, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajiv C. Michael
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Natarajan Ramalingam
- Department of Head and Neck Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hesarghatta S. Asha
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
49
|
Zheng VM, Fei Leong EK, Pinto D, Parameswaran R, Wu B, Tan NJH, Lee JWK. A Case of Parathyroid Carcinoma in Renal Hyperparathyroidism. Case Rep Oncol 2024; 17:283-290. [PMID: 38371168 PMCID: PMC10870123 DOI: 10.1159/000536444] [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: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Parathyroid carcinoma is a rare malignant endocrine tumor that is usually associated with primary hyperparathyroidism. The coexistence of parathyroid carcinoma and renal hyperparathyroidism is a rare phenomenon. Hence, we present a case of parathyroid carcinoma in a patient with tertiary hyperparathyroidism. Case Presentation Our patient is a 31-year-old woman with a past medical history of end-stage renal failure (ESRF), on hemodialysis for the past 18 years. She was referred by her nephrologist to the endocrine surgery department for consideration of parathyroidectomy in view of long-standing tertiary hyperparathyroidism complicated by hypercalcemia. Bedside ultrasonography scan (US) of the thyroid revealed three parathyroid glands and a hypoechoic right lower pole thyroid nodule with central calcification. Fine-needle aspiration cytology was performed for the suspected thyroid nodule on the same day, which eventually yielded a follicular lesion of undetermined significance. A right hemithyroidectomy and total parathyroidectomy with deltoid implantation was performed. Intraoperative exploration revealed that the thyroid nodule noted at initial US was found to be the right superior parathyroid gland invading into the right thyroid itself. The right superior parathyroid gland was excised en bloc with the right hemithyroidectomy. Post-operatively, the patient was hypocalcemic but was discharged well on post-operative day 5. Histopathological diagnosis of the right hemithyroidectomy specimen containing the right superior parathyroid gland was consistent with that of parathyroid carcinoma. Conclusion Parathyroid carcinoma is a rare entity that is difficult to diagnose. In patients with ESRF, the presence of concurrent tertiary hyperparathyroidism makes this even more challenging.
Collapse
Affiliation(s)
- Victoria Meijia Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Eugene Kwong Fei Leong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Diluka Pinto
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Rajeev Parameswaran
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, National University Hospital, Singapore, Singapore
- Department of Surgery, Alexandra Hospital, Singapore, Singapore
| | - Bingcheng Wu
- Department of Pathology, National University Hospital, Singapore, Singapore
| | | | - James Wai Kit Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of General Surgery (Thyroid and Endocrine Surgery), University Surgical Cluster, National University Hospital, Singapore, Singapore
- Department of Surgery, Alexandra Hospital, Singapore, Singapore
| |
Collapse
|
50
|
Cetinoglu I, Aygun N, Yanar C, Caliskan O, Kostek M, Unlu MT, Uludag M. Can Unilateral Therapeutic Central Lymph Node Dissection Be Performed in Papillary Thyroid Cancer with Lateral Neck Metastasis? SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:458-465. [PMID: 38268664 PMCID: PMC10805041 DOI: 10.14744/semb.2023.22309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024]
Abstract
Objectives Unilateral or bilateral prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC) is still controversial. We aimed to evaluate the risk factors for contralateral paratracheal lymph node metastasis and whether CND might be performed unilaterally. Methods Prospectively collected data of patients who underwent bilateral CND and lateral neck dissection (LND) with thyroidectomy due to PTC with lateral metastases, between January 2012 and November 2019, were evaluated retrospectively. The patients were divided into two groups according to the presence (Group 1) and absence (Group 2) of metastasis in the contralateral paratracheal region.A total of 42 patients (46 ±15.7 years) were operated. In the contralateral paratracheal region, Group 1 (35.7%) had metastases, while Group 2 (64.3%) had no metastases. In groups 1 and 2, metastasis rates were 100% vs 77.8% (p=0.073), 46.7% vs 18.5% (p=0.078), and 80% vs 40.7% (p=0.023) for the ipsilateralparatracheal, prelaryngeal and pretracheal lymph nodes, respectively.The number of metastatic lymph nodes in the central region was significantly higher in Group 1 compared to Group 2 as; 10.7±8.4 vs. 2.6±2.4 (p=0.001) in bilateral central region material; 8.3±7.4 vs. 2.9±2.7 (p=0.001) in lateral metastasis with ipsilateral unilateral central region; 3.8±3.4 vs. 1.9±1.9 (p=0.023) in ipsilateralparatracheal area; and 3.7±4.6 vs. 0.6±0.9 (p=0.001) in pretracheal region, respectively. However, no significant difference was found regarding the prelaryngeal region material (0.9±1.8 vs. 0.2±0.4 (p=0.71)). Results >2 metastatic central lymph nodes in unilateral CND material (AUC: 0.814, p<0.001, J=0.563) can estimate contralateral paratracheal metastasis with 93% sensitivity, 63% specificity, while >2 pretracheal metastatic lymph nodes (AUC: 0.795, p<0.001, J: 0.563) can estimate contralateral paratracheal metastasis with 60% sensitivity and 96.3% specificity. Conclusion In patients with lateral metastases, the rate of ipsilateralparatracheal metastasis is 85%, while the rate of contralateral paratracheal metastasis is 35.7%. The number of ipsilateral central region or pretracheal lymph node metastases may be helpful in predicting contralateral paratracheal lymph node metastases. Notably, unilateral CND may be performed in the presence of ≤ 2 metastases in the ipsilateral central region.
Collapse
Affiliation(s)
- Isik Cetinoglu
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Nurcihan Aygun
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ceylan Yanar
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ozan Caliskan
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Kostek
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Taner Unlu
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mehmet Uludag
- Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| |
Collapse
|