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Management guidelines for patients with thyroid nodules and differentiated thyroid cancer the American thyroid association guidelines taskforce
... However, even FNAC has limitations because of low yield of cells, loss of histological architecture and inability to distinguish follicular adenoma and well differentiated follicular carcinoma. 14- 16 The aim of our study was to investigate the value of FNAC as a basic investigation in patients with thyroid enlargement. We aimed specifically to assess the sensitivity of FNAC within cancer suspicious group. ...
... The vast majority (95%) of cases have benign disease. 1 The decision whether or not to perform FNAC will depend on the clinical picture, and the responsible clinician needs to make an appropriate judgment about pursuing cytological confirmation, in order to avoid overtreatment of clinically benign conditions. 16 Despite clinical size of a nodule being used as criteria in some guidelines, the evidence does not support size as a reliable indicator of malignancy. While there are some studies indicating that nodule size is associated with malignancy, a larger body of evidence suggests that size is not specific in distinguishing benign from malignant thyroid nodules. ...
... While there are some studies indicating that nodule size is associated with malignancy, a larger body of evidence suggests that size is not specific in distinguishing benign from malignant thyroid nodules. 16 US appearances that are indicative of a benign nodule should be regarded as reassuring not requiring fine needle aspiration cytology (FNAC), unless the patient has a statistically high risk of malignancy. On the other hand, If the US appearances are equivocal, indeterminate or suspicious of malignancy, an US guided FNAC should follow. ...
... Although oncogenes and other growth factors are also involved in the growth and development of International Archives of Otorhinolaryngology Vol. 24 No. 1/2020 thyroid carcinoma, TSH is a main stimulant for cancer growth. 16 While many thyroid tumors grow unnoticed until forming nodules or enlarged lobes, the measurement of this growth factor hormone can provide a crucial contribution to predict the potential course from benign enlargement into the differentiated carcinoma. ...
... 23 Another community populationbased study with 865 subjects reported that there were 53% uninodular patients, 47% multinodular, and that 51% of the patients in the malignancy group were uninodular (p < 0.002). 24 In patients with nodular thyroid disease, the risk of thyroid malignancy increases with serum TSH, and even within normal ranges, higher TSH values are associated with a higher frequency and with a more advanced stage of thyroid cancer. The likelihood of PTC is reduced when TSH is lower, as in thyroid autonomy, and increased when TSH is higher, as in thyroid autoimmunity. ...
... The likelihood of PTC is reduced when TSH is lower, as in thyroid autonomy, and increased when TSH is higher, as in thyroid autoimmunity. 6,9,24 Thyroid nodules are $ 4 times more common in women than in men. Palpable nodules increase in frequency throughout life, reaching a prevalence of $ 5% in the population of the United States aged ! ...
Introduction Papillary and follicular thyroid carcinoma are common head and neck cancers. This cancer expresses a thyroid stimulating hormone (TSH) receptor that plays a role as a cancer stimulant substance. This hormone has a diagnostic value in the management of thyroid carcinoma.
Objective The present study aimed to determine the difference in TSH levels between differentiated thyroid carcinoma and benign thyroid enlargement.
Methods The present research design was a case-control study. The subjects were patients with thyroid enlargement who underwent thyroidectomies at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia. Thyroid stimulating hormone levels were measured before the thyroidectomies. The inclusion criteria for the case group were: 1) differentiated thyroid carcinoma, and 2) complete data; while the inclusion criteria for the control group were: 1) benign thyroid enlargement, and 2) complete data. The exclusion criteria for both groups were: 1) patients suffering from thyroid hormone disorders requiring therapy before thyroidectomy surgery, 2) patients receiving thyroid suppression therapy before the thyroidectomy was performed, and 3) patients suffering from severe chronic diseases such as renal insufficiency, and severe liver disease.
Results There were 40 post-thyroidectomy case group patients and 40 post-thyroidectomy control group patients. There were statistically significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement (p = 0.001; odds ratio [OR] = 8.42; 95% confidence interval [CI]: 3.19–36.50).
Conclusion Based on these results, it can be concluded that there were significant differences in TSH levels between the groups with differentiated thyroid carcinoma and benign thyroid enlargement.
... 7 Even after thyroidectomy there is still 15-30 percent of chance for recurrence and 33-50 percent of these patients who develop recurrence from papillary thyroid cancer die. 8 Almost 90 percent of these recurrences are in the cervical lymph nodes-surgical excision of the recurrence provides the best opportunity for cure. 8 Currently, bilateral central neck lymph node removal is recommended due to the high incidence of recurrence because of microscopic metastases that are not identified during operation. ...
... 8 Almost 90 percent of these recurrences are in the cervical lymph nodes-surgical excision of the recurrence provides the best opportunity for cure. 8 Currently, bilateral central neck lymph node removal is recommended due to the high incidence of recurrence because of microscopic metastases that are not identified during operation. Studies show that doing routine central neck lymph node dissection increases the risk for hypoparathyroidism. ...
Objectives: This study aims to ascertain if is there is an association between the clinico-pathologic features and characteristics of papillary thyroid cancer patients and the occurrence of central lymph node metastasis. The authors specifically looked at age, gender, tumor size, tumor multicentricity and extracapsular invasion. Methods: Patients admitted at the Department of Surgery, University of Santo Tomas Hospital between January 2006 and December 2010 who underwent total thyroidectomy with Central Lymph Node Dissection (CLND) for papillary thyroid carcinoma were included in the study after fulfilling the exclusion/inclusion criteria. Descriptive statistics related to patient demographics and tumor characteristics were applied using Pearson chi-square, independent T-test and univariate and multivariate analysis using binary logistic regression. Results: Out of 47 patients, 27 patients have positive pathologic Central Lymph Node (CLN) metastasis (57.4%). On univariate analysis, only gender had a significant effect on the occurrence of central lymph node metastasis. Age, capsular invasion, multicentricity and tumor size on the other hand, had no significant correlation with the presence of CLN metastasis. On multivariate analysis, none of the defined parameters are independent predictors of CLN metastasis. Conclusion: Based on the patient population included in this study, gender is the only demographic characteristic that has a significant effect on the occurrence of CLN metastasis among patients with papillary thyroid carcinoma. Other demographic data and tumor features analyzed in this study had no significant association with the occurrence of positive cervical lymph nodes. Key words: papillary thyroid cancer, central lymph node dissection, lymph node metastasis
... Delaying a fine needle aspiration biopsy for thyroid nodules that are functional is advised by current guidelines for thyroid nodule evaluation. However, there is a significant number of research on the co-occurrence of thyroid cancer with hyperthyroidism (Cooper et al, 2009). Patients received surgery for the purpose of treating hyperthyroidism in most of these studies. ...
... Antithyroid drugs are used to create euthyroidism before surgery is performed as the way of treatment. The full removal of thyroid tissues and all local metastases is advised for all aggressive thyroid malignancies, such as the one in this patient (Cooper et al, 2009). This is frequently true for operations carried out primarily to treat hyperthyroidism or in patients with small, subcentimeter tumors (Hay et al, 2008). ...
Abstrak: Sekitar 5% sampai 10% pasien dengan karsinoma tiroid papiler (PTC) memiliki metastasis lokoregional, sedangkan metastasis jauh sangat sedikit ditemui. Metastasis tulang hanya ditemukan pada sekitar 4% dari semua pasien kanker tiroid dan akibatnya kurang banyak dipelajari tetapi tetap berasosiasi dengan morbiditas dan mortalitas yang jauh lebih tinggi. Terapi klinis dan rehabilitasi mungkin sangat dipengaruhi oleh resorpsi tulang yang disebabkan oleh kanker tiroid. Seorang wanita berusia 58 tahun datang dengan keluhan nyeri pada pangkal paha sebelah kanan nya sejak 5 bulan SMRS. Sebelumnya pasien memiliki Riwayat terpeleset kurang lebih 1 tahun SMRS sehingga kesulitan untuk berjalan. Selain nyeri pada pangkal paha pasien merasakan jantungnya sering berdebar, mudah lelah, berat badan turun, disertai kerontokan pada rambut yang dirasakan kurang lebih 6 bulan SMRS. Pemeriksaan lanjutan menunjukkan kadar TSH rendah dengan Riwayat Plummer’s disease dan suspek massa tihyroid kanan dan kiri (TIRADS 4). Pada pemeriksaan thyroid scan terdapat gambaran cold nodul di kedua thyroid dan bone scan menggambarkan adanya lesi metastasis dengan fraktur patologi pada di collum femur kanan disertai lesi metastasis C5-7. Patogenesis metastasis tulang nampak menunjukkan asosiasi antara kanker dan lingkungan mikro tulang yang menciptakan “siklus destruktif” penghancuran tulang. Selain itu, tumor tiroid folikuler dan meduler lebih mungkin berkembang menjadi metastase tulang, menunjukkan kebutuhan follow up yang lebih detail pada individu dengan histologi ini. Karsinoma tiroid berdiferensiasi memiliki kelangsungan hidup rata-rata hanya 4 tahun dengan adanya metastasis tulang. Dibandingkan dengan kelenjar getah bening lokal dan metastasis paru, metastasis tulang sering terlewatkan dan tidak banyak diteliti. Kanker tiroid yang terkait dengan penyakit Plummer’s menunjukkan perilaku biologis yang agresif dan lebih sering bermetastasis jauh ke area tulang. Meskipun kanker tiroid yang terdiferensiasi dengan baik memiliki progresi yang lambat, metastasis tulang yang terabaikan pada diagnosis awal dapat berdampak buruk pada kualitas hidup dan prognosis pasien.
... The initial steps in the evaluation of a thyroid nodule consist of medical history including symptoms (recent onset of hoarseness, neck discomfort or dysphagia), history of head/neck radiation and personal/family history of cancer, followed by physical examination and measurement of serum thyrotropin levels. Ultrasonography (US) is the next step in order to determine the size of the nodule, its characteristics and to assess for cervical lymphadenopathy [10]. If thyrotropin levels are normal or elevated and the nodule size is >1 cm, then fine needle aspiration (FNA) is indicated, according to the American Thyroid Association guidelines [11,12]. ...
... Cyclic adenosine monophosphate (cAMP)-dependent protein kinase type 1-alpha regulatory subunit is encoded by the PRKAR1A gene. PRKAR1A consists of 11 exons; ten of them (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) are coding. Protein kinase A (PKA) (Figure 1), a serine/threonine kinase, is a second messenger-dependent enzyme and it is involved in G-protein coupled intracellular pathways. ...
Thyroid cancer is the most common type of endocrine malignancy and the incidence is rapidly increasing. Follicular (FTC) and papillary thyroid (PTC) carcinomas comprise the well-differentiated subtype and they are the two most common thyroid carcinomas. Multiple molecular genetic and epigenetic alterations have been identified in various types of thyroid tumors over the years. Point mutations in BRAF, RAS as well as RET/PTC and PAX8/PPARγ chromosomal rearrangements are common. Thyroid cancer, including both FTC and PTC, has been observed in patients with Carney Complex (CNC), a syndrome that is inherited in an autosomal dominant manner and predisposes to various tumors. CNC is caused by inactivating mutations in the tumor-suppressor gene encoding the cyclic AMP (cAMP)-dependent protein kinase A (PKA) type 1α regulatory subunit (PRKAR1A) mapped in chromosome 17 (17q22–24). Growth of the thyroid is driven by the TSH/cAMP/PKA signaling pathway and it has been shown in mouse models that PKA activation through genetic ablation of the regulatory subunit Prkar1a can cause FTC. In this review, we provide an overview of the molecular mechanisms contributing to thyroid tumorigenesis associated with inactivation of the RRKAR1A gene.
... We used American Thyroid Association clinical practice guidelines (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015), wherein fine-needle aspiration biopsy is the recommended 30-33 gold-standard procedure for thyroid nodule evaluation, 31,34 to classify differentiated thyroid cancer diagnosis as incidentally detected or not, by examining diagnostic pathways using OHIP billings (Appendix 1, Supplementary Figure 2). Advanced diagnostic imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are not recommended in the guidelines for thyroid cancer diagnostic purposes. ...
... Advanced diagnostic imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are not recommended in the guidelines for thyroid cancer diagnostic purposes. [30][31][32][33] For each patient who received a diagnosis of differentiated thyroid cancer, the index study date was defined as date of prediagnostic thyroid gland aspiration, core or fine-needle biopsy ("thyroid biopsy"). When thyroid biopsy was not ascertained, the date of differentiated thyroid cancer diagnosis was used as the index date. ...
Background:
Incidence rates of thyroid cancer in Ontario have increased more rapidly than those of any other cancer, whereas mortality rates have remained relatively stable. We evaluated the extent to which incidental detection of differentiated thyroid cancer during unrelated prediagnostic imaging procedures contributed to Ontario's incidence rates.
Methods:
We conducted a retrospective cohort study involving Ontarians who received a diagnosis of differentiated thyroid cancer from 1998 to 2017 using linked health care administrative databases. We classified cases as incidentally detected if a nonthyroid diagnostic imaging test (e.g., computed tomography [CT]) preceded an index event (e.g., prediagnostic fine-needle aspiration biopsy); all other cases were nonincidentally detected cases. We used Joinpoint and negative binomial regressions to characterize sex-specific rates of differentiated thyroid cancer by incidentally detected status and to quantify potential age, diagnosis period and birth cohort effects.
Results:
The study included 36 531 patients with differentiated thyroid cancer, of which 78.7% were female. Incidentally detected cases increased from 7.0% to 11.0% of female patients and from 13.5% to 18.2% of male patients over the study period. Age-standardized incidence rates increased more rapidly for incidentally detected cases (4.2-fold for female and 3.7-fold for male patients) than for nonincidentally detected cases (2.6-fold for female and 3.0-fold for male patients; p < 0.001). Diagnosis period was the primary factor associated with increased incidence rates of differentiated thyroid cancer, adjusting for other factors. Within each period, incidentally detected rates increased faster than nonincidentally detected rates, adjusting for age. Our results showed that CT was the most common imaging procedure preceding incidentally detected diagnoses.
Interpretation:
Incidentally detected cases represent a large and increasing component of the observed increases in differentiated thyroid cancer in Ontario over the past 20 years, and CT scans are primarily associated with these cases despite the modality having similar, increasing rates of use compared with magnetic resonance imaging (1993-2004). Recent increases in rates of differentiated thyroid cancer among males and incidentally detected cases among females in Ontario appear to be unrelated to birth cohort effects.
... Lymph node (LN) metastases are a common fi nding in papillary thyroid carcinoma (PTC), occurring in the central compartment of the neck (level VI) in 20-50% of patients and in the lateral compartment of the neck (levels II-V) in 10-30% [2]. Th e high rate of metastases to regional lymph nodes is clearly associated with a higher risk for persistent or recurrent disease, although eff ects on survival remain controversial [3]. ...
... 16,17 In addition, some studies have found that increased hardness of thyroid nodules led to a higher risk of malignancy. 18 While conventional ultrasound (CUS) falls short in providing comprehensive nodule hardness data, innovative elastography technologies, such as strain imaging and shear wave imaging, offer qualitative and quantitative assessments of tissue stiffness. 19,20 In recent studies, CUS combined with virtual touch tissue imaging and quantification (VTIQ: a 2D shear wave elastography) showed high diagnostic accuracy (area under the receiver operating characteristic curve [AUC] ¼ 0.79) for predicting CLNM. ...
Objectives
To build a predictive model for central lymph node metastasis (CLNM) in unifocal papillary thyroid carcinoma (UPTC) using a combination of clinical features and multimodal ultrasound (MUS).
Methods
This retrospective study, included 390 UPTC patients who underwent MUS between January 2017 and October 2022 and were divided into a training cohort (n = 300) and a validation cohort (n = 90) based on a cut-off date of June 2022. Independent indicators for constructing the predictive nomogram models were identified using multivariate regression analysis. The diagnostic yield of the 3 predictive models was also assessed using the area under the receiver operating characteristic curve (AUC).
Results
Both clinical factors (age, diameter) and MUS findings (microcalcification, virtual touch imaging score, maximal value of virtual touch tissue imaging and quantification) were significantly associated with the presence of CLNM in the training cohort (all P < .05). A predictive model (MUS + Clin), incorporating both clinical and MUS characteristics, demonstrated favourable diagnostic accuracy in both the training cohort (AUC = 0.80) and the validation cohort (AUC = 0.77). The MUS + Clin model exhibited superior predictive performance in terms of AUCs over the other models (training cohort 0.80 vs 0.72, validation cohort 0.77 vs 0.65, P < .01). In the validation cohort, the MUS + Clin model exhibited higher sensitivity compared to the CLNM model for ultrasound diagnosis (81.2% vs 21.6%, P < .001), while maintaining comparable specificity to the Clin model alone (62.3% vs 47.2%, P = .06). The MUS + Clin model demonstrated good calibration and clinical utility across both cohorts.
Conclusion
Our nomogram combining non-invasive features, including MUS and clinical characteristics, could be a reliable preoperative tool to predict CLNM treatment of UPTC.
Advances in knowledge
Our study established a nomogram based on MUS and clinical features for predicting CLNM in UPTC, facilitating informed preoperative clinical management and diagnosis.
... Major sets of guidelines for the follow-up and management of ITNs are established by the American Thyroid Association (ATA) and the British Thyroid Association (10,11). Although it is proposed that patients with ITNs larger than 1 cm undergo US for further evaluation in some guidelines (12), it was reported that utilizing a three-component grading system that strati es nodules according to risk increases diagnostic accuracy in the study by Nguyen et al. (13). ...
Introduction:
Computerized thoracic tomography (CT) imaging was extensively employed, especially in the early era of the Coronavirus pandemic. An incidental thyroid nodule (ITN) is defined as a nodule not previously detected or suspected clinically but identified by an imaging study. This study aimed to determine the incidence of thyroid nodules incidentally detected in thoracic CTs for the suspicion of Covid-19 pneumonia.
Materials and methods
Adult patients who underwent thoracic CT in our hospital for Covid-19 management between March 2020 and September 2020 were retrospectively identified. Medical information registered in the hospital and national health system were reviewed. The prevalence of incidental thyroid nodules at CT, thyroid function test results of patients with incidental lesions, correlation of CT findings with ultrasonography (US) findings, and fine-needle aspiration biopsy (FNAB) results were evaluated.
Results
We determined 36.939 adult patients that had a CT scan. Among these, 624 had a previous history of thyroid operation, and 1201 had already been diagnosed with a thyroid pathology. The final analysis included 35.113 patients. There was information about the thyroid gland in CT reports of 3049 patients. The prevalence of ITN was 3.82% (1343/35113 patients), and thyroid heterogeneity was 1.11% (388/35113 patients). While it was explicitly stated that no pathology was found in the thyroid gland in 3.75% (1318/35113) of the patients, no information was given about the thyroid gland in 91.32% (32064/35113) of the patient. Thus, the number of patients informed about the thyroid was 3049 (8.68%), and the number of patients with thyroid pathology was 1731 (4.93%). It was observed that 308 of 1731 (17.80%) patients had follow-up thyroid US. An FNAB was indicated in 238 (87.50%) patients. Of the 238 patients with biopsy indication, only 115 (48.31%) underwent a thyroid FNAB. The cytological diagnosis was benign in 59 (51.30%), non-diagnostic in 30 (26.08%), atypia of uncertain significance in 22 (19.13%), suspected follicular neoplasia/follicular neoplasia in 4 (3.46%) patients. Thyroidectomy was performed in six more patients due to giant nodules, and the final diagnosis was benign in 2 and papillary thyroid cancer in 3 patients.
Conclusion
In conclusion, increased use of thoracic CT during Covid 19 pandemic probably caused increased detection of ITNs. In this large-scale study, the prevalence of thyroid nodules reported in thoracic CT was 3.82%, and thyroid cancer was detected in 1.30% of patients evaluated in the US. Therefore, Thoracic CT scans taken for different reasons might provide the opportunity for early diagnosis and treatment of thyroid cancers.
... We have molecular markers that can help us predict the behavior of thyroid neoplasms like solitary RAS mutations are seen in low-risk tumors, solitary BRAF mutations are seen in intermediate risk tumors, and RAS+TERT or BRAF+TERT are seen in high risk tumors, and solitary TERT mutations located in between intermediate risk and high risk tumors (Figure 12)[52,53]. Today in parallel to the postoperative classification from the ATA we are beginning to understand the molecular profile of low risk, intermediate risk, and high-risk thyroid tumors, helping us come up with a molecular markers that can help us risk stratify thyroid cancer in the preoperative and postoperative setting (Figure 13)[51,54,55]. ...
The majority of thyroid neoplasms originate from the thyroid epithelial follicular cells, while 3% to 5% of neoplasms arise from the C cells or parafollicular cells. Differentiated thyroid cancer (DTC), which derives from these follicular cells, includes papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), oncocytic cell carcinoma (formerly known as Hürthle Cell Carcinoma/OCC), poorly differentiated carcinoma (insular carcinoma), and anaplastic thyroid carcinoma (ACC/undifferentiated). These thyroid tumors comprise the majority, more than 90% of the cases, of all thyroid neoplasms. Of all these subtypes, ATC is the rarest and is characterized by its extremely poor prognosis. Likewise, poorly differentiated carcinoma is characterized by its aggressive behavior and its unfavorable prognosis. Recent advances in our comprehension of the molecular genetics of thyroid cancer have been made by identification of targetable genetic alterations in its pathogenesis. This paper will undergo an extensive review of molecular pathways that lead to the development of thyroid cancer, their implications in the diagnosis, surgical management, and adjuvant treatment. The preponderance of thyroid neoplasms originate from the thyroid epithelial follicular cells, while 3% to 5% of neoplasms arise from the C cells or parafollicular cells [1]. Differentiated thyroid cancer (DTC), which derives from these follicular cells, includes papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), oncocytic cell carcinoma (formerly known as Hürthle Cell Carcinoma / OCC), poorly differentiated carcinoma (insular carcinoma), and anaplastic thyroid carcinoma (ACC / undifferentiated) [1-7]. These thyroid tumors comprise the majority, more than 90% of the cases, of all thyroid neoplasms. Of all these subtypes, ATC is the rarest and is characterized by its extremely poor prognosis. Likewise, poorly differentiated carcinoma is characterized by its aggressive behavior and its unfavorable prognosis. Between the year 2010 and 2014, 63,229 patients per year were diagnosed with thyroid cancer. Of these 89.4% had PTC, 4.6% had FTC, 2.0% had OCC, 1.7% had medullary thyroid carcinoma (MTC), and 0.8% had ATC [1, 8]. A follicular adenoma is a benign tumor (clonal neoplasm) that may serve as a precursor lesion for some follicular carcinomas. Less-differentiated thyroid cancers, namely poorly differentiated carcinomas, and
... A white paper of the American Society of Radiology (ACR) Thyroid Ultrasound Dictionary (Middleton et al, 2017) delineates the correlation between these imaging features and thyroid malignancies. This correlation forms the foundation of the ACR Thyroid Imaging Reporting and Data System (TI-RADS) (Grant et al, 2015;Imaging, 2017;Russ et al, 2017;Cooper et al, 2006), a risk stratification and management framework that utilizes ultrasound features. To standardize thyroid ultrasound reports, the ACR recommends the adoption of a scoring system consisting of five categories (TR1-TR5), each associated with different management recommendations (Remonti et al, 2015). ...
Purpose Thyroid cancer is a prevalent form of cancer, ranking ninth in terms of incidence rate worldwide. To leverage the advancements in deep learning for medical imaging, we successfully developed a dynamic integration model that combines the transformer and convolutional neural network (CNN) architectures to estimate benignity or malignancy. Methods We recruited 202 patients with thyroid nodules from Quzhou People’s Hospital and 102 patients from the public Thyroid Ultrasound Images (DDTI) dataset. We randomly divided the data into a training set (429 ultrasound images) and testing set (70 ultrasound images) at a 7:3 ratio. To address the inherent imbalance in the dataset, we employed a data augmentation strategy that adds 1 noise as a compensatory measure. A dynamic integration strategy, DiTNet, which is based on Vision Transformer, ResNet, and DenseNet, is proposed, using a CNN and self-attention mechanism to extract image features. Results To evaluate the performance of DiTNet, its relevant indicators were assessed based on the Receiver Operating Characteristic (ROC). ROC analysis revealed an area under the curve (AUC) of 0.95, accompanied by accuracy, sensitivity, and specificity values of 0.89. Conclusion DiTNet exhibited excellent performance in the face of imbalanced datasets and complex and diverse samples, verifying the effectiveness of data augmentation strategies and the ability of different basic models to learn different features.
... Low-risk patients are recommended to control TSH slightly below the lower limit of the normal reference range (0.1-0.5 mU/L) or maintain the lower limit of the normal reference range (0.5-2.0 mU/L). After passing the double risk assessment, regardless of the risk of TSH suppression therapy, it is recommended to always control the TSH of highrisk recurrence patients at < 0.1 mU/ L. [13] Long term use of LT 4 makes subclinical hyperthyroidism occur in DTC patients with potential adverse reactions such as cardiovascular disease. [14] Osteoporosis is mainly manifested by the reduction of bone mass and the destruction of the fine structure of bone tissue, resulting in increased bone fragility and increased fracture risk. ...
Background:
The effect of thyroid stimulating endocrine (TSH) suppression medical aid on bone mineral density (BMD) of patients with differentiated thyroid carcinoma (DTC) or differentiated thyroid malignant neoplastic disease is still controversial. Our aim was to investigate the effect of TSH suppression therapy on BMD of patients with DTC.
Methods:
A total of 1651 DTC patients with TSH-suppression medical care were analyzed by RevMan 5.3 software (https://training.cochrane.org/online-learning/core-software/revman/revman-5-download) in the present study. The PubMed and Embase databases were consistently hunted for works revealed through July 29, 2022.
Results:
The results indicated that a significant association between femoral bone mineral density (FN-BMD) (P = .02) or lumbar spine bone mineral density (L-BMD) (P = .04) and DTC patients with TSH-suppression therapy. However, the total hip bone mineral density (TH-BMD) was not significantly related to DTC patients with TSH-suppression therapy (P = .11). For premenopausal women, it was shown that TH-BMD (P = .02) or L-BMD (P = .01) were closely related to DTC patients with TSH-suppression therapy. However, there was no relationship between FN-BMD and DTC patients with TSH-suppression therapy (P = .06). For postmenopausal women, TH-BMD was closely related to DTC patients with TSH-suppression therapy (P = .02). It was revealed that there was no significant difference between L-BMD (P = .16) or FN-BMD (P = .26) and DTC patients with TSH-suppression therapy. For men, there was no relationship between FN-BMD (P = .94) or L-BMD (P = .29) and DTC patients with TSH-suppression therapy.
Conclusion:
Our systematic review has demonstrated that TSH inhibition treatment mainly influence the TH-BMD or L-BMD of the DTC patients who were premenopausal women; the TH-BMD of the DTC patients who were postmenopausal women. In addition, there was no influence on the FN-BMD or L-BMD of the DTC patients who were men.
... However, it should be noted that in 10-40% of the cases that have been approached with FNA analysis, indeterminate malignancy diagnosis would be established. [4][5][6] Many categories have been reported under the word indeterminate malignancy by FNA analysis, including follicular or Hürthle cell neoplasm/suspicious for follicular or Hürthle cell neoplasm (FN/SFN), atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), and suspicious for malignancy (SFM). Estimates show that all of these subcategories might correlate for the diagnosis of malignancy at a rate of 20-30%, 5-10%, and 50-75%, respectively. ...
Estimates show that thyroid nodules are commonly reported among populations residing in iodine-sufficient countries, with estimated prevalence rates of 1%, and 4% of palpable nodules among men and women in these countries, respectively. Furthermore, early diagnosis can effectively direct clinicians to the right management modality, especially in cases with malignant lesions. In this literature review, we have discussed the types and roles of cytological molecular analysis in thyroid carcinomas. Our findings indicate the molecular analysis can significantly add to the diagnostic accuracy of cytological analysis and can greatly add to the efficacy of differentiating benign from malignant lesions. We have discussed the roles of different genetic mutations that were reported among the various studies in the literature, including BRAF, RAS, PAX8/PPARγ, and RET mutations. BRAF mutations are the most validated mutations among the current studies in the literature, which has been reported to greatly increase the positive predictive values in detecting thyroid carcinomas. Some genetic mutations can be used to diagnose difficult to differentiate malignancies by fine needle aspiration (FNA) analysis. For instance, RAS mutations were reported to accurately diagnose follicular variants of papillary thyroid carcinomas that are difficult to detect using routine FNA analysis.
... Thyroid cancers are classified into papillary carcinoma (PTC), follicular carcinoma (FTC), medullary thyroid carcinoma (MTC), anaplastic thyroid carcinoma (ATC), primary thyroid cancer (ATC), primary thyroid cancer primary thyroid sarcoma (PST). The PTC accounts to 80% of all thyroid malignancies (9), FTC, on the other hand, are the second most frequent malignancy. The MTC accounts for around 3% of all thyroid cancers (12). ...
... A thyroid nodule is a discrete lesion within the thyroid gland that is palpable and ultrasonographically distinct from the surrounding thyroid parenchyma. [1] TN are divided into cysts, inflammatory nodules, and tumoural nodules (benign, malignant) and may present as proliferative nodular goiter. [2] TN, whether solitary or multiple, are a common clinical problem. ...
Background:
Thyroid nodules (TN) are discrete lesions within the thyroid gland and are a common clinical problem detected in 19% to 68% of people. TN are more common as age increases and occur more frequently in women. TN can cause pressure symptoms, cosmetic complaints, and thyroid dysfunction. Treatment for benign thyroid nodules includes thyroid hormone therapy, surgery, radioiodine treatment, percutaneous ethanol injection therapy, and laser or radiofrequency treatment to shrink nodules. In China and many other countries, doctors use Chinese herbal medicines (CHM) to treat TN. However, systematic review and meta-analysis has not been found to assess the effects and safety of CHM in curing TN at present. Hence, the systematic review is conducted to scientifically and methodically evaluate the value of its effectiveness and safety of CHM on TN.
Methods:
Literatures related to CHM for TN from the establishment of the database to November 2020 will be retrieved from the following databases: PubMed, Excerpta Medica Database (EMBASE), MEDLINE, Web of Science, Cochrane Library, SpringerLink, WHO International Clinical Trials Registry Platform (ICTRP), Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP). There are no language restrictions for retrieving literatures. Case reports, animal studies, editorials, expert opinions, reviews without original data, and studies on pediatric population were excluded. Eligible randomized clinical trials (RCTs) evaluating the effectiveness and safety of CHM in TN patients will be put in the study including nodule volume reduction ≥50%, pressure symptoms, cosmetic complaints, quality of life, and adverse events. By scanning the titles, abstracts and full texts, 2 reviewers will independently select studies, extract data, and assess the quality of study. Meta-analysis of RCTs will be conducted using Review Manager 5.1 software. The results will be presented as risk ratio for dichotomous data, and standardized or weighted mean difference for continuous data.
Result:
This study will provide high-quality available evidence for the treatment of TN with CHM based on nodule volume reduction ≥50%, pressure symptoms, cosmetic complaints, quality of life, and adverse events.
Conclusion:
The systematic review will to evaluate the efficacy of CHM in treating benign thyroid nodules in adults and provide evidence for clinicians.
Inplasy registration number:
INPLASY2020120093.
... Significant elevation of their serum-Tg during the patient follow-up indicates either the persistence of remnant thyroid tissue or its recurrence as metastatic thyroid cancer. Therefore, the measurement of serum-Tg provides useful information during the clinical management of thyroidectomized DTC patients (Cooper et al., 2006). Though LC-MS/ MS based Tg measurements are reported in the literature, most clinical laboratories are still dependent on immunoassays based on polyclonal/monoclonal antibodies or their combinations to measure Tg (Kushnir et al., 2013). ...
Single domain antibodies (SdAbs) have been deployed in various biomedical applications in the recent past. However, there are no reports of their use in the immunoradiometric assays (IRMA) for thyroglobulin (Tg). Tg is the precursor molecule for the biosynthesis of thyroid hormones: thyroxine and triiodothyronine, which are essential for the regulation of normal metabolism in all vertebrates. Patients with differentiated thyroid cancer (DTC) require periodic monitoring of their serum thyroglobulin levels, as it serves as a prognostic marker for DTC. Here, we report a methodology to produce SdAbs against human-Tg, by a hybrid immunization/directed-evolution approach by displaying the SdAb gene-repertoire derived from a hyperimmune camel in the T7 phage display system.
We have demonstrated the immunoreactivity of anti-Tg-SdAb (KT75) in immunoassays for thyroglobulin and measured its affinity by surface plasmon resonance (KD ~ 18 picomolar). Additionally, we have shown the quantitative-binding property of SdAb for the first time in IRMA for thyroglobulin. The serum Tg values obtained from SdAb-Tg-IRMA and in-house assay using murine anti-Tg-monoclonal antibody as tracer significantly correlated, r = 0.81, p < 0.05. Our results highlight the scope of using the T7 phage display system as an alternative for the conventional M13-phage to construct single-domain antibody display libraries.
... Thyroid malignancy is the most common endocrine malignancy, which usually presents as a solitary thyroid nodule. Studies have suggested that 5% to 15% of all thyroid nodules evaluated are malignant (1)(2)(3). The current protocol for evaluation of thyroid nodules includes initial thyroid function test, ultrasonography (USG) of the thyroid gland, followed by USG-guided fine needle aspiration (FNA) cytology (FNAC) in those for whom it is indicated (4). ...
Background
Molecular testing is increasingly used to identify malignancy in thyroid nodules (especially indeterminate category). Cell free DNA (cfDNA) levels from plasma has been useful in diagnosis of cancers of other organs/tissue. cfDNA levels would be estimated in patients with thyroid nodules to explore possibility of establishing a cut-off for identification of malignancy.
Methods
Patients underwent ultrasonography (USG) and USG guided fine needle aspiration (FNA) and surgery, where indicated. Cell free DNA was extracted from plasma and quantified. In initial analysis (determination of cut-off) cfDNA levels were compared between Bethesda 2 and Bethesda 5 &6 to establish a cut-off that could differentiate malignant from benign nodules. In the subsequent analysis the aforementioned cut-off was applied (validation of cut-off) to those with indeterminate nodules to check ability to predict malignancy.
Results
FNA (n=119) yielded, Bethesda 2 (n=69) Bethesda 5 & 6 (n=13), underwent histopathological confirmation. Cell free DNA in these two groups were 22.85±1.27 and 96.20±8.31 (ng/ml) respectively. A cfDNA cut-off 67.9 ng/ml, with AUC 0.992 (95% CI=0.97- 1.0) with 100% sensitivity and 93% specificity was established to identify malignant lesions. Indeterminate group (Bethesda 3 & 4) underwent surgery (Malignant n=24), (Benign n=13), and using the previously identified cut off cfDNA we were able to identify malignant lesions with a sensitivity of 100% and specificity of 92.3%. There was a very strong agreement between cfDNA based classification with histopathology based classification of benign and malignant nodule (Cohen’s kappa 0.94, p<0.001)
Conclusion
Plasma cfDNA estimation could help differentiate malignant from benign thyroid nodules.
... In clinical practice, ultrasound (US) examination of the TN is conducted by taking images on the thyroid mass with the help of specialized ultrasonic equipment. The radiologist then analyzes the captured images and provides descriptions on the characteristics of the TN, sometimes according to the Thyroid Imaging, Reporting and Data System (TI-RADS) guidelines [5][6][7]. Patients with suspected thyroid cancer will undergo fine needle aspiration (FNA) biopsy for cytological examination, the results of which are usually regarded as a gold standard for diagnosis. It can be noted that the diagnosis of TNs is a time-consuming procedure, which also relies on personal experiences of radiologists. ...
Objective:
To develop a deep learning-based method with information fusion of US images and RF signals for better classification of thyroid nodules (TNs).
Methods:
One hundred sixty-three pairs of US images and RF signals of TNs from a cohort of adult patients were used for analysis. We developed an information fusion-based joint convolutional neural network (IF-JCNN) for the differential diagnosis of malignant and benign TNs. The IF-JCNN contains two branched CNNs for deep feature extraction: one for US images and the other one for RF signals. The extracted features are fused at the backend of IF-JCNN for TN classification.
Results:
Across 5-fold cross-validation, the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) obtained by using the IF-JCNN with both US images and RF signals as inputs for TN classification were respectively 0.896 (95% CI 0.838-0.938), 0.885 (95% CI 0.804-0.941), 0.910 (95% CI 0.815-0.966), and 0.956 (95% CI 0.926-0.987), which were better than those obtained by using only US images: 0.822 (0.755-0.878; p = 0.0044), 0.792 (0.679-0.868, p = 0.0091), 0.866 (0.760-0.937, p = 0.197), and 0.901 (0.855-0.948, p = .0398), or RF signals: 0.767 (0.694-0.829, p < 0.001), 0.781 (0.685-0.859, p = 0.0037), 0.746 (0.625-0.845, p < 0.001), 0.845 (0.786-0.903, p < 0.001).
Conclusions:
The proposed IF-JCNN model filled the gap of just using US images in CNNs to characterize TNs, and it may serve as a promising tool for assisting the diagnosis of thyroid cancer.
Key points:
• Raw radiofrequency signals before ultrasound imaging of thyroid nodules provide useful information that is not carried by ultrasound images. • The information carried by raw radiofrequency signals and ultrasound images for thyroid nodules is complementary. • The performance of deep convolutional neural network for diagnosing thyroid nodules can be significantly improved by fusing US images and RF signals in the model as compared with just using US images.
... However, the literature contains few reports on their utility with regard to specific organ sites especially thyroid. [9] This study was taken up to find out if cell block actually helps in improving the preoperative diagnostic accuracy Annals of Pathology and Laboratory Medicine, Vol. 7, Issue 7, July, 2020 and to evaluate the utility of doing an immuno-cytochemical staining on suspected cases of carcinomas. Objectives were to assess the sensitivity and diagnostic specificity of cell block preparation in diagnosis of thyroid lesions in comparison with FNA smears; to assess the reliability and difficulties of cell block assessment and to assess the utility of immunocytochemistry done on cell-block preparations in diagnosis of thyroid carcinomas. ...
Background: Thyroid nodules are quite common in the general population of India with increasing incidence of malignancy worldwide. Fine Needle Aspiration [FNA] has been the primary modality of pre-operative diagnosis of such lesions till date. But it has got its own share of fallacies and pit-falls. Cell-block [CB] can be done in the same sitting and it gives the advantage of architectural assessment with easy subjectivity to immuno-cytochemical [ICC] staining. Material and methods: FNA was done in all patients and CB was prepared by formalin method. ICC stains were used in cases with provisional diagnosis of malignancy and in all follicular neoplasm cases. SPSS v.20 was used for analysis. Sensitivity and specificity of cell block was calculated. Diagnostic correlation of both FNA and CB with respect to histopathological examination was done by using student t-test with confidence interval of 95%. Results: CB showed a correlation coefficient of 0.704 and a p value of 0.0001while FNA showed a correlation coefficient of .464 and a p-value of .001. So, CB showed a strong positive correlation and a high statistical significance. Cell block helped in diagnosing almost all the cases showing discordance in FNA except that of papillary carcinoma where the cellular yield was poor due to cystic degeneration. Sensitivity of cell block was 89.5% and Specificity was 96.9%. Conclusions: Cell block is definitely a good ancillary examination for thyroid nodular lesions in addition to FNA. It should be routinely performed in all thyroid cases as it improves the diagnostic yield and accuracy of cytological diagnosis.
... Thyroid cancer (TC) is one of the most common malignant tumors in endocrine organs, and surveys have shown that the incidence rate of thyroid nodules is as high as 50% in people aged over 50 years old [1,2]. Moreover, about 5% thyroid nodules are malignant. ...
Objective:
To investigate the correlations of proliferating cell nuclear antigen (PCNA) gene expression with thyroid cancer (TC) ultrasound (US) features, histopathology and clinical stage.
Methods:
A total of 66 TC patients admitted and treated in the Department of Oncology of our hospital from April 2014 to April 2018 were enrolled randomly. The conventional US imaging data of the patients were collected. Paired carcinoma and para-carcinoma tissues were obtained after operation to detect the expression of PCNA protein by immunohistochemistry (IHC). The correlations of PCNA expression with the patients' US manifestations and clinical stages were analyzed.
Results:
The positive rate of PCNA was 72.73% (48/66) in TC tissues and 13.64% (9/66) in paired para-carcinoma tissues, displaying a statistically significant difference between the two groups (P<0.05). The PCNA and US features suggested that there was no significant difference in tumor boundary between the PCNA positive group and PCNA negative group (P>0.05). However, significant differences in tumor diameter, echo, calcification and blood flow were found between the two groups (P<0.05). The pathologic data of preoperative US diagnosis and PCNA expression in postoperative TC specimens were analyzed, and the results indicated that PCNA expression was prominently associated with T stage and N stage in US diagnosis (P<0.05). The total correct rate of US in assessing the T stage was 75.8% (50/66), and the over-staging rate and under-staging rate in evaluating the T stage were 13.6% (9/66) and 10.6% (7/66), respectively.
Conclusion:
The expression of PCNA protein in TC tissues is significantly correlated with the diameter, echo, calcification and blood flow of US features as well as clinical stage detected by US. PCNA level and US examination can provide certain clinical values for TC treatment.
... 27 TIMP-1 is a specific inhibitor of MMP-9. Previous studies 28 found that TIMP-1 expression could be detected in fibroblasts of DTC and thyroid adenoma, and it is closely related with tumor size, lymph node metastasis, clinical stage, and vascular invasion, while promoting recurrence. A number of scholars think that the dynamic balance between TIMP-2 and MMP-2 affects tumor invasion and Figure 1 The expression levels of MMPs and TIMPs in patients with benign thyroid tumors were not significantly different from those in healthy persons, and there was no significant change after surgery (P>0.05). ...
Introduction
The objective of this study was to assess the clinical significance of determining the levels of matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), and TIMP-2 in the peripheral blood of patients with differentiated thyroid carcinoma (DTC).
Methods
Forty-nine patients with benign thyroid lesions and 57 patients with DTC were examined using the enzyme-linked immunosorbent assay method preoperatively and 1 month after operation.
Results
The levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 in the peripheral blood of patients with DTC were significantly higher than those measured in patients with benign thyroid disease (P<0.05). After surgery, these levels in the peripheral blood of patients with benign thyroid lesions were not significantly changed (P>0.05). However, after operation, these levels in the peripheral blood of patients with DTC were significantly lower (P<0.05). These levels in the serum of patients with DTC which were tumor-node-metastasis stage, tumor diameter ≥l cm, infiltrating capsula outside or existing lymph metastasis were significantly higher than those reported in patients with early tumor-node-metastasis stage, tumor diameter <l cm or absence of lymph metastasis (P<0.05).
Discussion
Detecting the levels of these factors in peripheral blood is helpful in the diagnosis of benign and malignant thyroid lesions, and can be used as a basis for the prognosis of DTC.
Ultrasonography (US)-guided fine-needle aspiration cytology (FNAC) is the primary modality for evaluating thyroid nodules. However, in cases of atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS), supplemental tests are necessary for a definitive diagnosis. Accordingly, we aimed to develop a non-invasive quantification software using the heterogeneity scores of thyroid nodules. This cross-sectional study retrospectively enrolled 188 patients who were categorized into four groups according to their diagnostic classification in the Bethesda system and surgical pathology [II-benign (B) (n = 24); III-B (n = 52); III-malignant (M) (n = 54); V/VI-M (n = 58)]. Heterogeneity scores were derived using an image pixel-based heterogeneity index, utilized as a coefficient of variation (CV) value, and analyzed across all US images. Differences in heterogeneity scores were compared using one-way analysis of variance with Tukey’s test. Diagnostic accuracy was determined by calculating the area under the receiver operating characteristic (AUROC) curve. The results of this study indicated significant differences in mean heterogeneity scores between benign and malignant thyroid nodules, except in the comparison between III-M and V/VI-M nodules. Among malignant nodules, the Bethesda classification was not observed to be associated with mean heterogeneity scores. Moreover, there was a positive correlation between heterogeneity scores and the combined diagnostic category, which was based on the Bethesda system and surgical cytology grades (R = 0.639, p < 0.001). AUROC for heterogeneity scores showed the highest diagnostic performance (0.818; cut-off: 30.22% CV value) for differentiating the benign group (normal/II-B/III-B) from the malignant group (III-M/V&VI-M), with a diagnostic accuracy of 72.5% (161/122). Quantitative heterogeneity measurement of US images is a valuable non-invasive diagnostic tool for predicting the likelihood of malignancy in thyroid nodules, including AUS or FLUS.
The management of nodal metastasis in well-differentiated thyroid cancer has generated considerable debate and controversy. This is primarily related to the excellent outcome in younger patients with nodal metastasis and the relatively low impact on long-term survival. There is also considerable controversy in relation to prophylactic central compartment dissection, which clearly has a higher risk of complications. The risk of recurrence in bulky nodal metastasis is quite significant and may lead to multiple further surgeries. Certain prognostic features in the nodal metastasis are important, such as aggressive histology, size and number of lymph nodes, and lymph node ratio. Preoperative evaluation with dedicated ultrasound and CT scan with contrast is vital. Frozen section is helpful during central compartment dissection. Routine radioactive iodine ablation appears to have a lesser impact.
Purpose
To analyze risk factors for parapharyngeal (PP) and retropharyngeal (RP) metastases in papillary thyroid cancer (PTC).
Methods
A matched case–control study was conducted, comprising 130 age- and sex-matched cases of PTC. Among these cases, 50 had PP/RP metastases, 50 had central and/or lateral neck lymph node metastases, and 30 showed no lymph node metastases. Preoperative thyroid function test, computed tomography images, and postoperative pathological findings were collected. Associations between cases were assessed using univariate conditional logistic regression analysis, followed by multivariate conditional logistic regression analysis, and backward stepwise selection to predict risk factors for PP/RP metastases.
Results
The study found that thyroglobulin was significantly associated with the development of PP/RP metastases [136.10(16.55–312.60) vs. 27.60(10.28–55.62) vs. 8.74(6.35–21.10) P < 0.001].
Conclusions
The study concludes that thyroglobulin is a significant risk factor for PP/RP metastases in PTC. This finding emphasizes the importance of monitoring thyroglobulin levels in PTC patients to identify those at risk of developing PP/RP metastases.
Computerized thoracic tomography (CT) imaging was extensively employed, especially in the early months of the COVID-19 pandemic. An incidental thyroid nodule (ITN) is defined as a nodule not previously detected or suspected clinically but identified via an imaging study. The present study aimed to determine the incidence of thyroid nodules incidentally detected in thoracic CTs for the suspicion of COVID-19 pneumonia.
Adult patients who underwent thoracic CT in our hospital for COVID-19 management were retrospectively identified between March 2020 and September 2020. Medical information registered in the hospital and national health system was reviewed. The prevalence of incidental thyroid nodules at CT, thyroid function test results of patients with incidental lesions, correlation of CT findings with ultrasonography (US) findings, and fine-needle aspiration biopsy (FNAB) results were evaluated.
We analyzed 35,113 patients who had COVID-19-indicated CT scans. There was information about the thyroid gland in CT reports of 3049 patients. The prevalence of ITN was 3.82% (1343/35,113 patients) and thyroid heterogeneity was 1.11% (388/35,113 patients). While it was explicitly stated that no pathology was found in the patient’s thyroid gland in 3.75% of patients (1318/35,113), no information was given about the thyroid gland in 91.32% of the patients (32064/35,113). Thus, the number of patients informed about their thyroid was 3049 (8.68%) and the number of patients with thyroid pathology was 1731 (4.93%). It was observed that 308 of 1731 patients (17.80%) had follow-up thyroid US. An FNAB was indicated in 238 patients (87.50%). Of the 238 patients with indication for biopsy, only 115 (48.31%) underwent a thyroid FNAB. The cytological diagnosis was benign in 59 (51.30%), non-diagnostic in 30 (26.08%), atypia of uncertain significance in 22 (19.13%), and suspected follicular neoplasia/follicular neoplasia in four patients (3.46%). Thyroidectomy was performed in six more patients due to large nodules and the final diagnosis was benign in two and papillary thyroid cancer in three patients.
Increased use of thoracic CT during the COVID-19 pandemic probably enabled improved detection of ITNs. In this large-scale study, the prevalence of thyroid nodules reported with thoracic CT was 3.82%, while thyroid cancer was detected in 1.30% of patients evaluated with US. We recommend against using thoracic CT scans as a direct means of assessing thyroid disease owing to the low number of detected cancer cases in our cohort of 35,113 patients. However, thoracic CT scans obtained for various reasons might provide the opportunity for early diagnosis and treatment of thyroid disease, including cancers.
We report the case of a female in her 50’s with slowly progressive neck mass for 9 years. For last 2 years the mass has rapidly grown to present size. The size of the mass was 5 × 6 cm and underwent fine needle aspiration cytology six months earlier. Histopathological studies confirmed papillary thyroid carcinoma and cutaneous needle track seeding of the primary tumour. To our knowledge, this is a rare report of seeding of papillary thyroid carcinoma along the track of fine needle aspiration. Some factors involved in needle track seeding are: needle size; number of passes; withdrawing the needle without releasing suction; injecting the tumour at time of biopsy.
Purpose
Drop-out in clinical long-term follow-up is a general problem that is potentially harmful to patients. No data about patients that drop out from thyroid ultrasound follow-up is available literature. The aim of the present retrospective study was to evaluate the characteristics of patients that dropped out from ultrasound thyroid nodule follow-up.
Patients and methods
We reviewed medical records of all consecutive patients who underwent a fine needle aspiration from January 2007 to March 2009 in our department. All the patients with benign nodule(s) were recommended annual ultrasounds; patients who had dropped out from follow-up were included and a telephone interview was obtained to evaluate the reasons for dropping out.
Results
289/966 (30%) of patients with benign nodules dropped out during follow-up; 94% of them within the first 5 years. Phone interviews were obtained from 201/289 (70%) of the patients. In the 57% of cases, the main declared reason for dropping out was nodular dimension stability during the first 2-3 years; 8.7% of them had forgotten about the appointment; 6.4% of subjects claimed to check only serum TSH, and 3.2% stated that they would undergo an ultrasound only if the nodule(s) were symptomatic. Finally, 10.7% patients continued follow-up in other centres.
Conclusion
we showed that a third of patients miss their thyroid ultrasound follow-ups, and that the major cause is the low perceived threat coming from the disease. As a certain amount of drop-out is inevitable, attempting to reinforce our patients’ awareness regarding their own health state is mandatory.
Trial registration
Trial registration: no. 4084.
Background
The 2009 American Thyroid Association (ATA) guidelines for medullary thyroid cancer (MTC) were created to unify national practice patterns. Our aims were to (1) evaluate national adherence to ATA guidelines before and after 2009, (2) identify factors that are associated with concordance with guidelines, and (3) evaluate whether there is an association between survival and concordant treatment.Patients and Methods
Patients with MTC were identified from the 2009 to 2015 National Cancer Database. Adherence to ATA recommendations regarding extent of surgery (R61–R66) was analyzed. Logistic regression was used to determine predictors of discordance and propensity score matching was used to compare concordant treatment rates between time periods. Kaplan–Meier survival analysis was used to determine association between survival and concordant treatment.ResultsThere were 3421 patients with MTC, and of these 3087 had M0 disease and 334 had M1 disease. We found that 72% of M0 cases adhered to R61–66, and 68% of M0 cases without advanced local disease were adherent to R61–63. Following propensity score matching, the adherence rate was 67% before 2009 and 74% after. Patient factors associated with discordant treatment were female gender, older age, treatment at a nonacademic facility, and living within 50 miles of the treatment facility. Adherence to guidelines was associated with improved overall survival (OS) (p < 0.01).Conclusions
Treatment of MTC was discordant from guidelines in 26% of cases from 2009 to 2015 compared with 33% prior to 2009 in a propensity matched analysis, and was most often in cases with localized, noninvasive disease. Improved adherence to guidelines may improve overall survival.
Importance
Ultrasound-guided fine-needle aspiration biopsies (UGFNA) play a crucial role in the diagnosis of thyroid nodules. There are two techniques for performing an UGFNA: short-axis technique and long-axis technique. There is sparsity in the literature regarding the differences between these two techniques.
Objective
To compare the efficiency between long-axis and short-axis thyroid UGFNA techniques in trainees. Our secondary outcomes were to define the comfort level and learning curves of trainees.
Design
A longitudinal prospective cohort study, completed from December 2018 to November 2019, using the Blue Phantom Thyroid Model© for UGFNA. Face and construct validity of the model were verified. Residents completed UGFNA on an assigned nodule using both long-axis and short-axis techniques, the order of which was sequentially allocated. The rate and time to successful biopsy were obtained for both techniques. Biopsy attempts were repeated to establish learning curves.
Setting
Single-center study.
Participants
Fourteen Otolaryngology—Head & Neck Surgery residents at the University of Toronto.
Main outcome measure
Biopsy success and efficiency for novice learners completing UGFNA on a simulated thyroid model using long-axis and short-axis techniques.
Results
A trend towards higher odds of successful biopsy using the long-axis technique with no difference in procedure duration was observed (OR = 2.2, p = 0.095, CI = 0.87–5.39). Learning curve graphs appeared heterogenous according to trainee level. Trainees found the long-axis technique easier to perform (10/14, 71%), and the simulator valuable for learning (12/14, 86%).
Conclusion
Thyroid UGFNA using the long-axis technique may have an increased success rate and is generally favored by trainees for being easier to perform. Thyroid simulators have the potential to increase learner comfort and efficiency with UGFNA.
Graphical Abstract
Thyroid nodules are a common worldwide health problem and a diagnostic challenge for clinicians and cytopathologists. Follicular growth pattern constitutes the majority of thyroid lesions. Thyroid nodules can be neoplastic or non-neoplastic, and neoplastic nodules can be classified as benign, malignant, or gray zone. Gray zone lesions include different benign and malignant entities that might be resulted in unnecessary thyroidectomies with risk of morbidity and higher health care costs. Depending on the cellularity, most cases might fall into the Follicular neoplasia (FN)/ suspicious for FN (SFN) category or FLUS in The Bethesda System for Reporting Thyroid Cytopathology. Pathologists must be aware of the relationship between this diagnostic category and follow-up patient management and avoid over-diagnosing by mastering the diagnostic criteria.
Objective
The Thyroid Imaging Reporting and Data System (TIRADS) has been proposed to reduce the number of unnecessary fine needle aspirations (FNA) from thyroid nodules.
Materials and Methods
An individual radiologist provided sonographic examinations and FNA on a collection of 188 thyroid nodules. The recommendations based on the TIRADS system, for each nodule, was determined and evaluated against the cytology results.
Results
The American College of Radiology (ACR), artificial intelligence (AI), European (EU), and Korean (K) scoring systems reduced FNAs by 53%, 56%, 48%, and 28%, respectively. Among those lesions without a recommendation for immediate FNA, The ACR would have missed four malignant nodules, the AI would have missed four malignant nodules, and K TIRADS would have missed three malignant nodules but with a recommended follow-up imaging. The ACR would have missed three malignant nodules, the AI would have missed four malignant nodules, and EU TIRADS would have missed four malignant nodules, without a recommended follow-up examination. The highest and lowest kappa interrelated agreements were between ACR and AI (0.902) and AI and K (0.448).
Conclusion
The ACR and AI TIRADS could substantially decrease the number of FNAs but rely on follow-up imaging. The EU TIRADS reduced the number of FNAs, the least however this system had less dependence on follow-up imaging. The K TIRADS was the most conservative method and the least dependent on follow-up diagnostics.
Introduction
Differentiated thyroid cancer (DTC; >90% of all TCs) derives from follicular cells. Surgery is the main therapeutic strategy, and radioiodine (RAI) is administered after thyroidectomy. When DTC progresses, it does not respond to RAI and thyroid-stimulating hormone (TSH)-suppressive thyroid hormone treatment, and other therapies (i.e. surgery, external beam radiation therapy and chemotherapy) do not lead to a better survival. Thanks to the understanding of the molecular pathways involved in TC progression, important advances have been done. Lenvatinib is a multitargeted tyrosine kinase inhibitor of VEGFR1-3, FGFR1-4, PDGFRα, RET, and KIT signaling networks implicated in tumor angiogenesis, approved in locally recurrent or metastatic, progressive, RAI-refractory DTC. Unmet needs regarding the patient clinical therapy responsiveness in aggressive RAI-refractory DTC still remain.
Areas covered
We provide an overview from the literature of in vitro, in vivo and real-life studies regarding lenvatinib as an investigational agent for the treatment of aggressive TC.
Expert opinion
According to the SELECT trial, the treatment should be initiated with a dosage of 24 mg/day, subsequently decreasing it in relation to the side effects. The decision making process in patients with aggressive RAI-refractory DTC should be personalized and the potential toxicity should be properly managed.
Introduction
The 2015 American Thyroid Association guidelines (ATA15) consider hemithyroidectomy (HT) a viable treatment option for low-risk papillary thyroid cancers (PTCs) between 1 and 4 cm. We aimed to examine the impact of ATA15 in a high-volume Australian endocrine surgery unit.
Methods
A retrospective study of all patients undergoing thyroidectomy from January 2010 to December 2019. Inclusion criteria: PTC histopathology, Bethesda V-VI, size 1–4 cm, and absence of clinical evidence of lymph node or distant metastases pre-operatively. Primary outcome was rate of HT before and after ATA15.
Results
Of 5408 thyroidectomy patients, 339 (6.3%) met the inclusion criteria – 186 (54.9%) pre-ATA15 (2010–2015) and 153 (45.1%) post-ATA15 (2016–2019). The patient groups were similar; there were no significant differences between groups in age, sex, tumour size, proportion with Bethesda VI cytology, compressive symptoms, or thyrotoxicosis. Post-ATA15, there was a significant increase in HT rate from 5.4% to 19.6% (P = 0.0001). However, there was no corresponding increase in completion thyroidectomy (CT) rate (50.0% versus 27.6%, P = 0.2). The proportion managed with prophylactic central neck dissection (pCND) fell from 80.5% to 10.8% (P < 0.0001). Pre-ATA15, the only factor significantly associated with HT was Bethesda V. In contrast, post-ATA15, HT was more likely in patients with younger age, smaller tumours, and Bethesda V.
Conclusion
After the release of 2015 ATA guidelines, we observed a significant increase in HT rate and a significant decrease in pCND rate for low-risk PTCs in our specialised thyroid cancer unit. This reflects a growing clinician uptake of a more conservative approach as recommended by ATA15.
Fine‐needle aspiration (FNA) is the first‐line and a cost‐effective examination method of nonfunctional thyroid nodules. Acute transient thyroid swelling after an FNA is a rare complication, and to date, only 14 cases have been reported in the English literature. Herein, we report a case of a 26‐year‐old woman with acute transient thyroid swelling, which occurred after an ultrasound‐guided FNA of a thyroid nodule. Although the patient had undergone an FNA without complication 2 years previously, the second FNA caused acute thyroid swelling. The present case emphasizes the potential risk of acute thyroid swelling associated with every FNA procedure.
Background
Fine-needle aspiration (FNA) is a frequently utilized method for the diagnosis of thyroid nodules. Although the technique has clear advantages, the injury caused by the aspiration needle can induce various histological alterations. Herein, we report a case of follicular adenoma showing histological alterations possibly caused by FNA biopsy. Furthermore, the histological appearance of the lesion mimicked those of medullary thyroid carcinoma, particularly in the frozen section.
Case presentation
Ultrasonography of a thyroid nodule in a 39-year-old man revealed a mass (2.2 cm in diameter) in the right thyroid lobe. FNA was performed three times on the mass, and the results of the cytology were atypia of undetermined significance. Thereafter, the patient underwent right hemithyroidectomy. The histological findings of the operative frozen section analysis indicated medullary thyroid carcinoma. However, after evaluation and immunohistochemical staining of the permanent section, the mass was diagnosed as follicular adenoma with extensive fibrosis.
Conclusion
The histological alterations observed in the follicular adenoma are believed to have been caused by injury during the repeated FNA procedures.
Background/Purpose
Thyroid Imaging Reporting and Data System (TI-RADS) is validated in adults but not yet in children. The purpose of this study was to determine the sensitivity, specificity, and accuracy of TI-RADS in predicting thyroid malignancy for pediatric nodules, and to compare the diagnostic accuracy to the current American Thyroid Association (ATA) guidelines.
Methods
A single institution retrospective review was performed of patients younger than 21 years who underwent thyroid nodule fine needle aspiration biopsy (FNAB). Two radiologists were blinded to the pathology and independently classified all biopsied thyroid nodules based on TI-RADS. ATA and TI-RADS guidelines were analyzed to determine the diagnostic sensitivity and specificity of both scoring systems.
Results
115 patients (median age 15.5 years, 90 females) with 138 nodules were scored using TI-RADS. There was moderate inter-rater agreement between radiologists (Kappa = 0.51; p<.0001). Evaluating several potential TI-RADS criteria, 23.2%-68.1% of nodules were recommended for FNAB, compared to 82.6% of nodules using ATA guidelines. Using TI-RADS ≥ 3 (without size cutoff) as an indication for FNAB had 100% sensitivity with no missed suspicious or malignant nodules on cytology or pathology.
Conclusions
Using TI-RADS for diagnostic management of pediatric thyroid nodules improves accuracy in predicting malignancy.
Occlusion of the internal jugular vein (IJV) can be observed in thyroid cancer either on preoperative imaging with ultrasound or cross-sectional imaging, particularly contrast-enhanced CT-scan, and can be detected during follow-up when using these same imaging modalities. For thyroid cancer, four different causes of occlusion of the IJV can be identified: venous thrombosis associated with a hypercoagulable state, tumor thrombus in the vein, compression or invasion of the IJV by thyroid disease or lymph node metastases, and fibrotic collapse of the IJV following lateral neck dissection. Clinicians managing patients with thyroid cancer need to be aware of and able to diagnose each of these conditions. The overall patient impact and appropriate management of each will be discussed.
The debate regarding the surgical management of low‐risk differentiated thyroid cancer (DTC) is ongoing. The recommended extent of surgery in DTC is based on an assessment of the predicted risk of recurrence and recent guidelines reflect an evolving philosophy of de‐escalation of surgical management, informed by a growing understanding of the determinants of tumour biology and important prognostic factors. However, our current clinical and pathological risk stratification processes are imperfect and hence there is significant variation in clinical practice. Surgeons face the challenge of finding the balance between avoiding overtreatment, minimizing complications and providing adequate oncological management. This article discusses the nuances of the current management guidelines as well as the important considerations in preoperative decision making. In managing low‐risk differentiated thyroid cancer, surgeons face the challenge of finding the balance between avoiding over‐treatment, minimising complications and providing adequate oncological management. This article discusses the nuances of the current management guidelines as well as the important considerations in preoperative decision making.
The aim of this study is to evaluate the feasibility of using blood serum surface-enhanced Raman spectroscopy (SERS) to identify benign and malignant thyroid nodules. Blood serum samples collected from three different groups including healthy volunteers (n = 22), patients with benign nodules (n = 19) and malignant nodules (n = 22) were measured by SERS. The spectral analysis results demonstrate that biomolecules in serum, such as amino acids, adenine and nucleic acid bases, change differently due to the different progression of nodules. By further combining with partial least square analysis and linear discriminant analysis (PLS-LDA) method, diagnostic accuracies of 93.65% and 82.93%, sensitivities of 92.68% and 81.82% and specificities of 95.45% and 84.21% can be achieved for differentiating healthy versus thyroid nodular groups and benign versus malignant groups, respectively. The above results have suggested that the blood serum SERS technique is helpful for precise diagnosis and timely treatment for patients with thyroid nodules.
Context: Thyroid swelling is a relatively common problem encountered in clinical practice throughout the world. Early detection of thyroid neoplasm is the fundamental basis of thyroid screening. quest for ease, simple and accurate diagnostic tool that would differentiate between benign and malignant lesion has facilitated fine needle aspiration cytology (FN C) as the first line tool in the initial thyroid evaluation. Aims: The study was aimed at classifying thyroid lesions according to the ethesda System for eporting Thyroid Cytopathology and to compare the diagnostic efficacy of fine needle aspiration cytology by correlating with gold standard histopathology. Settings and Design: This prospective cross-sectional study was conducted over a period of two years in a tertiary hospital, erala. Met ods and Material: total of 710 patients were included in the study. FN C was performed and Staining was performed with aematoxylin Eosin (E), Papanicolaou and May-r nwald iemsa Stains. Diagnosis was made based on T S TC. Excision biopsies were fixed in 10 formalin. Statistical Anal sis sed: I M Statistical Package for the Social Sciences Software version 21 was used to perform Pearson Chi-square test and Fischer Exact. Res lts: In this study 592 (83.4) cases of non-neoplastic lesions, 111 (15.6) cases of neoplastic lesions and seven cases were found unsatisfactory for diagnosis. FN C showed high sensitivity and specificity in diagnosing neoplastic thyroid lesions and it showed high level of significance in diagnosing papillary thyroid carcinoma. Concl sions: FN C is an excellent diagnostic tool in the management of thyroid lesions since it provides rapid diagnosis with high accuracy rate. eywords: ethesda System Neoplasm istopathology Papillary Thyroid Carcinoma.
Purpose:
The use of prophylactic central neck dissection (PCND) and the extent of thyroid surgery in clinically node-negative (cN0) papillary thyroid carcinoma (PTC) are controversial. This study aimed to investigate whether the extent of thyroid surgery influences the prognosis of patients with PTC with central lymph node metastasis (N1a), which was cN0 but pathologically confirmed after PCND.
Methods:
This was a single-center retrospective study using medical records. Patients who underwent thyroid surgery with PCND for the treatment of PTC between 2004 and 2019 were included. Predictive factors and local recurrence rates were analyzed.
Results:
Of 2,274 patients with cN0 PTC, 436 were confirmed to have pathologic N1a disease after PCND. Among them, 340 patients (78.0%) underwent total thyroidectomy (TT) and 96 patients (22.0%) underwent less than TT. Of the 374 patients who were followed up for >6 months, 5 (1.3%) experienced recurrence. The 15-year recurrence-free survival (RFS) rate was 98.2%. No clinicopathologic factor was predictive of tumor recurrence. RFS tended to be lower in patients who underwent less than TT than in those who underwent TT; however, the difference was not statistically significant.
Conclusion:
Our study showed low recurrence rates in patients with cN0 PTC pathologically confirmed as N1a after PCND. The RFS did not differ according to the extent of thyroid surgery. Considering the low recurrence rate and the surgical morbidity associated with thyroid surgery, less than TT with PCND may be considered for patients with cN0 unilateral PTC even with a pathologic staging of N1a after PCND.
Objectives
The aims were to analyze the clinical features, response to treatment, prognostic factors and long-term follow-up of children and adolescents with differentiated thyroid carcinoma (DTC).
Methods
Eighty patients with DTC were studied retrospectively. All underwent total or near-total thyroidectomy, and in 75 cases, ablative iodine therapy was recommended. Patients were assessed periodically by tests for serum thyroglobulin levels and whole-body iodine scans. Age, gender, initial clinical presentation, histology, tumor stage, postoperative complications, radioiodine treatment protocol, treatment response, thyroglobulin (Tg), recurrence and long-term disease progression were evaluated.
Results
Seventy patients completed >2 years of follow-up (23 males, 47 females; median age: 14 years; range: 3–18 years). Sixty-two patients showed papillary DTC and eight, follicular DTC. Sixty-five percent presented nodal metastasis and 16%, pulmonary metastasis at diagnosis. Six months after first radioiodine treatment, 36.2% of patients were free of disease. Seven recurrences were documented. At the end of follow-up, overall survival was 100%, and 87.2% of patients were in complete remission. Nine patients had persistent disease. We found a significant association between stage 4 and persistent disease. Hundred percent of patients with negative Tg values at 6 months posttreatment were documented free of disease at the end of the follow-up. The analysis of disease-free survival based on radioiodine treatment protocols used showed no statistically significant differences.
Conclusions
DTC in children and adolescents is frequently associated with presence of advanced disease at diagnosis. Despite this, complete remission was documented after treatment in most cases, with a good prognosis in the long-term follow-up. Negative posttreatment thyroglobulin and stage 4 at diagnosis were significant prognostic variables.
Background
Breast approach endoscopic thyroidectomy with lateral neck lymph node metastases dissection has been described. However, in this article, we report on 10 years’ experience with the breast approach to patients with endoscopic thyroidectomy with level II, III, and IV lateral neck dissection (LND). Patients with papillary thyroid carcinoma (PTC) who received scarless endoscopic thyroidectomy (SET) were included to evaluate its therapeutic effect.Methods
Between June 2009 and June 2019, we selected 155 patients with PTC with level II, III, or IV level lymph node metastasis suspected. Ipsilateral level II, III, and IV dissection was performed, accompanied by thyroidectomy and central compartment dissection. In addition, 102 patients received conventional open LND during the same period and were included. Clinicopathological characteristics, outcomes, and tumor prognosis were retrospectively compared in the two groups.ResultsDuring the 10 years, the submitted patients’ clinicopathological characteristics including tumor size, tumor stage, retrieved lymph nodes number, complication rates, postoperative PTH, and mean postoperative hospital stay were similar between the SET and open group. The mean operating time in the SET group (278.2 ± 38.6 min) was longer than in the open group (179.3 ± 25.4 min). The recurrent rate was not significantly different (2/155, 2/106) in the SET and conventional open group.Conclusion
The safety and oncological completeness dissection of SET was similar to that of open procedures. SET is an effective treatment approach for patients with PTC having cosmetic results’ demand of lateral neck lymph node metastases.
PurposeThere are controversial debates if patients with Hürthle cell carcinoma, also known as oxyphilic or oncocytic cell follicular thyroid carcinoma, have a poorer outcome. In this study, we systematically evaluated the clinical outcome in a large patient cohort following thyroidectomy and initial I-131 radioactive iodine therapy (RIT).Methods
We retrospectively evaluated a total of 378 patients with diagnosed oncocytic follicular Hürthle cell carcinoma (OFTC) (N = 126) or with classical follicular thyroid carcinoma (FTC) (N = 252). Patients received thyroidectomy and complementary I-131 RIT. Clinical data regarding basic demographic characteristics, tumor grade, persistent disease and recurrence during follow-up, and disease-free, disease-specific, and overall survival were collected during follow-up of 6.9 years (interquartile range 3.7; 11.7 years). Univariate and multivariate analyses were used to identify factors associated with disease-related and overall survival.ResultsBefore and after matching for risk factors, recurrence was significantly more frequently diagnosed in OFTC patients during follow-up (17% vs. 8%; p value 0.037). Likewise, OFTC patients presented with a reduced mean disease-free survival of 17.9 years (95% CI 16.0–19.8) vs. 20.1 years (95% CI 19.0–21.1) in FTC patients (p value 0.027). Multivariate analysis revealed OFTC (HR 0.502; 95% CI 0.309–0.816) as the only independent prognostic factor for disease-free survival. Distant metastases of OFTC patients were significantly less iodine-avid (p value 0.014). Mean disease-specific and overall survival did not differ significantly (p value 0.671 and 0.687) during follow-up of median 6.9 years (3.7; 11.7 years).Conclusions
Our study suggests that recurrence is more often seen in OFTC patients. OFTC patients have a poorer prognosis for disease-free survival. Thus, OFTC and FTC behave differently and should be categorized separately. However, patients suffering from OFTC present with the same overall and disease-specific survival at the end of follow-up indifferent to FTC patients after initial RIT.
Objective:
To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy.
Background:
Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US.
Methods:
The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content.
Results:
These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation.
Conclusions:
Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
Background:
This systematic review and meta-analysis collected data for evaluating the effect of surgical extent on overall survival (OS) and recurrence-free survival (RFS) in patients with papillary thyroid cancer (PTC).
Methods:
We searched the PubMed, Embase, and Cochrane Library databases. The included studies compared two groups of patients with PTC: the total thyroidectomy (TT) group and the lobectomy (LT) group. The combined hazard ratio (HR) was calculated.
Results:
Thirteen studies were included in the present study. The TT and LT groups had similar OS results (HR = 1.04; 95% CI: 0.90-1.21; P = .60). In the subgroup analysis, the combined HR of the ≤1 cm group and the 1.0 to 2.0 cm group showed that TT had no advantage with regard to OS compared to LT. In the 2.0 to 4.0 cm group, TT provided better OS than LT (HR = 0.88; 95% CI: 0.79-0.99; P = .03). Patients who underwent TT had a better RFS outcome than those who underwent LT (HR = 0.56; 95% CI: 0.41-0.77; P < .0001). In the subgroup analysis, both the ≤1 cm group and >1 cm group that underwent TT were associated with better RFS.
Conclusions:
Our meta-analysis suggested that LT increased the risk of recurrence in PTC patients with tumors ≤1.0 cm and in PTC patients with tumors >1.0 cm. More importantly, LT was associated with higher mortality in PTC patients with 2.0 to 4.0 cm tumors. Caution is warranted when LT is performed in this group of patients.
Background:
Preoperative differentiation of follicular thyroid carcinoma (FTC) from follicular adenoma (FA) remains an unsolved puzzle. Patients sometimes undergo unnecessary lobectomy for histology confirmation inevitably.
Objective:
In this retrospective study, we propose new gray-scale ultrasonographic (US) features that may help to differentiate FTC from FA.
Method:
Medical charts and US images of follicular thyroid neoplasms were collected prospectively. Gray-scale US features including conventional parameters adding tubercle-in-nodule and trabecular formation were recorded.
Results:
The histopathologic diagnosis was FA in 139 and FTC in 49 patients. In patients with FTC, minimally invasive follicular carcinoma (MIFC) was seen in 36 patients and widely invasive follicular carcinoma (WIFC) in 13. The incidences of calcifications (p < 0.0001), tubercle-in-nodule signs (p < 0.0001), spiculated margins (p = 0.014), and trabecular formations (p = 0.03) were significantly higher in FTC. Tubercle-in-nodule (p < 0.01) and calcification (p < 0.001) were independent factors in the differentiation of FTC in multivariate analysis (area under the curve = 0.689).
Conclusions:
US characteristics of tubercle-in-nodule in combination with calcification help to differentiate FTC from FA.
Objective:
Regional variation in thyroid cancer incidence in Belgium, most pronounced for low risk cancer, was previously shown to be related to variation in clinical practice, with higher thyroid surgery rates and lower proportions of preoperative fine-needle aspiration (FNA) in regions with high thyroid cancer incidence (period 2004-2006). The objective of this study was to investigate regional thyroid cancer incidence variation in relation with variation in thyroid surgery threshold in a more recent Belgian thyroid cancer cohort.
Methods:
A population-based cohort of thyroid cancer patients that underwent a (near) total thyroidectomy in the period 2009-2011 (n = 2,329 patients) was identified and studied by linking data from the Belgian cancer registry and the Belgian health insurance companies, and case-by-case study of the pathology protocols. The execution of preoperative FNA and the thyroid resection specimen weight were compared between high and low thyroid cancer incidence regions. Thyroid weight in the pT1a-restricted group was studied as a proxy for surgical threshold for benign nodular goiter. Furthermore, time trend analyses were performed for the execution of FNA for the period 2004-2012.
Results:
Although a lower proportion of FNA in the high thyroid cancer incidence region persisted in the period 2009-2011 (41.2% [31.9-50.9] vs. 72.9% [64.9-79.7] in the low-incidence region (LIR), p < 0.001), a positive time trend was observed for the period 2004-2012. The median thyroid surgical specimen weight was lower in the high incidence region compared to the LIR (27.0 g [IQR 18.0-45.3] vs. 36.0 g [IQR 22.0-73.0], p < 0.0001), and this finding was corroborated in the pT1a-restricted group.
Conclusion:
Interregional differences in use of FNA and surgical thyroid specimen weight are consistent with an inverse relation between thyroid cancer incidence and thyroid surgery threshold, carrying risk for overdiagnosis.
Objective:
It is well established that long-term hypothyroidism is associated with cognitive deficits. Based on recent literature, we hypothesized that pharmacologically induced euthyroidism would lead to improved cognitive performance compared to a hypothyroid state.
Methods:
We analyzed data from 14 nondepressed thyroidectomized female patients after differentiated thyroid carcinoma during hypothyroidism (due to a four-week withdrawal of thyroid hormone, T1) and euthyroidism brought about by substitution with L-thyroxine (T2). At both measurement points, patients completed a cognitive test battery as our dependent measure and Beck’s Depression Inventory to control depressive states.
Results:
A Wilcoxon signed-rank tests revealed a significant improvement in the Rey–Osterrieth complex figure test (cognitive reproduction), Z = −3.183, p = 0.001, and the D2 concentration score, Z = −1.992, p = 0.046 in euthyroidism compared to hypothyroidism.
Conclusions:
Our results confirm that hormone replacement therapy with L-thyroxine promotes cognitive reproduction and concentration in thyroidectomized female patients after differentiated thyroid carcinoma.
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