[Preoperative Evaluation of Cervical Lymph Node Metastasis in Patients With Hashimoto's Thyroiditis Combined With Thyroid Papillary Carcinoma Using Machine Learning and Radiomics-Based Features: A Preliminary Study]. / åŸºäºŽå½±åƒç»„å­¦å’Œä¸´åºŠç‰¹å¾çš„æœºå™¨å­¦ä¹ æœ¯å‰è¯„ä¼°æ¡¥æœ¬ç”²çŠ¶è ºç‚Žåˆå¹¶ç”²çŠ¶è ºä¹³å¤´çŠ¶ç™Œé¢ˆéƒ¨æ·‹å·´ç»“è½¬ç§»çš„åˆæ­¥ç ”ç©¶.

Objective: To analyze the radiomic and clinical features extracted from 2D ultrasound images of thyroid tumors in patients with Hashimoto's thyroiditis (HT) combined with papillary thyroid carcinoma (PTC) using machine learning (ML) models, and to explore the diagnostic performance of the method in making preoperative noninvasive identification of cervical lymph node metastasis (LNM). Methods: A total of 528 patients with HT combined with PTC were enrolled and divided into two groups based on their pathological results of the presence or absence of LNM. The groups were subsequently designated the With LNM Group and the Without LNM Group. Three ultrasound doctors independently delineated the regions of interest and extracted radiomic features. Two modes, radiomic features and radiomics-clinical features, were used to construct random forest (RF), support vector machine (SVM), LightGBM, K-nearest neighbor (KNN), and XGBoost models. The performance of these five ML models in the two modes was evaluated by the receiver operating characteristic (ROC) curves on the test dataset, and SHapley Additive exPlanations (SHAP) was used for model visualization. Results: All five ML models showed good performance, with area under the ROC curve (AUC) ranging from 0.798 to 0.921. LightGBM and XGBoost demonstrated the best performance, outperforming the other models (P<0.05). The ML models constructed with radiomics-clinical features performed better than those constructed using only radiomic features (P<0.05). The SHAP visualization of the best-performing models indicated that the anteroposterior diameter, superoinferior diameter, original_shape_VoxelVolume, age, wavelet-LHL_firstorder_10Percentile, and left-to-right diameter had the most significant effect on the LightGBM model. On the other hand, the superoinferior diameter, anteroposterior diameter, left-to-right diameter, original_shape_VoxelVolume, original_firstorder_InterquartileRange, and age had the most significant effect on the XGBoost model. Conclusion: ML models based on radiomics and clinical features can accurately evaluate the cervical lymph node status in patients with HT combined with PTC. Among the 5 ML models, LightGBM and XGBoost demonstrate the best evaluation performance.

Factors influencing TSH suppression efficacy in postoperative papillary thyroid carcinoma patients: a retrospective cohort study.

OBJECTIVES: While surgery plays a crucial role in treating papillary thyroid carcinoma (PTC), the potential effects of subsequent TSH suppression therapy on prognosis should not be overlooked. This study aims to investigate the factors that influence postoperative TSH suppression therapy in patients with PTC. METHODS: This study was a retrospective cohort study conducted at our hospital. It included 268 patients who underwent surgery and were pathologically diagnosed with PTC between February 2019 and February 2021. The selected patients received postoperative TSH suppression therapy. Based on the TSH level measured 12 months after surgery, the patients were divided into two groups: TSH level conforming group (n = 80) and non-conforming group (n = 188). We then compared the general clinical data, clinicopathological characteristics, preoperative laboratory test indicators, postoperative levothyroxine sodium tablet dosage, follow-up frequency, and thyroid function-related indicators between the two groups of patients. The correlation between the observed indicators and the success of TSH suppression therapy was further analyzed, leading to the identification of influencing factors for TSH suppression therapy. RESULTS: There were no statistically significant differences in general clinical data and clinicopathological characteristics between the two groups of patients (P > 0.05). The proportion of patients with preoperative TSH ≥ 2.0 mU/L was higher in the non-conforming group compared to the TSH level conforming group (P < 0.05), and the ROC curve analysis indicated that the area under the curve for the preoperative TSH index was 0.610 (P < 0.05). The proportion of patients in the TSH level conforming group who took oral levothyroxine sodium tablets at a dose of ≥ 1.4 µg/kg·d after surgery was higher (P < 0.05). The postoperative levels of FT3 and FT4 were higher in the TSH level conforming group (P < 0.05). The results of binary logistic regression analysis indicated that factors "Postoperative TSH level ≥ 2 mU/L", "Levothyroxine sodium tablet dose<1.4 µg/kg·d", and "Combined with Hashimoto thyroiditis" were significantly associated with an elevated risk of postoperative TSH levels failing to reach the target (P < 0.05). CONCLUSION: Optimal thyroid function in patients with PTC post-surgery is best achieved when adjusting the dose of levothyroxine sodium in a timely manner to reach the target TSH level during follow-up visits.

Thyroid papillary carcinoma combined with primary follicular lymphoma: a case report.

BACKGROUND: Papillary thyroid carcinoma (PTC) stands out as the most prevalent epithelial malignant thyroid tumor. Thyroid primary follicular lymphoma (PFL) represents a rare malignant tumor originating from mesenchymal tissues. The concurrent occurrence of PTC and PFL is exceptionally rare, particularly in the context of Hashimoto's thyroiditis, presenting significant challenges in clinical diagnosis and treatment. CASE DEMONSTRATION: A 44-year-old female patient presented with a neck mass persisting for over 1 month. The patient underwent surgery, and the incised tissues were subjected to pathology examinations, along with immunohistochemistry and next-generation sequencing tests suggestive of an EZH2 gene mutation in the tumor cells. The final pathological diagnosis confirmed the presence of PTC combined with PFL. Following a 27-month follow-up, the patient displayed no signs of recurrence or metastasis. CONCLUSIONS: The concurrent occurrence of PTC and PFL poses notable challenges in clinical practice, requiring careful consideration in diagnosis and treatment. Herein, we present a rare case of PTC combined with PFL featuring an EZH2 gene mutation, which can be easily overlooked in the context of Hashimoto's thyroiditis. The patient's favorable response to surgical and radiotherapeutic interventions underscores the importance of accurate diagnosis and tailored treatment strategies in similar cases.

Thyroid poorly differentiated carcinoma metastatic to pancreas diagnosed by fine-needle aspiration and demonstrating a novel BRAF fusion.

Differentiating pancreatic duct adenocarcinoma from metastasis can be challenging by morphology alone. Metastasis from a classic papillary thyroid carcinoma can present as a poorly differentiated carcinoma and mimic pancreatic ductal adenocarcinoma's morphology.

A pan-cancer analysis of the prognosis and immune infiltration of eEF1A2 and its potential function in thyroid carcinoma.

Purpose: Eukaryotic translation elongation factor 1α2 (eEF1A2) promotes tumour progression in various cancers. We performed a pan-cancer analysis of eEF1A2 and explored its role in thyroid carcinoma (THCA). Methods: Databases from The Cancer Genome Atlas (TCGA), the University of Alabama at Birmingham Cancer data analysis Portal (UALCAN), and the Human Protein Atlas (HPA) were used to investigate the differential expression of eEF1A2 in pan-cancer. The pathological stage, prognostic characteristics, tumour microenvironment (TME), tumour mutational burden (TMB), and microsatellite instability (MSI) were analysed in diverse tumours with different expression levels of eEF1A2. The expression levels in papillary thyroid carcinoma (PTC) and its specific role in cell proliferation, migration, invasion, and cell glycolysis in PTC cells were verified by quantitative real time polymerase chain reaction (qRT-PCR), immunohistochemistry, cell counting kit-8, colony formation, wound healing, Transwell assay, and lactate acid and glucose assays.Results:eEF1A2 was differentially expressed in various malignant tumour tissues compared to control tissues and was associated with poor pathological stage and prognosis in most types of tumours. Moreover, eEF1A2 expression closely correlated with the infiltration of immunosuppressive cells, TMB, and MSI in some tumour types. Expression of eEF1A2 in PTC is higher than the para-carcinoma, and eEF1A2 downregulation suppressed TPC-1 and BCPAP cell proliferation, migration, invasion, and glycolysis. Conclusion: Our study suggests that the expression of eEF1A2 is related to the prognosis and immune infiltration of some tumours and may be a predictor of prognosis and immunotherapy. eEF1A2 could promote malignant behaviour of PTC cells.

NMR-based metabolomics to select a surgical method for treating papillary thyroid carcinoma

OBJECTIVE: This study aims to investigate differences in the metabolomic profiles of patients who received different surgeries for papillary thyroid carcinoma (PTC). METHODS: Two surgical methods, i.e., unilateral and total thyroidectomy, were employed according to different disease conditions. Sera from patients who were treated with levothyroxine sodium tablets before and after surgery was analyzed with a Bruker 500 Hz nuclear magnetic resonance (NMR) spectrometer. Data were analyzed via principal component analysis (PCA) and partial least squares discriminate analysis (PLS-DA) with SIMCA-P+ 11.0 software, and metabolites were obtained and compared. The first and second principal components were selected from PCA, PLS-DA, and orthogonal partial least squares discriminate analysis (OPLS-DA). A p-value less than 0.05 was considered statistically significant. RESULTS: There were significant differences in serum metabolomics before and after surgery. Compared with unilateral thyroidectomy, total thyroidectomy reversed some highly increased metabolite levels (e.g., taurine and betaine). More significant variations in abnormal metabolites were noted after total thyroidectomy than after unilateral thyroidectomy (e.g., alanine, choline, hippurate, and formic acid). CONCLUSIONS: The choice of surgical method for PTC patients should be based not only on the tumor condition but also on the potential consequences of metabolic variations. Total thyroidectomy reversed some increased metabolite levels but led to accumulation of some other metabolites due to the loss of thyroid function; thus, metabolic disturbances caused by thyroid hormone deficiency should be prevented in advance.

Angiosarcoma primario de mama y carcinoma papilar de tiroides sincrónico: presentación de un caso / Primary angiosarcoma of breast and synchronous thyroid papillary carcinoma: a case report

Antecedentes: El angiosarcoma primario de mama constituye un tumor infrecuente que se desarrolla de forma predominante en mujeres en la tercera y cuarta décadas de la vida. Los nódulos tiroideos incidentales son aquellos que se objetivan en pruebas de imagen realizadas por otra causa y se observan en menos de un 10 por ciento con la tomografía por emisión de positrones (PET). Objetivo: Presentar el caso excepcional de una paciente con angiosarcoma primario de mama y un carcinoma papilar de tiroides sincrónicos. Caso clínico: Mujer de 34 años con angiosarcoma primario en la mama derecha sometida a mastectomía simple. En el estudio de extensión se halló un incidentaloma tiroideo derecho compatible con carcinoma papilar que requirió tiroidectomía total y linfadenectomía del compartimento central cervical en un segundo tiempo. Comentarlo: Los angiosarcomas primarios suponen menos del 0,05 por ciento de todos los tumores primarios malignos de la mama. El diagnóstico definitivo de estos tumores viene definido por el estudio anatomopatológico, que establece tres grados: alto, bajo e intermedio, los cuales se relacionan de forma directa con la supervivencia. La prevalencia de los incidentalomas malignos tiroideos objetivados por PET varía del 14-30,9 por ciento, según diferentes estudios. La planificación del tratamiento quirúrgico de las neoplasias incidentales tiroideas en pacientes con otro tumor primario debe analizarse de forma individualizada, según la supervivencia esperada del tumor primario.

Background: The primary angiosarcoma of breast is a rare tumor that develops predominantly in women in the third and fourth decades of life. Incidental thyroid nodules are observed in imaging tests performed for other reasons and it's observed in less than 10 percent with the positron emission tomography (PET). Aims: To report the exceptional case of a patient with primary angiosarcoma of the breast and synchronous thyroid papillary carcinoma. Clinical case: Female patient 34 year old with primary angiosarcoma in the right breast, submitted to a simple mastectomy. In the extension study we found an incidental thyroid papillary carcinoma that required a total thyroidectomy and central cervical lymphadenectomy in a second time. Comments: The primary angiosarcoma are less than 0.05 percent of all primary malignant tumors of the breast. The definitive diagnosis is determined by the pathology, which defines three grades: high, low and intermediate, which relate directly to survival. Prevalence of malignant thyroid incidentalomas observed by PET varies from 14 to 30.9 percent, according different studies. Planning the surgical treatment of incidental thyroid malignancies in patients with other primary tumor should be analyzed individually, according the expected survival of the primary tumor.

Factores pronosticos de recurrencia y muerte en 202 pacientes seleccionados con carcinoma papilar de tiroides / Recurrence and death prognostic factors among 202 selected patients with thyroid papillary carcinoma

Introducción: el carcinoma papilar de tiroides (CPT) es una enfermedad indolente y de buen pronóstico; sin embargo, algunos pacientes recidivan y otros fallecen a causa del CPT. Objetivo: identificar factores de riesgo de recurrencia y muerte a causa del CPT en pacientes con un tratamiento homogéneo. Método: Lugar de aplicación: Centro de Tiroides Dr. José Luis Novelli, Rosario, Argentina. Diseño: estudio analítico de cohorte. Población: Pacientes con diagnóstico de CPT tratados en forma inicial con tiroidectomía total con criterio curativo. No cirugías previas. No metástasis a distancia al momento de la consulta. Seguimiento mínimo: 5 años. N = 202 CPT. Análisis de regresión de riesgos proporcionales de Cox. Factores de riesgo evaluados: edad (< y 45 años), sexo, tamaño tumoral (20, 20-40 y >40mm), multifocalidad, invasión capsular y compromiso ganglionar (ganglios negativos (-), ganglios positivos (+) en compartimiento central y/o laterales). Medidas de evaluación: Recurrencia y muerte a causa del CPT, sobrevida libre de enfermedad y sobrevida total. Resultados: del análisis multivariado, los factores de riesgo de recurrencia del CPT fueron: edad y el compromiso ganglionar. Los factores de riesgo de muerte por CPT fueron: el tamaño tumoral y la edad (débilmente asociada). Conclusiones: la edad adulta así como las metástasis ganglionares condicionan significativamente la aparición de recurrencias. El tamaño tumoral condiciona la muerte por CPT; la edad adulta la afecta débilmente.

Introduction: the thyroid papillary carcinoma (TPC) is an indolent illness and has well prognosis. However, some patients have recurrences and others die due to TPC. Objective: to identify risk factors of recurrence and death due to TPC in patients with an homogeneous treatment. Patients and methods: Setting. Centro de Tiroides Dr. José Luis Novelli, Rosario, Argentina. Design: analytical cohort design. Population: patients with TPC diagnosis treated initially with total thyroidectomy with curative criteria. No previous surgeries. No distant metastases at diagnosis. Minimal follow-up: 5 years. N = 202 TPC. Cox proportional hazards regression model. Risk factors evaluated: age (< y 45 years), gender, tumor size (20, 20-40 y >40 mm), multifocality, extrathyroidal extension and lymph node involvement - negative nodes, (+) central compartment, (+) lateral compartiment. Outcome measures: recurrence of TPC, death due to TPC, free disease survival, total survival. Results: from the multivariate analysis, the recurrence risk factors were age and lymph node involvement. Death risk factors were: tumor size and age (weakly associated). Conclusions: adult age and node metastasis have a significant effect on TPC recurrences. The tumor size has significant influence on TPC death; adult age weakly affect it.