Impact of periodic neck ultrasonography on locoregional disease control in surveillance after total thyroidectomy for patients with low- and intermediate-risk papillary thyroid carcinoma: a propensity score-matched study.

This study aimed to evaluate the impact of periodic neck ultrasonography (US) on postoperative surveillance for locoregional disease control of patients with low- and intermediate-risk papillary thyroid carcinoma (PTC) who underwent total thyroidectomy. This retrospective cohort study included patients with PTC who underwent total thyroidectomy and central neck dissection at our institution between January, 2000 and December, 2016. The patients were divided into two groups: the physical examination (PE) group (follow-up by PE without periodic US) and the US group (follow-up by PE with periodic US). Serum thyroglobulin levels were measured periodically in both groups. Propensity score matching was used to rigorously balance the significant variables and assess the 10-year postoperative outcomes between the groups. Of the 189 patients, 150 were included after matching (75 in each group). There were no significant differences between the two groups in terms of background characteristics. The median follow-up period was 127.9 months. There was no significant difference in locoregional relapse-free survival between the PE and US groups (97.0 vs. 98.7%, p = 0.541). The overall survival was 96.7% and 98.7% in the PE and US groups, respectively, with no significant difference (p = 0.364). This study demonstrated that the addition of periodic US to PE for postoperative surveillance of patients with low- and intermediate-risk PTC who underwent total thyroidectomy did not significantly affect locoregional control.

Cytologic and Clinicopathologic Features of Papillary Thyroid Carcinoma with Prominent Hobnail Features on FNAC.

The hobnail variation of papillary thyroid cancer (PTC) is an uncommon, aggressive variety with hobnail characteristics on more than 30% of the tumour cells. Because of the entity's rarity, the clinical behaviour and pathologic characteristics of these tumours are still unknown. The purpose of this case study was to look at the cytologic, clinical, and pathological aspects of the hobnail variant of PTC, because of its severe clinicopathologic features and poor outcome, the unusual hobnail type of PTC may necessitate more aggressive treatment than traditional PTCs. The cytologic features of the hobnail variety are distinctive, and FNAC specimens can be used to provide a preoperative diagnosis. Diagnostic parameters for proportion of hobnail morphology need to be refined further. More research is needed to understand how detection of this high-risk variation affects clinical treatment.

Differentiated Thyroid Cancers with Synchronous Second Primary Cancers: Case Series.

The incidence of synchronous second primary cancer (SSPC) with DIfferentiated Thyroid Cancers (DTC) is a very rare entity. Very few case reports and case series were published in the literature. To enumerate the clinicopathological data of patients with DTC with SSPC. This is a single-center retrospective study. All the patients diagnosed with DTC and SSPC from January 2016 to July 2023 were included in the study. The demographic, clinicopathological data, and survival data were collected from the institute's database. Twelve patients were found to have DTC with SSPC. All the patients had papillary thyroid cancer. Ten patients had head and neck squamous cell carcinoma, one patient had malignant phyllodes tumor, and another patient had endometrioid adenocarcinoma as the SSPC. Six patients were diagnosed during preoperative evaluation, one patient was diagnosed 3 months after the oral malignancy diagnosis, and five patients were diagnosed with PTC in cervical nodes after neck dissection. Complete thyroid removal was done in six patients and hemithyroidectomy in two patients. The median follow-up was 25.55 months. The median overall survival was 40.97 months. Head and neck SCC is the most common SSPC with DTC. Since these are rare scenarios multi-disciplinary panel discussion can help in deciding management.

The functional DIAPH3-FOXM1 interaction modulates the aggressive transformation of anaplastic thyroid carcinoma cells and Wnt/ß-catenin signalling.

Anaplastic thyroid carcinoma (ATC) is reckoned as an infrequent but extremely advanced neoplasm of the endocrine system. Diaphanous-related formin 3 (DIAPH3) has been extensively implicated in carcinogenic events, but it has not been introduced in ATC. Herein, the role of DAPIH3 and the interrelated functional mechanism are characterised in ATC. The Gene Expression Omnibus (GEO) database was checked for differential DIAPH3 expression in ATC samples and noncancerous samples. Western blotting examined DIAPH3 and forkhead box M1 (FOXM1) expression in ATC cells. In vitro cell counting kit 8 (CCK-8) method, 5-ethynyl-2'-deoxyuridine (EdU) incorporation, Scratch, Matrigel invasion, and terminal-deoxynucleotidyl transferase mediated nick end labelling (TUNEL) assays were used to assess the potential of cells to proliferate, migrate, and invade as well as the cellular apoptotic rate. Co-IP was applied to access DIAPH3-FOXM1 protein interaction. Western blotting also disclosed the expression of proteins associated with apoptosis and Wnt/ß-catenin signalling. DIAPH3 was hyper-expressed in papillary cell carcinoma (PTC) tissues and cells. Depleting DIAPH3 strongly eliminated the proliferative, migratory, as well as invasive capabilities of PTC cells while intensifying the apoptotic ability. FOXM1 also harboured elevated expression in PTC cells. FOXM1 was the binding partner with DIAPH3, and the 2 were positively correlated. FOXM1 upregulation again exacerbated the potentials to proliferate, migrate, and invade but it repressed the apoptotic rate of DIAPH3-depleted cells. Furthermore, loss of DIAPH3 downregulated FOXM1 to block Wnt/b-catenin signalling in PTC cells. Combined with these findings, DIAPH3 might favour the aggressive advancement of ATC and motivate the Wnt/ß-catenin signalling via binding with FOXM1.

Application of modified spiral tracheoplasty in thyroid carcinoma with trachea invasion: a retrospective analysis of 15 cases.

BACKGROUND: To describe the indications, techniques and preliminary experience of modified spiral tracheoplasty in the reconstruction of large tracheal defect after thyroidectomy. METHODS: The medical records of patients who underwent tracheal torsion to repair large tracheal defects after thyroid carcinoma surgery from January 2019 to January 2022 were retrospectively reviewed. The extent of tracheal defect, duration of tracheal reconstruction, postoperative complications and surgery results were analyzed. RESULTS: The duration of tracheal reconstruction was 30-60 min. No postoperative bleeding, incision infection, tracheostomy stenosis occurred. Recurrent laryngeal nerve palsy occurred in 5 patients. All patients were followed up for 24 to 60 months. The 2-year overall survival rate was 100%, the 2-year local control rate of trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. CONCLUSION: The modified spiral tracheoplasty is a safe and effective method to repair the large defect of trachea after thyroid carcinoma invading the trachea.

RARE ASSOCIATION BETWEEN HASHITOXICOSIS, BASEDOW DISEASE AND PAPILLARY THYROID CARCINOMA.

We present the case of a 32 yeas old male, diagnosed 7 years ago with Graves disease, with numerous recidives which needed anti-thyroid medication, with poor response (hypo to hyper-thyroid status, with high variations of TSH and FT4) whom after a period of remission (8 months, no treatment) came in for a polymorphic symptomatology sugestive for hyperthyroidism. The hyperthyroid state was confirmed he had high TRAb (31 UI/ml vs. <1.75 UI/ml) - on his last check in the detection rate of TRAb was under 0.3 UI/ml. The thyroid ultrasound revels on the left lobe a small mass of 0.8/0.8 cm, with EU-TIRADS score of 4, that was newly diagnosed. Postoperative histopathology revealed papillary microcarcinoma developed on Hashitoxicosis- pT1aN0, of 1 mm in the middle of left thyroid lobe. The particularity of this case consists in a long evolution of Graves disease with numerous relapses, the appearance of a thyroid nodule after 7 years in which they identified a papillary microcacinoma associated with Hashimoto thyroiditis and also the postoperative recovery that was slowed by the parathyreoprive tetany.

UTILITY OF THE 2023 BETHESDA SYSTEM AUS SUBCATEGORIZATION ON THYROID ASPIRATES.

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) is widely used for the standardized reporting of thyroid fine-needle aspiration (FNA) cytology. The 2023 revision of TBSRTC introduced specific subcategories for the classification of atypia of undetermined significance (AUS). This study tests the association between AUS subtypes and malignant diagnoses, namely AUS-nuclear atypia and AUS-other, in archived thyroid - FNA specimens with atypia from 2018-2022 at King Abdulaziz University Hospital. A total of 104 thyroid - FNA specimens with AUS were re-evaluated cytologically and correlated with subsequent surgical outcomes, along with a discussion of discrepant cases.

A comprehensive prediction model for central lymph node metastasis in papillary thyroid carcinoma with Hashimoto's thyroiditis: BRAF may not be a valuable predictor.

Purpose: Papillary thyroid carcinoma (PTC) frequently coexists with Hashimoto's thyroiditis (HT), which poses challenges in detecting central lymph node metastasis (CLNM) and determining optimal surgical management. Our study aimed to identify the independent predictors for CLNM in PTC patients with HT and develop a comprehensive prediction model for individualized clinical decision-making. Patients and methods: In this retrospective study, a total of 242 consecutive PTC patients who underwent thyroid surgery and central lymph node dissection between February 2019 and December 2021 were included. 129 patients with HT were enrolled as the case group and 113 patients without HT as control. The results of patients' general information, laboratory examination, ultrasound features, pathological evaluation, and BRAF mutation were collected. Multivariate logistic regression analysis was used to identify independent predictors, and the prediction model and nomogram were developed for PTC patients with HT. The performance of the model was assessed using the receiver operating characteristic curve, calibration curve, decision curve analysis, and clinical impact curve. In addition, the impact of the factor BRAF mutation was further evaluated. Results: Multivariate analysis revealed that gender (OR = 8.341, P = 0.013, 95% CI: 1.572, 44.266), maximum diameter (OR = 0.316, P = 0.029, 95% CI: 0.113, 0.888), multifocality (OR = 3.238, P = 0.010, 95% CI: 1.319, 7.948), margin (OR = 2.750, P = 0.046, 95% CI: 1.020, 7.416), and thyrotropin receptor antibody (TR-Ab) (OR = 0.054, P = 0.003, 95% CI: 0.008, 0.374) were identified as independent predictors for CLNM in PTC patients with HT. The area under the curve of the model was 0.82, with accuracy, sensitivity, and specificity of 77.5%, 80.3% and 75.0%, respectively. Meanwhile, the model showed satisfactory performance in the internal validation. Moreover, the results revealed that BRAF mutation cannot further improve the efficacy of the prediction model. Conclusion: Male, maximum diameter > 10mm, multifocal tumors, irregular margin, and lower TR-Ab level have significant predictive value for CLNM in PTC patients with HT. Meanwhile, BRAF mutation may not have a valuable predictive role for CLNM in these cases. The nomogram constructed offers a convenient and valuable tool for clinicians to determine surgical decision and prognostication for patients.

Thyroid cancer epidemiology in Ireland from 1994 to 2019 - Rising diagnoses without mortality benefit.

BACKGROUND: The epidemiology and management of thyroid cancer has changed radically in the recent past, with rising international incidence of early-stage papillary thyroid cancer (PTC) in particular. In this paper, we review the epidemiology of thyroid cancer in Ireland. METHODS: A retrospective cohort study of National Cancer Registry of Ireland data, 1994-2019. RESULTS: Records from 4158 patients were analysed. 73 % (n = 3040) were female. The average age was 50.4 years. Patient sex did not change over time (p = 0.662), while age decreased significantly (p < 0.0001). The most common diagnoses were PTC (n = 2,905, 70 %) and follicular thyroid carcinoma (n = 549, 13 %). Incidence rose over threefold (1.8-6.2 cases/100000 person-years). The incidence of T1 PTC rose over twelvefold (0.169-2.1 cases/100000 person-years), while the incidence of stage III and IV disease did not change significantly. Five-year disease-specific survival (DSS) was 85 % and varied significantly by diagnosis - 97 % for PTC versus 5 % for anaplastic thyroid carcinoma. Survival did not change significantly over time. Male sex was a risk factor for more advanced disease (p < 0.0001) but did not independently predict overall survival except in PTC (HR 1.6, p = 0.03). The use of radioactive iodine declined markedly from 49 % to 12.5 %. RAI improved DSS for PTC patients aged over 55 years (p = 0.02) without a notable effect on survival for those under 55 years (p = 0.99). CONCLUSION: The epidemiology and management of thyroid cancer in Ireland has changed dramatically in a manner reflective of international trends.

Management of Incidental Thyroid Nodules in the Pretransplant Population.

INTRODUCTION: The incidence of thyroid nodules has increased as diagnostic imaging has become more prevalent, but the management in transplant candidates, a high-risk population because of the need for chronic immunosuppression, has not been described. We sought to review our institution's approach to thyroid nodules incidentally found during pretransplant workup. METHODS: A multisite retrospective review was performed of pretransplant patients with incidental thyroid nodules diagnosed between 2011 and 2021. Demographics, nodule characteristics, treatment timeline, and oncologic outcomes were collected. Patients diagnosed before and after 2017 were compared to evaluate how adoption of Thyroid Imaging Reporting and Data System and expansion of a dedicated transplant center were correlated with changes in patient management. RESULTS: A total of 10,340 patients underwent abdominal transplant, 236 had incidental thyroid nodules. After 2017, radiology recommendations for biopsy decreased from 39% to 29% (P = 0.174) and fewer biopsies were performed, 45%-33% (P = 0.055). Time between imaging and biopsy was significantly shorter after 2017, from 14 mo to 4 (P = 0.038). Overall time from imaging to transplant was also significantly reduced, from 31 mo to 11 (P < 0.001). Thirty-one (13.1%) patients underwent thyroid surgery before transplant and four (1.7%) patients after. CONCLUSIONS: In the recent years, thyroid biopsy rates for thyroid incidentalomas found during pretransplant workup have decreased and more closely match imaging-based guideline recommendations. Patients who required biopsy obtained them sooner and underwent transplant surgery sooner. Guideline-driven thyroid incidentaloma workup for the pretransplant population allows for timely and appropriate cancer care while avoiding unnecessary delays in transplant.

Machine learning-based diagnostics of capsular invasion in thyroid nodules with wide-field second harmonic generation microscopy.

Papillary thyroid carcinoma (PTC) is one of the most common, well-differentiated carcinomas of the thyroid gland. PTC nodules are often surrounded by a collagen capsule that prevents the spread of cancer cells. However, as the malignant tumor progresses, the integrity of this protective barrier is compromised, and cancer cells invade the surroundings. The detection of capsular invasion is, therefore, crucial for the diagnosis and the choice of treatment and the development of new approaches aimed at the increase of diagnostic performance are of great importance. In the present study, we exploited the wide-field second harmonic generation (SHG) microscopy in combination with texture analysis and unsupervised machine learning (ML) to explore the possibility of quantitative characterization of collagen structure in the capsule and designation of different capsule areas as either intact, disrupted by invasion, or apt to invasion. Two-step k-means clustering showed that the collagen capsules in all analyzed tissue sections were highly heterogeneous and exhibited distinct segments described by characteristic ML parameter sets. The latter allowed a structural interpretation of the collagen fibers at the sites of overt invasion as fragmented and curled fibers with rarely formed distributed networks. Clustering analysis also distinguished areas in the PTC capsule that were not categorized as invasion sites by the initial histopathological analysis but could be recognized as prospective micro-invasions after additional inspection. The characteristic features of suspicious and invasive sites identified by the proposed unsupervised ML approach can become a reliable complement to existing methods for diagnosing encapsulated PTC, increase the reliability of diagnosis, simplify decision making, and prevent human-related diagnostic errors. In addition, the proposed automated ML-based selection of collagen capsule images and exclusion of non-informative regions can greatly accelerate and simplify the development of reliable methods for fully automated ML diagnosis that can be integrated into clinical practice.

Anaplastic transformation of metastatic papillary thyroid carcinoma lesion histologically mimicking a squamous cell carcinoma: A case report.

INTRODUCTION: The incidence of anaplastic transformation of thyroid cancer from Papillary Thyroid Carcinoma (PTC) is a rare tumor event, which ranges from 1 to 2 % of all cases of thyroid malignancy. Anaplastic transformation is often reported in primary lesions, but is rarely found in metastatic lesions from Differentiated Thyroid Carcinoma (DTC). PRESENTATION OF CASE: This case report reports a unique tumor process where a 70-year-old woman had a metastatic lesion in the Mandible from PTC which transformed into ATC with histological features resembling squamous cell carcinoma-type. Immunohistochemical examination was able to prove that the lesion in the Mandible is a type of undifferentiated Thyroid carcinoma (anaplastic) with a squamous pattern originating from PTC. DISCUSSION: This type of tumor with histological variant images that resemble other types of tumors is a challenge for diagnosis and appropriate management, so understanding the variants of this type of ATC is important for better management. CONCLUSION: Although rare, anaplastic transformation can occur in metastatic sites of PTC. This necessitates the need for early accurate diagnosis through IHC assessment and somatic mutation testing so that appropriate treatment can be delivered.

Non-secretory medullary thyroid carcinoma with laryngotracheal invasion: a case report and review of the literature.

Background: Medullary thyroid carcinoma (MTC) is a rare and aggressive type of thyroid cancer. Patients with this condition typically manifest palpable neck swelling and compressive symptoms. Biochemical evaluation and neck ultrasound play vital roles in diagnosis. The management options differ based on the extent of the disease. Case Description: This paper describes a 47-year-old male patient diagnosed with MTC invading the trachea and larynx. He presented with a 5 cm × 5 cm hard thyromegaly on the right side with right-sided level IV lymphadenopathy, measuring approximately 2 cm. He underwent total thyroidectomy, total laryngectomy, and bilateral neck dissection. Postoperatively, the patient developed a neck abscess and pharyngocutaneous fistula (PCF), which was managed surgically and had a satisfactory outcome. After 128 days of inpatient care, he was discharged in a stable condition with resolution of complications and had no evidence of local recurrence during the 6-month follow-up. Conclusions: MTC is a rare type of thyroid neoplasia that can manifest with various symptoms resulting from either the primary lesion or secondary invasion. Surgery remains the mainstay of treatment, however, there are limited options and no approved adjuvant therapies for patients with disseminated MTC. Complications that arise after total thyroidectomy and laryngectomy can be noteworthy and demand careful surveillance and immediate treatment to prevent further deterioration.

Hyperthyroidism in thyroid carcinoma originating in struma ovarii.

Summary: Thyroid carcinoma originating in Struma Ovarii (SO) is a rare thyroid ectopic cancer that accounts for 0.01% of all ovarian malignancies and is associated with hyperthyroidism in less than 15% of cases. In a 44-year-old patient with pelvic pain, the CT scan revealed a solid-cystic formation in the ovarium. A left oophorectomy was performed and showed a borderline serous tumor and papillary thyroid carcinoma ('thyroid carcinoma originating in Struma Ovarii') measuring 10 cm. Thyroid function was assessed, and hyperthyroidism was diagnosed. Surgical complementation and a pelvic re-approach were performed. The histological findings showed a papillary thyroid carcinoma in the uterine serosa and the right adnexa. Thyroid function was re-evaluated, and despite normal thyroid function, the TRAb test remained positive. The patient underwent total thyroidectomy and radioiodine therapy (RIT), after which the TRAb test became negative. During 3 years of follow-up, no evidence of tumor was observed. In our case of thyroid carcinoma originating in SO, hyperthyroidism was treated with ovarian surgery, total thyroidectomy, and RIT. It is worth noting that thyroid function was normalized after ovarian surgery, but the TRAb test only became negative after total thyroidectomy. We hope to draw attention to the importance of evaluating thyroid function in patients with SO and treating high-risk SO patients with RIT after total thyroidectomy to achieve disease remission. Learning points: Struma ovarii can cause hyperthyroidism. Thyroid carcinoma can originate in Struma Ovarii. Differentiated thyroid carcinoma and hyperthyroidism originating in Struma Ovarii are rare conditions.

Combination kinase inhibitors and immunotherapy for unresectable anaplastic thyroid carcinoma: A retrospective single-center study.

INTRODUCTION: Anaplastic thyroid carcinoma (ATC) is rare but has a very poor prognosis. New therapeutic options such as multikinase inhibitors and selective tyrosine kinase inhibitors have revolutionized the treatment of ATC, with immunotherapy also showing encouraging effects. This study evaluated the efficacy and safety of kinase inhibitors combined with an anti-PD-1 inhibitor as first-line treatment, as well as in the neoadjuvant setting for patients with unresectable ATC. MATERIALS & METHODS: This retrospective single-center study recruited consecutive patients with stage IVB and IVC ATC who received first-line kinase inhibitors plus immunotherapy between June 2021 and June 2023. The patients were treated with either selective or multi-kinase inhibitors (dabrafenib/trametinib, lenvatinib, or anlotinib) in combination with one immune checkpoint inhibitor (pembrolizumab, sintilimab, or camrelizumab). The endpoints included overall survival (OS), progression-free survival (PFS), response evaluation, and feasibility of R0/R1 resection. RESULTS: Eighteen patients were included in this analysis. The median OS (mOS) was 14.0 months and the 12-month survival rate was 55.6 %. The mOS in BRAF V600E mutated ATC was not reached, significantly longer than non-BRAF V600E mutated ATC (4.0 months [95 %CI, 1.1-6.9], p = 0.049). Among evaluable patients, 5 achieved a complete response (CR) and 6 patients achieved partial response (PR). The best ORR was 61.1 %. Surgical resection was feasible in 7/18 (38.9 %) patients. One grade 5 adverse event (AE) occurred. Most AEs were well tolerated. CONCLUSIONS: Combination kinase inhibitors with immunotherapy as first-line therapy are safe and effective for the treatment of unresectable ATC, especially with BRAF V600E mutation.

Catching the Silent Culprits: TERT Promoter Mutation Screening of Minimally Invasive Follicular and Oncocytic Thyroid Carcinoma in Clinical Practice.

De-escalation of thyroid cancer treatment is crucial to prevent overtreatment of indolent disease, but it remains important to identify clinically aggressive cases. TERT promoter mutations are molecular events frequently associated with high-risk thyroid tumors with poor outcomes and may identify cases at risk of dissemination. In various international guidelines, small minimally invasive follicular thyroid carcinoma and oncocytic thyroid carcinoma (miFTC/miOTC) are classified as low-risk lesions and are not recommended adjuvant treatment. Our study aimed to explore the association between size-based risk assessment and TERT promoter mutations. Between 2019 and May 2024, 84 miFTCs/miOTCs diagnosed at our department underwent digital droplet PCR analysis targeting TERT promoter mutational hotspots C228T and C250T in clinical routine. TERT promoter mutations were found in 10 out of 84 cases (11.9%). Mutated cases were pT1 (n = 1), pT2 (n = 3), or pT3 (n = 6). Patients with mutated tumors were older compared to patients with wild-type tumors (median age of 71 years vs. 57 years, p = 0.041). There were no significant differences regarding patient sex, tumor size, Ki-67 labeling index, or the presence of distant metastases. Notably, 30% of mutations displayed variant allele frequencies < 10%, possibly suggesting subclonal events. To conclude, TERT promoter mutations in miFTCs and miOTCs were associated with higher patient age and were often suspected to be subclonal. However, they did not affect clinical outcomes, possibly due to short follow-up. Reflex testing for this genetic alteration in miFTCs and miOTCs could be justified regardless of tumor size, though the clinical benefit remains uncertain.

Identification of potential biomarkers of papillary thyroid carcinoma.

Papillary thyroid cancer (PTC) is the predominant form of malignant tumor affecting the thyroid gland. AIM: This study aimed to identify candidate biomarkers for papillary thyroid carcinoma using an integrative analysis of bioinformatics and machine learning (ML). MATERIAL AND METHOD: The PTC datasets GSE6004, GSE3467, and GSE33630 (species: Homo sapiens) were downloaded from NCBI and analyzed using the limma package to obtain DEGs. Once DEGs were identified, GO and KEGG enrichment analyses were performed as the first step in the bioinformatics process. Subsequently, a protein-protein interaction (PPI) network was constructed according to the common genes in bioinformatics and machine learning using STRING to elucidate the important genes involved in PTC pathogenesis. In machine learning, finding genes entails feature selection to identify the key genes that distinguish biological states. Hybrid feature selection will be used for this. In the second step, the original data sets were preprocessed to detect and correct missing and noisy data; after that, all data were merged. Following performing Linear and Discriminative Hybrid Feature Selection (LDHFS) on the processed dataset, machine learning algorithms such as Random Forest (RF), Naive Bayes (NB), and Support Vector Machines (SVM) are utilized. RESULTS: Bioinformatics and machine learning analyses indicate that the genes RXRG, CDH2, ETV5, QPCT, LRP4, FN1, and LPAR5 are integral to the progression of thyroid cancer. This study attained the highest accuracy utilizing the RF algorithm, achieving an accuracy rate of 94.62%, a Kappa value of 91.36%, and an AUC value of 96.13%. These results offer additional evidence and confirmation for the genetic alterations of these genes. These findings may accelerate the development of prospective therapeutic and diagnostic methods in future research. CONCLUSIONS: Bioinformatics and machine learning techniques identified the common genes "RXRG, CDH2, ETV5, QPCT, LRP4, FN1, and LPAR5" as PTC biomarkers, providing novel reference markers for the diagnosis and treatment of PTC patients. The model is anticipated to possess significant predictive value and assist in the early diagnosis and screening of clinical PTC. These insights enhance the field of PTC management and offer guidance for future research.

The Clinical Application of Superb Microvascular Imaging in Evaluating Thyroid Related Diseases: A Systematic Review.

This article reviews all published articles on the application of superb microvascular imaging (SMI) technique in thyroid related diseases before December 31, 2023. SMI, a recently developed ultrasound imaging modality, could display microvascular information by eliminating clutter and preserving low flow signals. Most studies used SMI to help diagnose malignant thyroid nodules and concluded that SMI performed better than color Doppler imaging and power Doppler imaging. At present, there is no consensus when depicting the morphology of vascularity of thyroid nodules (TNs). This problem may be solved by quantitative SMI which makes it possible to quantitatively evaluate the vascularity of TNs. SMI is also applied to evaluate cervical lymph node or thyroid inflammatory diseases. Although, SMI has some limitations, such as no standard for the normal perfusion patterns, and it has a broad application prospect in the diagnosis and management of thyroid related diseases.

Intranodal lymphangiography combined with foam sclerotherapy embolization of thoracic duct in the treatment of postoperative chylous leakage for thyroid carcinoma: a case report and review.

Background: Chylous leakage (CL) is a rare but significant complication following cervical lymph node dissection, particularly in patients with papillary thyroid carcinoma (PTC). This condition is characterized by the leakage of lymphatic fluid, which can result in severe consequences such as malnutrition, immunosuppression, and prolonged hospital stays. Conventional treatments for CL include conservative measures and surgical interventions, but these approaches often face limitations and challenges. This case report discusses a successful treatment of CL using thoracic duct lymphangiography combined with local injection of sclerotherapy, demonstrating a novel and effective approach for managing this complication. Case presentation: A 72-year-old female patient with PTC underwent total thyroidectomy and bilateral Level VI and left Levels II, III, IV, and V cervical lymph node dissection. Postoperatively, the patient developed milky drainage indicative of CL. Despite initial conservative treatments including pressure bandaging, negative pressure drainage, and nutritional adjustments, the patient's condition did not improve. The patient declined surgical options, leading to the decision to perform thoracic duct lymphangiography combined with local injection of sclerotherapy. Under real-time ultrasound guidance, the inguinal lymph nodes were accessed, and lipiodol was injected to visualize the thoracic duct. Subsequently, foam sclerosant was injected at the leakage site under fluoroscopic guidance. The procedure resulted in a significant reduction of chyle leakage, and the patient was discharged with no recurrence during a 1-year follow-up. Conclusions: This case illustrates that thoracic duct angiography combined with local injection of sclerotherapy can be an effective treatment for high-output CL when conservative measures fail and surgical intervention is not preferred. The approach offers a minimally invasive alternative that can reduce complications and improve patient outcomes. The successful management of CL in this case underscores the potential of advanced interventional techniques in treating lymphatic system complications and highlights the need for further research to establish standardized treatment protocols.

Rethinking the prognosis model of differentiated thyroid carcinoma.

Background: The prediction efficiency of long-term cancer-specific survival (CSS) in guiding the treatment of differentiated thyroid carcinoma (DTC) patients is still unsatisfactory. We need to refine the system so that it more accurately correlates with survival. Methods: This is a retrospective study using the Surveillance, Epidemiology, and End Results (SEER) database, and included patients who underwent surgical treatment and were diagnosed with DTC from 2004 to 2020. Patients were divided into a training cohort (2004-2015) and validation cohort (2016-2020). Decision tree methodology was used to build the model in the training cohort. The newly identified groups were verified in the validation cohort. Results: DTC patient totals of 52,917 and 48,896 were included in the training and validation cohorts, respectively. Decision tree classification of DTC patients consisted of five categorical variables, which in order of importance were as follows: M categories, age, extrathyroidal extension, tumor size, and N categories. Then, we identified five TNM groups with similar within-group CSS. More patients were classified as stage I, and the number of stage IV patients decreased significantly. The new system had a higher proportion of variance explained (PVE) (5.04%) and lower Akaike information criterion (AIC) (18,331.906) than the 8th TNM staging system (a PVE of 4.11% and AIC of 18,692.282). In the validation cohort, the new system also showed better discrimination for survival. Conclusion: The new system for DTC appeared to be more accurate in distinguishing stages according to the risk of mortality and provided more accurate risk stratifications and potential treatment selections.