Metabolic Profiles and Blood Biomarkers to Discriminate between Benign Thyroid Nodules and Papillary Carcinoma, Based on UHPLC-QTOF-ESI+-MS Analysis.

In this study, serum metabolic profiling of patients diagnosed with papillary thyroid carcinoma (PTC) and benign thyroid pathologies (BT) aimed to identify specific biomarkers and altered pathways when compared with healthy controls (C). The blood was collected after a histological confirmation from PTC (n = 24) and BT patients (n = 31) in parallel with healthy controls (n = 81). The untargeted metabolomics protocol was applied by UHPLC-QTOF-ESI+-MS analysis and the statistical analysis was performed using the MetaboAnalyst 5.0 platform. The partial least squares-discrimination analysis, including VIP values, random forest graphs, and heatmaps (p < 0.05), was complemented with biomarker analysis (with AUROC ranking) and pathway analysis, suggesting a model for abnormal metabolic pathways in PTC and BT based on 166 identified metabolites. There were 11 classes of putative biomarkers selected that were involved in altered metabolic pathways, e.g., polar molecules (amino acids and glycolysis metabolites, purines and pyrimidines, and selenium complexes) and lipids including free fatty acids, bile acids, acylated carnitines, corticosteroids, prostaglandins, and phospholipids. Specific biomarkers of discrimination were identified in each class of metabolites and upregulated or downregulated comparative to controls, PTC group, and BT group. The lipidomic window was revealed to be more relevant for finding biomarkers related to thyroid carcinoma or benign thyroid nodules, since our study reflected a stronger involvement of lipids and selenium-related molecules in metabolic discrimination.

18F-FDG-PET/CT-based machine learning model evaluates indeterminate adrenal nodules in patients with extra-adrenal malignancies.

BACKGROUND: To assess the value of an 18F-FDG-positron emission tomography/computed tomography (PET/CT)-based machine learning model for distinguishing between adrenal benign nodules (ABNs) and adrenal metastases (AMs) in patients with indeterminate adrenal nodules and extra-adrenal malignancies. METHODS: A total of 303 patients who underwent 18F-FDG-PET/CT with indeterminate adrenal nodules and extra-adrenal malignancies from March 2015 to June 2021 were included in this retrospective study (training dataset (n = 182): AMs (n = 97), ABNs (n = 85); testing dataset (n = 121): AMs (n = 68), ABNs (n = 55)). The clinical and PET/CT imaging features of the two groups were analyzed. The predictive model and simplified scoring system for distinguishing between AMs and ABNs were built based on clinical and PET/CT risk factors using multivariable logistic regression in the training cohort. The performances of the predictive model and simplified scoring system in both the training and testing cohorts were evaluated by the areas under the receiver operating characteristic curves (AUCs) and calibration curves. The comparison of AUCs was evaluated by the DeLong test. RESULTS: The predictive model included four risk factors: sex, the ratio of the maximum standardized uptake value (SUVmax) of adrenal lesions to the mean liver standardized uptake value, the value on unenhanced CT (CTU), and the clinical stage of extra-adrenal malignancies. The model achieved an AUC of 0.936 with a specificity, sensitivity and accuracy of 0.918, 0.835, and 0.874 in the training dataset, respectively, while it yielded an AUC of 0.931 with a specificity, sensitivity, and accuracy of 1.00, 0.735, and 0.851 in the testing dataset, respectively. The simplified scoring system had comparable diagnostic value to the predictive model in both the training (AUC 0.938, sensitivity: 0.825, specificity 0.953, accuracy 0.885; P = 0.5733) and testing (AUC 0.931, sensitivity 0.735, specificity 1.000, accuracy 0.851; P = 1.00) datasets. CONCLUSIONS: Our study showed the potential ability of a machine learning model and a simplified scoring system based on clinical and 18F-FDG-PET/CT imaging features to predict AMs in patients with indeterminate adrenal nodules and extra-adrenal malignancies. The simplified scoring system is simple, convenient, and easy to popularize.

Application of dual-source computed tomography in the diagnosis of thyroid cancer and evaluation of biological behaviors.

OBJECTIVE: Thyroid cancer (TC) is an extremely prevailing malignant endocrine tumor. Therefore, effective diagnostic tools are necessary. This study explored the application value of dual-source computed tomography (DSCT) in TC diagnosis and biological behavior assessment. METHODS: This study retrospectively selected 68 TC patients and another 74 benign patients with thyroid adenoma, nodular goiter, or adenomatous hyperplasia. All patients were confirmed by pathological examination and underwent DSCT examination. The iodine concentration (IC) obtained from plain computed tomography (CT) scanning and normalized iodine concentration (NIC) in the arterial phase and venous phase were recorded. The positive expression rates of estrogen receptor alpha (ERα), estrogen receptors beta (ERß), and Ki67 in pathological tissues were determined by immunohistochemistry, and their correlation with IC in plain CT was assessed by Pearson correlation analysis, respectively. The diagnostic values of IC in plain CT and venous phase NIC in TC patients were evaluated using the receiver operating characteristic curve. RESULTS: Malignant patients had lower IC in plain DSCT scanning, venous phase NIC, and ERß, and higher ERα and Ki67 than benign patients. IC level in plain DSCT scanning was inversely-correlated with ERα and Ki-67 positive expression rates, but positively-related to ERß to different degrees. For the diagnosis of TC patients, the AUC of IC level in plain DSCT was 0.771, with a cut-off value of 1.250 (97.06% sensitivity and 41.89% specificity), and the AUC of venous phase NIC was 0.738, with a cut-off value of 0.825 (100% sensitivity and 43.24% specificity). CONCLUSION: The IC level obtained from DSCT scanning could assist in the differential diagnosis of malignant and benign thyroid nodules and evaluation of biological behaviors.

Intraoperative Radiofrequency Ablation for Contralateral Benign Nodules in Unilateral Thyroid Cancer Patients to Relieve Anxiety.

INTRODUCTION: For unilateral papillary thyroid carcinoma (PTC) with contralateral benign nodules, optimal extent of surgery remains controversial. This retrospective cohort study was performed to evaluate the life quality of patients who underwent lobectomy alone and lobectomy with radiofrequency ablation (RFA). METHODS: From October 2014 to October 2018, unilateral PTC patients with contralateral benign nodules reported by fine-needle aspiration cytology who encountered anxiety about contralateral nodule progression underwent lobectomy for PTC and intraoperative RFA for contralateral nodules. The patients who underwent thyroid lobectomy were matched for sex, age at time of surgery, number, size, and location of primary tumors and contralateral nodules to the patients who underwent lobectomy with intraoperative RFA. Three questionnaires were used to evaluate life quality in the two groups. The complications and rate of patients who were not required to receive thyroid-stimulating hormone suppression therapy were recorded. RESULTS: One hundred forty-eight patients with 194 contralateral nodules underwent RFA in the lobectomy plus RFA group, and age- and sex-matched patients underwent thyroid lobectomy alone. The mean volume reduction ratio was 67.7% at 12 mo and 95.2% at 24 mo. After a median follow-up of 4.2 y, nine patients (6.1%) in the lobectomy plus RFA group and 17 (11.5%) in the thyroid lobectomy-alone group underwent completion thyroidectomy (P = 0.100). Patients who underwent lobectomy plus RFA had a better quality of life in terms of anxiety, physiological health, social and family aspects, and psychological and sensory features that were measured cross-sectionally at 6 mo using three instruments. CONCLUSIONS: Intraoperative RFA is effective in terms of volume reduction of contralateral nodules and improved quality of life for unilateral PTC patients with anxiety about disease progression.

Ultrasound-guided laser ablation of very large benign thyroid nodules: 4-year, retrospective follow-up in 24 patients.

BACKGROUND: Percutaneous, ultrasound-guided laser ablation is a proven management approach for the treatment of Benign Thyroid Nodules (BTN), but only sporadic cases of treatment of large-volume nodules with laser ablation have been reported. The aim of this study was to evaluate the efficacy and safety of laser ablation in the treatment of very large (> 100 mL) thyroid nodules. METHODS: Between 2009 and 2016, 24 patients with very large, BTN received 2-3 sessions of laser ablation over the course of 12 months. Nodule volume was measured before treatment, and at 1 and 4 years. RESULTS: Prior to treatment, median nodule volume was 138 mL (range: 102-289 mL). At 1 year, technique efficacy was achieved in 75% of patients, with median nodule volume significantly reduced to 26 mL (range: 15-31 mL, p < 0.001 vs pretreatment). Volume reduction ratio (VRR) at 1 year was 81%. At 4-year follow-up, median nodule volume was 27 mL (range: 15-33 mL, p < 0.001 vs pretreatment), with a VRR of 80%. Two patients had nodule regrowth > 50% and went to surgery - one patient after 1 year and the other after 3 years. Treatment was well tolerated; there were no major complications, although transient fever occurred in 12% (3/24) of patients and mild-to-moderate pain was experienced by 8% (2/24) of patients. CONCLUSIONS: In this patient series, percutaneous, ultrasound-guided laser ablation of very large thyroid modules provided long-term benefits and the treatment was well tolerated.

Evaluating pre- and post-operation plasma miRNAs of papillary thyroid carcinoma (PTC) patients in comparison to benign nodules.

BACKGROUND: Thyroid cancer is the most common endocrinology cancer that its incidence has increased in recent decades. miRNAs are new biomarkers in recent studies in the diagnosis and follow-up of these patients. METHODS: Blood and thyroid tissue samples were obtained from two groups of included patients (PTC and benign nodules), pre- and post-operation. miRNAs were extracted from these plasma samples and were measured quantitatively. After cDNA synthesis, qPCR was carried out. Then tissue samples were investigated, and their relation to miR expression was studied. These results were analyzed by paired- and independent samples t-test, and non-parametric tests. RESULTS: miR-222 and miR-181a declined in PTC patients before and after surgery, significantly (P < 0.001 for both groups), with no significant difference in control group before and after surgery (P = 0.61 for miR-222 and P = 0.06 for miR-181a). The difference between the two groups, pre-and post-operation, was statistically significant (P = 0.01 for miR-222 and P < 0.001 for miR-181a). Comparing case and control groups, pre- and post-operatively, yielded no significant difference, in miR-155-5p levels (P = 0.61 and P = 0.53, respectively). Comparing PTC and control groups before surgery showed a significant difference (P = 0.01), while no significant difference was observed comparing them after surgery, in miR146-a (P = 0.27). Our results depicted a higher miR-155-5p and miR-146a expression before surgery than after it (P < 0.001 in both groups, for both miRs). We found a significant relationship between miR-222 and BRAFV600E mutation and significantly higher levels of miR-181a with increasing tumor size in PTC patients. CONCLUSION: miR-222 showed overexpression in all PTC cases, which is indicative of a relation between miRNA and PTC. Also, comparing miR-181 and miR-146a showed a significant difference between cancerous and benign cases. miR-155-5p as an inflammatory factor, showed no significant changes, comparing two groups.

Ultrasonographic liver nodules are more often benign lesions in dogs with hemoperitoneum secondary to splenic tumor rupture.

OBJECTIVE: To evaluate the reliability of preoperative abdominal ultrasonography as a staging tool for dogs with hemoperitoneum due to presumed splenic tumor rupture, focusing on the detection of metastatic lesions in the liver. ANIMALS: 99 dogs from 20 emergency and specialty hospitals across the US. METHODS: Dogs with nontraumatic hemoperitoneum secondary to splenic tumor rupture were included. A post hoc analysis was conducted on data from a nationwide prospective trial investigating novel treatments for canine hemangiosarcoma. The accuracy of preoperative staging was assessed by comparing ultrasonographic findings with intraoperative observations and histologic findings. RESULTS: On preoperative ultrasonography, there was a 20% incidence of liver lesions identified, with no association to liver lesions seen during operation. Notably, 22% of liver lesions observed during operation were missed on preoperative ultrasonography. The presence of liver lesions on preoperative ultrasonography was associated with a higher likelihood of a benign splenic tumor diagnosis. There was no association between the identification of liver lesions on preoperative ultrasonography and the presence of metastatic disease on liver biopsy, with a sensitivity and specificity of 19% and 82%, respectively. Additionally, ultrasound had low sensitivity in detecting intra-abdominal lesions beyond the liver and spleen, with 82% of these lesions missed preoperatively. CLINICAL RELEVANCE: This study challenges conventional perceptions around the approach to staging in dogs with hemoperitoneum. These findings advocate for a reevaluation of the staging approach, with more comprehensive modalities like whole-body CT or MRI potentially being more warranted.

Model-Optimizing Radiofrequency Parameters of 3D Finite Element Analysis for Ablation of Benign Thyroid Nodules.

Radiofrequency (RF) ablation represents an efficient strategy to reduce the volume of thyroid nodules. In this study, a finite element model was developed with the aim of optimizing RF parameters, e.g., input power and treatment duration, in order to achieve the target volume reduction rate (VRR) for a thyroid nodule. RF ablation is modelled as a coupled electro-thermal problem wherein the electric field is applied to induce tissue heating. The electric problem is solved with the Laplace equation, the temperature distribution is estimated with the Pennes bioheat equation, and the thermal damage is evaluated using the Arrhenius equation. The optimization model is applied to RF electrode with different active tip lengths in the interval from 5 mm to 40 mm at the 5 mm step. For each case, we also explored the influence of tumour blood perfusion rate on RF ablation outcomes. The model highlights that longer active tips are more efficient as they require lesser power and shorter treatment time to reach the target VRR. Moreover, this condition is characterized by a reduced transversal ablation zone. In addition, a higher blood perfusion increases the heat dispersion, requiring a different combination of RF power and time treatment to achieve the target VRR. The model may contribute to an improvement in patient-specific RF ablation treatment.

Long-term outcome of microwave ablation for benign thyroid nodules: Over 48-month follow-up study.

Objectives: The short-term effects of microwave ablation (MWA) for the treatment of benign thyroid nodules (BTNs) were satisfactory in previous studies. However, as a slowly progressing disease, the long-term efficacy of MWA for BTNs at present is not clear. Our study aim was to assess the long-term results of MWA for BTNs after a 48-month follow-up. Methods: From June 2015 to September 2017, 148 patients had 148 BTNs. All patients were from the China-Japan Union Hospital of Jilin University. Careful ultrasound examinations were performed 1 day, 1 month, 3 months, 6 months, 12 months, and every 6 months after MWA. The volume, volume reduction rate (VRR), recurrence rate of the ablated area and thyroid function were recorded. Results: The mean volumes of the 148 nodules were 15.6 ± 9.4 cm3 (range: 1.3-48.9 cm3) and 0.6 ± 0.6 cm3 (range: 0-3.5 cm3) before and 48 months after MWA, respectively, with a nodule VRR of 96.9 ± 2.5% (range: 90.4-100%). Two patients (1.35%) had recurrence after MWA. Compared with thyroid function before MWA, no significant variation was observed after MWA. Five patients experienced complications (3.38%): two patients (1.35%) had bleeding, two patients (1.35%) had ear pain and toothache during MWA, and one patient (0.68%) had hoarseness after MWA. No cases of oesophageal injury, tracheal injury, infection, skin burns, etc., were reported during or after MWA. Conclusions: Based on a long-term follow-up, MWA is an effective method for treating BTNs and is expected to be a potential first-line treatment.

Total thyroidectomy versus hemithyroidectomy with intraoperative radiofrequency ablation for unilateral thyroid cancer with contralateral nodules: A propensity score matching study.

BACKGROUND: For unilateral papillary thyroid carcinoma (PTC) patients with contralateral benign nodules, optimal treatment decisions are made according to patient preference and the disease's pathological features. This study was performed to evaluate the efficacy and complications of hemithyroidectomy with intraoperative radiofrequency ablation (RFA) compared with total thyroidectomy. METHODS: Patients with unilateral PTC and cytologically benign contralateral nodules were enrolled from 2014 to 2018. Total thyroidectomy or hemithyroidectomy with intraoperative RFA of the contralateral nodule was offered to patients who had anxiety regarding their disease. The operation-related parameters, transient or permanent nerve injury, hypocalcemia and disease recurrence, were recorded and compared between the two groups. RESULTS: After propensity score matching, 191 patients who underwent total thyroidectomy and 224 contralateral nodules in 191 patients underwent hemithyroidectomy with intraoperative RFA (HTRFA) were included. The volume reduction ratios of the contralateral nodules were 67.7% at 12 months and 95.8% at 24 months. The total thyroidectomy group reported significantly higher hypocalcemia than HTRFA within one year (7.8% vs. 2.6%, p = 0.022). Supplemental levothyroxine was not required in 28.3% (54/191) of the patients one year after HTRFA. With a median follow-up of 4.1 years, three recurrences (1.6%) were observed in the HTRFA, and no recurrence occurred in the total thyroidectomy group (p = 0.246). CONCLUSIONS: Hemithyroidectomy for unilateral PTC and intraoperative RFA for contralateral nodules were acceptable and effective treatment approaches and did not increase the risk of complications.

Correlation Between Ultrasound and Cytological Findings of Patients With Suspicious Thyroid Nodules: The King Hamad University Hospital Experience.

Background Thyroid nodules are a common presentation in otolaryngology-head and neck clinics. The detection of thyroid nodules has increased significantly with the advancements in radiological technology such as computed tomography and ultrasound (US). The present study aims to improve the clinical practice and management of thyroid disorders by establishing correlations between US and cytological findings in the diagnosis of thyroid nodules. Methodology A retrospective cohort study was conducted at the King Hamad University Hospital (KHUH), Bahrain. A total of 189 cases met the study criteria. Pathological records for thyroid nodule fine needle aspiration (FNA) cytology and US features of sampled nodules from the patients were obtained. The cytological results were categorized into the Bethesda grading system, while the US features were organized into internationally accepted features using the Thyroid Imaging Reporting and Data System (TIRADS). Results The radiologic characteristics from US showed positive features largely for the composition (76.2%) and vascularity (59.3%). Very few showed echogenicity (6.9%). Most records indicated negatively for the shape (94.7%), margins (76.2%), echogenicity (63.5%), or echogenic foci (66.1%). Of the 47 cases in TIRADS 1 and 2, only two were found to be Bethesda 4 classification, showing that most of these nodules were benign. Among those with TIRADS 3 on US, 85% turned were benign (Bethesda 2), two of the remaining six were grade 3, and the other four were suspiciously malignant. Of the 100 cases in TIRADS 4 and 5, 63% were of Bethesda grade 2, and therefore, benign, 14% were mildly suspicious, and only 23% were in Bethesda grades 4-6. A significant positive correlation was noted between the TIRADS and Bethesda scores (r = 0.338, p ≤ 0.001). Conclusions If the thyroid nodules are classified properly by US using the TIRADS system, the probability of a nodule being malignant can be established with a certain level of confidence. The appropriate management of the nodule can be initiated avoiding unwarranted FNA procedures.

Interleukin-17 and vascular endothelial growth factor: new biomarkers for the diagnosis of papillary thyroid carcinoma in patients with Hashimoto's thyroiditis.

OBJECTIVE: The incidences of papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) have shown increasing trends. Numerous studies have shown a close relationship between the two diseases, but the exact mechanism linking PTC with HT is still unclear. Interleukin-17 (IL-17) plays an important role in the development of malignant tumors. However, information on the association between IL-17 and thyroid disease is lacking. METHODS: Tissue samples were collected from patients with thyroid diseases admitted to the thyroid surgery department of our hospital between May 2015 and December 2017. The characteristics of the thyroid were observed by ultrasonography, hematoxylin-eosin staining, enzyme-linked immunosorbent assays, and immunohistochemistry. RESULTS: We found that HT with carcinoma (HTC) showed unique characteristics in two-dimensional ultrasound images. Moreover, IL-17 and vascular endothelial growth factor (VEGF) levels showed gradually increasing trends during the process of HT malignant transformation, with a significant positive correlation between the two cytokines. Serum IL-17 and VEGF levels could distinguish between HTC and HT with benign adenoma. CONCLUSION: Our data suggest that serum IL-17 and VEGF levels may represent novel biomarkers for the diagnosis of HT malignant nodules.

The efficacy and safety of microwave ablation versus lobectomy for the treatment of benign thyroid nodules greater than 4 cm.

PURPOSE: To evaluate the safety and effectiveness of microwave ablation (MWA) versus lobectomy for the treatment of benign thyroid nodules > 4 cm. METHODS: We retrospectively analyzed the data of 48 patients who underwent MWA and 53 patients who underwent lobectomy to treat benign thyroid nodules > 4 cm. The patients were followed up for 12 months. The volume reduction ratio (VRR) was calculated. The operation time, incision length, hospitalization time, complications, thyroid function, symptoms, and cosmetic improvement were analyzed and compared between the two groups. RESULTS: During the 12-month follow-up, the mean nodule volume in the MWA group was reduced from 36.1 ± 23.1 to 4.0 ± 4.1 ml, and the mean VRR of the nodules was 90 ± 5% in the MWA group, which was comparable with that in the surgery group. No significant postoperative change in thyroid function was observed in the MWA group. Compared with the surgery group, the incidence of complications and postoperative pain in the MWA group were lower, the operation time, incision length, and hospitalization time in the MWA group were shorter, and satisfaction with the esthetic results in the MWA group was greater. CONCLUSION: MWA is safe and effective for the treatment of benign thyroid nodules > 4 cm. Moreover, MWA is associated with a faster recovery, fewer complications, better protection of thyroid function, and superior esthetic results relative to thyroid lobectomy.

Percutaneous Ultrasound-Guided Laser Ablation of Benign Thyroid Nodules: Results of 10-Year Follow-Up in 171 Patients.

CONTEXT: Percutaneous, ultrasound-guided laser ablation is effective in nodular thyroid disease. OBJECTIVE: The aim of this study was to evaluate the long-term (10-year) efficacy and safety of laser ablation in the treatment of benign thyroid nodules. METHODS: From 2009 to 2010, 171 patients received a single session of laser ablation. Evaluation of nodule volume was performed before treatment, at 6 months, and every year. RESULTS: Technique efficacy was achieved in 92% of patients at 1 year. Median nodule volume significantly decreased from 16.7 mL (range, 11.0-97.0 mL) at baseline to 5.0 mL (range, 4.1-32.0 mL) at 1 year, a volume reduction ratio (VRR) of 68%. The benefit of the treatment was durable (P < 0.001 vs baseline at all timepoints), with a VRR of 59% after 10 years. No cases of nodule regrowth > 50% were observed at 1 year, although such cases did occur after 4 years (n = 3; 1.7% of the overall cohort) and 7 years (n = 8; 4.7%). There were no further cases of regrowth beyond 7 years. When patients were stratified according to baseline nodule volume (< 15 mL, 15-25 mL, or > 25 mL), durable results were observed across all 3 categories, with the largest, most prolonged effect observed in patients with nodules < 15 mL. Treatment was well tolerated, with only minor, transient complications of fever and local pain, and 98% of patients willing to recommend the treatment. CONCLUSION: Percutaneous, ultrasound-guided laser ablation of benign thyroid nodules provides long-term benefits and the treatment is well tolerated.

The Value of Ultrasound-Guided Fine-Needle Aspiration Cytology Combined with Puncture Feeling in the Diagnosis of Thyroid Nodules.

INTRODUCTION: There are few studies on the role of puncture feeling in thyroid nodules during ultrasound-guided fine-needle aspiration cytology (US-FNAC), although it is expected to become a new predictive technique. We aimed to analyze the importance of puncture feeling in combination with US-FNAC and investigate whether it can be used as an indicator to predict the nature of thyroid nodules. MATERIALS AND METHODS: From January 1, 2018, to October 31, 2020, a total of 623 thyroid nodules were included. Puncture feeling was classified as "soft," "hard," or "hard with grittiness." The correlation between puncture feeling and postoperative pathology and the diagnostic value of FNAC combined with puncture feeling were analyzed, and the influence of thyroid nodule size on puncture feeling, FNAC, and FNAC combined with puncture feeling was studied. We further explored the correlation between puncture feeling and histopathology in Bethesda III and IV thyroid nodules. RESULTS: There was a significant correlation between puncture feeling and postoperative pathology (p < 0.001). The sensitivity, negative predictive value, and total coincidence rate of US-FNAC combined with puncture feeling for the diagnosis of thyroid nodules were higher than those of US-FNAC alone (96.1, 83.6, and 94.7% vs. 89.0, 65.5, and 89.7%, respectively). Thyroid nodule size was the influencing factor for puncture feeling, FNAC, and FNAC combined with puncture feeling (p < 0.05 for all). The area under the curve for puncture feeling, FNAC, and FNAC combined with puncture feeling for thyroid nodules of size ≤1 cm was greater than for modules of size >1 cm. Puncture feeling was of great value in diagnosing Bethesda III thyroid nodules (p < 0.001), and all Bethesda IV thyroid nodules had puncture feeling of soft. CONCLUSION: Puncture feeling is of great value during US-FNAC. "Hard" and "hard with grittiness" were indicators for malignancy, while "soft" indicated that the thyroid nodule was likely to be benign. The diagnostic value of US-FNAC combined with puncture feeling for thyroid nodules is higher than US-FNAC alone, especially when nodule size is ≤1 cm. Puncture feeling is of great value in predicting the nature of Bethesda III thyroid nodules.

Comparison of stress response following microwave ablation and surgical resection of benign thyroid nodules.

PURPOSE: To compare the effects and safety of using microwave ablation (MWA) and surgical resection for the treatment of benign thyroid nodules (BTNs) under ultrasonic guidance and investigate the effects of this treatment on stress response. METHODS: Patients with BTNs were divided into the MWA and operation groups (72 cases each). Interleukin (IL)-6, IL-8, serum tumor necrosis factor (TNF-α), and hydrostatic visual analog scale (VAS) prior to the operation, at 6 h, 24 h, and 72 h post-operation were compared between the two groups. Operation times, hospitalization times, hospitalization expenses, and postoperative complications in the two groups were also compared. All patients underwent routine ultrasound and thyroid function testing at 3 and 6 months post-operation for assessment of nodule changes and thyroid hormone levels. RESULTS: Compared to the MWA group, the operation group had longer average operation times, longer hospital stays, a higher rate of neck pain after surgery, and a higher rate of fever (P < 0.05). Body temperature, as well as VAS, IL-6, IL-8, and TNF-α levels in the operation group were higher than those in the MWA group at 6 h, 24 h, and 72 h post-operation (P < 0.05). The levels of free thyroxine and free triiodothyronine in the operation group were lower than those in the MWA group (P < 0.05). CONCLUSION: MWA is a safe and effective treatment for patients with BTNs. The effects of MWA are more tolerable than those of surgical resection and the physiological function of the thyroid is preserved, which has high clinical value.

Comparative Study of Autoantibody Responses between Lung Adenocarcinoma and Benign Pulmonary Nodules.

INTRODUCTION: The reduction in lung cancer mortality associated with computed tomography (CT) screening has led to its increased use and a concomitant increase in the detection of benign pulmonary nodules. Many individuals found to have benign nodules undergo unnecessary, costly, and invasive procedures. Therefore, there is a need for companion diagnostics that stratify individuals with pulmonary nodules into high-risk or low-risk groups. Lung cancers can trigger host immune responses and elicit antibodies against tumor antigens. The identification of these autoantibodies (AAbs) and their corresponding antigens may expand our knowledge of cancer immunity, leading to early diagnosis or even benefiting immunotherapy. Previous studies were performed mostly in the context of comparing cancers and healthy (smoker) controls. We have performed one of the first studies to understand humoral immune response in patients with cancer, patients with benign nodules, and healthy smokers. METHODS: We first profiled seroreactivity to 10,000 full-length human proteins in 40 patients with early-stage lung cancer and 40 smoker controls by using nucleic acid programmable protein arrays to identify candidate cancer-specific AAbs. Enzyme-linked immunosorbent assays of promising candidates were performed on 137 patients with lung cancer and 127 smoker controls, as well as on 170 subjects with benign pulmonary nodules. RESULTS: From protein microarray screening experiments using a discovery set of 40 patients and 40 smoker controls, 17 antigens showing higher reactivity in lung cancer cases relative to the controls were subsequently selected for evaluation in a large sample set (n = 264) by using enzyme-linked immunosorbent assay. A five-AAb classifier (tetratricopeptide repeat domain 14 [TTC14], B-Raf proto-oncogene, serine/threonine kinase [BRAF], actin like 6B [ACTL6B], MORC family CW-type zinc finger 2 [MORC2], and cancer/testis antigen 1B [CTAG1B]) that can differentiate lung cancers from smoker controls with a sensitivity of 30% at 89% specificity was developed. We further tested AAb responses in subjects with CT-positive benign nodules (n = 170), and developed a five-AAb panel (keratin 8, type II, TTC14, Kruppel-like factor 8, BRAF, and tousled like kinase 1) with a sensitivity of 30% at 88% specificity. Interestingly, messenger RNA levels of six AAb targets (TTC14, BRAF, MORC family CW-type zinc finger 2, cancer/testis antigen 1B, keratin 8, type II, and tousled like kinase 1) were also found to increase in lung adenocarcinoma tissues based on The Cancer Genome Atlas data set. CONCLUSION: We discovered AAbs associated with lung adenocaricnoma that have the potential to differentiate cancer from CT-positive benign diseases. We believe that these antibodies warrant future validation using a larger sample set and/or longitudinal samples individually or as a panel. They could potentially be part of companion molecular diagnostic modalities that will benefit subjects undergoing CT screening for lung cancer.

Ultrasound-guided percutaneous laser ablation in treating symptomatic solid benign thyroid nodules: Our experience in 45 patients.

BACKGROUND: Laser ablation may be useful in debulking of benign thyroid nodules. METHODS: In order to retrospectively evaluate the effectiveness and safety of laser ablation, 45 patients with benign solid thyroid nodules, with a fluid component ≤20%, were included in our series between October 2009 and January 2011. All reported pressure and/or cosmetic complaints. Nd:YAG laser at 1064 nm was used, with a fix-power (3W), changing the application time. All patients were evaluated at baseline, 6 months, and 12 months and any complications were recorded. RESULTS: Mean nodule volume reduction decreased from 24.2 mL ± 19.4 to 4.5 ± 5.2 at 12 months (p < .001). Mean nodule volume reduction was 84% ± 13. Cosmetic signs were completely resolved in 87%, reduced in 9%, unchanged in 2%, and pressure symptoms were resolved in 88%. One patient experienced transient dysphonia. CONCLUSION: Ultrasound-guided laser ablation is an effective tool for treatment of symptomatic benign thyroid nodules in patients not eligible for surgery.

Association between microRNA polymorphisms and papillary thyroid cancer susceptibility.

OBJECTIVES: Papillary thyroid cancer (PTC) is the most common subtype of thyroid cancer, which accounts for 80-90% of all thyroid cancer cases. Though the pathological mechanism hasn't been fully understood, it is reported that both environmental and genetic factor may contribute to the PTC susceptibility. MicroRNAs (miRNAs) are small non-coding RNA molecules which function as the suppressors to participate in a variety of biological processes. Accumulating evidence suggests that polymorphisms of miRNAs were associated with the tumorigenesis of various cancers, including PTC. In this article, we focus on the association between four common microRNA polymorphisms (miR-146a, miR-608, miR-933, and miR-149) and PTC risk in a Han Chinese population. METHODS: In this case-control study, we recruited 1,398 participants in total, including 369 PTC patients, 278 patients with thyroid benign nodules (BN) and 751 normal controls. The miRNAs polymorphisms were genotyped and analyzed by using MALDI-TOF mass spectrometry. The odd ratios and their 95% confidence interval (95% CI) were calculated to evaluate the association between miRNAs polymorphisms and PTC risk. Furthermore, a meta-analysis based on previous studies was conducted to comprehensively assess the diagnostic performance of miR-146a in the PTC diagnosis. RESULTS: The miR-146a polymorphisms were shown to be significantly correlated with elevated risk of PTC under the heterozygous, homozygous, dominant and allelic models by comparing the genotype distribution between PTC cases and healthy controls, as well as between PTC cases and BN cases. However, the result of meta-analysis showed no significant association between miR-146a polymorphisms and PTC risk. CONCLUSIONS: Our study indicated that the miR-146a polymorphism was significantly associated with PTC risk. In contrast, meta-analysis revealed no evidence of association between miR-146a variants and PTC risk. Further studies are required to elucidate the role of miR-146a in the etiology of PTC.

Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis

OBJECTIVES: Ultrasound-guided fine-needle aspiration biopsies are recommended for the detection of suspicious thyroid nodules. However, the best approach regarding suspicious ultrasound features for thyroid nodules is still unclear. This study aimed to evaluate the effect of location and size of thyroid nodules on the diagnostic performance of strain ultrasound elastography. In addition, this study evaluated whether ultrasound elastography predicts malignancy in thyroid nodules. METHODS: Data regarding the size, depth, and distance from the carotid artery of nodules, the elasticity contrast index, and the nature of nodules were analyzed. RESULTS: There was no significant difference in the depth (p=0.092) and the distance from the carotid artery (p=0.061) between benign and suspicious nodules. Suspicious nodules were smaller than benign nodules (p<0.0001, q=23.84) and had a higher elasticity contrast index (p<0.0001, q=21.05). The depth of nodules and the size of the nodule were not associated with the correct value of the elasticity contrast index (p>0.05 for both). The diagnostic performance of ultrasound elastography was not affected by the distance of the nodules from the carotid artery if they were located ≥15 mm from the carotid artery (p=0.5960). However, if the suspicious nodules were located <15 mm from the carotid artery, the diagnostic accuracy was hampered (p=0.006). CONCLUSIONS: The strain ultrasound elastography should be carefully evaluated when small thyroid nodules are located near the carotid artery.