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El cáncer de tiroides (CT) es el primer tumor maligno en glándulas endocrinas, y se estima que al 2030 estará en el top cinco de cáncer a nivel mundial. En Chile, el CT fue incluido, recientemente, como la patología N° 82 con Garantías Explícitas de Salud, lo que implica destinar importantes recursos públicos y privados al tratamiento de pacientes con un cáncer que va en aumento en el mundo. Existen grupos de pacientes jóvenes con tumores pequeños que presentan un comportamiento clínico más agresivo desde el inicio, donde se podría adelantar la toma de decisiones. Específicamente, destaca un grupo de pacientes menores de 55 años con tumores pequeños menores de 2 cm, pero con metástasis regionales, que quedan fuera de la indicación de radioyodoterapia y podrían requerir tratamiento complementario o presentar peor evolución. Las herramientas clínicas y moleculares para guiar el tratamiento adecuado en pacientes con metástasis linfonodales son limitadas y no han sido actualizadas hasta el momento. Existen factores de tumorigenicidad y pronóstico, tales como los marcadores de Transición Epitelio-Mesenquimal (TEM) y Cáncer Stem Cells (CSC) que se han incorporado al estudio de otros tumores y recientemente en cáncer de tiroides. Actualmente estudios que relacionan TEM y CSC con CT apuntan a la descripción molecular y genética, con escasos reportes que correlacionen, clínicamente, estos hallazgos, (particularmente en subgrupos con características particulares de agresividad) y que los propongan como marcadores de tumorigenicidad y pronóstico. La descripción de estos biomarcadores en la población descrita podría facilitar la toma de decisiones en cuanto a seguimiento, terapia quirúrgica y radioyodoterapia.
Thyroid cancer (TC) is the first malignant tumor in endocrine glands, and it is estimated that by 2030 it will be in the top five cancers worldwide. In Chile, TC was recently included as pathology No. 82 with Explicit Health Guarantees, which implies allocating significant public and private resources to the treatment of patients with a cancer that is on the rise. There are groups of young patients with small tumors that present a more aggressive clinical behavior, where decision-making could be advanced. Specifically, a group of patients under 55 years of age with tumors less than 2 cm in size but with regional metastases, that lack indication for radioiodine therapy and could require complementary treatment or present a worse evolution. Clinical and molecular tools to guide appropriate treatment in patients with lymph node metastases are limited and have not been updated. There are tumorigenicity and prognostic factors, such as EpithelialMesenchymal Transition (EMT) and Cancer Stem Cells (CSC) markers that have been incorporated into the study of other tumors and recently in thyroid cancer. Studies linking EMT and CSC with TC currently point to molecular and genetic description, with few reports clinically correlating these findings (particularly in subgroups with particular characteristics of aggressiveness) and proposing them as tumorigenicity and prognosis markers. The description of these biomarkers in the described population could facilitate decision-making regarding follow-up, surgical therapy, and radioiodine therapy.
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Introducción: El cáncer de tiroides es una enfermedad frecuente en el mundo, con mayor prevalencia del tipo diferenciado. El diagnóstico temprano y manejo pertinente, individualizado y adaptable puede mejorar su pronóstico. Objetivo: Generar recomendaciones basadas en evidencia sobre el tratamiento y seguimiento de personas adultas con cáncer diferenciado de tiroides (CDT). Metodología: Guía de práctica clínica (GPC) a partir de revisión sistemática de literatura (RSL) y consenso de expertos clínicos. El grupo desarrollador definió el alcance y cuatro preguntas que se resolvieron a través de revisión de evidencia de GPC existentes, RSL, estudios primarios publicadas en español o inglés en diferentes fuentes de información desde 2013. Las preguntas de investigación fueron: 1. ¿Cuáles son las indicaciones de la vigilancia activa?, ¿cómo realizarla?, ¿cuándo y con que periodicidad realizarla? 2. ¿Cuál es el tratamiento y su indicación en pacientes con nódulos tiroideos sospechosos de cáncer? 3. ¿Cómo y cuándo realizar seguimiento de pacientes con CDT de acuerdo con el riesgo dinámico? 4. ¿Cuál es el manejo actual de los pacientes iodo refractarios? Se propusieron recomendaciones basadas en la evidencia, y analizadas y discutidas por el colectivo experto en sesiones asincrónicas. Se evalúo la calidad de la evidencia y las recomendaciones fueron gradadas en fuerte o condicional y a favor o en contra a partir del análisis de la calidad de la evidencia, contexto de implementación (disponibilidad e implementación) y la experticia clínica. En el presente documento se desarrollada la primera pregunta, referente a vigilancia activa. Resultados: 86 recomendaciones fueron propuestas y acordadas por el grupo desarrollador, categorizadas en tratamiento y seguimiento para resolver las preguntas planteadas. 10 de las recomendaciones corresponden a vigilancia activa y se incluyen en el presente documento. Recomendaciones claves incluyen, brindar información completa y oportuna a pacientes, conformación de equipos multidisciplinarios, análisis individualizado del paciente para la decisión de tratamiento, estadificación rutinaria de riesgo dinámico para evaluar la respuesta al tratamiento y ajustarlo, minimización de procedimientos fútiles o que aportan poco a la supervivencia y calidad de vida de los pacientes. Conclusión: Se presentan recomendaciones que esperan incidir en la estandarización de la práctica clínica cotidiana de pacientes con CDT y mejores resultados en salud.
Introduction: Thyroid cancer is a common disease in the world, with a higher prevalence of the differentiated type. Early diagnosis individualized and adaptive management can improve prognosis. Objective: Generate evidence-based recommendations on the treatment and follow-up of adults with differentiated thyroid carcinoma (DTC). Methodology: Clinical practice guideline (CPG) based on systematic literature review (RSL) and consensus of clinical experts. The development group defined the range and four questions that were resolved through a review of evidence from existing CPGs, RSLs, primary studies published in Spanish or English in various sources of information since 2013. The research questions were: 1. What are the indications for active surveillance? How to carry it out? When and how often to carry it out? 2. What is the treatment and its indication in patients with thyroid nodules suspicious for cancer? 3. How and when to follow up patients with CDT according to dynamic risk? 4. What is the current management of iodine refractory patients? Evidence-based recommendations analyzed and discussed by the expert group in asynchronous sessions were proposed. The quality of the evidence was evaluated, and the recommendations were graded as strong or conditional and in favor or against based on the analysis of the quality of the evidence, implementation context (availability and implementation) and clinical expertise. In this document, is developed the first question, referring to active surveillance. Results: 86 recommendations were proposed and agreed upon by the development group, categorized into treatment and follow-up to solve the questions raised. 10 of the recommendations correspond to active surveillance and are included in this document. Key recommendations include providing complete and timely information to patients, develop of multidisciplinary teams, individualized patient analysis for treatment decisions, routine dynamic risk staging to evaluate response to treatment and adjust it, minimization of futile procedures or that contribute little to the survival and quality of life of patients. Conclusion: Recommendations are presented that longs to influence the standardization of the daily clinical practice of patients with DTC and better health outcomes.
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OBJECTIVE To investigate the diagnostic efficacy of serum calcitonin(Ctn)in medullary thyroid cancer(MTC),the correlation between preoperative serum Ctn and clinicopathological features,and the risk factors affecting the progression of MTC disease during follow-up.METHODS The clinical data of 50 patients admitted to the Hospital of Integrated Traditional Chinese and Western Medicine of Nanjing University of Chinese Medicine from 2011 to 2022 were systematically reviewed,the ROC curve calculated the diagnostic efficacy of Ctn and CEA levels on MTC,and the risk factors for lymph node metastasis in the central region of MTC were analyzed in univariate and multivariate,and the survival curve without disease progression was drawn to predict risk factors.RESULTS The ROC curve yields the preoperative cut-off value of Ctn was 23.81 pg/ml and the cut-off value of CEA was 3.035 ng/ml for the diagnosis of MTC.The age of disease,tumor diameter,and preoperative serum Ctn and CEA levels in MTC patients were higher than those in non-MTC patients.Ctn≥289.62 pg/ml was an independent risk factor for central lymph node metastasis in MTC.The survival curve showed that invasion of the capsule,central region metastasis,and TNM stage above T2 were risk factors for predicting disease progression(P<0.05).Patients with MTC who have disease progression have higher preoperative Ctn.CONCLUSION Serum Ctn has important clinical value in the differential diagnosis,preoperative evaluation and postoperative follow-up of MTC.
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OBJECTIVE To compare the metabolomic characteristics of stage T1 papillary thyroid carcinoma(PTC)and nodular goiter(NG),and the relationship between metabolites and lymph node metastasis of PTC.METHODS Serum samples were collected from 60 patients with stage T1 PTC and 30 patients with NG who underwent thyroidectomy at the Department of Otolaryngology Head and Neck Surgery,Civil Aviation General Hospital between September 2021 and April 2022.The PTC group was divided into the N+ group with lymph node metastasis and the N-group without lymph node metastasis according to the presence or absence of lymph node metastasis.The serum metabolites of the N+ and N-groups and the PTC and NG groups were compared and analyzed using an ultra-performance liquid chromatography-mass spectrometry(UPLC-Q-Exactive-MS)coupled platform,and principal component analysis(PCA),partial least squares discriminant analysis(PLS-DA),and orthogonal partial least squares discriminant analysis(OPLS-DA)was performed using SIMCA-P 14.1 software.OPLS-DA modeling,combined with FDR-corrected Mann-Whitney-Wilcoxon test results and metabolite difference multiples in the two groups undergoing comparison,etc.to screen for potential small molecule metabolic markers,and to establish a joint diagnostic model by binary logistic regression analysis.RESULTS There were no significant differential metabolites between the N+ group with lymph node metastasis and the N-group without lymph node metastasis.Seven differential metabolites were found between PCA patients and NG patients,and the five relevant metabolic pathways were the pentose phosphate pathway,pentose and glucuronide interconversion,glycolysis/gluconeogenesis,fructose,and mannose metabolism,and fatty acid biosynthesis.The differential metabolite with an area under the ROC curve>0.9 was D-glyceraldehyde 3-phosphate,and another N-undecanoylglycine,uronic acid,and the area under the ROC curve for three metabolites,N-undecanoylglycine,uric acid,and triiodothyronine glucuronide,was>0.8.CONCLUSION PTC patients differed from NG patients mainly in glucose metabolism and lipid metabolism,and D-glyceraldehyde 3-phosphate could be distinguished from NG patients with the aid of N-undecanoylglycine,uric acid,and triiodothyronine glucuronide,combined with imaging findings.Also,no significant differences in serum metabolites were found in the N+ group compared with the N-group,and the presence or absence of lymph node metastases did not affect serum metabolites in patients with stage T1 PTC.
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The purpose of minimally invasive thyroid surgery is to perform refined surgery through an intelligent operating system, achieving minimal physical and psychological trauma for patients, thereby improving their quality of life. At present, the commonly used minimally invasive surgical methods are laparoscopic surgery and robotic surgery, both by creating tunnels from a distance to the thyroid gland, requiring high technical requirements for surgical instruments and robotic surgeons. Regardless of the type of minimally invasive surgery, in the early stages of implementation, doctors have a process of exposure, understanding, proficient mastery, and innovative expansion of the system, instruments, operating methods, and surgical thinking. In this process, it is inevitable to encounter some erroneous operations, which are the main causes of medical safety adverse events, including complications, and bring a failed medical experience to patients. At the same time, mistakes can also cause psychological burden for robotic surgeons and have an impact on the development of new technologies. The occurrence of errors also depends on the open surgical experience and clinical adaptability of robotic surgeons, and experienced robotic surgeons can significantly reduce errors. With the innovation of medical technology and the urgent demand of patients for efficacy and beauty, errors should not be a factor hindering the development of minimally invasive thyroid surgery. This article will analyze the erroneous operations of robot surgeons, formulates countermeasures, and provides reference for the safe implementation of robot surgery, thereby promoting the development of intelligent precision minimally invasive surgery, and further benefiting patients with minimally invasive needs.
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Surgery is an important means of clinical treatment of thyroid diseases. For thyroid diseases that have failed conservative treatment, surgical treatment is recommended. With the maturation of thyroid endoscopy technology and the increasing demand for cosmetic surgery, more and more thyroid endoscopic surgeries are being performed. Endoscopic thyroid surgery has the advantages of small incision, less bleeding, less postoperative complications, less scar tissue, and so on, which has been clinically recognized and approved. Although endoscopic surgery has achieved remarkable results in the treatment of thyroid diseases, how to effectively protect the parathyroid gland during surgery and avoid hypothyroidism is one of the difficulties that surgeons pay attention to. In this paper, the identification and protection techniques of the parathyroid gland during endoscopic thyroid surgery were analyzed, and summarized, in order to provide a reference for improving the protection techniques of the parathyroid gland during endoscopic thyroid surgery.
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Cervical lymph node metastasis in thyroid cancer is closely related to the disease recurrence and prognosis of patients. Accurate judgment of lymph node metastasis is vital for tumor stage and treatment in patients with thyroid cancer, which can effectively improve the prognosis of patients. However, preoperative detection of cervical lymph node metastasis is the key points and difficulties in individualized treatment of thyroid cancer. Currently, fine needle aspiration washout fluid thyroglobulin is often used to assess cervical lymph node metastasis of differentiated thyroid cancer preoperatively, and it has a higher diagnostic efficacy. The continuous exploration and application of tumor markers and emerging biomarkers have provided new perspectives for the preoperative diagnosis of lymph node metastasis in thyroid cancer. As a new non-invasive detection technique, liquid biopsy is convenient to obtain samples and has broad clinical application in early diagnosis of cervical lymph node metastasis of thyroid cancer. In addition, the analysis and application of liquid biopsy biomarkers will help the development of clinical diagnosis and treatment strategies, and provide the possibility of early precision therapy for thyroid cancer patients. This review summarizes current research surrounding the molecular markers related to cervical lymph node metastasis of thyroid cancer.
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Objective:To explore the value of salivary gland imaging based on deep learning and Delta radiomics in assessing salivary gland injury after 131I treatment in post-thyroidectomy thyroid cancer patients. Methods:A retrospective analysis on 223 patients (46 males, 177 females, age(47.7±14.0) years ) with papillary thyroid cancer, who underwent total thyroidectomy and 131I treatment in Affiliated Hospital of Guilin Medical University between December 2019 and January 2022, was conducted. All patients underwent salivary gland 99Tc mO 4- imaging before and after 131I therapy. The patients were categorized according to salivary gland function based on 99Tc mO 4- imaging results (normal salivary gland vs salivary gland injury), and divided into training and test sets in a ratio of 7∶3. A ResNet-34 neural network model was trained using images at the time of maximum salivary gland radioactivity and those based on background radioactivity counts for structured image feature data. The Delta radiomics approach was then used to subtract the image feature values of the two periods, followed by feature selection through t-test, correlation analysis, and the least absolute shrinkage and selection operator( LASSO) algorithm, to develop logistic regression (LR), support vector machine (SVM), and K-nearest neighbor (KNN) predictive models. The diagnostic performance of 3 models for salivary gland function on the test set was compared with that of the manual interpretation. The AUCs of the 3 models on the test set were compared (Delong test). Results:Among the 67 cases of the test set, the diagnostic accuracy of 3 physicians were 89.6%(60/67), 83.6%(56/67), and 82.1%(55/67) respectively, with the time required for diagnosis of 56, 74 and 55 min, respectively. The accuracies of LR, SVM, and KNN models were 91.0%(61/67), 86.6%(58/67), and 82.1%(55/67), with the required times of 12.5, 15.3 and 17.9 s, respectively. All 3 radiomics models demonstrated good classification and predictive capabilities, with AUC values for the training set of 0.972, 0.965, and 0.943, and for the test set of 0.954, 0.913, and 0.791, respectively. There were no significant differences among the AUC values for the test set ( z values: 0.72, 1.18, 1.82, all P>0.05). Conclusion:The models based on deep learning and Delta radiomics possess high predictive value in assessing salivary gland injury following 131I treatment after surgery in patients with thyroid cancer.
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Thyroid cancer is one of the most common tumors of the endocrine system, characterized by high morbidity and low mortality. Thyroid stimulating hormone (TSH) is an important factor in the development of thyroid cancer. TSH suppression therapy is widely used in clinical practice to reduce recurrence and metastasis through long-term strict monitoring and control of postoperative TSH level in patients with differentiated thyroid cancer (DTC). However, the specific mechanism of the effect played by TSH in the proliferation and progression of DTC has not been clarified. The current researches focus on classifying the relation between TSH and the onset risk, adverse clinicopathological factors and prognosis of DTC, and the applicable scope of TSH suppression therapy and targeted TSH receptor (TSHR) therapy. This article reviews the relation between TSH and DTC and the latest research progress of TSH suppression therapy and TSHR targeted therapy.
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Objective:To analyze the protective effect of neurotracheal catheter monitoring on recurrent laryngeal nerve in patients with bilateral cervical lymph node dissection of thyroid cancer.Methods:The clinical data of 92 patients undergoing bilateral cervical lymph node dissection for thyroid cancer at the First People's Hospital of Shangqiu from Jul 2019 to Aug 2022 were retrospectively analyzed. Patients were divided into control group (routine exposure, 52 cases) and study group (intraoperative neurotrachatic catheter monitoring, 40 cases) The general data, perioperative indicators, parathyroid function, vocal cord function, voice disorder index, quality of life and postoperative complications were compared between the two groups.Results:The intraoperative blood loss in the study group [(12.3±3.3) ml] was less than that in the control group [(16.9±4.0) ml]. The exposure time [(8.7±2.6) min], operation time [(4.0±0.8) h] and postoperative hospitalization time [(3.2±0.9) d] were shorter than those of control group [(14.4±3.6) min, (4.5±1.2) h, (5.7±1.3) d] ( t=5.770, 8.391, 2.387, 10.853, all P<0.05);Amplitude perturbation (4.85%± 0.58%), fundamental frequency perturbation (0.28%±0.17%), standardized noise energy [(-20.3±4.4) dB], VHI-10 score [(1.6±0.5) score], Quality of life scale for cancer patients 1 month after surgery the TG-V4 score [(43.7±4.8) points] was lower than that of control group [(3.05%±0.54%), (0.42%±0.16%), (-14.6±3.3) dB, (3.3±0.4) points, (50.4±5.6) points]. The harmonic noise ratio [(24.9±4.1) dB] was higher than that of the control group [(20.3±4.4) dB] ( t=10.446, 4.049, 7.036, 19.076, 6.116, 5.144, all P<0.001);The incidence of postoperative complications in the study group (8%) was lower than that in the control group (23%) ( χ2=4.020, P=0.045). Conclusion:Neurotracheal catheter monitoring during bilateral cervical lymph node dissection for thyroid cancer can improve vocal cord function, reduce recurrent laryngeal nerve injury, reduce voice disturbance and improve quality of life.
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Objective:To explore the potential categories of return-to-work self-efficacy of postoperative patients with thyroid cancer and analyze the influencing factors, so as to provide theoretical basis for implementing precise interventions of occupational rehabilitation.Methods:This was a cross-sectional study. A convenient sampling method was used to select 257 postoperative patients with thyroid cancer in Zhujiang Hospital of Southern Medical University from May 2022 to July 2023. The General Information Questionnaire, Return-To-Work Self-Efficacy Questionnaire and Cancer Fatigue Scale were used for investigation. Latent profile analysis was used to explore the potential categories of return-to-work self-efficacy of postoperative patients with thyroid cancer. Logistic regression and decision tree were used to analyze the influencing factors of different potential categories.Results:Finally, 250 postoperative patients with thyroid cancer were included. There were 76 males and 174 females, aged (37.91 ± 8.04) years old. The return-to-work self-efficacy of postoperative patients with thyroid cancer was divided into 2 potential categories: low return-to-work self-efficacy group (72.0%, 180/250) and high return-to-work self-efficacy group (28.0%, 70/250). Logistic regression showed education, thyrotropin suppressive therapy, cancer-related fatigue and age were factors influencing the potential categories of return-to-work self-efficacy of postoperative patients with thyroid cancer ( OR values were 0.951 - 19.820, all P<0.05). Decision tree model showed education level and cancer-related fatigue were the most important factors ( χ2 = 31.40, 16.95, both P<0.05). Conclusions:There were two potential categories of return-to-work self-efficacy of postoperative patients with thyroid cancer. Most of them had low levels of return-to-work self-efficacy. Health care professionals should focus on patients who are less educated and having cancer-related fatigue, meanwhile, should not ignore patients who are substandard thyrotropin suppressive therapy, and older. Implement precise interventions of occupational rehabilitation to improve the return-to-work self-efficacy of postoperative patients with thyroid cancer so as to help them reintegrate into society.
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Primary hyperthyroidism and thyroid cancer are usually considered as independent diseases,but recent studies suggest that these two diseases may share common pathogenic mechanisms.This article aims to emphasize the standardized diagnosis and treatment of primary hyperthyroidism patients with concomitant thyroid cancer.By comprehensively analyzing related domestic and foreign research,it provides useful reference and guidance for clinicians when dealing with patients with hyperthyroidism and concurrent thyroid cancer,to improve the level of diagnosis and treatment.
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Objective:To investigate the clinical value of ultrasonography combined with serum thyroglobulin (Tg) levels in preoperative N staging and therapeutic effect evaluation in patients with thyroid cancer.Methods:A retrospective analysis was conducted on the clinical data of 125 patients with thyroid cancer who underwent total thyroidectomy at The 903 Hospital of PLA Joint Logistics Support Force between January 2016 and December 2021. Based on the pathological results, the patients were divided into stages N0, N1a, and N1b. Consistency testing was performed to assess the consistency between ultrasonographic and pathological findings. The serological markers were compared between stage N0 and stage N1. A multivariate logistic regression analysis was conducted to investigate the correlation between antithyroid peroxidase antibodies (TPOAb) and Tg and lymph node metastasis. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of serum Tg, ultrasonography, and the combination of serum Tg with ultrasonography for lymph node metastasis.Results:Among the 125 patients, 51 cases were diagnosed with stage N1, including 36 cases of stage N1a and 15 cases of stage N1b. The pathological examination confirmed stage N0 in 74 cases. Ultrasonography results showed stage N0 in 96 cases, stage N1a in 7 cases, and stage N1b in 22 cases. The preoperative N staging of thyroid cancer patients by ultrasonography was moderately consistent with the pathological staging ( Kappa = 0.44, P < 0.001). Serum free triiodothyronine and Tg levels were higher in stage N1 compared with stage N0 ( P < 0.001), while serum TPOAb levels were lower in stage N1 than in stage N0 ( P = 0.017). Multivariate logistic regression analysis was performed with lymph node metastasis as the dependent variable and the factors FT3, TPOAb, and Tg levels as independent variables. The analysis revealed that Tg was associated with lymph node metastasis ( OR = 1.02, P < 0.001). The ROC curve analysis showed that the area under the ROC curve for serum Tg level and ultrasonography for the diagnosis of lymph node metastasis were 0.67 and 0.65, respectively, which were significantly lower than the area under the curve (0.76) for the combined detection ( P < 0.001). Conclusion:The combined utilization of ultrasonography and serum Tg levels in the preoperative staging of thyroid cancer patients holds distinct clinical relevance. Notably, this combined approach offers a more precise diagnosis of lymph node metastasis compared with ultrasonography alone. Consequently, when making clinical judgments regarding preoperative lymph node metastasis, it is advisable to consider the results of both ultrasonography and serum Tg testing to facilitate surgical planning and evaluate surgical outcomes.
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Objective To assess the effect of ultrasonic thyroid artificial intelligence(AI)-assisted diagnostic system(AI-assisted diagnostic system)for diagnosing medullary thyroid carcinoma(MTC)compared with different physicians and taken papillary thyroid carcinoma(PTC)as the controls.Methods Totally 63 MTC,70 PTC and 62 benign thyroid nodules confirmed by pathology were enrolled.AI-assisted diagnostic system was utilized to analyze thyroid nodules and identify the likelihood of malignancy,and the probability value threshold was set at ≥0.40.All thyroid nodules were retrospectively reviewed and categorized by 3 physicians(1 senior physician,1 attending physician and 1 junior physician)according to Chinese thyroid imaging reporting and data system(C-TIRADS).The efficacy of AI-assisted diagnostic system and physicians for diagnosing MTC and PTC were evaluated.Results AI-assisted diagnostic system showed lower sensitivity,specificity,positive predictive value,negative predictive value,accuracy,and area under the curve(AUC)for diagnosing MTC and PTC compared with physicians.Significant differences of AUC were found between senior physician and AI-assisted diagnostic system,as well as between attending physician and AI-assisted diagnostic system for diagnosing MTC and PTC(all P＜0.01),while no significant difference of AUC was between junior physicians and AI-assisted diagnostic system(both P＞0.05).The sensitivity,specificity,positive predictive value,negative predictive value,accuracy and AUC for AI-assisted diagnostic system for diagnosing MTC were all lower than those for diagnosing PTC,but the AUC was not significantly different(P＞0.05).Conclusion Ultrasonic thyroid AI-assisted diagnostic system had relatively high value for diagnosing MTC.
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Ultrasound is the imaging modality of choice for the diagnosis of thyroid diseases.The establishment of thyroid imaging reporting and data system based on conventional ultrasound plays a key role in the diagnosis of thyroid tumors.In recent years,new technologies such as elastography,superb microvascular imaging,ultrasonography and artificial intelligence have been widely used in the ultrasound diagnosis of thyroid diseases.The application of multimodal ultrasound technology has greatly improved the diagnostic accuracy of thyroid malignancies and provided a theoretical basis for the formulation of individualized diagnostic and treatment plans for thyroid cancer patients.
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Objective:To investigate the value of multi-parametric analysis based on dual-layer detector spectral CT (DLCT) in predicting the initial recurrence risk for papillary thyroid carcinoma (PTC).Methods:From November 2021 to October 2022, 102 PTC patients confirmed by pathology were retrospectively collected at the First Affiliated Hospital of Nanjing Medical University in this cross-sectional study. There were 25 males and 77 females, with an age of (42±13) years old. The initial recurrence risk assessment for PTC patients was categorized into a low-risk group (75 cases) and an intermediate-high-risk group (27 cases). Clinical data, including age, gender, body mass index, history of nodular goiter, history of Hashimoto thyroiditis, and preoperative thyroid function, were collected. Tumor morphological features, including size, location, shape, aspect ratio, the degree of thyroid capsule contact, calcification, and cystic change, were evaluated. Quantitative DLCT parameters, including iodine concentration (IC), standardized iodine concentration (NIC), effective atomic number (Z eff), standardized effective atomic number (NZ eff), electronic density (ED), CT values under different energy levels (40-200 keV, 30 keV intervals) and slope of energy spectrum curve (λ HU) both in the arterial and venous phase were measured. The differences in clinical, morphological features, and spectral CT quantitative parameters between the two groups were compared using independent sample ttest, Mann-Whitney U test, or χ2 test. Multivariate logistic regression analyses were used to construct three models based on clinical and morphological features, quantitative DLCT parameters and their combination, respectively. The receiver operating characteristic curve was used to evaluate the predictive performance of these models for the initial recurrence risk of PTC patients, and the area under the curve (AUC) was compared using the DeLong test. Results:Significant differences were found in gender, lesion long diameter, lesion short diameter and calcification between the low-risk group and intermediate-high-risk groups ( P<0.05). The arterial phase IC, arterial phase Z eff, arterial phase λ HU, arterial phase CT 40 keV, venous phase NIC and venous phase NZ eff in intermediate-high-risk group were significantly lower than those in the low-risk group ( P<0.05). The logistic regression analysis revealed that the clinical model included gender ( OR=2.895, 95% CI 1.047-8.002, P=0.040) and lesion long diameter ( OR=1.142, 95% CI 1.042-1.251, P=0.004), with an AUC of 0.720, sensitivity of 63.0%, and specificity of 78.7% in predicting the initial recurrence risk of PTC patients. The DLCT quantitative parameter model included arterial phase IC ( OR=0.580, 95% CI 0.370-0.908, P=0.017), venous phase NIC ( OR=0.077, 95% CI 0.011-0.536, P=0.010), and venous phase NZ eff ( OR=0.002, 95% CI 0.001-0.103, P=0.009), with an AUC of 0.774, sensitivity of 71.9%, and specificity of 70.0%. The AUC of the combined model was 0.857, with a sensitivity of 74.1%, and specificity of 88.0%, outperforming the clinical model ( Z=2.92, P=0.004) and the DLCT quantitative parameter model ( Z=2.07, P=0.046). Conclusion:Multi-parametric analysis based on DLCT can help predict the initial recurrence risk for PTC, and combining it with clinical and morphological features, the predictive accuracy can be improved.
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ABSTRACT Follicular thyroid cancers account for 15%-20% of all thyroid tumors. Choroidal metastases secondary to follicular thyroid cancer rarely occur. Herein, we report the case of an 85-year-old woman who presented choroidal metastasis from a follicular thyroid carcinoma in the right eye 7 years after total thyroidectomy and underwent enucleation. To confirm the diagnosis and primary tumor site, histopathological, and immunohistochemical examinations were performed. One year later, she presented metastasis in the contralateral eye. Few similar cases have been described in the literature.
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ABSTRACT Schwannomas commonly develop in the cervical region, 25% - 45% of cases are diagnosed in this anatomical region. Tracheal neurogenic tumors are exceedingly rare and can be misdiagnosed as invasive thyroid carcinomas or other infiltrating malignancies when present at the level of the thyroid gland. Here, we present a case of synchronous benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma in a patient who was initially hospitalized for COVID-19. The patient presented with dyspnea that was later found to be caused by tracheal extension of a cervical tumor. Surgical excision was performed, and the surgical team proceeded with segmental tracheal resection, removal of the cervical mass, and total thyroidectomy. The specimen was sent for pathological analysis, which revealed synchronous findings of a benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma. The literature on this subject, together with the present case report, suggests that neurogenic tumors should be included in the differential diagnosis of obstructing tracheal cervical masses. Surgical excision is the first-line of treatment for benign cervical schwannomas.
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Aim: To carry out a retrospective analysis of the frequency and severity of clinical signs of radioiodine (131I)-induced damage to the salivary glands in the early and long-term post-radiation periods, and identify risk factors for their occurrence in patients with differentiated thyroid carcinomas. Methods: A total of 330 patients underwent thyroidectomy with dissection of lymphatic nodes. One month after surgery, all the patients received radioiodine therapy. The dose and number of courses varied depending on the stage and morphological type of the tumor. In the late post-radiation period, the patients were surveyed with the use of a standard questionnaire, which allowed retrospective assessment of the nature and severity of symptoms of radiationinduced damage, as well as the time of their onset/subsidence. Results: Radiation-induced sialoadenitis of the salivary glands was observed in 51.2% of patients treated with 131I. The main symptoms included pain and discomfort in the salivary glands (51.2% of patients), swelling (48.8%), transient or permanent dry mouth (38%), and distortion of taste (38%). There were statistically significant correlations between the presence and severity of the main clinical symptoms of salivary gland irradiation. A significant relationship (r = 0.91, p < 0.001) was found between swelling of the salivary glands and the feeling of pain or discomfort, which was indicative of inflammation and retention of saliva. Conclusion: The main factors influencing the formation of chronic radiation-induced sialoadenitis and the severity of the inflammatory process included the tumor stage, the total dose of radiopharmaceuticals, and the duration following radioiodine therapy
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Radiothérapie , Glandes salivaires , Xérostomie , Tumeurs de la thyroïde , Thyroïdectomie , Noeuds lymphatiquesRésumé
Abstract Objectives To assess the safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy in thyroid tumor. Methods Bilateral axillo-breast approach robotic thyroidectomy and other approaches (open thyroidectomy, transoral robotic thyroidectomy, and bilateral axillo-breast approach endoscopic thyroidectomy) were compared in studies from 6 databases. Results Twenty-two studies (8830 individuals) were included. Bilateral axillo-breast approach robotic thyroidectomy had longer operation time, greater cosmetic satisfaction, and reduced transient hypoparathyroidism than conventional open thyroidectomy. Compared to bilateral axillo-breast approach endoscopic thyroidectomy, bilateral axillo-breast approach robotic thyroidectomy had greater amount of drainage, lower chances of transient vocal cord palsy and permanent hypothyroidism, and better surgical completeness (postopertive thyroblobulin level and lymph node removal). Bilateral axillo-breast approach robotic thyroidectomy induced greater postoperative drainage and greater patient dissatisfaction than transoral robotic thyroidectomy. Conclusion Bilateral axillo-breast approach robotic thyroidectomy is inferior to transoral robotic thyroidectomy in drainage and cosmetic satisfaction but superior to bilateral axillo-breast approach endoscopic thyroidectomy in surgical performance. Its operation time is longer, but its cosmetic satisfaction is higher than open thyroidectomy.