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1.
Medicine (Baltimore) ; 99(5): e18917, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000400

RESUMEN

BACKGROUND: B-type Raf kinase (BRAF) mutation is proved to be a critical predictive factor in papillary thyroid cancer (PTC) with aggressive characteristics. However, the association between BRAF mutation and cervical lymphatic metastasis in PTC is controversial. METHODS: We searched papers on the study of BRAF mutation and cervical lymphatic metastasis in PTC patients through PubMed, Web of Science, Embase, and Cochranelibrary. The BRAF (+) cases, BRAF (-) cases, and cervical lymphphatic metastatic cases in both BRAF (+) and BRAF (-) groups were collected. After Quality assessment, statistical Analysis (funnel plot and Harbord evaluation, Random-effect model, heterogeneity, subgroup analysis, sensitivity analysis, and metacum analysis) were done by the Review Manager (RevMan) 5.3 and stata14 statistical software. RESULTS: There were 78 cross-section studies which met our inclusion criteria. And all of them had no selection bias, publication bias, or any other bias. A significant association existed between BRAF mutation and cervical lymph node metastasis (LNM) (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.44-1.84; P < .05). Overall, 46 studies were conducted among East Asians. Twenty four articles had provided the data of central lymph node metastasis (CLNM), 11 articles with the data of lateral lymph node metastasis (LLNM), and classic/conventional PTC (CPTC) was analyzed in 10 studies. Subgroup analyses were performed based on ethnicity, metastatic site, and subtype of PTC. Significant association between BRAF (+) mutation and cervical LNM were indicated in East Asians (OR = 1.73; 95% CI: 1.49-2.02; P < .05), in non-East Asians (OR = 1.57; 95% CI: 1.26-1.96; P < .05), and in CLNM (OR = 1.80; 95% CI: 1.56-2.07; P < .05). While no significant association was found in LLNM (OR = 1.37; 95% CI: 0.76-2.48; P = .29 > .05) and in CPTC (OR = 1.32; 95% CI: 0.97-1.80; P = .08 > .05). We did not find any other major changes when sensitivity analysis was performed. The metacum analysis showed no significant association existed before 2012. While a significant association began to exist between BRAF mutation and LNM from 2012, and this association became stable from 2017. CONCLUSIONS: We consider that a significant association exists between BRAF mutation and cervical LNM. Further meta-analysis on subgroup may reveal some valuable factors between BRAF gene mutation and LNM. And we do not recommend that BRAF (+) as the biomarker for LNM in PTC.


Asunto(s)
Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/genética , Quinasas raf/genética , Humanos , Metástasis Linfática , Cuello/patología , Cáncer Papilar Tiroideo/patología
2.
Orv Hetil ; 161(2): 75-79, 2020 Jan.
Artículo en Húngaro | MEDLINE | ID: mdl-31902232

RESUMEN

The authors present the case of a multiplex endocrine neoplasia type 2A (MEN2A). The 55-year-old woman underwent detailed examinations for abdominal complaints. Bilateral adrenal masses and thyroid nodular goiter were found. Based on metanephrine excretion and MIBG imaging, bilateral phaeochromocytomas were diagnosed. The thyroid nodules were confirmed by thyroidectomy as bilateral medullary thyroid carcinoma. Asymptomatic primary hyperparathyroidism was also detected. Laparoscopic adrenalectomy and parathyroid adenoma removal were performed. Based on family history and the characteristic clinical presentation, MEN2A syndrome was confirmed by genetic testing. During genetic screening of first-degree relatives, the patient's 25-year-old daughter was shown to be a gene carrier. Preventive thyroidectomy was performed and histology proved multifocal medullary thyroid cancer. In addition to the importance of genetic testing, the authors emphasize the guideline-based, but individualized approach to patients with suspected MEN2A syndrome. Orv Hetil. 2020; 161(2): 75-79.


Asunto(s)
Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía , Neoplasia Endocrina Múltiple Tipo 2a/diagnóstico , Feocromocitoma , Neoplasias de la Tiroides/diagnóstico por imagen , Nódulo Tiroideo/cirugía , 3-Yodobencilguanidina , Neoplasias de las Glándulas Suprarrenales/patología , Adulto , Femenino , Bocio Nodular , Humanos , Metanefrina , Persona de Mediana Edad , Neoplasia Endocrina Múltiple Tipo 2a/genética , Neoplasias de las Paratiroides , Proteínas Ribosómicas , Neoplasias de la Tiroides/genética , Nódulo Tiroideo/patología , Tiroidectomía
3.
BMJ ; 368: l6670, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31911452

RESUMEN

Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.


Asunto(s)
Neoplasias/diagnóstico , Medición de Riesgo/métodos , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo , Biopsia/métodos , Pruebas de Química Clínica , Diagnóstico Diferencial , Humanos , Hallazgos Incidentales , Nódulo Tiroideo/diagnóstico por imagen , Nódulo Tiroideo/patología
4.
J Surg Res ; 246: 535-543, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31711613

RESUMEN

BACKGROUND: A growing body of evidences shows that systemic inflammatory responses are involved in patient prognosis in multiple cancers. Combinations of peripheral leukocyte fractions have been shown to be useful markers for the inflammatory responses. However, significance of such systemic inflammatory responses is still unknown in thyroid cancer. Accordingly, we aimed to clarify clinical impact of peripheral leukocyte fractions in papillary thyroid cancer (PTC). METHODS: Clinicopathological analyses were performed including preoperative leukocyte fractions in 570 patients with curatively resected PTC. Receiver operating characteristic curves were used to determine cutoffs of leukocyte fraction or inflammation indexes such as lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio. A Kaplan-Meier analysis and a Cox's proportional hazard model were used to conduct prognostic analysis. A multivariable logistic regression analysis was performed for correlation assay. RESULTS: Preoperative low LMR predicted recurrence with high sensitivity (63.3%) and specificity (68.7%) (P = 0.002). The multivariable prognostic analyses revealed that preoperative low LMR (P = 0.025), pathological N1b (P = 0.019), high metastatic lymph node ratio (node density) (P = 0.014), and high thyroglobulin level (P = 0.002) independently predicted worse prognosis. The combination of these independent parameters clearly enriched high-risk patients (P < 0.001). Of note, low LMR was dramatically associated with recurrence especially in patients with advanced PTC. CONCLUSIONS: Preoperative low LMR dramatically predicts high-risk patients for recurrences. The results in this study give rational to focusing on immune cell profiles to tackle advanced PTC.


Asunto(s)
Linfocitos , Monocitos , Recurrencia Local de Neoplasia/diagnóstico , Cáncer Papilar Tiroideo/sangre , Neoplasias de la Tiroides/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/prevención & control , Periodo Preoperatorio , Pronóstico , Curva ROC , Estudios Retrospectivos , Cáncer Papilar Tiroideo/mortalidad , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/mortalidad , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Adulto Joven
5.
Acta Cytol ; 64(1-2): 40-51, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-30947167

RESUMEN

Ancillary molecular testing has emerged as a promising way to refine the preoperative risk stratification of thyroid nodules with indeterminate fine needle aspiration (FNA) biopsy results. Commercially available molecular tests for thyroid FNAs include those that analyze samples for mutations and gene fusions, gene expression alterations, microRNA expression alterations, chromosomal copy number alterations, or a combination thereof. This review summarizes the performance characteristics of the most current iterations of three tests currently marketed for cytologically indeterminate thyroid nodules: ThyroSeq v3, ThyGeNEXT/ThyraMIR, and Afirma Gene Sequencing Classifier.


Asunto(s)
Biopsia con Aguja Fina/métodos , Técnicas de Diagnóstico Molecular/métodos , Glándula Tiroides/patología , Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Diagnóstico Diferencial , Perfilación de la Expresión Génica/métodos , Regulación Neoplásica de la Expresión Génica , Humanos , Mutación , Glándula Tiroides/metabolismo , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/metabolismo , Nódulo Tiroideo/genética , Nódulo Tiroideo/metabolismo
7.
J Surg Res ; 245: 523-528, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31450040

RESUMEN

BACKGROUND: The rate of thyroid cancer in patients with hyperthyroidism is reported to be rare, and patients with toxic thyroid nodules do not routinely undergo fine-needle aspiration (FNA) to evaluate for malignancy. However, higher rates of malignancy in hyperthyroid patients may exist than previously reported. This study examines the rate of malignancy in patients with hyperthyroidism who have undergone thyroidectomy. METHODS: A retrospective review of prospectively collected data of 138 patients with hyperthyroidism who underwent thyroidectomy at a single institution was performed. Patients were divided into three groups: Graves' disease (n = 80), toxic multinodular goiter (n = 46), and toxic solitary nodule (n = 12). Patients with previous thyroid surgery were excluded from the study. All patients had biochemical confirmation of hyperthyroidism with thyroid-stimulating hormone <0.1 mIU/L and clinical diagnosis by a referring physician. RESULTS: Of 138 patients, 22% (31/138) were found to have malignancy on final pathology. The breakdown of malignancy by hyperthyroid condition was as follows: 16% in Graves' disease, 24% in toxic multinodular goiter patients, and 50% in toxic solitary nodule patients. CONCLUSIONS: There is a clinically significant rate of malignancy seen in patients who undergo thyroidectomy for hyperthyroidism. Patients with distinct thyroid nodules in the presence of hyperthyroidism may have the highest rates of malignancy and should undergo appropriate workup with ultrasound and FNA to exclude underlying malignancy. In cases with suspicious ultrasound features and/or FNA cytopathology, surgical treatment should be considered as initial management.


Asunto(s)
Bocio Nodular/cirugía , Enfermedad de Graves/cirugía , Hallazgos Incidentales , Neoplasias de la Tiroides/epidemiología , Tirotoxicosis/cirugía , Bocio Nodular/complicaciones , Enfermedad de Graves/complicaciones , Humanos , Incidencia , Estudios Prospectivos , Estudios Retrospectivos , Glándula Tiroides/patología , Glándula Tiroides/cirugía , Neoplasias de la Tiroides/etiología , Neoplasias de la Tiroides/patología , Tiroidectomía/estadística & datos numéricos , Tirotoxicosis/complicaciones
8.
Ann R Coll Surg Engl ; 102(1): 43-48, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31865760

RESUMEN

INTRODUCTION: The diagnostic performance of ultrasound-fine needle aspiration to identify thyroid nodules harbouring malignancy remains variable. The aim of this study was to determine thyroid nodule size and cytological classification as predictors of malignancy risk. MATERIALS AND METHODS: We conducted a retrospective cohort analysis at an academic hospital involving 499 consecutive patients who underwent thyroid surgery between 2004 and 2015. RESULTS: A total of 503 thyroid nodules (499 patients, 84% female; mean age 50.8 years, standard deviation, SD, 15.4 years) were analysed. Of these, 19.5% were malignant. The mean (± SD) nodule size was 3.28 ± 1.63 cm and 3.27 ± 1.54 cm for benign and malignant nodules, respectively. The odds of malignancy for thyroid nodules less than 3.0 cm was similar to those for nodules of 3.0 cm or greater (0.26 compared with 0.29; p=0.77). Overall, the sensitivity and specificity of fine-needle aspiration in this cohort were 71.4% and 100%, respectively. The overall false negative rate was 5.4%. When the cut-off of 3.0 cm was used, the false negative rate in thyroid nodules less than 3.0 cm was 0% compared with 7.0% in nodules of 3.0 cm or greater. Thus, class (p<0.01) but not nodule size (p=0.49), was associated with higher malignancy risk. CONCLUSIONS: Our results suggest that thyroid nodule size did not accurately predict the risk of thyroid malignancy irrespective of fine-needle aspiration cytology. Routine diagnostic thyroid lobectomy solely owing to thyroid nodule size of 3.0 cm or greater is currently not justified.


Asunto(s)
Neoplasias de la Tiroides/patología , Nódulo Tiroideo/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja Fina/métodos , Biopsia con Aguja Fina/normas , Femenino , Humanos , Biopsia Guiada por Imagen/métodos , Biopsia Guiada por Imagen/normas , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Estudios Retrospectivos , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas , Adulto Joven
9.
Khirurgiia (Mosk) ; (12): 18-27, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31825339

RESUMEN

OBJECTIVE: To analyze own initial experience of transoral thyroid surgery. MATERIAL AND METHODS: There were 7 patients thyroid nodules who underwent surgery for the period from March 2018 to May 2019. All patients signed an informed consent to be included in the study. Surgical approach was performed through three incisions in the lower arch of the vestibule of the mouth with deployment of 10 mm endoscope and two 5 mm tools. Gas insufflation was used. All patients were females aged 43.3±11.8 years. Thyroidectomy was performed in 2 cases, hemithyroidectomy - in 5 patients. Dimensions of nodules varied from 10 to 42 mm. RESULTS: Mean time of hemithyroidectomy and thyroidectomy was 206.4±63.8 and 232±37.5 min, respectively. Papillary carcinoma was histologically verified in 1 case. Injuries of recurrent laryngeal nerve, postoperative hypocalcemia and local complications were absent. Drainage was not applied. Postoperative hospital-stay was 3.7±1.1 days. CONCLUSION: Transoral approach to the thyroid gland is technically feasible with standard endoscopic instruments, safe for important anatomical structures and more precise due to the optical capabilities of endoscopic equipment. Any types of procedures are possible. Undoubtedly, aesthetic outcome is also favorable.


Asunto(s)
Cirugía Endoscópica por Orificios Naturales/efectos adversos , Cirugía Endoscópica por Orificios Naturales/métodos , Nódulo Tiroideo/cirugía , Tiroidectomía/métodos , Adulto , Carcinoma Papilar/cirugía , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Boca/cirugía , Neoplasias de la Tiroides/cirugía
10.
Rev Saude Publica ; 53: 106, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800907

RESUMEN

BACKGROUND: Although the prognosis of differentiated thyroid carcinoma (DTC) therapy is considered excellent over time, some cases have a poorer prognosis and evolve into death. OBJECTIVE: This study aimed to estimate the 5-year specific survival and to identify prognosis factors in a cohort of DTC adult subjects. METHODS: Survival probability was estimated by Kaplan-Meier's method in a retrospective hospital-based cohort study. Comparisons were made by log-rank test. Prognosis factors were identified using Cox risk modeling and crude and adjusted Hazard Ratio measures were obtained. Two models were estimated, considering age grouping of the 7th and 8th editions of TNM. RESULTS: Specific 5-year survival in the cohort was 98.5% (95%CI: 94.2 - 97.5). Considering TNM 7th edition, the risk estimates were 9.88 (95%CI: 1.67 - 58.33) for age group ≥ 55 years, 18.87 (95%CI: 7.38 - 48.29) for individuals with distant metastasis, 6.36 (95%CI: 2.26 - 17.91) for patients who underwent lymphadenectomy and 0.16 (95%CI: 0.06 - 0.43) for those who received radioiodine therapy. For TNM 8th edition, the risk estimates were 10.12 (95%CI: 2.05 - 50.09) for age group ≥ 55 years, 12.43 (95%CI: 4.58 - 33.77) for individuals with distant metastasis, 5.06 (95%CI: 1.82 - 14.05) for patients who underwent lymphadenectomy and 0.19 (95%CI: 0.07 - 0.51) for those who received radioiodine therapy. CONCLUSIONS: This cohort had a very high survival over a 5-year period. The prognosis was negatively influenced by age, distant metastasis and lymphadenectomy, whereas radioiodine therapy was found to be protective.


Asunto(s)
Carcinoma/mortalidad , Derivación y Consulta/estadística & datos numéricos , Neoplasias de la Tiroides/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Brasil/epidemiología , Carcinoma/patología , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias de la Tiroides/patología , Factores de Tiempo , Carga Tumoral , Adulto Joven
11.
Biol Res ; 52(1): 61, 2019 Dec 23.
Artículo en Inglés | MEDLINE | ID: mdl-31870440

RESUMEN

BACKGROUND: Papillary thyroid cancer (PTC) is the most common malignancy of all thyroid cancers. LncRNA LINC00460 has been proved to play roles in the oncogenesis and progression of various tumors, including papillary thyroid cancer. However, the potential molecular mechanism of LINC00460 in PTC is poorly investigated. RESULTS: LINC00460 was upregulated in PTC tissues and cells. Raf1 was upregulated in PTC tissues, but miR-485-5p was down-regulated. High LINC00460 expression was associated with poor prognosis. LINC00460 knockdown suppressed proliferation, migration, invation and EMT of PTC cells. Bioinformatics prediction revealed that LINC00460 had binding sites with miR-485-5p, which was validated by luciferase reporter assay. In addition, miR-485-5p was confirmed to directly target Raf1 3'-UTR. Moreover, LINC00460 promoted PTC progression by sponging miR-485-5p to elevate the expression of Raf1. Knockdown of LINC00460 restrained tumor growth in vivo. CONCLUSION: LINC00460 induced proliferation, migration, invation and EMT of PTC cells by regulating the LINC00460/miR-485-5p/Raf1 axis, which indicated that LINC00460 may be a potential biomarker and therapeutic target for PTC.


Asunto(s)
MicroARNs/genética , ARN Largo no Codificante/genética , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/patología , Apoptosis , Proliferación Celular , Transformación Celular Neoplásica , Progresión de la Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/genética , Regulación hacia Arriba
14.
Medicine (Baltimore) ; 98(51): e18309, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31860980

RESUMEN

This study aimed to investigate the application of the healthcare failure mode and effect analysis (HFMEA) to reduce the incidence of posture syndrome of thyroid surgery (PSTS).Subjects before (n = 78, July 2017-December 2017) and after (n = 114, January 2018-June 2018) HFMEA implementation (The Second Hospital of Nanjing, Nanjing University of Chinese Medicine) were selected. The training for PSTS was optimized using HFMEA.The occurrence of PSTS was reduced from 59% to 18% after HFMEA (P < .001). Symptoms of pain and nausea and vomiting were also decreased after HFMEA (all P < .001). The critical thinking ability of 34 medical personnel to evaluate the reduction of thyroid postoperative posture syndrome increased from 246 ±â€Š19 to 301 ±â€Š14 (P < .001) after HFMEA.HFMEA was used to create preoperative posture training procedures for PSTS, bedside cards for training, innovative preoperative posture training equipment, and a diversified preoperative posture training health education model.


Asunto(s)
Análisis de Modo y Efecto de Fallas en la Atención de la Salud , Posicionamiento del Paciente/métodos , Complicaciones Posoperatorias/prevención & control , Glándula Tiroides/cirugía , Tiroidectomía/efectos adversos , Adolescente , Adulto , Anciano , Análisis de Modo y Efecto de Fallas en la Atención de la Salud/métodos , Humanos , Incidencia , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Mejoramiento de la Calidad , Síndrome , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/cirugía , Tiroidectomía/educación , Tiroidectomía/métodos , Adulto Joven
15.
Medicine (Baltimore) ; 98(51): e18437, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31861014

RESUMEN

This study investigated the correlation between basal thyroglobulin (Tg) and recombinant human thyroid-stimulating hormone (rhTSH)-stimulated Tg in differentiated patients with thyroid cancer, and sought to determine whether the basal Tg level predicts the rhTSH-stimulated Tg level.We retrospectively enrolled 177 patients with papillary thyroid cancer (mean age = 44 years; 50 males, 127 females) who received rhTSH before radioiodine therapy (RIT). Serum Tg levels were measured 7 days before the 1st rhTSH injection (basal Tg) and on the days of RIT (rhTSH-stimulated Tg). Patients were divided into 3 groups according to rhTSH-stimulated Tg cut-off levels of 2, 5, and 10 ng/mL. The correlation between basal Tg and rhTSH-stimulated Tg levels was assessed, and whether basal Tg was useful in predicting the rhTSH-stimulated Tg level was determined.A significant positive correlation was observed between basal and rhTSH-stimulated Tg levels (|rho| = 0.48, P < .0001). The basal Tg level had significant diagnostic ability in predicting an rhTSH-stimulated Tg level of 2 ng/mL or higher, and the optimal basal Tg level for this prediction was 0.3 ng/mL (AUC = 0.77, P < .0001). A basal Tg level of 0.5 ng/mL was optimal for predicting rhTSH-stimulated Tg levels of 5 ng/mL or higher (AUC = 0.81, P < .0001), and of 10 ng/mL or higher (AUC = 0.82, P = .0171).The basal Tg level was significantly correlated with the rhTSH-stimulated Tg level. If the basal Tg level is >0.3 or 0.5 ng/mL, then the rhTSH-stimulated Tg level can be expected to be sufficiently high to necessitate clinical examination.


Asunto(s)
Tiroglobulina/sangre , Cáncer Papilar Tiroideo/sangre , Neoplasias de la Tiroides/sangre , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tirotropina
16.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(6): 919-924, 2019 Dec.
Artículo en Chino | MEDLINE | ID: mdl-31880125

RESUMEN

OBJECTIVE: To explore the relationships of BRAF V600E and TERT promoter mutations with the clinicopathological features in papillary thyroid carcinoma (PTC). METHODS: The mutations of BRAF V600E and TERT promoters were examined by PCR-direct sequencing in tumor tissues from 326 PTC patients, while the relationships between the gene mutations and clinicopathological features were analyzed. RESULTS: BRAF V600E mutation was found in 269/326 (82.52%), and TERT promoter mutation in 11/326 (3.37%) of PTC patients. In site mutations of TERT promoter, 9 cases were C228T and 2 cases were C250T. Single factor analysis showed that BRAF V600E mutations were significantly associated with age and recurrence/distant metastasis of tumor (P < 0.05), while TERT promoter mutations were significantly associated with age, tumor size, extrathyroidal extension, T stage, AJCC stage and recurrence/distant metastasis of tumor (P < 0.05). Coexistence of BRAF V600E and TERT promoter mutations (BRAF+/TERT+) were particularly associated with age, tumor size, extrathyroidal extension, T stage and AJCC stage (P < 0.05). CONCLUSION: Coexistence of BRAF V600E and TERT promoter mutations in PTC shows more aggressive tumor behavior.


Asunto(s)
Proteínas Proto-Oncogénicas B-raf/genética , Telomerasa/genética , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Humanos , Mutación , Recurrencia Local de Neoplasia , Pronóstico , Cáncer Papilar Tiroideo/genética , Neoplasias de la Tiroides/genética
17.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 54(12): 954-958, 2019 Dec 07.
Artículo en Chino | MEDLINE | ID: mdl-31887827

RESUMEN

For a long time, the diagnosis and treatment of pediatric thyroid nodules and cancer (PTNC) are mainly referred to adults. In recent years, it has been found that there are great differences between PTNC and TNC in adults. In 2015, the American Thyroid Association released the first Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. In the guidelines, the characteristics of PTNC were described, and clear management strategies were provided. In this paper, we mainly interpret the surgical part of the guidelines and also review the associated research progress in recent years.


Asunto(s)
Adenocarcinoma , Neoplasias de la Tiroides , Nódulo Tiroideo , Adenocarcinoma/terapia , Niño , Humanos , Guías de Práctica Clínica como Asunto , Neoplasias de la Tiroides/terapia , Nódulo Tiroideo/terapia , Estados Unidos
18.
Medicine (Baltimore) ; 98(50): e18213, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31852078

RESUMEN

We aimed to investigate the association between excess body mass index (BMI) and papillary thyroid cancer (PTC) in an operative population, and the impact of higher BMI on clinicopathological aggressiveness of PTC.Charts of 10,844 consecutive patients with thyroid nodules undergoing partial or total thyroidectomy between 1993 and 2015 were reviewed. Patients diagnosed with PTC were stratified in 4 groups: BMI < 18.5 (underweight), 18.5 ≤ BMI < 24 (normal-weight), 24 ≤ BMI < 28 (overweight) and BMI ≥ 28(obese). The impacts of high BMI on prevalence and clinicopathological parameters of PTC were retrospectively analyzed in both univariate and multivariate binary logistic regression analysis.For every 5-unit increase in body mass, the odds of risk-adjusted malignance increased by 36.6%. The individuals who were obese and overweight were associated with high risk of thyroid cancer [odds ratio (OR)= 1.982, P < .001; OR= 1.377, P < .001; respectively] compared to normal weight patients, and this positive association was found in both genders. Obesity was independent predictors for tumors larger than 1 cm (OR = 1.562, P < .001) and multifocality (OR = 1.616, P < .001). However, there was no difference in cervical lymph node (LN) metastasis among BMI groups. Crude analysis showed BMI was associated with advanced tumor-node-metastasis (TNM) stage (relative risk, approximately 1.23 per 5 BMI units, P < .001), but this association disappeared after adjusting for confounding factors.Obesity was significantly associated with the risk of PTC in a large, operative population. Higher BMI was significantly associated with larger tumor size and multifocal tumor.


Asunto(s)
Índice de Masa Corporal , Obesidad/complicaciones , Cáncer Papilar Tiroideo/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Tiroidectomía/métodos , Estudios de Casos y Controles , China/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Estudios Retrospectivos , Cáncer Papilar Tiroideo/etiología , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/etiología , Neoplasias de la Tiroides/cirugía
19.
Am Surg ; 85(11): 1265-1268, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31775969

RESUMEN

We investigated whether laryngoscopy should be performed before total thyroidectomy on all patients without a history of neck surgery. A total of 2523 patients who underwent total thyroidectomy between January 1, 2013, and March 18, 2018, were retrospectively examined. Preoperative vocal cord examination was performed on 2070 of these patients by the otorhinolaryngology department using indirect laryngoscopy. Patients with a history of neck or thyroid surgery were not included in the study. The patients were evaluated in terms of age, gender, symptom (hoarseness/dyspnea), comorbidity, surgical history, biopsy, nodule diameter, pathological diagnosis, and tracheal deviation. Preoperative vocal cord paralysis was detected in 0.8 per cent of the patients (17/2070). Four patients (23.5%) were male and 13 patients (76.5%) were female. The mean age was 62 (range, 25-82) years. Seven of the 17 patients (41%) were symptomatic, with complaints of dyspnea in five and hoarseness in two. The univariate analysis revealed that a nodule diameter >30 mm and the presence of dyspnea were associated with vocal cord damage. Furthermore, the multivariate analysis showed that dyspnea alone was an independent variable (P = 0.011). It is recommended that preoperative vocal cord evaluation should be performed only in patients with severe symptoms, such as dyspnea.


Asunto(s)
Laringoscopía , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Parálisis de los Pliegues Vocales/diagnóstico , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Disnea/etiología , Femenino , Ronquera/etiología , Humanos , Laringoscopía/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Estudios Retrospectivos , Factores Sexuales , Evaluación de Síntomas/métodos , Cáncer Papilar Tiroideo/diagnóstico , Cáncer Papilar Tiroideo/cirugía , Neoplasias de la Tiroides/diagnóstico , Nódulo Tiroideo/diagnóstico , Nódulo Tiroideo/cirugía , Parálisis de los Pliegues Vocales/complicaciones
20.
Medicine (Baltimore) ; 98(47): e18043, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764826

RESUMEN

For chondrosarcoma, metastasis to the thyroid gland is extremely rare. The diagnosis and treatment of thyroid metastasis from chondrosarcoma are discussed here.We found a case of thyroid malignancy occurring after treatment of chondrosarcoma. We reviewed patient characteristics, histological presentations on initial chondrosarcoma and thyroid metastasis, treatments, times of recurrence and death. In addition, we searched Embase, PubMed, and ISI Web of Science databases (1996-2018) for articles published in the English language using the key words "chondrosarcoma" and "thyroid" and we reviewed almost all the reports about thyroid metastasis from chondrosarcoma.Only 5 cases of chondrosarcoma metastases in the thyroid gland have been reported in the literature. We found that most patients are adults, with compression signs or pain, most of whom have poor prognoses. The main examinations are ultrasound, CT and fine needle aspiration biopsy, and primary treatment is surgery.These rare cases of chondrosarcoma presenting as a metastasis in the thyroid gland highlight the importance of close communication between radiologists, histopathologists, and clinicians to ensure that such exceptional cases are not missed.


Asunto(s)
Neoplasias Óseas/patología , Condrosarcoma/secundario , Neoplasias de la Tiroides/secundario , Femenino , Humanos , Persona de Mediana Edad
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