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1.
Zhonghua Bing Li Xue Za Zhi ; 50(4): 349-352, 2021 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-33831993

RESUMO

Objective: To develop a color-moment based model for frozen-section diagnosis of thyroid lesions, and to evaluate the model's value in the frozen-section diagnosis of thyroid cancer. Methods: In this study, 550 frozen thyroid pathological slides, including malignant and non-malignant cases, were collected from Taizhou Central Hospital (Taizhou University Hospital), China, between June 2018 and January 2020. The 550 digitalized frozen-section slides of thyroid were divided into training set (190 slides), validation set (48 slides), test set A (60 slides) and test set B (252 slides). The tumor regions on the slides of malignant cases in the training and validation sets were labeled by pathologists. The labeling information was then used to train the thyroid frozen-section diagnosis models based on the voting method and those based on the color moment. Finally, the performance of two pathological slide diagnosis models was evaluated using the test set A and test set B, respectively. Result: The classification accuracy of the thyroid frozen-section diagnosis model based on the voting method was 90.0% and 83.7%, using test sets A and B, respectively, while that based on color moments was 91.6% and 90.9%, respectively. For actual frozen-section diagnosis of thyroid cancer, the model developed in this study had higher accuracy and stability. Conclusion: This study proposes a color-moment based frozen-section diagnosis model, which is more accurate than other classification models for frozen-section diagnoses of thyroid cancer.


Assuntos
Neoplasias da Glândula Tireoide , Algoritmos , China , Secções Congeladas , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico
2.
Artigo em Chinês | MEDLINE | ID: mdl-33832195

RESUMO

Objective: To evaluate the complications of Da Vinci robotic thyroid surgery by bilateral axillo-breast approach. Methods: A retrospective analysis of complications was conducted on 1, 198 cases of Da Vinci robotic thyroid surgery by bilateral axillo-breast approach of the 960 th Hospital of the People's Liberation Army from February 2014 to March 2020. There were 263 men and 935 women, age ranged from 9 to 68 years old, and included 288 benign lesions and 910 malignancies according to preoperative imaging examination, FNAC, and intraoperative frozen pathology. Results: Surgical complications occurred in 187 (15.61%) patients, including 10 cases of temporary larynx nerve injury (0.83%), 1 case of permanent larynx nerve injury (0.08%), and 152 cases of temporary hypoparathyroidism (12.69%), no permanent hypoparathyroidism, 1 case of hypoglossal injury (0.08%), 2 cases of facial nerve jaw branch damage (0.17%), 2 cases of trachea injury (0.17%), no esophagus damage, 5 cases of celiac leakage (0.42%), 3 cases of neck skin adhesion (0.25%), 2 cases of subdermal bleeding (0.17%), 2 cases of skin burns (0.17%), 5 cases of hematoma (0.42%), 1 case of cephalic artery rupture (0.08%), 1 case of jugular vein rupture (0.08%), no tumor cultivation, no arm plex nerve, accessory nerve or phrenic nerve damage. Conclusion: Da Vinci robot thyroid surgery by bilateral axillo-breast approach is safe, with less severe complications.


Assuntos
Neoplasias da Mama , Carcinoma Papilar , Procedimentos Cirúrgicos Robóticos , Robótica , Neoplasias da Glândula Tireoide , Adolescente , Adulto , Idoso , Axila , Carcinoma Papilar/cirurgia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Adulto Jovem
3.
Wiad Lek ; 74(3 cz 1): 529-534, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33813463

RESUMO

OBJECTIVE: The aim of the research is to increase the effectiveness of preoperative diagnosis of patients with thyroid tumors and to assess the use of cancer-embryonic antigen and immunocytochemical research. PATIENTS AND METHODS: Materials and methods: Patients were interviewed about their complaints and lifestyle; performed ultrasound with fine-needle aspiration, determination of the level of cancer-embryonic antigen (CEA), cytological and immunocytochemical researches. RESULTS: Results: The Benign process in the thyroid gland is low serum REA (less than 0.95 ng / ml), poor expression of thyroglobulin (77.8%), negative reaction with TTF-1 (100%) and cytokeratin-19 (55.6%). Differential-prognostic markers of thyroid neoplasms with risk of malignancy include increased serum REA (0.95 ng / ml and above), the presence of a moderate reaction with antibodies to thyroglobulin (80.0%), a positive reaction - to TTF-1 (100.0%) and E-cadherin (90.0%), with moderate or strong expression of cytokeratin-19 (90.0%). Statistically significant markers of malignant thyroid disease were determined: the presence of harmful factors at work (45.5%), smoking (27.3%), elevated serum REA (0.95 ng / ml and above), the presence of strong cytoplasmic expression of thyroglobulin (63.6%), moderate or strong expression of TTF-1 (90.9%) and cytokeratin-19 (81.8%). CONCLUSION: Conclusions: The most appropriate and practically significant for preoperative diagnosis of thyroid tumors is a set of several diagnostic methods, which are carried out in one hospital - ultrasound with fine-needle aspiration, cytomorphological, and immunocytochemical and REA levels in a primary screening.


Assuntos
Doenças da Glândula Tireoide , Neoplasias da Glândula Tireoide , Biópsia por Agulha Fina , Humanos , Tireoglobulina , Neoplasias da Glândula Tireoide/diagnóstico
4.
Medicine (Baltimore) ; 100(14): e21323, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832057

RESUMO

ABSTRACT: Parathyroid protection during thyroid lobectomy was not illustrated previously. Aim of this study was to find out the influence of parathyroid glands in situ preservation and autotransplantation on postoperative parathyroid function in thyroid lobectomy.Consecutive patients who underwent primary thyroid lobectomy with unilateral central neck dissection for papillary thyroid carcinoma in our center were included retrospectively. Postoperative hypoparathyroidism was defined as low parathyroid hormone (PTH) levels (<1.6 pmol/L) and keeping over 6 months was defined as permanent. Patients were divided into 3 groups: all identified parathyroid glands preserved in situ (preservation group); at least one parathyroid gland autotransplanted without accidental resection (autotransplantation group); at least one parathyroid gland accidental resected (resection group).A total of 425 patients were included. No permanent hypoparathyroidism was reported, and the rates of transient hypoparathyroidism were similar among all groups. Significantly lower serum PTH levels were found in autotransplantation group versus preservation group at postoperative 1-day (3.77 ±â€Š1.61 vs 4.72 ±â€Š2.31, P < .001). Transient hypoparathyroidism was significantly associated with reduced intraoperative carbon nanoparticles utilization (57.1% vs 77.4%, P = .039).Thyroid lobectomy was a safe surgical method for parathyroid protection no matter the practice to ipsilateral parathyroid glands. However, preservation of all parathyroid glands was still recommended considering relatively stable PTH levels.


Assuntos
Glândulas Paratireoides/lesões , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Bases de Dados Factuais , Feminino , Humanos , Hipoparatireoidismo/prevenção & controle , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/lesões , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Tireoidectomia/efeitos adversos
5.
Artigo em Chinês | MEDLINE | ID: mdl-33794611

RESUMO

Objective:To evaluate the risk factors for metastasis of the lymph nodes posterior to the right recurrent laryngeal nerve in thyroid micropapillary carcinoma(PTMC) by Meta-analysis. Methods:We searched domestic and foreign databases for relevant studies published up to June, 2020. Two independent reⅥewers performed literature screening and data extraction according to the inclusion and exclusion criteria. Then, Meta-analysis was performed using Revman 5.3 software. Results:A total of 5 articles were included, with a total of 1884 subjects.The results of the study showed that the rate of lymph node metastasis in PTMC Ⅵb area was 10.8% (203/1884). The risk factors for metastasis included patients' age <45 years old, male, right lobe tumor Diameter ≥0.5 cm, invading the envelope, Ⅵa lymph node metastasis. Conclusion:Ⅵb lymph node dissection is recommended when there exists age<45 years, male sex, right lobe tumor≥0.5 cm, capsular invasion or Ⅵa lymph node metastasis.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Carcinoma Papilar/cirurgia , Humanos , Linfonodos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Nervo Laríngeo Recorrente , Estudos Retrospectivos , Fatores de Risco , Glândula Tireoide , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
6.
Artigo em Chinês | MEDLINE | ID: mdl-33794614

RESUMO

Objective:To investigate the clinical and ultrasonic features of papillary thyroid microcarcinoma (PTMC) and the risk factors of central lymph node metastasis (CLNM), to provide help for individualized treatment. Methods:One hundred and eighty-five patients with PTMC confirmed by surgery and pathology and underwent prophylactic CLN dissection were retrospectively analyzed. According to lymph node metastasis, patients were divided into metastasis group and non metastasis group. The size, shape, echo, aspect ratio, edge, protruding capsule, nodule location, calcification and calcification were analyzed. The relationship between clnm and ultrasonographic features, sex, age, single/multiple, whether or not with Hashimoto thyroiditis was analyzed. Results:Among 185 patients with PTMC, 55 cases had lymph node metastasis, and the metastasis rate was 30.0%. In univariate analysis, clnm of PTMC was significantly correlated with gender, age, tumor size, protruding capsule, type of calcification and single / multiple (all P<0.05). In multivariate logistic regression analysis, tumor size, single/multiple, protruding capsule, gender and age were the risk factors of clnm. According to the ROC curve, when the age was 49.5 years old and the mass size was 4.8 mm, the diagnostic test yoden index reached the maximum value. Conclusion:When the risk factors of male, ≤49.5 years old, tumor size≥4.8 mm, multiple and protruding capsule appeared in PTMC patients, preventive CLN clearance should be taken actively.


Assuntos
Neoplasias da Glândula Tireoide , Ultrassom , Carcinoma Papilar , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/diagnóstico por imagem
7.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 35(3): 272-273;281, 2021 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33794618

RESUMO

The rare entity of primary T-cell lymphoma of thyroid gland may pose great diagnostic challenges to the clinician. We report a case of malignant T-cell lymphoma of the thyroid gland that developed in a 36-year-old man with a past history of Hashimoto's thyroiditis. The chief complaint was a rapidly growing neck mass and pressure symptoms. This man, diagnosed with Hashimoto's thyroiditis for the previous several years. CT and ultrasonographic examination revealed a diffuse large thyroid gland with cervical lymphadenopathy. It was suspected that thyroid lymphoma involved regional lymph nodes. Fine needle aspiration cytology diagnosed chronic thyroiditis, and ultrasound-guided core needle biopsy was performed. Finally, peripheral T cell lymphoma was diagnosed.


Assuntos
Doença de Hashimoto , Linfoma de Células T , Neoplasias da Glândula Tireoide , Adulto , Biópsia com Agulha de Grande Calibre , Doença de Hashimoto/diagnóstico por imagem , Humanos , Masculino , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia de Intervenção
9.
Int J Mol Sci ; 22(4)2021 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-33669943

RESUMO

Space travel has always been the man's ultimate destination. With the ability of spaceflight though, came the realization that exposure to microgravity has lasting effects on the human body. To counteract these, many studies were and are undertaken, on multiple levels. Changes in cell growth, gene, and protein expression have been described in different models on Earth and in space. Extracellular vesicles, and in particular exosomes, are important cell-cell communicators, being secreted from almost all the cells and therefore, are a perfect target to further investigate the underlying reasons of the organism's adaptations to microgravity. Here, we studied supernatants harvested from the CellBox-1 experiment, which featured human thyroid cancer cells flown to the International Space Station during the SpaceX CRS-3 cargo mission. The initial results show differences in the number of secreted exosomes, as well as in the distribution of subpopulations in regards to their surface protein expression. Notably, alteration of their population regarding the tetraspanin surface expression was observed. This is a promising step into a new area of microgravity research and will potentially lead to the discovery of new biomarkers and pathways of cellular cross-talk.


Assuntos
Exossomos/metabolismo , Voo Espacial , Neoplasias da Glândula Tireoide/metabolismo , Ausência de Peso , Antígenos CD/metabolismo , Linhagem Celular Tumoral , Fluorescência , Humanos , Interferometria , Tamanho da Partícula
11.
Endocr Pract ; 27(4): 306-311, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33645517

RESUMO

OBJECTIVE: To compare the thyroid autoantibody status of patients with papillary thyroid cancer (PTC) and benign nodular goiter as well as possible associations between thyroid autoantibodies and clinicopathologic features of PTC. METHODS: A total of 3934 participants who underwent thyroidectomy were enrolled in this retrospective study. Patients were divided into PTC and benign nodule groups according to pathological diagnosis. Based on the preoperative serum antibody results, PTC patients were divided into thyroid peroxidase antibody (TPOAb)-positive, thyroglobulin antibody (TgAb)-positive, dual TPOAb- and TgAb-positive, or antibody-negative groups. RESULTS: Of the 3934 enrolled patients, 2926 (74.4%) were diagnosed with PTC. Multivariate regression analyses suggested that high thyroid-stimulating hormone levels (adjusted odds ratio [OR] = 1.732, 95% CI [1.485-2.021], P < .001), positive TgAb (adjusted OR = 1.768, 95% CI [1.436-2.178], P < .001), and positive TPOAb (adjusted OR = 1.452, 95% CI [1.148-1.836], P = .002) were independent risk factors for predicting malignancy of thyroid nodules. Multinomial multiple logistic regression analyses indicated that positive TPOAb alone was an independent predictor of less central lymph node metastasis in PTC patients (adjusted OR = 0.643, 95% CI [0.448-0.923], P = .017), whereas positive TgAb alone was significantly associated with less extrathyroidal extension (adjusted OR = 0.778, 95% CI [0.622-0.974], P = .028). PTC patients with dual-positive TPOAb and TgAb displayed a decreased incidence of extrathyroidal extension (adjusted OR = 0.767, 95% CI [0.623-0.944], P = .012) and central lymph node metastasis (adjusted OR = 0.784, 95% CI [0.624-0.986], P = .037). CONCLUSION: Although preoperative positive TPOAb and TgAb are independent predictive markers for PTC, they are also associated with better clinicopathologic features of PTC.


Assuntos
Tireoglobulina , Neoplasias da Glândula Tireoide , Autoanticorpos , Humanos , Iodeto Peroxidase , Estudos Retrospectivos , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia
12.
Endocr Pract ; 27(4): 342-347, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33715818

RESUMO

OBJECTIVE: Our objective was to analyze the effect of radioiodine (RAI) therapy on parathyroid hormone (PTH) secretion. METHODS: A total of 137 patients were included and divided into 2 groups based on pretherapy PTH levels. The residual thyroid tissue volume was classified into 4 grades (0-3), and a value of 0 indicated that there was no apparent residual tissue. We analyzed the PTH level changes among different time points in each group and the factors that could predict the PTH level changes. RESULTS: In 113 patients with normal parathyroid gland function, the PTH level at baseline, 1 day, 7 days, 1 month, 3 months, and 6 months after RAI therapy did not show any significant difference; in 24 patients with decreased parathyroid gland function, the level of PTH immediately decreased after the implementation of RAI therapy but gradually returned to a pre-RAI therapy level within 6 months. On the seventh day after therapy, the mean value of PTH in patients with a residual thyroid tissue volume of extent of 0/1 was 8.0 ± 2.3 pg/mL, which was significantly higher than that in patients with a residual thyroid tissue volume of extent of 2/3 (P = .011). Similar phenomena were observed 1 month, 3 months, and 6 months after therapy. CONCLUSION: RAI therapy had a significant transient adverse effect on parathyroid gland function in patients with decreased PTH secretion pretherapy, and the extent was associated with the amount of residual thyroid tissue.


Assuntos
Radioisótopos do Iodo , Neoplasias da Glândula Tireoide , Humanos , Radioisótopos do Iodo/uso terapêutico , Glândulas Paratireoides , Hormônio Paratireóideo , Estudos Prospectivos , Neoplasias da Glândula Tireoide/radioterapia
13.
BMC Surg ; 21(1): 127, 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33750374

RESUMO

BACKGROUND: Gasless trans-axillary endoscopic thyroidectomy (GTAET) has satisfactory cosmetic effects for the patients who have benign goiter and small thyroid carcinoma, however the complications of this surgical procedure have not been fully documented. Ipsilateral hypoglossal nerve palsy (IHNP) associated with GTAET has never been reported before. CASE PRESENTATION: A 33-year old male patient presented with a 4 × 5 mm solid thyroid nodule in the right lobe. Papillary thyroid carcinoma was confirmed by the fine needle aspiration. He had strong cosmetic demand, therefore GTAET for right lobectomy and central cervical lymphadenectomy was performed in a supine position with cervical extension. Six hours after the operation, he developed tongue deviation to the right side, speech and swallowing difficulties, indicating IHNP. Head and cervical MRI showed no abnormality. The intravenous steroid was used for three days, and oral vitamin B1 and mecobalamin was prescribed for 1 month. Nine days after surgery, he was discharged. Three months after the operation, all the symptoms were completely resolved. CONCLUSIONS: To the best of the authors' knowledge, this is the first case of IHNP after GTAET, which will be valuable to add our knowledge to diagnose and treat rare complications of GTAET.


Assuntos
Endoscopia , Doenças do Nervo Hipoglosso , Neoplasias da Glândula Tireoide , Tireoidectomia , Adulto , Endoscopia/efeitos adversos , Endoscopia/métodos , Humanos , Doenças do Nervo Hipoglosso/diagnóstico , Doenças do Nervo Hipoglosso/etiologia , Masculino , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos
14.
Endocr Pract ; 27(3): 174-184, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33779552

RESUMO

OBJECTIVES: To provide a clinical disease state review of recent relevant literature and to generate expert consensus statements regarding the breadth of pediatric thyroid cancer diagnosis and care, with an emphasis on thyroid surgery. To generate expert statements to educate pediatric practitioners on the state-of-the-art practices and the value of surgical experience in the management of this unusual and challenging disease in children. METHODS: A literature search was conducted and statements were constructed and subjected to a modified Delphi process to measure the consensus of the expert author panel. The wording of statements, voting tabulation, and statistical analysis were overseen by a Delphi expert (J.J.S.). RESULTS: Twenty-five consensus statements were created and subjected to a modified Delphi analysis to measure the strength of consensus of the expert author panel. All statements reached a level of consensus, and the majority of statements reached the highest level of consensus. CONCLUSION: Pediatric thyroid cancer has many unique nuances, such as bulky cervical adenopathy on presentation, an increased incidence of diffuse sclerosing variant, and a longer potential lifespan to endure potential complications from treatment. Complications can be a burden to parents and patients alike. We suggest that optimal outcomes and decreased morbidity will come from the use of advanced imaging, diagnostic testing, and neural monitoring of patients treated at high-volume centers by high-volume surgeons.


Assuntos
Endocrinologia , Neoplasias da Glândula Tireoide , Criança , Consenso , Diagnóstico por Imagem , Humanos , Neoplasias da Glândula Tireoide/cirurgia , Estados Unidos
15.
Endocr Pract ; 27(3): 185-190, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33779553

RESUMO

OBJECTIVE: Thionamides (methimazole and propylthiouracil) have been associated with common side effects, such as rash and pruritus, and rare but serious adverse effects, such as agranulocytosis and hepatotoxicity. Methimazole is usually the preferred thionamide for the treatment of hyperthyroidism if the patient is not planning to conceive or not in the first trimester of pregnancy, given the less frequent dosing and lower risk of hepatotoxicity. In patients who experience rash or itching when treated with methimazole, switching them to propylthiouracil is one treatment option. Here we report our experience regarding desensitization to methimazole to allow continued treatment with methimazole as an alternative management option. METHODS: We conducted a retrospective chart review of patients at a single institution who had side effects to methimazole and who were desensitized to methimazole under the supervision of an allergist. A total of 7 patients were included who experienced side effects to methimazole that did not include agranulocytosis or hepatotoxicity. RESULTS: All 7 patients were able to take methimazole for treatment of their hyperthyroidism, either for continued medical therapy or as a bridge to definitive therapy, with either surgery or radioactive iodine treatment. CONCLUSION: Under the supervision of an allergist, desensitization to methimazole is an option for treating patients who experience side effects to methimazole (excluding agranulocytosis and hepatotoxicity).


Assuntos
Hipertireoidismo , Neoplasias da Glândula Tireoide , Antitireóideos/efeitos adversos , Feminino , Humanos , Radioisótopos do Iodo , Metimazol/efeitos adversos , Gravidez , Propiltiouracila/efeitos adversos , Estudos Retrospectivos
16.
Endocr Pract ; 27(3): 216-222, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33779554

RESUMO

OBJECTIVE: The sensitivity of thyroglobulin (Tg) to detect differentiated thyroid cancer recurrence increases with the rise of the thyrotropin level. Since 1998, recombinant human thyrotropin (rhTSH) has been commercially available for this purpose. The traditional protocol for using rhTSH calls for 2 daily injections of rhTSH, followed by the measurement of Tg 72 hours after the second dose. In this study, we compared the performance of rhTSH-stimulated Tg (rhTSH-Tg) obtained at 48 versus 72 hours after the second rhTSH. METHODS: A retrospective chart review of 1088 patients with thyroid cancer was conducted. Two hundred forty-nine rhTSH-Tg, without measurable Tg antibody, were identified, 134 of which were obtained at 48 hours (4-day test) and 115 at 72 hours after the second rhTSH (5-day test). The ability of rhTSH-Tg to identify recurrence or persistence of differentiated thyroid cancer and to predict response to therapy at the end of the study period was compared between the 2 groups. RESULTS: The median duration of follow-up was 8 years. When recurrent/persistent cancer was present based on a combination of unstimulated Tg, imaging and procedures, the ratio of rhTSH-Tg ≥ 1 ng/mL was similar in both groups (P value: .153). The negative predictive value of rhTSH-Tg to predict response to therapy over the long term was 95% or higher in 4-day and 5-day tests. CONCLUSION: Tg measured 48 and 72 hours after the second dose of rhTSH may provide a comparable prognostic value. These results encourage further studies to identify new protocols to obtain rhTSH-Tg.


Assuntos
Tireoglobulina , Neoplasias da Glândula Tireoide , Humanos , Recidiva Local de Neoplasia/diagnóstico , Prognóstico , Proteínas Recombinantes , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/tratamento farmacológico , Tireotropina
17.
Endocr Pract ; 27(3): 223-227, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33779555

RESUMO

OBJECTIVE: The Bethesda System for Reporting Thyroid Cytopathology is a uniform method used worldwide to report thyroid fine-needle aspiration (FNA) outcomes. This study focuses on the Nondiagnostic/Unsatisfactory category, designated as Bethesda1 (B1). The documented risk of malignancy for B1 nodules can vary significantly, implying this category is not homogenous and might be composed of different subtypes. Our hypothesis was that B1 subgroups (blood only, insufficient thyrocytes, cyst content) will vary in their malignancy rate. METHODS: The study design was observational and retrospective. The study population included 154 patients in the Galilee Medical Center who underwent FNA examination of the thyroid gland from 2013-2018 and had a B1 result. We looked at the final diagnosis of malignant or benign for patients who underwent surgery and calculated the malignancy rate for each subgroup. RESULTS: Malignancy rates were higher in the Blood subgroup than in the other subgroups, and higher in the Thyrocytes subgroup than in the Cyst subgroup (P < .05). All malignancies were papillary thyroid carcinomas. There was no significant difference in the malignancy rate when we further divided the B1 samples into 2 groups based on the presence of epithelial cells. Many repeat FNA tests resulted in a different B1 subgroup. CONCLUSION: The different malignancy rates suggest that individual management approaches should be considered for each B1 subgroup.


Assuntos
Neoplasias da Glândula Tireoide , Nódulo da Glândula Tireoide , Biópsia por Agulha Fina , Humanos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico
18.
Endocr Pract ; 27(3): 228-235, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33779556

RESUMO

OBJECTIVE: Guidelines endorse active surveillance for low-risk papillary thyroid carcinoma (PTC), but this is not commonly utilized. Those with limited life expectancy due to age and comorbidity may be best suited for active surveillance given their higher likelihood of other-cause mortality compared to disease-specific mortality. METHODS: Surveillance, epidemiology, and end results-Medicare was queried for patients >65 years with T1, N0, M0 PTC who received surgery. We evaluated the overall survival, disease-specific survival (DSS), and survival based on tumor size and extent of surgery (hemi- vs total thyroidectomy). We created a competing risk model to identify the cumulative incidence of other-cause mortality to define patient groups with life expectancies of less than 10 and 15 years. RESULTS: A total of 3280 patients were included. The 20-year overall survival and DSS were 38.2% and 98.5%, respectively. DSS was comparable between patients based on tumor size and surgery. The cancer cohort had better survival compared to matched controls (P < .001). Life expectancy was less than 15 years for any patient aged >80 years regardless of Charlson comorbidity score (CCS ≥ 0) and any patient aged >70 years with CCS ≥ 1. Life expectancy was less than 10 years for any patient a >80 years with CCS ≥ 1 and aged >70 years with CCS ≥ 3. CONCLUSION: Older patients with comorbidities have limited life expectancies but excellent DSS from low-risk PTC. Incorporating life expectancy into management decisions and guidelines would likely promote selection of less aggressive management for populations that are most suited for this approach.


Assuntos
Expectativa de Vida , Neoplasias da Glândula Tireoide , Idoso , Humanos , Medicare , Câncer Papilífero da Tireoide/epidemiologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Estados Unidos/epidemiologia
19.
Anticancer Res ; 41(3): 1555-1561, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33788749

RESUMO

BACKGROUND/AIM: Anaplastic thyroid carcinoma (ATC) is the least common but most lethal of thyroid cancer, despite various therapeutic options, with limited efficacy. In order to help therapeutic decision-making, the purpose of this study was to develop a new prognostic score providing survival estimates in patients with ATC. PATIENTS AND METHODS: Based on a multivariate analysis of 149 retrospectively analyzed patients diagnosed with ATC from 1968 to 2017 at a referral center, a propensity score was developed. A model was generated providing survival probability at 6 months and median overall survival estimates. RESULTS: The median survival was 96 days. The overall survival rate was 35% at 6 months, 20% at 1 year and 13% at 2 years. Stepwise Cox regression revealed that the most appropriate death prediction model included metastatic spread, tumor size and age class as explanatory variables. This model made it possible to define three categories of patients with different survival profiles. CONCLUSION: Distant metastasis, age and primary tumor size are strong independent factors that affect prognosis in patients with ATC. Using these significant pretreatment factors, we developed a score to predict survival in these patients with poor prognosis.


Assuntos
Carcinoma Anaplásico da Tireoide/mortalidade , Neoplasias da Glândula Tireoide/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico , Pontuação de Propensão , Modelos de Riscos Proporcionais , Sistema de Registros , Estudos Retrospectivos , Carcinoma Anaplásico da Tireoide/tratamento farmacológico , Carcinoma Anaplásico da Tireoide/patologia , Neoplasias da Glândula Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/patologia , Adulto Jovem
20.
Anticancer Res ; 41(3): 1683-1691, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33788766

RESUMO

BACKGROUND/AIM: Lenvatinib is standard therapy for radioiodine-refractory differentiated thyroid cancer (RR-DTC), although the optimal timing for starting treatment is still controversial. The aim of this study was to evaluate the prognostic impact of baseline tumour size (BTS) in patients with RR-DTC treated with lenvatinib. PATIENTS AND METHODS: Fifty-one RR-DTC patients who had at least one measurable lesion and treated with lenvatinib were retrospectively analysed. BTS was defined as the sum of the longest dimensions of all measurable target lesions. RESULTS: Median progression-free survival (PFS) and overall survival (OS) in the larger BTS (≥42 mm) group were shorter than those in the smaller (<42 mm) group. This result was more significant in patients with fast-growing tumours. BTS was an independent prognostic factor for both PFS and OS. CONCLUSION: Starting lenvatinib at BTS <42 mm should be recommended to achieve good treatment outcomes in patients with RR-DTC.


Assuntos
Radioisótopos do Iodo/uso terapêutico , Compostos de Fenilureia/uso terapêutico , Quinolinas/uso terapêutico , Neoplasias da Glândula Tireoide/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia
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