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1.
J Surg Oncol ; 123(1): 149-155, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33063318

RESUMO

BACKGROUND AND OBJECTIVES: Total laryngectomy in thyroid cancer is controversial. Functional and oncologic outcomes are needed to inform surgical indications in this population. METHODS: A retrospective cohort study was performed at a tertiary referral center from 1997 to 2018 to identify patients with a diagnosis of thyroid carcinoma who underwent total laryngectomy. Complications, survival outcomes, and functional outcomes were analyzed. RESULTS: Thirty patients met the inclusion criteria. The mean age was 62 years (range, 30-88 years) and the male-to-female ratio was 1:2.75. The most common diagnosis was well-differentiated thyroid cancer (53.3%), followed by poorly differentiated (30%) and anaplastic (16.7%). Total laryngectomy was performed with a 10% rate of Clavien-Dindo Grade III-V complications. The median overall survival was 40 months (range, 1-237). Five-year overall survival was 39.5% and disease-specific survival was 51.1%. Locoregional control was achieved in 80.0% of patients. Twelve months postoperatively, 100% of surviving patients were taking oral intake and 86.4% had a self-reported functional voice. CONCLUSION: Total laryngectomy for locally advanced thyroid cancer is safe and provides acceptable rates of locoregional control. While the risk of distant metastases remains high, advances in systemic therapy may justify aggressive local control strategies to improve the quality of life.


Assuntos
Neoplasias Laríngeas/mortalidade , Laringectomia/mortalidade , Recidiva Local de Neoplasia/mortalidade , Complicações Pós-Operatórias/mortalidade , Qualidade de Vida , Neoplasias da Glândula Tireoide/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia
3.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(6): 1098-1101, 2020 Dec 18.
Artigo em Chinês | MEDLINE | ID: mdl-33331320

RESUMO

OBJECTIVE: To summarize and analyze the clinical data and prognosis of the patients with Hürthle cell tumor (HCT) in order to raise the clinicians' awareness of the disease. METHODS: The clinical data on patients with histopathologically proven HCT, without other thyroid carcinomas, were collected retrospectively in Peking University First Hospital from January 2001 to February 2017. All the patients underwent surgery due to thyroid nodules. The follow-up information was also collected. RESULTS: A total of 100 patients were enrolled in the current study. All of them were diagnosed with Hürthle cell adenoma (HCA). There were 77 females and 23 males, with the male-to-female ratio of 1 : 3.3. The average age of these patients was (52±14) years at the time of operation. Fifty-one patients were found their thyroid nodules accidentally by ultrasonography during their health check-ups. 69.4% of the 49 symptomatic patients presented with painless cervical nodules. 83.0% HCA patients were combined with multinodular goiters (MNGs). 88.4% (76/86) patients were euthyroid and 53.8% (21/39) had increasing thyroglobulin levels. The mean longest diameter of HCAs was (3.2±1.5) cm (range: 0.9-7.3 cm) on ultrasonography. There were a series of sonographic features of HCA, such as larger, solidity, hypoecho, a smooth outline, intranodular vascularization, perinodular vascularization, absence of calcification in nodules and absence of enlarged cervical lymph nodes. Compared with the histological diagnosis, the diagnostic accuracy by frozen section (FS) during operation was 97.4%. Twenty-nine patients were followed up with an average period of (49.2±22.1) months and none of them had local recurrence or cervical lymph node metastasis. Six patients accepted thyroid hormone replacement treatment and one had thyrotoxicosis due to over-dose. CONCLUSION: HCA is more common in women. It is often found accidentally by ultrasonography during their health check-ups or presented with painless cervical nodules. It is combined with MNG frequently. HCA exhibits numerous sonographic features but not unique. FS during operation is a reliable method to identify HCA with high diagnostic accuracy. Patients with thyroid hormone administration should be monitored for thyroid function after thyroid surgery.


Assuntos
Adenoma Oxífilo , Neoplasias da Glândula Tireoide , Adenoma Oxífilo/diagnóstico , Adenoma Oxífilo/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Células Oxífilas , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia
4.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(5): 632-639, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33131518

RESUMO

Objective To evaluate the factors affecting health-related quality of life (HRQoL) of patients with thyroid papillary microcarcinoma (PTMC) after ultrasound-guided radiofrequency ablation (RFA).Methods The clinical data of 100 patients with PTMC who underwent reexamination after RFA in the Ultrasound Department of our center from October to December 2019 were retrospectively analyzed.Demographic information was collected.SF-36 and Thyroid Cancer-specific Health-related Quality of Life Questionnaire scales were used to assess patients' quality of life and thyroid-related specific symptoms.The SF-36 scale includes two general domains including physical component summary (PCS) and mental component summary (MCS).The impacts of demographic characteristics and thyroid-related symptoms after RFA on PCS and MCS scores were further analyzed.Results Univariate analysis and correlation analysis showed that the PCS scores in quality of life of PTMC patients were related to sex, neuromuscular, voice, concentration, sympathetic nerve, and throat/mouth complaints, psychological state, sensory symptoms, scar, chills, tingling, and headache (all P<0.1);and the MCS scores were associated with education level, residence, neuromuscular, voice, concentration, sympathetic nerve, and throat/mouth complains, psychological state, sensory symptoms, scar, chills, tingling, and headache (all P<0.1).Multivariate regression analysis showed that the PCS scores were only associated with sex and the neuromuscular and throat/mouth complains and the psychological state.The regression equation was:PCS=110.367-8.025×sex-0.213×psychological state-0.280×neuromuscular complain-0.278×throat/mouth complain.In contrast, the MCS scores were only associated with the psychological state and the throat/mouth and concentration complains, with the regression equation being:MCS=91.323-0.237×psychological state-0.437×throat/mouth-0.304×concentration.Conclusions The main risk factors affecting the quality of life of PTMC patients after ultrasound-guided RFA were female gender, psychological burden, lack of attention, and symptoms in neuromuscular system and throat/mouth.Therefore, preoperative explanations should be made according to the relevant symptoms that the patients may report, and psychological interventions should be offered after RFA to improve the quality of life of PTMC patients after treatment.


Assuntos
Carcinoma Papilar , Qualidade de Vida , Ablação por Radiofrequência , Neoplasias da Glândula Tireoide , Carcinoma Papilar/cirurgia , Feminino , Humanos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia
5.
PLoS One ; 15(11): e0223627, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33170845

RESUMO

OBJECTIVE: To assess the efficiency of the carbon nanoparticles (CNs) in lymph node identification and parathyroid gland (PG) protection during thyroidectomy for non-anaplastic thyroid carcinoma (N-ATC). METHODS: A systematic literature search for relevant literatures published up to December 2018 in PubMed, EMBASE, Web of Science and Cochrane Library was performed. Both English and Chinese literatures were retrieved and analyzed. Randomized controlled trials or nonrandomized controlled trials comparing the use of CNs with the use of methylene blue or a blank control in patients undergoing thyroidectomy for N-ATC were enrolled in this study. The primary outcomes included the number of lymph nodes harvested, the rate of lymph nodes involved, and the rates of accidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Weighted mean differences (WMDs), odds ratios (ORs) and risk differences (RDs) were calculated for the dichotomous outcome variables. Between study heterogeneity was tested using the Q tests and the I2 statistics. All analyses were performed using Review Manager (version 5.3.5). RESULTS: 25 studies comprising 3266 patients were included in this analysis. The total number of lymph nodes harvested in the CNs groups was significantly higher than that in the control groups (WMD, 2.36; 95% CI, 1.40 to 3.32; P <0.01). Administrating CNs was associated with a lower incidence of accidental PG removal (OR = 0.28, 95% CI = 0.21 to 0.37, P<0.01) and lower rates of both postoperative transient hypoparathyroidism (OR = 0.46, 95% CI = 0.33 to 0.64, P <0.01) and transient hypocalcemia (OR = 0.46, 95% CI = 0.33 to 0.65, P <0.01). No significant difference was found concerning lymph node metastatic rates between CNs group and control group. Subgroup analysis indicated that the application of CNs in reoperation thyroidectomy reduced both the rate of transient hypoparathyroidism (OR = 0.21, 95% CI = 0.06 to 0.75, P = 0.02) and the possibility of accidental PGs removal (OR = 0.21, 95% CI = 0.07 to 0.62, P = 0.004, P<0.05). CONCLUSIONS: The application of CNs in thyroidectomy for N-ATC results in higher number of lymph node harvested and better PG protection during both initial and reoperation thyroidectomy.


Assuntos
Carbono/química , Complicações Intraoperatórias/prevenção & controle , Linfonodos/patologia , Nanopartículas/administração & dosagem , Glândulas Paratireoides/lesões , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/efeitos adversos , Humanos , Nanopartículas/química , Neoplasias da Glândula Tireoide/patologia
6.
Artigo em Chinês | MEDLINE | ID: mdl-33254308

RESUMO

In recent years, with the wide application of ultrasound in health examination, the incidence of papillary thyroid microcarcinoma(PTMC) is increasing rapidly. There is more controversy about whether prophylactic central lymph node dissection(PCND) should be performed in PTMC patients with clinical lymph node negative(cN0). Some clinical and pathological factors were associated with central lymph node metastasis in patients with PTMC. This paper review the risk factors for predicting central lymph node metastasis so as to screen high-risk PTMC patients who need to receive PCND, and guide clinicians to choose reasonable individualized surgery.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Humanos , Linfonodos , Metástase Linfática , Estudos Retrospectivos , Fatores de Risco , Neoplasias da Glândula Tireoide/cirurgia
7.
Harefuah ; 159(11): 809-814, 2020 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-33210851

RESUMO

INTRODUCTION: Anaplastic thyroid cancer (ATC) is accepted as transformation of a pre-existing glandular papillary thyroid carcinoma (PTC). Anaplastic transformation within a neck PTC metastasis is extraordinary. We present a patient with an exceptional timeline of an untreated neck PTC recurrence and its rare anaplastic transformation. In 2010, a 68-year-old patient with PTC and neck metastasis, (Stage III/Stage II 7th/8th AJCC, respectively) underwent thyroidectomy and neck dissection followed with radioiodine treatment (150 mCi). In 2012, he received an additional 150 mCi following an iodine scan suggested right neck recurrence. In late 2013, ultrasound revealed a 2.3 cm, suspicious right neck lymph node (level II-III). Only in 2017, after growing to 2.7 cm, the patient consented to undergoing a fine needle aspiration. PTC was verified, yet intervention was declined. In June 2018, he presented with a rapid growing neck mass occupying right levels II,III, carotid artery encasement and jugular vein involvement. A large bore needle biopsy revealed a highly malignant tumor, surrounded by necrosis, positive for cytokeratin (CK MNF 116), thyroid lineage marker (PAX8), negative for TTF-1 and thyroglobulin, i.e., ATC. The patient passed away in November 2018. In comparison, a patient with an identical primary staging received equivalent primary treatment. Yet, among the PTC nodular metastasis found in the neck specimen, one had ATC transformation. Over a 12-year follow-up there was no recurrence. To conclude, untreated PTC neck recurrence may have long-term consequences, such as rare anaplastic transformation. Although a case study, it advocates treating PTC neck recurrence.


Assuntos
Carcinoma Papilar , Neoplasias da Glândula Tireoide , Idoso , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/cirurgia , Humanos , Radioisótopos do Iodo , Linfonodos , Metástase Linfática , Masculino , Recidiva Local de Neoplasia , Câncer Papilífero da Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
8.
Ther Umsch ; 77(9): 457-465, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33146093

RESUMO

Surgical aspects of multiple endocrine neoplasia type 2 Abstract. The multiple endocrine neoplasia type 2 (MEN 2) is an autosomal-dominant hereditary tumor-syndrome. The subtypes show clinically specific disease manifestations. In MEN 2a, medullary thyroid carcinoma, pheochromocytoma, and primary hyperparathyroidism occur, while in familial medullary thyroid carcinoma, the medullary thyroid carcinoma is the only clinical manifestation. In MEN 2b medullary thyroid carcinoma and pheochromocytoma are the clinically dominant manifestations. All MEN-2-specific disease is treated primarily surgically. It is of utmost importance to identify the individual gene carrier in order to enable timely intervention before malignancy develops (prophylactic surgery) or to reach surgical cure as well as to identify relatives that are MEN 2 gene-carriers. Typical MEN 2 manifestations and clinical signs important for surgery are outlined. In case MEN 2 is suspected, it may be vital to exclude underlying pheochromocytoma before diagnostic or surgical interventions are started to forego hyperadrenergic crisis unprepared.


Assuntos
Neoplasias das Glândulas Suprarrenais , Carcinoma Medular , Neoplasia Endócrina Múltipla Tipo 2a , Neoplasia Endócrina Múltipla Tipo 2b , Neoplasias da Glândula Tireoide , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/cirurgia , Humanos , Neoplasia Endócrina Múltipla Tipo 2a/diagnóstico , Neoplasia Endócrina Múltipla Tipo 2a/genética , Neoplasia Endócrina Múltipla Tipo 2a/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/cirurgia
9.
Ther Umsch ; 77(9): 427-431, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33146095

RESUMO

The ablative radioiodine therapy of differentiated thyroid carcinoma Abstract. In the treatment of differentiated thyroid carcinoma, ablative radioiodine therapy holds a key role in curative intended therapy after total thyroidectomy and consideration of the appropriate indication. The benefit of ablation therapy extends from the completion of initial staging via post-therapeutic whole body scintigraphy via optimization of the value of thyreoglobuline measurement and implementation of dynamic risk stratification in follow-up care to decreasing the rate of tumor recurrence and mortality of thyroid cancer. Within this article, we discuss aims, indication, side reactions and specifics in preparation and execution of ablative radioiodine therapy.


Assuntos
Radioisótopos do Iodo , Neoplasias da Glândula Tireoide , Humanos , Radioisótopos do Iodo/uso terapêutico , Recidiva Local de Neoplasia , Cintilografia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/radioterapia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
10.
PLoS One ; 15(11): e0241597, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33147258

RESUMO

Cytologic diagnosis of thyroid follicular adenoma and carcinoma, and Hurthle cell adenoma and carcinoma (FACHAC) is challenging due to cytomorphologic features that overlap with other follicular-patterned lesions. This study was designed to analyze diagnostic categories (DCs) of preoperative fine needle aspiration cytology (FNAC) of histologically proven thyroid FACHACs to evaluate under- or misdiagnoses in FNAC and elucidate potential causes for such phenomena. A total of 104 thyroid nodules with preoperative FNAC which were diagnosed as FACHAC in resection specimens were included in this study. Of these, 66 cases had also undergone thyroid core needle biopsy (CNB); FNAC and CNB DCs were compared in these cases. Various cytologic and histologic parameters were compared between the nodules with different FNAC DCs. After a review of FNAC slides, DCs were re-assigned in 20 (19.2%) out of the 104 cases. Of the 66 cases with CNB diagnoses which were mostly classified as lower DCs in FNAC, 31 (47.0%) were diagnosed as suspicious for a follicular neoplasm in CNB. Cases which were underdiagnosed in FNACs were associated with lower cellularity, predominant macrofollicular pattern, absence of microfollicles arranged in trabecular pattern, and absence of transgressing vessels in cytology smears. High cellularity, microfollicles arranged in trabecular pattern, nucleolar prominence, and large cell dysplasia were more frequently found in malignancy than in benign neoplasm. In conclusion, thyroid FACHACs seem to be under- and misdiagnosed in preoperative FNAC. Innate characteristics of the nodules were associated with under-diagnosis as well as the quality of the FNAC specimens. Certain cytomorphologic features can be helpful in differentiating malignancy among FACHACs.


Assuntos
Adenocarcinoma Folicular/patologia , Adenoma Oxífilo/patologia , Erros de Diagnóstico/estatística & dados numéricos , Neoplasias da Glândula Tireoide/patologia , Adenocarcinoma Folicular/cirurgia , Adenoma Oxífilo/cirurgia , Biópsia por Agulha Fina/normas , Erros de Diagnóstico/prevenção & controle , Feminino , Humanos , Masculino , Período Pré-Operatório , Neoplasias da Glândula Tireoide/cirurgia
11.
Khirurgiia (Mosk) ; (11): 19-24, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33210503

RESUMO

OBJECTIVE: To develop a non-invasive method for differential diagnosis of thyroid nodes. MATERIAL AND METHODS: Optical sonography was made in 623 patients with thyroid nodes including 374 women (60%) and 249 men (40%) aged 19-79 years (mean 64±15 years). All patients underwent ultrasound-assisted fine-needle aspiration biopsy. Cytological examination revealed cystic colloidal goiter (CCG) in 317 (51%) cases, follicular adenoma (FA) - in 197 (31.5%) cases, thyroid cancer - in 109 (17.5%) cases. All patients underwent surgery. Histological examination verified cystic colloidal goiter in 354 (56.8%) cases, follicular adenoma - 75 (12.0%) cases, thyroid cancer - 194 (31.2%) cases. Follicular cancer was diagnosed in 120 cases, papillary cancer - 70 cases, undifferentiated cancer - 4 cases. RESULTS AND CONCLUSION: Sensitivity, specificity and accuracy of optical ultrasonography in differential diagnosis of thyroid nodules were estimated. Sensitivity of ultrasonography in the diagnosis of thyroid malignancies was 0.75, specificity 0.62, accuracy 0.67. Sensitivity of ultrasonography in the diagnosis of thyroid adenoma was 0.85, specificity 0.62, accuracy 0.73. Sensitivity of optical sonography in the diagnosis of CCH was 0.62, specificity 0.61, accuracy 0.7. Optical sonography ensures differentiation of CCH and follicular adenoma, CCH and thyroid cancer, follicular adenoma and thyroid cancer. Sensitivity, specificity and accuracy of ultrasonography in differential diagnosis of FA and thyroid cancer are 0.85, 0.62, 0.73 and 0.8, 0.71, 0.7, respectively.


Assuntos
Nódulo da Glândula Tireoide , Adulto , Idoso , Biópsia por Agulha Fina , Diagnóstico Diferencial , Feminino , Humanos , Biópsia Guiada por Imagem , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/cirurgia , Ultrassonografia , Adulto Jovem
12.
Medicine (Baltimore) ; 99(42): e22783, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080749

RESUMO

RATIONALE: Anaplastic thyroid carcinoma (ATC) is a rare highly aggressive thyroid malignancy. Thyroid sclerosing mucoepidermoid carcinoma with eosinophilia is also a rare low grade malignant thyroid neoplasm. To date, comorbidity of these 2 tumors in the thyroid gland has not been reported in the English literature. PATIENT CONCERNS: Here, we present a case of a 67-year-old women with a 6-month history of mass of left neck. She complained of a painless mass in the right neck. DIAGNOSES: Based on histopathological examination of H&E stained sections, immunohistochemical staining assay and molecular tests, the patient was diagnosed with ATC combined with sclerosing mucoepidermoid carcinoma with eosinophilia. INTERVENTIONS: The patient underwent radical surgery for thyroid cancer. OUTCOMES: No complications, local recurrence or metastases were observed during a 1 year and 3 months follow-up after surgery. LESSONS: To the best of our knowledge, this is the first case report on ATC combined with sclerosing mucoepidermoid carcinoma with eosinophilia in the English literature. This condition can be easily misdiagnosed during thyroid fine needle cytology. Clinicians should perform morphological examination, immunohistochemistry and molecular tests on resected specimen to make a definitive diagnosis.


Assuntos
Carcinoma Mucoepidermoide/patologia , Eosinofilia/diagnóstico , Neoplasias Primárias Múltiplas/patologia , Carcinoma Anaplásico da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Idoso , Carcinoma Mucoepidermoide/cirurgia , Feminino , Humanos , Neoplasias Primárias Múltiplas/cirurgia , Esclerose , Carcinoma Anaplásico da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
13.
J Cancer Res Clin Oncol ; 146(12): 3297-3312, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33108513

RESUMO

PURPOSE: Robotic surgical system has been gradually applied in thyroid neoplasms as a novel treatment for years, with presenting some superiorities as well as limitations. To compare the effectiveness and safety of robotic surgery with open surgery for the patients with thyroid neoplasms, this review was conducted METHODS: We performed electronic search in CENTRAL, MEDLINE, EMBASE, CNKI, CBM, Opengray, and Sciencepaper Online databases and manual search in specific online databases and according to the reference list of relevant papers to get all the studies that compared the effectiveness and safety of robotic surgery with that of open surgery for patients with thyroid neoplasms. Last update was conducted in March 2020. Randomized-controlled trials, case-control studies, cohort studies, and cross-sectional surveys were all included. RESULTS: In this review, 59 studies were included: two RCTs, 15 NRSs, 40 cohort studies, and two cross-sectional studies. Robotic surgery was found to be associated with longer operative duration, less retrieved lymph nodes, higher postoperative thyroglobulin before radioactive iodine ablation, similar complication incidence but less blood loss, better functional recovery, and higher cosmetic satisfaction compared to open surgery. CONCLUSIONS: Robotic surgery is a safe and feasible approach with remarkable superiority in reducing intraoperative damage and improving patients' quality of life compared to open surgery for thyroid neoplasms. Meanwhile, this procedure is also associated with long operative duration, insufficient removal of neck lymph nodes, which need to be given careful consideration.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Gerenciamento de Dados , Humanos , Complicações Pós-Operatórias , Qualidade de Vida , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/tendências , Neoplasias da Glândula Tireoide/epidemiologia , Tireoidectomia/tendências , Resultado do Tratamento
14.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 34(9): 836-839;843, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33040510

RESUMO

Objective:A prospective randomized controlled study of patients with thyroid papillary carcinoma requiring lateral neck dissection was conducted to investigate the thoroughness, safety and cosmetic features of endoscope-assisted lateral neck dissection. Method:Patients who underwent total thyroidectomy, bilateral central lymph node dissection and unilateral lateral neck dissection for papillary thyroid cancer were randomly divided into two groups: endoscopic assisted group and open group, 18 cases in each group. The clinical characteristics, operation conditions, postoperative complications and aesthetic satisfaction of the two groups were compared. Result:There were no statistically significant differences between the endoscopic group and the open group in age, gender, tumor size, dissection side, operation time, postoperative hospital stay, number of lymph nodes to be dissected, number of metastatic lymph nodes, postoperative hoarseness, and hypoparathyroidism(P>0.05); No hematoma or lymphatic leakage occurred in the two groups after surgery, and no tumor recurrence or residual was found in the ultrasound review at 6 months after surgery. Serum Tg level in the endoscopic group was higher than that in the open group at 6 months after surgery, but the difference between the two groups was not statistically significant(P>0.05); The neck pain score at day 3 after operation, the neck numbness and discomfort score at month 1 after operation, and the aesthetic satisfaction score at 3 months after operation in the endoscope assisted group were better than that in the open group(P<0.05). Conclusion:Endoscope-assisted lateral neck dissection is safe, feasible and with excellent cosmetic effect for the treatment of lymph node metastasis in the lateral cervical region of papillary thyroid carcinoma.


Assuntos
Carcinoma Papilar , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide , Carcinoma Papilar/cirurgia , Humanos , Recém-Nascido , Linfonodos , Metástase Linfática , Esvaziamento Cervical , Estudos Prospectivos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia
15.
J Cancer Res Ther ; 16(5): 960-966, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004735

RESUMO

As a treatment option for cancer, thermal ablation has satisfactory effects on many types of solid tumors (such as liver and renal cancers). However, its clinical applications for the treatment of thyroid nodules and metastatic cervical lymph nodes are still under debate both in China and abroad. In 2015, the "Zhejiang Expert consensus on thermal ablation for thyroid benign nodules, microcarcinoma, and metastatic cervical lymph nodes (2015 edition)," was released by the Thyroid Cancer Committee of Zhejiang Anti-Cancer Association, China. To further standardize the application of thermal ablation for thyroid tumors, the Thyroid Tumor Ablation Experts Group of Chinese Medical Doctor Association has organized many seminars and finally produced a consensus to formulate the "Expert consensus workshop report: Guidelines for thermal ablation of thyroid tumors (2019 edition)."


Assuntos
Ablação por Cateter/métodos , Linfonodos/patologia , Recidiva Local de Neoplasia/terapia , Guias de Prática Clínica como Assunto/normas , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/cirurgia , Conferências de Consenso como Assunto , Humanos , Recidiva Local de Neoplasia/patologia , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia
16.
J Cancer Res Ther ; 16(5): 1056-1062, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004747

RESUMO

Context: We analyzed the clinical features and ultrasound image features of follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA). Aims: This study aimed to identify ultrasonographic differences and correlations between FTC and FTA. Meanwhile, ultrasonographic manifestations of thyroid follicular tumor were also retrospectively analyzed. Settings and Design: Using pathological results as the gold standard, the clinical and ultrasonic image characteristics of FTA and FTC were statistically analyzed, and the differences were analyzed. Materials and Methods: A total of 304 patients who were diagnosed with FTC or FTA by pathology after thyroidectomy from March 2009 to March 2018 were enrolled in this study. Their ultrasonic images were analyzed; image features were extracted and correlation analyses for these features were conducted. Differences in ultrasonic images between FTC and FTA were also compared. Statistical Analysis Used: Independent sample t-test; Wilcoxon rank sum test; A Chi-square test: Univariate and multivariate logistic regression analyses. Results: When performing ultrasound diagnosis, attention should be paid to identify FTC and FTA in terms of age, nodular goiter conditions, nodular boundary conditions, internal echo, calcification, blood flow signals, thyroid imaging reporting and data system (TI-RADS) grading and cystic solidity conditions. Moreover, a multivariate logistic regression showed that the boundaries were unclear, and cystic degeneration, TI-RADS, hypoecho, nodular goiter, macrocalcification and microcalcification were associated with FTC. Among them, macrocalcification is a protective factor for thyroid follicular tumors, and other indicators are risk factors. Conclusion: Ultrasound can provide valuable information for the identification of follicular neoplasms, but further research in this area is still necessary.


Assuntos
Adenocarcinoma Folicular/diagnóstico , Adenoma/diagnóstico , Diagnóstico Diferencial , Neoplasias da Glândula Tireoide/diagnóstico , Ultrassonografia/métodos , Adenocarcinoma Folicular/diagnóstico por imagem , Adenocarcinoma Folicular/cirurgia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Sistemas de Apoio a Decisões Clínicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos
17.
J Cancer Res Ther ; 16(5): 1077-1081, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004750

RESUMO

Aims: The role of prophylactic central neck dissection (CND) in the management of papillary thyroid carcinoma (PTC) is controversial. This study reports outcomes of an observational approach in PTC patients without clinical evidence of lymph node metastasis. Materials and Methods: Patients with PTC who had surgery (without prophylactic CND) between January 2000 and December 2008 were included in this study. Recurrence-free survival (RFS) and disease-specific survival (DSS) were calculated using the Kaplan-Meier method. Cox regression was used in multivariable models. Results: Out of 625 patients, 486 (77.8%) were female, 144 (23%) were aged 55 years or more, 73 (11.7%) had macroscopic extrathyroidal extension, and 79 (12.7%) had pT3 or pT4 disease. Samples were collected from 12 (1.9%) patients with lymph node metastasis in the perithyroidal tissue and 2 (0.3%) patients with lymph node metastasis in the lateral neck lymph tissue for frozen section examination. After a median follow-up of 104 months, the 10-year DSS and RFS rates were 99.7% and 90.2%, respectively. The 10-year lymph node recurrence rate in the central compartment was 2.7%. pT3/4 stage was an independent predictive factor for RFS (P < 0.001, hazard ratio 1.966, 95% confidence interval 1.446-2.673). Conclusion: The outcomes of patients with clinically negative lymph nodes in the central compartment were favorable without prophylactic CND.


Assuntos
Esvaziamento Cervical/mortalidade , Procedimentos Cirúrgicos Profiláticos/mortalidade , Câncer Papilífero da Tireoide/mortalidade , Neoplasias da Glândula Tireoide/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Adulto Jovem
18.
Braz J Med Biol Res ; 53(11): e9781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33053096

RESUMO

Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values. Thus, although ps-Tg above 10-30 ng/mL is considered an independent predictor of worse prognosis, the value that is associated with distant metastases is not defined. Thus, this was our objective. We selected 655 DTC patients from a nuclear medicine department database (Irmandade Santa Casa de Misericórdia de São Paulo, Brazil). All patients had received total thyroidectomy and radioactive iodine (RAI) therapy and had ps-Tg values higher than 10 ng/mL with negative anti-thyroglobulin antibodies. Then, we selected patients who presented post-therapy whole-body scan with pulmonary and/or bone uptake but with no mediastinum or cervical uptake. Patients with negative findings on functional imaging or any doubt on lung/bone uptake were submitted to additional exams to exclude another non-thyroid tumor. Of the 655 patients, 14.3% had pulmonary and 4.4% bone metastases. There was a significant difference in ps-Tg levels between patients with and without metastases (P<0.001). The cutoff value of ps-Tg was 117.5 ng/mL (sensitivity: 70.2%; specificity: 71.7%) for those with lung metastasis, and 150.5 ng/mL (sensitivity: 79.3%; specificity: 85%) for those with bone metastasis. The cutoff value for patients with eitherpulmonary or bone metastasis was 117.5 ng/mL (sensitivity: 70.2%; specificity: 83.7%). Our findings demonstrated that ps-Tg could predict distant metastasis in DTC patients. We identified a cutoff of 117.5 ng/mL with a high negative predictive value of 93.7%.


Assuntos
Neoplasias da Glândula Tireoide , Adulto , Brasil , Feminino , Humanos , Radioisótopos do Iodo , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Tireoglobulina , Neoplasias da Glândula Tireoide/cirurgia
19.
Medicina (B Aires) ; 80(5): 447-452, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33048788

RESUMO

There are numerous reports of incidental findings of thyroglossal duct remnants (TGDR) after total thyroidectomy, but its implication on the outcome of patients with differentiated thyroid cancer (DTC) is unknown. The aim of this study was to determine the frequency of TGDR detected by ultrasonography after total thyroidectomy in patients with DTC and to evaluate the impact of this finding on the response to treatment. A total of 377 records of patients with DTC who received total thyroidectomy between January 1994 and January 2017 were reviewed. Patients with less than one year of follow-up after surgery were excluded. TGDR was diagnosed in 16 out of 377 (4.2%). Fifteen had a low risk of recurrence DTC and 13 of them were treated with radioactive iodine. All low risk patients had an excellent response to treatment. Only one with an intermediate risk of recurrence DTC had an initial structural incomplete response which changed to an indeterminate response after a modified central lymph node dissection. The median time of TGDR diagnosis after thyroidectomy was 5 years (1-16). Two patients underwent TGDR surgery due to the presence of a rapidly growing neck mass, 2.4 and 4 cm in size, detected 9 and 16 years after thyroidectomy, respectively. The prevalence of this condition seems to be rare. However, the appearance of a cystic mass during the follow-up of a patient with DTC cancer could be confused with metastatic disease. The diagnosis of TGDR seems not to have an impact on the response to treatment.


Assuntos
Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Humanos , Radioisótopos do Iodo , Recidiva Local de Neoplasia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Ultrassonografia
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