|
1
|
Miao S, Xuan Q, Huang W, Jiang Y, Sun M, Qi H, Li A, Liu Z, Li J, Ding X, Wang R. Multi-region nomogram for predicting central lymph node metastasis in papillary thyroid carcinoma using multimodal imaging: A multicenter study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2025; 261:108608. [PMID: 39827707 DOI: 10.1016/j.cmpb.2025.108608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 12/10/2024] [Accepted: 01/15/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND AND OBJECTIVE Central lymph node metastasis (CLNM) is associated with high recurrence rate and low survival in patients with papillary thyroid carcinoma (PTC). However, there is no satisfactory model to predict CLNM in PTC. This study aimed to integrate PTC deep learning feature based on ultrasound (US) images, fat radiomics features based on computed tomography (CT) images and clinical characteristics to construct a multimodal and multi-region nomogram (MMRN) for predicting the CLNM in PTC. METHODS We enrolled 661 patients diagnosed with PTC by thyroidectomy from two independent centers. Patients were divided into the primary cohort, internal test cohort (ITC), and external test cohort (ETC), and collected their US images and CT images. Resnet50 was employed to predict the CLNM status of PTC based on US images. Using radiomics feature extraction methods to extract fat radiomics features from CT images. Feature selection was conducted using the least absolute shrinkage and selection operator (LASSO) regression. The predictive performance of the MMRN was evaluated using five-fold cross-validation. We comprehensively evaluated the DLRCN and compared it with five radiologists. RESULTS In the ITC and ETC, the area under the curves (AUCs) of MMRN were 0.829 (95 % CI: 0.822, 0.835) and 0.818 (95 % CI: 0.808, 0.828). The calibration curve revealed good predictive accuracy between the actual probability and predicted probability (P > 0.05). Decision curve analysis showed that the MMRN was clinically useful. Under equal specificity or sensitivity, the performance of MMRN increased by 6.5 % or 2.9 % compared to radiologist assessments. The incorporation of fat radiomics features led to significant net reclassification improvement (NRI) and integrated discrimination improvement (IDI) (NRI=0.174, P < 0.05, IDI=0.035, P < 0.05). CONCLUSION The MMRN demonstrated good performance in predicting the CLNM status of PTC, which was comparable to radiologist assessments. The fat radiomics features exhibited supplementary value for predicting CLNM in PTC.
Collapse
Affiliation(s)
- Shidi Miao
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, China
| | - Qifan Xuan
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, China
| | - Wenjuan Huang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin 150081, China
| | - Yuyang Jiang
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, China
| | - Mengzhuo Sun
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, China
| | - Hongzhuo Qi
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, China
| | - Ao Li
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, China
| | - Zengyao Liu
- Department of Interventional Medicine, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Jing Li
- Department of Geriatrics, The Second Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Xuemei Ding
- School of Computing, Engineering & Intelligent Systems, Ulster University, Northern Ireland, BT48 7JL, United Kingdom
| | - Ruitao Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, NO.150 Haping ST, Nangang District, Harbin 150081, China.
| |
Collapse
|
|
2
|
Paspala A, Bompetsi G, Paschou SA, Charalambopoulos A, Pikoulis E, Peppa M, Nastos C. The value of preoperative molecular testing in the management of Bethesda V and Bethesda VI thyroid tumors. Hormones (Athens) 2025; 24:217-229. [PMID: 39225945 DOI: 10.1007/s42000-024-00597-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
The incidence of thyroid cancer has increased over recent years due to the fact that several diagnostic tools, such as neck ultrasound and fine-needle aspiration, are being ever more widely adopted. Lately, another modality which might provide significant information preoperatively on the aggressiveness of a thyroid tumor, its prognosis, and its recurrence rate is molecular testing. We reviewed the literature with regard to the role of preoperative molecular testing in patients with Bethesda V and Bethesda VI thyroid nodules and its impact on choice of the optimal treatment strategy. Several molecular mutations and alterations are associated with thyroid cancer and its biological behavior, such as BRAF-V600E, RET, and TERT promoter. Although the value of preoperative molecular testing for indeterminate nodules (Bethesda III and Bethesda IV) have been analyzed in numerous studies, the impact of preoperative molecular testing on Bethesda V and Bethesda VI thyroid nodules is not adequately described in the current literature. The preoperative recognition of specific molecular mutations, such as BRAFV600E and TERT promoter mutation, might provide more individualized management for thyroid cancer patients by altering the surgical approach and the extent of surgery for patients diagnosed with a more aggressive or iodine-resistant subtype of thyroid cancer.Thyroid cancer is characterized by multiple genetic mutations and alterations and, as a result, preoperative molecular testing of malignant nodules could be a very useful tool for surgeons, enabling them to decide on the most appropriate surgical approach for each patient.
Collapse
Affiliation(s)
- Anna Paspala
- Department of Surgery, Evgenideio Hospital, Papadiamantopoulou 20, Athens, 115 28, Greece.
| | - Georgia Bompetsi
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Stavroula A Paschou
- Endocrine Unit and Diabetes Centre, Department of Clinical Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anestis Charalambopoulos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Emmanuil Pikoulis
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Melpomeni Peppa
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine & Research Institute, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Constantinos Nastos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| |
Collapse
|
|
3
|
Ren T, Min S, Grodski S, Serpell J, Lee JC. Prophylactic central lymph node dissection for low-risk papillary thyroid cancer-Impact on subsequent therapy. World J Surg 2025; 49:170-178. [PMID: 39625389 DOI: 10.1002/wjs.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 11/02/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND For small papillary thyroid cancers (PTCs) with no lateral nodal involvement, American Thyroid Association guidelines recommend performing prophylactic central lymph node dissection (pCLND) if it influences further management. Our cohort study explored to what extent performing pCLND for small PTCs can de-escalate subsequent therapy including completion thyroidectomy and adjuvant radioactive iodine (RAI) ablation. METHODS Adults with T1, T2, and cN0 PTCs were identified from 42 centers across the prospectively maintained Australian and New Zealand Thyroid Cancer Registry (ANZTCR) between 2017 and 2023. Patients were excluded if they had clinical nodal involvement or distant metastases. Subsequent therapy and complication rates were compared between patients with and without pCLND. RESULTS Out of 1290 patients with T1, T2, and cN0 PTCs (78% female and median age 53 years), 660 (51%) received a total thyroidectomy and 630 (49%) received a hemithyroidectomy. Prophylactic CLND was performed for 477 patients (37%) and 36% uncovered occult lymph node metastases. After adjusting for differences in age, sex, and tumor characteristics, absence of lymph node metastasis after pCLND was independently associated with fewer completion thyroidectomies (adjusted relative risk [aRR] = 0.65 and p = 0.008) and reduced RAI ablation (aRR 0.55 and p < 0.001). Additionally, pCLND was not associated with higher risks of recurrent laryngeal nerve injury (p = 0.33), temporary hypocalcemia (p = 0.21), or permanent hypoparathyroidism (p = 0.48). CONCLUSIONS In specialized settings across Australia and New Zealand, identifying negative lymph nodes from pCLND is associated with reduced completion thyroidectomies and RAI ablation amongst low risk cN0 PTCs. There were no additional complications rates when performed by experienced thyroid surgeons.
Collapse
Affiliation(s)
- Tianrui Ren
- Monash University Endocrine Surgery Unit, Alfred Health, Melbourne, VIC, Australia
| | - Seojung Min
- Monash University Endocrine Surgery Unit, Alfred Health, Melbourne, VIC, Australia
| | - Simon Grodski
- Monash University Endocrine Surgery Unit, Alfred Health, Melbourne, VIC, Australia
- Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - Jonathan Serpell
- Monash University Endocrine Surgery Unit, Alfred Health, Melbourne, VIC, Australia
- Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| | - James C Lee
- Monash University Endocrine Surgery Unit, Alfred Health, Melbourne, VIC, Australia
- Department of Surgery, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
|
4
|
Wang Y, Si Y, Wu J, Lu H, Wei J, Ding Q. Preoperative ultrasound-guided injection of nanocarbon for central lymph node dissection in patients with papillary thyroid carcinoma. Sci Rep 2024; 14:29185. [PMID: 39587201 PMCID: PMC11589612 DOI: 10.1038/s41598-024-80364-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 11/18/2024] [Indexed: 11/27/2024] Open
Abstract
To explore better methods for tracing central lymph nodes in patients with papillary thyroid carcinoma by comparing the differences in the numbers and staining rates of central lymph nodes as well as the degree of nanocarbon extravasation between the preoperative ultrasound-guided injection of nanocarbon particles and the intraoperative injection of nanocarbon particles. A total of 302 patients were randomly divided into a preoperative ultrasound-guided injection group and an intraoperative injection group. The number and degree of staining of the lymph nodes in each subgroup of central lymph nodes, including linea alba cervical lymph nodes, Delphian lymph nodes, and pretracheal and paratracheal lymph nodes, were recorded and analyzed. The extent of dye extravasation was reduced when nanocarbon was injected preoperatively. Significantly more linea alba cervical lymph nodes and pretracheal and paratracheal lymph nodes were detected in the preoperative injection group. Preoperative injection of nanocarbon can accelerate the staining and detection of central lymph nodes in patients with Hashimoto's thyroiditis, clinically positive lymph nodes (cN1) and tumors with diameters > 1 cm. Preoperative ultrasound-guided injection of nanocarbon can reduce the likelihood of dye spillage and improve the staining rate as well as the detection rate of central lymph nodes.
Collapse
Affiliation(s)
- Ying Wang
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Yan Si
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jing Wu
- Department of Pathology, The First Affiliated Hospital With Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Hui Lu
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China
| | - Jifu Wei
- Department of Pharmacy, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, 210009, China.
| | - Qiang Ding
- Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, China.
| |
Collapse
|
|
5
|
Luis PO, Lucía MJA, Hugo RC, Ramiro RM, Stalin CQ. Differentiated Thyroid Carcinoma Long-Term Prognostic Factors. Int J Surg Oncol 2024; 2024:1067447. [PMID: 39291250 PMCID: PMC11407879 DOI: 10.1155/2024/1067447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/13/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction Thyroid cancer is the most common cancer in women in Ecuador. Objective The aim of this study was to determine the demographics and clinical and treatment variables of patients with papillary or follicular thyroid cancer, referred to as differentiated thyroid cancer (DTC), treated at a third-level hospital in Quito, Ecuador. Methods We reviewed retrospectively the medical records of patients with DTC, who underwent surgical treatment, from 1990 to 2019. Data included demographics, pathological information, clinical stage, type of surgery, and radioactive iodine (RAI) adjuvant therapy. Patients were monitored for up to 29 years (median follow-up time 6.9 years). Results The corrected overall 5-, 10-, 20-, and 30-year survival rates (Kaplan-Meier) were 93%, 85%, 70%, and 63%, respectively. On univariate analysis, age, histological type, tumor grade, histological variants, capsular invasion, vascular invasion, tumor size, clinical stage, distant metastases at diagnosis, surgical margins, extrathyroidal invasion, radioactive iodine adjuvant treatment, and locoregional recurrence were found to be significant prognostic factors. In a multivariate analysis, the following independent variables: age over 55 years, extrathyroidal spread, metastasis at diagnosis, and stage II to IV raised the risk of death (hazard risk) (HR). Conclusions Age over 55 years, extrathyroidal spread, metastasis at diagnosis, and advanced clinical stage were found to have a harmful prognosis and an increased risk of death in a series of Ecuadorian patients surgically treated for a DTC.
Collapse
MESH Headings
- Humans
- Female
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/surgery
- Thyroid Neoplasms/diagnosis
- Middle Aged
- Male
- Retrospective Studies
- Adult
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/surgery
- Adenocarcinoma, Follicular/therapy
- Adenocarcinoma, Follicular/mortality
- Adenocarcinoma, Follicular/diagnosis
- Prognosis
- Survival Rate
- Thyroidectomy
- Iodine Radioisotopes/therapeutic use
- Neoplasm Recurrence, Local/epidemiology
- Aged
- Follow-Up Studies
- Ecuador/epidemiology
- Neoplasm Staging
- Young Adult
- Thyroid Cancer, Papillary/therapy
- Thyroid Cancer, Papillary/pathology
- Thyroid Cancer, Papillary/surgery
- Thyroid Cancer, Papillary/mortality
- Thyroid Cancer, Papillary/diagnosis
- Radiotherapy, Adjuvant
- Neoplasm Invasiveness
Collapse
|
|
6
|
Rhim JH, Lee JY, Park SW, Lee Y, Jung SL, Yun TJ, Ha EJ, Baek JH, Kim J, Na DG, Kim JH. Malignancy risk of indeterminate lymph node at the central compartment in patients with thyroid cancer and concomitant sonographic thyroiditis. Head Neck 2024; 46:1922-1931. [PMID: 38305145 DOI: 10.1002/hed.27670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/11/2024] [Accepted: 01/21/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND To evaluate the malignancy risk of sonographic (US) indeterminate lymph node (LN)s at the central compartment in thyroid cancer patients with US-thyroiditis (ST). METHODS Among the central compartments of suspicious, indeterminate, and probably benign LN US categories, the malignancy rates were compared between ST and non-US-thyroiditis (non-ST) groups. Those of indeterminate category were compared with suspicious and probably benign categories. RESULTS At 531 central compartments from 349 patients, the malignancy rate was lower in ST group (34.4% [44/128]) than non-ST group (43.4% [175/403]), although statistically not significant (p = 0.08). The malignancy rate of indeterminate category in ST group (35.7% [5/14]) was lower than non-ST group (71.9% [23/32]) (p = 0.047). Within ST group, the malignancy rate of indeterminate category (35.7% [5/14]) did not differ from probably benign category (29.1% [30/103]) (p = 0.756), but was lower than suspicious category (81.8% [9/11]) (p = 0.042). CONCLUSIONS The malignancy risk of US indeterminate LNs at the central compartment in thyroid cancer patients with US thyroiditis was lower than that in patients without US thyroiditis.
Collapse
Affiliation(s)
- Jung Hyo Rhim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, South Korea
| | - Sun-Won Park
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, South Korea
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Younghen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, South Korea
| | - Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinna Kim
- Department of Radiology, Severance Hospital, Seoul, South Korea
| | - Dong Gyu Na
- Department of Radiology, Gang Neung Asan Hospital, Gangneung, South Korea
- Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, South Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, South Korea
| |
Collapse
|
|
7
|
Luo S, Lai F, Liang R, Li B, He Y, Chen W, Zhang J, Li X, Xu T, Hou Y, Liu Y, Long J, Yang Z, Chen X. Clinical prediction models for cervical lymph node metastasis of papillary thyroid carcinoma. Endocrine 2024; 84:646-655. [PMID: 38175390 DOI: 10.1007/s12020-023-03632-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Accurate preoperative diagnosis of lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) remains an unsolved problem. This study aimed to construct a nomogram and scoring system for predicting LNM based on the clinical characteristics of patients with PTC. METHODS 1400 patients with PTC who underwent thyroidectomy and lymph node dissection at the First Affiliated Hospital of Sun Yat-sen University were retrospectively enrolled and randomly divided into training and internal testing sets. Furthermore, 692 patients with PTC from three other medical centers were collected as external testing sets. Least absolute shrinkage and selection operator (LASSO) was used to screen the predictors, and a nomogram was constructed. In addition, a scoring system was constructed using 10-fold cross-validation. The performances of the two models were verified among datasets and compared with preoperative ultrasound (US). RESULTS Six independent predictors were included in the multivariate logistic model: age, sex, US diagnosis of LNM, tumor diameter, location, and thyroid peroxidase antibody level. The areas under the receiver operating characteristic curve (AUROC) (95% confidence interval) of this nomogram in the training, internal testing, and three external testing sets were 0.816 (0.791-0.840), 0.782 (0.727-0.837), 0.759 (0.699-0.819), 0.749 (0.667-0.831), and 0.777 (0.726-0.828), respectively. The AUROC of the scoring system were 0.810 (0.785-0.835), 0.772 (0.718-0.826), 0.736 (0.675-0.798), 0.717 (0.635-0.799) and 0.756 (0.704-0.808), respectively. The prediction performances were both significantly superior to those of preoperative US (P < 0.001). CONCLUSION The nomogram and scoring system performed well in different datasets and significantly improved the preoperative prediction of LNM than US alone.
Collapse
Affiliation(s)
- Shuli Luo
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fenghua Lai
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ruiming Liang
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yufei He
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenke Chen
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiayuan Zhang
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuyang Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tianyi Xu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingtong Hou
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yihao Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianyan Long
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Zheng Yang
- Department of Pathology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.
| | - Xinwen Chen
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
|
8
|
Guo H, Zhang Y, Ren S, Yang X, Tian L, Huang Y, Zhang C, Zhang X. Real-time imaging of ipsilateral parathyroid glands by retrograde injection of methylene blue into the superior thyroid artery: a new intraoperative parathyroid protection method. BMC Surg 2024; 24:108. [PMID: 38615003 PMCID: PMC11015547 DOI: 10.1186/s12893-024-02360-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/15/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Postoperative hypoparathyroidism caused by parathyroid injury is a problem faced by thyroid surgeons. The current technologies for parathyroid imaging all have some defects. METHODS Patients with differentiated thyroid carcinoma (DTC) who underwent unilateral thyroidectomy plus ipsilateral central lymph node dissection were recruited. We dissected the main trunk of the superior thyroid artery entering the thyroid gland and placed the venous indwelling tube into the artery. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS A total of 132 patients enrolled in this single-arm clinical trial, 105 of them completed retrograde catheterization via the superior artery. The sensitivity was 69.23 and 83.33% respectively. The specificity was 72.91 and 64.89%. The accuracy was 72.91 and 64.89%. The PPV was 85.71 and 81.08%. The NPV was 22.58 and 45.45%. There were no patients with allergic reactions to the methylene blue, or methylene blue toxicity. CONCLUSIONS Retrograde injection of methylene blue via the superior thyroid artery is an effective and safe method to visualize parathyroid glands. This method can accurately locate the target organ by ultraselecting the blood vessel and injecting the contrast agent while avoiding background contamination and reducing the amount of contrast agent. TRIAL REGISTRATION Clinical trial registration numbers and date of registration: ChiCTR2300077263、02/11/2023.
Collapse
Affiliation(s)
- Hanjie Guo
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China
| | - Yuxing Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Saiyu Ren
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China
| | - Xiaodong Yang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Lei Tian
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Yun Huang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China
| | - Chaojun Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China.
| | - Xiliang Zhang
- Department of General Surgery, The First Medical Center of PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, People's Republic of China.
- School of Medicine, South China University of Technology, 382 Waihuan Rd E, Panyu, Guangzhou, 510006, People's Republic of China.
- Department of General Surgery, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian, Beijing, 100048, People's Republic of China.
| |
Collapse
|
|
9
|
Sartori PV, Andreani S, De Pasquale L, Pauna I, Bulfamante AM, Aiello PSL, Melcarne R, Giacomelli L, Boniardi M. How to Manage Advanced Differentiated Thyroid Cancer: Step-by-Step Analysis from Two Italian Tertiary Referral Centers. J Clin Med 2024; 13:708. [PMID: 38337400 PMCID: PMC10856418 DOI: 10.3390/jcm13030708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) has an excellent prognosis; however, advanced disease is associated with a worse prognosis and is relatively common. Surgery followed by RAI treatment remains the mainstream treatment for a large majority of patients with high- and intermediate-risk DTC, but its benefits should be carefully weighed against the potential for harm. The aim of this paper is to critically review the experience in treating advanced DTC at two tertiary referral centers in Italy. METHODS Retrospective analysis of 300 patients who underwent surgery for ADTC over 30 years. RESULTS The complication rate was 50.33%. A total of 135 patients (45%) remained at regular follow-up, 118 (87.4%) were alive, while 17 (12.6%) were deceased. The mean overall survival at 12 years was 84.8% with a mean of 238 months. Eleven patients (8.1%) experienced a relapse after a median of 13 months. CONCLUSIONS ADTC patients adequately treated can achieve prolonged survival even in the case of metastasis or disease relapse. Patients with ADTC should be referred to high-volume centers with the availability of an extended multidisciplinary team to receive tailored treatment.
Collapse
Affiliation(s)
| | - Sara Andreani
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy;
| | - Iuliana Pauna
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| | - Antonio Mario Bulfamante
- Pediatric Otolaryngology Unit, ASST Fatebenefratelli-Sacco, Buzzi Children Hospital, 20162 Milan, Italy;
| | | | - Rossella Melcarne
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Laura Giacomelli
- Department of General and Specialty Surgery, Sapienza University of Rome, AOU Umberto I, 00185 Rome, Italy;
| | - Marco Boniardi
- Endocrine Surgery Unit, Niguarda Hospital, 20162 Milan, Italy; (S.A.); (I.P.); (P.S.L.A.); (M.B.)
| |
Collapse
|
|
10
|
Neagoe OC, Ionică M. Improvement in Central Neck Dissection Quality in Thyroid Cancer by Use of Tissue Autofluorescence. Cancers (Basel) 2024; 16:258. [PMID: 38254749 PMCID: PMC10813481 DOI: 10.3390/cancers16020258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Risk of postoperative transient or permanent hypoparathyroidism represents one of the most common complications following total thyroidectomy. This risk increases if a cervical lymphadenectomy procedure must also be performed, as is usually the case in thyroid carcinoma patients. Parathyroid autofluorescence (AF) is a non-invasive method that aids intraoperative identification of parathyroid glands. METHODS In this prospective study, 189 patients with papillary thyroid cancer who underwent total thyroidectomy with central neck dissection were included. Patients were randomly allocated to one of two groups: NAF (no AF, surgery was performed without AF) and the AF group (surgery was performed with AF-Fluobeam LX system, Fluoptics, Grenoble, France). RESULTS The number of excised lymph nodes was significantly higher in the AF compared to the NAF group, with mean values of 21.3 ± 4.8 and 9.2 ± 4.1, respectively. Furthermore, a significantly higher number of metastatic lymph nodes were observed in the AF group. Transient hypocalcemia recorded significantly lower rates in the AF group with 4.9% compared to 16.8% in the NAF group. CONCLUSIONS AF use during total thyroidectomy with central neck dissection for papillary thyroid carcinoma patients, decreased the rate of iatrogenic parathyroid gland lesions, and increased the rate of lymphatic clearance.
Collapse
Affiliation(s)
- Octavian Constantin Neagoe
- Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical Municipal Hospital Timișoara, 300079 Timișoara, Romania;
- Second Discipline of Surgical Semiology, First Department of Surgery, ”Victor Babeș” University of Medicine, 300041 Timișoara, Romania
| | - Mihaela Ionică
- Second Clinic of General Surgery and Surgical Oncology, Emergency Clinical Municipal Hospital Timișoara, 300079 Timișoara, Romania;
- Second Discipline of Surgical Semiology, First Department of Surgery, ”Victor Babeș” University of Medicine, 300041 Timișoara, Romania
| |
Collapse
|
|
11
|
Xu Z, Mao Z, Chen S, Mo Z, Zhou J, Chen Z, Zarnegar R, Fahey Iii TJ, Wang W, Teng L. Long-term impact of prophylactic central neck dissection in non-invasive classic papillary thyroid carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107305. [PMID: 38070466 DOI: 10.1016/j.ejso.2023.107305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The utilization of prophylactic central neck dissection (pCND) in cases of non-invasive clinical node-negative (cN0) papillary thyroid carcinoma (PTC) remains a topic of debate, with a dearth of long-term evidence. MATERIALS AND METHODS We retrospectively reviewed 1181 cN0 PTC patients from 1997 to 2011. Of these, 641 underwent pCND (pCND + group) and 540 did not (pCND-group). Propensity score matching (PSM) was used to identify similar patients. Event-free survival and long-term complications including permanent hyperparathyroidism and permanent recurrent laryngeal nerve (RLN) paralysis were analyzed after PSM. RESULTS The pCND + group had more aggressive characteristics. In the matched cohort after PSM, the 5-year, 10-year, and 15-year EFS rates were 98.9 %, 98.2 %, and 97.1 % for the pCND + group, and 97.7 %, 97.1 %, and 97.1 % for the pCND-group, respectively. There was no statistically significant difference in EFS rates between the two groups (Log Rank P = 0.38). There was no statistically significant difference in the incidence of permanent hyperparathyroidism (3.3 % vs. 1.5 %, P = 0.08) and permanent RLN paralysis (1.7 % vs. 0.9 %, P = 0.13) between the pCND+ and pCND- groups. CONCLUSION Our study, with a median follow-up duration of 107 months, indicates that pCND does not lead to a significant reduction in nodal recurrence among non-invasive cN0 PTC patients.
Collapse
Affiliation(s)
- Zehang Xu
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Zhuochao Mao
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Shitu Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Zhe Mo
- Department of Environmental and Health, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China.
| | - Jie Zhou
- Department of Pathology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Zhendong Chen
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital, and Weill Medical College of Cornell University, 525 East 68th Street, Room F-2024, New York, 10065, NY, USA.
| | - Thomas J Fahey Iii
- Department of Surgery, New York Presbyterian Hospital, and Weill Medical College of Cornell University, 525 East 68th Street, Room F-2024, New York, 10065, NY, USA.
| | - Weibin Wang
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Lisong Teng
- Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| |
Collapse
|
|
12
|
Sheetal K, Sooria ND, Nikisha GN. Impact of Clinico Pathological and Surgical Related Risk Factor in Post Operative Hypoparathyroidism in Total Thyroidectomy Patients. Indian J Otolaryngol Head Neck Surg 2023; 75:3402-3409. [PMID: 37974793 PMCID: PMC10645958 DOI: 10.1007/s12070-023-03949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Multiple risk factors have been predicted in post operative hypoparathyroidism in total thyroidectomy patients but none have been clearly defined. Present study aims at evaluating the clinic pathological and surgical impact factors in predicting the risk of post operative hypoparathyroidism in thyroidectomy patients. The study was done in Karpaga Vinayaga Institute of Medical Science and Research Centre where Retrospective prospective cohort study who underwent and undergoing total thyroidectomy with or without central neck dissection for both benign and malignant thyroid disorders during 2014 to 2022 was analyzed. The study has analyzed the various risk factors from clinic pathological and surgical skills of identifying the Inferior thyroid artery at its origin and tracing the branches to the parathyroid gland and evaluating the incidence of hypocalcemia in both study and control groups. Two groups were analyzed during the period 2014 to 2022. The study group was included patients with thyroidectomy where ITA were identified and traced up to the parathyroid gland. They were further classified into category A where both sides ITA were identified and saved, category B where only one side was preserved. In control group, the surgery was done only on basis of capsular dissection and peripheral ligation of vessels close to the gland. Total study participants in our study was 416. The overall prevalence of hypocalcemia in our study was 11.4%. The age, gender and pathological variants were comparable between the two groups. Female preponderance (76%) was seen among both the groups. Among total study subjects who underwent total thyroidectomy 44.8% were having multi nodular goitre, 7.3% toxic goitre, 9.8% follicular adenoma, 30.2% papillary carcinoma and 7.9% follicular carcinoma. In our study benign and malignant thyroid disorders had no significant difference. Prevalence of hypocalcemia among control group 14.5% vs study group 3.8%. We found incidence of hypocalcaemia was comparitively lesser among patients with thyroidectomy alone, than those with unilateral or bilateral CND. Prevalence of hypocalcemia among control group was 33% (45/133) and study group 7% (12/153), when thyroidectomy alone was done. However, with neck dissection in bilateral CND, incidence was 41% (23/56) in study group and 61% (11/18) in control group. In unilateral CND, study and control group had 31% (10/32) and 54% (13/24) which was found to be statistically significant. Parathyroid auto transplantation among the control group (29%) compared to the study group (16%). Bilateral neck dissection and gross extrathyroidal extension and cases with PTG inadvertent removal posed significant risk factors for hypoparathyroidism. The prevalence of immediate hypocalcemia among Cat A, Cat B and control group were 14%, 20.3% and 37.5% respectively and was statistically significant (P < .0001). Symptomatic and Biochemical hypocalcemia at the end of 1 week among Cat A, Cat B, and control group was 8%, 12%, and 33.6, & 12.9%, 21% and 30% respectively. Whereas transient hypocalcemia reported among these groups was 1.6%, 5% and 14.6%. Permanent hypocalcemia was < 1% in study group and 4% among control group. We observed that permanent hypocalcemia was high among patients with bilateral neck dissection and auto transplanted PTG. There was no significant statistical difference in hypocalcemia (transient or permanent) among study and control group, but the incidence of hypocalcemia had significantly reduced in both study groups when unilateral or bilateral identification of ITA was done compared to control group. Our hypothesis in this study aims at preserving the branches of ITA supplying PTG distally has greater functional preservation of the parathyroid than conventional technique. This technique also helps us maintaining the plane and capsular dissection if done properly. By trying to preserve the ITA surgeons may acquire better meticulous dissection skills and understanding the anatomical variation of vessels around PTG more precisely which improve the surgical outcome in preventing both transient and permanent hypocalcaemia.
Collapse
Affiliation(s)
- K. Sheetal
- Karpaga Vinayaga Institute of Medical Science and Research Center, Chengalpattu, Tamil Nadu India
| | - N. Deva Sooria
- Karpaga Vinayaga Institute of Medical Science and Research Center, Chengalpattu, Tamil Nadu India
| | - G. N. Nikisha
- Karpaga Vinayaga Institute of Medical Science and Research Center, Chengalpattu, Tamil Nadu India
| |
Collapse
|
|
13
|
Vaish R, Mahajan A, Sable N, Dusane R, Deshmukh A, Bal M, D’cruz AK. Role of computed tomography in the evaluation of regional metastasis in well-differentiated thyroid cancer. FRONTIERS IN RADIOLOGY 2023; 3:1243000. [PMID: 38022790 PMCID: PMC10643764 DOI: 10.3389/fradi.2023.1243000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023]
Abstract
Background Accurate neck staging is essential for performing appropriate surgery and avoiding undue morbidity in thyroid cancer. The modality of choice for evaluation is ultrasonography (US), which has limitations, particularly in the central compartment, that can be overcome by adding a computed tomography (CT). Methods A total of 314 nodal levels were analyzed in 43 patients with CT, and US; evaluations were done between January 2013 and November 2015. The images were reviewed by two radiologists independently who were blinded to histopathological outcomes. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of US, CT, and US + CT were calculated using histology as the gold standard. Results The overall sensitivity, specificity, PPV, and NPV for US, CT, and US + CT were 53.9%, 88.8%, 74.1%, and 76.4%; 81.2%, 68.0%, 60.1%, and 85.9%; and 84.6%, 66.0%, 59.6%, and 87.8%, respectively. The overall accuracy of the US was 75.80%, the CT scan was 72.93%, and the US + CT scan was 72.93%. For the lateral compartment, the sensitivity, specificity, PPV, and NPV for the US, CT, and US + CT were 56.6%, 91.4%, 77.1%, and 80.5%; 80.7%, 70.6%, 58.3%, and 87.8%; and 84.3%, 68.7%, 57.9%, and 89.6%, respectively. The accuracy of the US was 79.67%, the CT scan was 73.98%, and the US + CT scan was 73.98% for the lateral compartment. For the central compartment, the sensitivity, specificity, PPV, and NPV for the US, CT, and US + CT were 47.1%, 76.5%, 66.7%, and 59.1%; 82.4%, 55.9%, 65.1%, and 76.0%; and 85.3%, 52.9%, 64.4%, and 78.3%, respectively. The accuracy of the US was 61.76%, the CT scan was 69.12%, and the US + CT scan was 69.12% for the central compartment. Conclusions This study demonstrated that CT has higher sensitivity in detecting nodal metastasis; however, its role is complementary to US due to low specificity.
Collapse
Affiliation(s)
- Richa Vaish
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rohit Dusane
- Department of Statistics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anuja Deshmukh
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Anil K. D’cruz
- Head and Neck Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
|
14
|
Jiang W, Yu Y, Bhandari A, Hirachan S, Dong X, Huang X, Qu J, Chen C. Budding uninhibited by benzimidazoles 1 might be a poor prognosis biomarker promoting the progression of papillary thyroid cancer. ENVIRONMENTAL TOXICOLOGY 2023; 38:2047-2056. [PMID: 37163344 DOI: 10.1002/tox.23812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/27/2023] [Accepted: 04/16/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is one of the most widespread malignant tumors of the endocrine system, with a high incidence. Budding uninhibited by benzimidazoles 1 (BUB1), one of the spindle assembly checkpoint (SAC) genes, is a multitask protein kinase required for eukaryotic chromosome segregation. Although BUB1 has been explored in several types of cancer, its biological role and molecular mechanisms in PTC remain unclear. METHODS In this study, we performed an examination of four public datasets along with local PTC cohorts and discovered that BUB1 was elevated in PTC compared to non-cancer tissues. High BUB1 expression was linked with the status of BRAFV600E , RAS, and TERT after statistical analysis. RESULTS Clinically, BUB1 is associated with a variety of clinicopathological features in PTC patients. Interestingly, analysis of the TCGA database showed that BUB1 was closely associated with poor prognosis of PTC and significantly correlated with PFS. As determined by regression analysis, BUB1, and T stage were independent predictors of PTC and were related to BRAFV600E and lymph node metastatic status. By RT-qPCR, BUB1 was considerably overexpressed in PTC cell lines in comparison with normal thyroid epithelial cells. CONCLUSION We confirmed that the knockdown of BUB1 in BCPAP and TPC1 cell lines significantly inhibited cell proliferation, cloning, and migration in vitro experiments. These results imply that BUB1 may be a significant oncogenic gene that is directly associated with the prognosis of PTC and may represent a future target for therapeutic intervention.
Collapse
Affiliation(s)
- Wenjie Jiang
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Yan Yu
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Adheesh Bhandari
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
- Department of General Surgery, Breast and Thyroid Unit, Primera Hospital, Kathmandu, Nepal
| | - Suzita Hirachan
- Department of General Surgery, Breast and Thyroid Unit, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Xubin Dong
- Department of Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Xiaoli Huang
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Jinmiao Qu
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Chengze Chen
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| |
Collapse
|
|
15
|
Yang J, Han Y, Min Y, Chen C, Chen J, Xiang K, Liao J, Feng Y, Hu D, Yin G. Prophylactic central neck dissection for cN0 papillary thyroid carcinoma: is there any difference between western countries and China? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1176512. [PMID: 37576962 PMCID: PMC10413573 DOI: 10.3389/fendo.2023.1176512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Recommendations for the performance of prophylactic central neck dissection (pCND) in patients with clinically node-uninvolved (cN0) papillary thyroid carcinoma (PTC) are not the same. This meta-analysis set out to compare the effectiveness of pCND with total thyroidectomy (TT) in different countries and regions, mainly between western countries and China. Methods The electronic databases PubMed, EMBASE, and Cochrane Library were searched for studies published until August 2022. The incidence rate of cervical lymph node metastases (LNMs), locoregional recurrences (LRRs), and postoperative complications were pooled by a random-effects model. Subgroup analyses based on different countries and regions were performed. Results Eighteen studies involving 5,346 patients were analyzed. In the subgroup of western countries, patients undergoing pCND with TT had a significantly lower LRR rate [69/1,804, 3.82% vs. 139/2,541, 5.47%; odds ratio (OR) = 0.56; 95% CI 0.37-0.85] and a higher rate of temporary hypoparathyroidism (HPT) (316/1,279, 24.71% vs. 194/1,467, 13.22%; OR = 2.23; 95% CI 1.61-3.08) than that of the TT alone group, while no statistically significant difference was found in the rate of permanent HPT and temporary and permanent recurrent laryngeal nerve (RLN) injury. In the Chinese subgroup, the pCND with TT group had a significantly higher incidence rate of both temporary HPT (87/374, 23.26% vs. 36/324, 11.11%; OR = 2.24; 95% CI 1.32-3.81) and permanent HPT (21/374, 5.61% vs. 4/324, 1.23%; OR = 3.58; 95% CI = 1.24-10.37) than that of the TT alone group, while no significant difference was detected in the rate of LRR and temporary and permanent RLN injury. Conclusion Compared with the TT alone for cN0 PTC patients, pCND with TT had a significantly lower LRR rate while having a higher temporary HPT rate in Europe, America, and Australia; however, it showed no significant difference in decreasing LRR rate while having a significantly raised rate of temporary and permanent HPT in China. More population-based results are required to advocate precision medicine in PTC. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022358546.
Collapse
Affiliation(s)
- Jiaxin Yang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuling Han
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Min
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jialin Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiahu Liao
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Feng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
|
16
|
Wang X, Wang SL, Cao Y, Li CQ, He W, Guo ZM. Postoperative hypoparathyroidism after thyroid operation and exploration of permanent hypoparathyroidism evaluation. Front Endocrinol (Lausanne) 2023; 14:1182062. [PMID: 37361530 PMCID: PMC10286794 DOI: 10.3389/fendo.2023.1182062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Abstract
Background To investigate the risk factors for hypoparathyroidism, discuss the prevention of postoperative hypoparathyroidism, and explore permanent postoperative hypoparathyroidism evaluation (PPHE). Methods A total of 2,903 patients with thyroid nodules were treated between October 2012 and August 2015. Serum calcium and intact parathyroid hormone (iPTH) levels were measured at 1 day, 1 month, and 6 months postoperatively. The incidence and management of hypoparathyroidism were analyzed. The PPHE was established based on the risk factors and clinical practice. Results A total of 637 (21.94%) patients developed hypoparathyroidism, and 92.15% of them had malignant nodules. The incidence rates of transient and permanent hypoparathyroidism were 11.47% and 10.47%, respectively. The iPTH level was lower in patients with malignant nodules who underwent total thyroidectomy (TT) and central-compartment neck dissection (CND). These factors were independently associated with the recovery rate of parathyroid function. The formula for PPHE is as follows: {iPTH} + {sCa} + {surgical procedure} + {reoperation} + {pathologic type}. A scoring system was developed, and we scored low, middle, and high risk of permanent postoperative hypoparathyroidism as 4-6, 7-9, and 10-13, respectively. The differences in the recovery rates of parathyroid function in several risk groups were statistically significant (p < 0.001). Conclusion Simultaneous TT and CND is a risk factor for hypoparathyroidism. The reoperation is not associated with hypoparathyroidism. Identification of parathyroid glands in situ and preservation of their vascular pedicles are key factors in managing hypoparathyroidism. PPHE can forecast the risk of permanent postoperative hypoparathyroidism well.
Collapse
Affiliation(s)
- Xi Wang
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
- The First School Of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shun-lan Wang
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Yang Cao
- Department of Oncology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Chun-qiao Li
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Weiping He
- Department of Otolaryngology, Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital, Guangzhou, China
| | - Zhu-ming Guo
- Department of Head and Neck, Sun Yat-sen University Cancer Center, Guangzhou, China
| |
Collapse
|
|
17
|
Chang L, Zhang Y, Zhu J, Hu L, Wang X, Zhang H, Gu Q, Chen X, Zhang S, Gao M, Wei X. An integrated nomogram combining deep learning, clinical characteristics and ultrasound features for predicting central lymph node metastasis in papillary thyroid cancer: A multicenter study. Front Endocrinol (Lausanne) 2023; 14:964074. [PMID: 36896175 PMCID: PMC9990492 DOI: 10.3389/fendo.2023.964074] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE Central lymph node metastasis (CLNM) is a predictor of poor prognosis for papillary thyroid carcinoma (PTC) patients. The options for surgeon operation or follow-up depend on the state of CLNM while accurate prediction is a challenge for radiologists. The present study aimed to develop and validate an effective preoperative nomogram combining deep learning, clinical characteristics and ultrasound features for predicting CLNM. MATERIALS AND METHODS In this study, 3359 PTC patients who had undergone total thyroidectomy or thyroid lobectomy from two medical centers were enrolled. The patients were divided into three datasets for training, internal validation and external validation. We constructed an integrated nomogram combining deep learning, clinical characteristics and ultrasound features using multivariable logistic regression to predict CLNM in PTC patients. RESULTS Multivariate analysis indicated that the AI model-predicted value, multiple, position, microcalcification, abutment/perimeter ratio and US-reported LN status were independent risk factors predicting CLNM. The area under the curve (AUC) for the nomogram to predict CLNM was 0.812 (95% CI, 0.794-0.830) in the training cohort, 0.809 (95% CI, 0.780-0.837) in the internal validation cohort and 0.829(95%CI, 0.785-0.872) in the external validation cohort. Based on the analysis of the decision curve, our integrated nomogram was superior to other models in terms of clinical predictive ability. CONCLUSION Our proposed thyroid cancer lymph node metastasis nomogram shows favorable predictive value to assist surgeons in making appropriate surgical decisions in PTC treatment.
Collapse
Affiliation(s)
- Luchen Chang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Yanqiu Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Jialin Zhu
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Linfei Hu
- Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Xiaoqing Wang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Haozhi Zhang
- Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Qing Gu
- Department of Ultrasonography, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, Hebei, China
| | - Xiaoyu Chen
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Sheng Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Ming Gao
- Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Breast and Thyroid Surgery, Tianjin Union Medical Center, Tianjin, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- *Correspondence: Xi Wei,
| |
Collapse
|
|
18
|
Shahriarirad R, Meshkati Yazd SM, Zahedi R, Mokhtari Ardekani A, Rekabi MM, Nasiri S. Evaluation of the role of prophylactic bilateral central neck lymph node dissection in patients with papillary thyroid carcinoma: a case controlled study. Updates Surg 2022; 75:679-689. [PMID: 36527603 DOI: 10.1007/s13304-022-01440-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Thyroid cancer is the most common malignancy in the endocrine system. Papillary thyroid carcinoma (PTC) is the most common differentiated thyroid cancer. There are considerable discrepancies regarding the role and extent of prophylactic central lymph node dissection (PCLND) for patients with PTC. Our primary goal was the evaluation of CLN involvement based on the tumor features and staging on the eight version of the American Joint Committee on Cancer and also the TNM method. Our secondary aim was to evaluate the features of the CLNs with tumoral features and also features associated with the development of transient hypoparathyroidism. This prospective case-controlled study was performed among PTC patients. Total thyroidectomy and bilateral dissection of the CLNs of the central compartment of the neck was performed, and samples were sent for pathological evaluation. CLN involvement, tumoral features and transient hypoparathyroidism were cross-evaluated and analyzed with SPSS version 26.0. In this study, out of 61 patients, 11 (18%) were male, the average age was 37.3 ± 13.7 years, based on AJCC staging, 53 (86.9%) were stage I and 8 (13.1%) were stage II, and based on TNM staging, 39 patients (66.1%) were T1, including 13 (22.0%) T1a and 26 (44.1%) T1b, 15 patients (25.4%) were T2, and five patients (8.5%) were T3. Based on permanent pathology evaluation, the majority of patients (n = 48; 78.7%) had CLN involvement. None of the preoperative and tumor features had a significant association with CLN involvement. 75% of stage I and 100% of stage two cases, while 76.9% of T1, 86.7% of T2, and 80.0% of T3 cases had CLN involvement. There was no significant association between the involvement of CLN and the AJCC staging (P = 0.184) or TNM staging (P = 0.875). The involved to dissected CLN ratio was significantly higher in stage II patients compared to stage I (72.5 vs. 34.8%; P = 0.006), and also with higher T staging (0.009). There was a statistically significant association between the larger CLN size and older patients' age, higher postoperative thyroglobulin levels, and smaller tumor size. Higher postoperative thyroglobulin level was significantly associated with larger tumors size and thyroid capsule invasion. Also, 26 (44.8%) of patients developed transient hypoparathyroidism, which was significantly associated with vascular invasion (P = 0.048), bilateral location of tumor (P = 0.048) or on the right side (0.005), and larger size of the tumor (P = 0.016). Tumor features and staging were not associated with CLN involvement features. Therefore, full extent PCLND should be carried out to avoid reoperation or metastasis in PTC patients.
Collapse
Affiliation(s)
- Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Roya Zahedi
- Department of Operation Room, Faculty of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abnoos Mokhtari Ardekani
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Science, and Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Shirzad Nasiri
- Tehran University of Medical Sciences, Department of Surgery, Tehran, Iran.
| |
Collapse
|
|
19
|
Rosati D, Bononi M, Ruscito P, Radici M, Cavaliere C, Minni A. Bilateral and Ipsilateral Central Neck Dissection in Total Thyroidectomy: a Long Term Comparison of Complications. Indian J Otolaryngol Head Neck Surg 2022; 74:6206-6212. [PMID: 36742527 PMCID: PMC9895597 DOI: 10.1007/s12070-021-02904-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
The role of prophylactic central compartment neck dissection (CCND) in total thyroidectomy (TT) is controversial in patients without clinically evident lymph nodes metastasis (cN0) because of association with transient and permanent hypoparathyroidism (HPT) as well as transient and permanent recurrent laryngeal nerve (RLN) injury. Instead of bilateral central neck dissection (bCCND), ipsilateral central compartment neck dissection (iCCND) has recently been proposed as a safer, alternative treatment for selected patients. The aim of this study is to characterize the morbidity that CCND (ipsilateral and bilateral) adds to TT. We enrolled 453 patients: Group A (316 patients) underwent TT alone, Group B (86 patients) underwent TT + iCCND, Group C (51 patients) underwent TT + bCCND. We compared the rates of RLN injury and HPT in three groups and data analysis showed that iCCND was associated with increased rate of transient HPT but not permanent HPT and bCCND was associated with increased rate of transient and permanent HPT, when compared with TT alone. Further studies are needed to evaluate the clear advantages of CCND (both ipsilateral and bilateral), but this should be considered in the context of an higher risk of surgical complications (especially transient and permanent hypoparathyroidism), in comparison with TT alone.
Collapse
Affiliation(s)
- Davide Rosati
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Camillo de Lellis, via John Fitzgerald Kennedy, 02100 Rieti, Italy
| | - Marco Bononi
- Department of Surgery “P. Valdoni”, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Paolo Ruscito
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Camillo de Lellis, via John Fitzgerald Kennedy, 02100 Rieti, Italy
| | - Marco Radici
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Giovanni Calibita - Fatebenefratelli, Isola Tiberina, Rome, Italy
| | - Carlo Cavaliere
- Department of Sensory Organs, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Antonio Minni
- Department of Sensory Organs, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| |
Collapse
|
|
20
|
Hei H, Zhou B, Gong W, Zheng C, Fang J, Qin J. Preoperative prediction of central neck metastasis in patients with clinical T1-2N0 papillary thyroid carcinoma. Surg Today 2022; 53:507-512. [PMID: 36202940 DOI: 10.1007/s00595-022-02595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/30/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND Central neck metastasis (CNM) is common in patients with papillary thyroid carcinoma (PTC). However, the prediction of CNM risk remains poorly defined, especially for patients with clinically negative lymph nodes. We developed a preoperative clinical nomogram to predict CNM risk in patients with clinical T1-2N0 (cT1-2N0) PTC. METHODS Data from 436 patients with unifocal cT1-2N0 PTC were available. We analyzed the association between preoperative variables and CNM using univariate and multivariate logistic regression and developed a clinical nomogram based on the multivariate regression model. The nomogram was validated externally using an independent dataset. RESULTS The CNM rate was 25.5%. Three clinical variables were associated with CNM, including age, gender, and tumor size. We built a CNM nomogram integrating these three variables. It had a poor index of internal discrimination (C-index, 0.655; 95% CI 0.596-0.715) and a poor index of external discrimination (C-index, 0.690; 95% CI 0.611-0.769). CONCLUSIONS We developed a preoperative nomogram to quantify the risk of CNM in unifocal cT1-2N0 PTC patients. However, our data showed that preoperative clinical parameters were not able to accurately predict the likelihood of CNM. Other variables need to be investigated to improve the prediction capability of this nomogram.
Collapse
Affiliation(s)
- Hu Hei
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China
| | - Bin Zhou
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China
| | - Wenbo Gong
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China
| | - Chen Zheng
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China
| | - Jugao Fang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jianwu Qin
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China.
| |
Collapse
|
|
21
|
Schmidt M, Bartenstein P, Bucerius J, Dietlein M, Drzezga A, Herrmann K, Lapa C, Lorenz K, Musholt TJ, Nagarajah J, Reiners C, Sahlmann CO, Kreissl MC. Individualized treatment of differentiated thyroid cancer: The value of surgery in combination with radioiodine imaging and therapy - A German position paper from Surgery and Nuclear Medicine. Nuklearmedizin 2022; 61:87-96. [PMID: 35299276 DOI: 10.1055/a-1783-8154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A consensus statement about indications for post-surgical radioiodine therapy (RIT) in differentiated thyroid cancer patients (DTC) was recently published by the European Thyroid Association (ETA) 1. This publication discusses indications for RIT on the basis of an individual risk assessment. Many of the conclusions of this consensus statement are well founded and accepted across the disciplines involved. However, especially from the perspective of nuclear medicine, as the discipline responsible for indicating and executing RIT, some of the recommendations may require further clarification with regard to their compatibility with established best practice and national standards of care. Assessment of the indications for RIT is strongly dependent on the weighing up of benefits and risks. On the basis of longstanding clinical experience in nuclear medicine, RIT represents a highly specific precision medicine procedure of proven efficacy with a favorable side-effect profile. This distinguishes RIT significantly from other adjuvant oncological therapies and has resulted in the establishment of this procedure as a usually well-tolerated, standard safety measure. With regard to its favorable risk/benefit ratio, this procedure should not be unnecessarily restricted, in the interest of offering reassurance to the patients. Both patients' interests and regional/national differences need to be taken into account. We would therefore like to comment on the recent consensus from the perspective of authors and to provide recommendations based on the respective published data.
Collapse
Affiliation(s)
- Matthias Schmidt
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.).,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Jan Bucerius
- Department of Nuclear Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany.,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Alexander Drzezga
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital of Cologne, Cologne, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Constantin Lapa
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Member of the Board, German Society of Nuclear Medicine (DGN e. V.)
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University of Halle Wittenberg, Faculty of Medicine, Halle, Germany.,Member of the surgical working group for endocrinology (CAEK) of the German society for general and visceral surgery (DGAV)
| | - Thomas J Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.,Member of the surgical working group for endocrinology (CAEK) of the German society for general and visceral surgery (DGAV)
| | - James Nagarajah
- Department of Medical Imaging, Nuclear Medicine, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, Netherland.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.).,Guideline Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Christoph Reiners
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Carsten O Sahlmann
- Department of Nuclear Medicine, University Medical Center Göttingen, Göttingen, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.)
| | - Michael C Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Otto von Guericke University, Magdeburg, Germany.,Thyroid Committee, German Society of Nuclear Medicine (DGN e. V.)
| |
Collapse
|
|
22
|
Parvathareddy SK, Siraj AK, Ahmed SO, DeVera F, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Risk Factors for Central Lymph Node Metastases and Benefit of Prophylactic Central Lymph Node Dissection in Middle Eastern Patients With cN0 Papillary Thyroid Carcinoma. Front Oncol 2022; 11:819824. [PMID: 35111686 PMCID: PMC8801573 DOI: 10.3389/fonc.2021.819824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background Prophylactic central lymph node dissection (PCLND) for adult patients with papillary thyroid carcinoma (PTC) is still a matter of debate. Data on incidence, risk and benefits of PCLND in Middle Eastern patients is lacking. Therefore, we aimed to identify the incidence and predictive clinico-pathological and molecular marker of PCLND in adult patients with clinically node negative (cN0) Middle Eastern PTC. Methods This retrospective study included 942 adult Middle Eastern patients with cN0 PTC who underwent total thyroidectomy (TT) or TT+PCLND. Clinico-pathological associations of central lymph node metastasis (CLNM) were assessed. Multivariate analysis was performed using logistic regression and Cox proportional hazards model. Results 213 patients underwent PCLND and 38.0% (81/213) had positive CLNM. Multivariate analysis demonstrated age ≤55 years (Odds Ratio (OR) = 7.38; 95% Confidence Interval (CI) = 1.59 – 34.31; p = 0.0108), tumor bilaterality (OR = 3.01; 95% CI = 1.01 – 9.21; p = 0.0483), lymphovascular invasion (OR = 2.92; 95% CI = 1.18 – 7.23; p = 0.0206) and BRAF mutation (OR = 3.24; 95% CI = 1.41 – 7.49; p = 0.0058) were independent predictors of CLNM in adult PTC. Furthermore, patients who underwent PCLND showed significant association with improved recurrence-free survival (RFS; p = 0.0379). Multivariate analysis demonstrated that PCLND was an independent predictor of improved recurrence-free survival. Conclusions cN0 Middle Eastern PTC patients treated with PCLND showed a significantly better prognosis. PCLND was effective in improving RFS in Middle Eastern PTC patients and should be encouraged for patients with potential risk factors for CLNM.
Collapse
Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdul K Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saeeda O Ahmed
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Felisa DeVera
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif S Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khawla S Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
|
23
|
Yan XQ, Zhang ZZ, Yu WJ, Ma ZS, Chen ML, Xie BJ. Prophylactic Central Neck Dissection for cN1b Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2022; 11:803986. [PMID: 35096606 PMCID: PMC8795744 DOI: 10.3389/fonc.2021.803986] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background The value of prophylactic central neck dissection (PCND) for papillary thyroid carcinoma (PTC) with clinically evident lateral cervical lymph node metastases (cN1b) remains unclear. Therefore, a systematic review and meta-analysis was conducted to assess the efficacy and safety of PCND. Methods A comprehensive systematic search was conducted on PubMed, Web of Science, Cochrane library and Embase databases up to September 2021 to identify eligible studies. Controlled clinical trials assessing therapeutic effects and safety of PCND for cN1b PTC patients were included. The risk of bias for each cohort study was assessed using the Newcastle-Ottawa Scale (NOS). The primary outcomes were indexes related to the locoregional recurrence (LRR) and surgical complications. Review Manager software V5.4.0 was used for statistical analysis. A fixed effects model was adopted for the data without heterogeneity, otherwise a random effects model was used. Results We included 4 retrospective cohort studies, which comprised 483 PTC patients. There was no statistically significant difference in the central neck recurrence (CNR) (10.2% vs. 3.8%, relative risk (RR) = 1.82; 95%CI 0.90–3.67; P = 0.09), lateral neck recurrence (LNR) (5.1% vs. 7.7%, RR = 0.47; 95% CI 0.13–1.74; P = 0.26), and overall recurrence (OR) (18.9% vs. 16.9%, RR = 0.77; 95%CI 0.34–1.76; P = 0.54), between LND + PCND group and LND group. Simultaneously, PCND increased the risk of permanent hypoparathyroidism (11.4% vs. 4.5%, RR = 2.70, 95%CI 1.05–6.94; P = 0.04) and overall complications (17.0% vs. 5.3%, RR = 3.28; 95%CI 1.37–7.86; P = 0.008). Conclusions This meta-analysis showed that PCND did not have any advantage in preventing LRR for cN1b PTC. Meanwhile, PCND may result in the increased rate of surgical complications. However, the current evidence is limited and more clinical trials are still needed to further clarify the true role of PCND. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, CRD42021281825.
Collapse
Affiliation(s)
- Xing-Qiang Yan
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Zhen-Zhen Zhang
- Department of Plastic Surgery, Enze Hospital of Taizhou Enze Medical Center (Group), Luqiao, China
| | - Wen-Jie Yu
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Zhao-Sheng Ma
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Min-Long Chen
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Bo-Jian Xie
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| |
Collapse
|
|
24
|
Wu YJ, Wang JB, Li FB, Jin L, Zhou L, Xie L. Fine-Needle Pricking Test of the Parathyroid Gland during Thyroid Surgery in Predicting Parathyroid Function. Int J Endocrinol 2022; 2022:8747680. [PMID: 35795846 PMCID: PMC9252692 DOI: 10.1155/2022/8747680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Permanent hypoparathyroidism is a serious complication following total thyroidectomy plus central neck dissection (CND). How to evaluate the vascularization of the parathyroid gland in real time is a major concern of thyroid surgeons. This study aimed to evaluate the fine-needle pricking (FNP) test in predicting parathyroid gland function. METHODS The FNP test was performed in patients undergoing total thyroidectomy plus CND between January 1, 2014, and December 31, 2019, to visualize the vascularization of the parathyroid glands. Patients were classified according to the number of parathyroid glands preserved in situ with excellent vascularity (PGPIEV) demonstrated by FNP: group 0 (without PGPIEV), group 1 (with one PGPIEV), group 2 (with two PGPIEV), group 3 (with three PGPIEV), and group 4 (with four PGPIEV). RESULTS A total of 608 patients with four parathyroid glands underwent FNP testing during thyroidectomy. At least one PGPIEV was demonstrated by FNP testing in 581 patients who had intact parathyroid hormone (iPTH) levels in the normal range after the operation. The prevalence of hypocalcemia decreased from 77.8% in group 0 to 9.8% in group 4 (P < 0.001), and the incidence of hypoparathyroidism decreased from 44.4% in group 0 to 0% in groups 1-4 (P < 0.001). iPTH concentrations on postoperative day 1 were positively correlated with PGPIEV groups (increased from 14.58 ng/l in group 0 to 45.22 ng/l in group 4, P < 0.001). CONCLUSIONS The FNP test is a safe and reliable method to predict parathyroid function. One PGPIEV demonstrated by the FNP test rules out the possibility of patients developing hypoparathyroidism.
Collapse
Affiliation(s)
- Ying-Jun Wu
- Department of Operation Room Nursing, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Jian-Biao Wang
- Department of Head and Neck Surgery, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Fei-Bo Li
- Second Department of General Surgery, Zhejiang Putuo Hospital, Zhoushan, Zhejiang 316100, China
| | - Lei Jin
- Department of Head and Neck Surgery, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Liang Zhou
- Department of Head and Neck Surgery, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| | - Lei Xie
- Department of Head and Neck Surgery, The Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, China
| |
Collapse
|
|
25
|
Chen Q, Liu Y, Lu W, Zhang L, Su A, Liu F, Zhu J. Pretracheal Lymph Node Subdivision in Predicting Contralateral Central Lymph Node Metastasis for Unilateral Papillary Thyroid Carcinoma: Preliminary Results. Front Endocrinol (Lausanne) 2022; 13:921845. [PMID: 35923620 PMCID: PMC9339796 DOI: 10.3389/fendo.2022.921845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aims of this study were to assess the clinical value of pretracheal lymph node subdivision in identifying patients with contralateral central lymph node metastasis (CLNM) and risk factors for occult contralateral CLNM in unilateral PTC. METHODS A total of 139 unilateral PTC patients with a clinically node-negative neck (cN0) who underwent bilateral central neck dissection (CND) were prospectively enrolled. Intraoperatively, the pretracheal region was further divided into ipsilateral and contralateral subregions. Ipsilateral and contralateral pretracheal lymph nodes (LNs) as well as other CLNs (prelaryngeal, ipsilateral paratracheal and contralateral paratracheal) were labeled separately and sent for pathological examination. Demographic and clinicopathologic variables were analyzed to identify factors predictive of contralateral CLNM. RESULTS Of 139 patients, bilateral CLNM was present in 37 (26.6%) patients. Contralateral pretracheal LNM was significantly associated with contralateral CLNM. In multivariate analysis, prelaryngeal LNM (P = 0.004, odds ratio = 3.457) and contralateral pretracheal LNM (P = 0.006, odds ratio = 3.362) were identified as risk factors for contralateral CLNM. Neither neck recurrence nor distant metastasis was observed within the mean follow-up duration of 9.1 ± 1.8 months. CONCLUSIONS In most unilateral cN0 PTCs, performing ipsilateral CND is appropriate, while patients presenting with evident nodal disease intraoperatively or preoperatively in the contralateral central neck should undergo bilateral CND. Intraoperative re-evaluation of prelaryngeal and contralateral pretracheal LNs may be helpful in determining the extent of CND.
Collapse
|
|
26
|
Yan XQ, Ma ZS, Zhang ZZ, Xu D, Cai YJ, Wu ZG, Zheng ZQ, Xie BJ, Cao FL. The utility of sentinel Lymph node biopsy in the lateral neck in papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:937870. [PMID: 35957824 PMCID: PMC9357979 DOI: 10.3389/fendo.2022.937870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Regional lymph node metastases (LNMs) are very common in papillary thyroid carcinoma (PTC) and associate with locoregional recurrence. The appropriate management of cervical lymph nodes is very important. Therefore, this study evaluated the application of sentinel lymph node biopsy (SLNB) in the lateral neck in PTC patients. METHODS This prospective study was conducted from 1 November 2015 to 31 December 2017 and recruited 78 PTC patients treated with SLNB in the lateral neck and prophylactic lateral neck dissection (compartments II-IV) followed by thyroidectomy or lobectomy and central neck dissection. RESULTS There were 78 PTC patients enrolled and sentinel lymph nodes (SLNs) were detected among 77 patients. A total of 30 patients were diagnosed with SLN metastases (SLNMs). The remaining 47 patients were pathologically negative of SLN, whereas 4 patients were found with metastases in the non-SLN samples. The detection rate, sensitivity, specificity, and accuracy rate of SLNB in the lateral neck were 98.7%, 87.1%, 98.7%, and 93.6%, respectively. However, the values varied greatly in each specific compartment of the lateral neck, and all of them were no more than 80%. These 34 PTC patients diagnosed with lateral compartment LNM (LLNM) were more likely to be younger (41.38 vs. 48.95 years old, p = 0.002) and exhibit extrathyroidal extension (56.8% vs. 31.7%, p = 0.026) and central compartment LNM (66.7% vs. 12.1%, p < 0.001). Tumors located in the upper third of the thyroid lobe also had a significantly higher probability of LLNM compared with those in middle or inferior location (66.7% vs. 35.3% vs. 34.8%, p = 0.044). At last, age (OR=0.912, p = 0.026), tumor location (upper vs inferior, OR=17.478, p = 0.011), and central compartment LNM (OR=25.364, p < 0.001) were independently predictive of LLNM. CONCLUSIONS SLNB can help surgeons to identify some PTC patients who may benefit from therapeutic lateral neck dissection and protect some patients from prophylactic lateral neck dissection. However, it cannot accurately indicate specific lateral compartment-oriented neck dissection. Meanwhile, LLNM is more likely to occur in PTC patients with younger age or upper pole tumors or central compartment LNM.
Collapse
Affiliation(s)
- Xing-qiang Yan
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Zhao-sheng Ma
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Zhen-zhen Zhang
- Department of plastic surgery, Enze Hospital of Taizhou Enze Medical Center (Group), Luqiao, China
| | - Dong Xu
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Yang-jun Cai
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Zeng-gui Wu
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Zhong-qiu Zheng
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
| | - Bo-jian Xie
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
- *Correspondence: Bo-jian Xie, ; Fei-lin Cao,
| | - Fei-lin Cao
- Department of Surgical Oncology, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, China
- *Correspondence: Bo-jian Xie, ; Fei-lin Cao,
| |
Collapse
|
|
27
|
Wang B, Liu Z, Wu J, Liu Y, Wang P, Liu H, Wang H, Wang T, Wang J, Tang Y, Zhang J. Bioelectrical impedance spectroscopy can assist to identify the parathyroid gland during thyroid surgery. Front Endocrinol (Lausanne) 2022; 13:963520. [PMID: 36187105 PMCID: PMC9521317 DOI: 10.3389/fendo.2022.963520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to explore the effectiveness of bioelectrical impedance spectroscopy in the identification of parathyroid glands during thyroid surgeries. METHOD All patients who received thyroid surgeries at our department from January 2018 to February 2020 were recruited for this study. The bioelectrical impedance spectroscopy analyzer was applied to analyze on following tissues: thyroid tissues, lymph nodes, adipose tissues, and the tissues suspected to be parathyroid glands. Postoperative pathological reports were obtained as the golden standard to compare with the characteristic parameters obtained from bioelectrical impedance spectroscopy. The receiver operating characteristic curve analysis was used to assess the diagnostic value and the selection of the optimal threshold of these parameters from bioelectrical impedance spectroscopy. RESULTS A total of 512 patients were enrolled in the study and 1898 specimens were measured by the bioelectrical impedance spectroscopy analyzer. There were significant differences in the parameter of f c among parathyroid glands, thyroid tissues, lymph nodes, and adipose tissues (252.2 ± 45.8 vs 144.7 ± 26.1, 491.7 ± 87.4, 602.3 ± 57.3; P<0.001, P<0.001, P<0.001). The area under the receiver operating characteristic curves was 0.993 (95%CI: 0.989-0.996) for f c. When the diagnostic criterion of f c was set at 188.85 kHz~342.55 kHz, the sensitivity and specificity to identify parathyroid glands from lymph nodes and adipose tissues were both 100%. At this f c, the sensitivity and specificity to identify parathyroid glands from thyroid tissues were 91.1% and 99.0%, respectively. CONCLUSION In conclusion, bioelectrical impedance spectroscopy could assist to differentiate parathyroid glands from peripheral tissues during thyroid surgeries.
Collapse
Affiliation(s)
- Bin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Zaoyang Liu
- Department of General Thoracic Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Jian Wu
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
- *Correspondence: Jian Wu,
| | - Ying Liu
- Department of Ultrasound, Chengdu Third People’s Hospital, Chengdu, China
| | - Pin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Hong Liu
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Haobin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Tielin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, Chengdu Third People’s Hospital, Chengdu, China
| | - Juan Wang
- Department of Ultrasound, Chengdu Third People’s Hospital, Chengdu, China
| | - Yan Tang
- Department of Pathology, Chengdu Third People’s Hospital, Chengdu, China
| | - Junyan Zhang
- Department of Computer Science, George Washington University, Washington, DC, United States
| |
Collapse
|
|
28
|
Nomograms to predict ipsilateral and contralateral central lymph node metastasis in clinically lymph node-negative patients with solitary isthmic classic papillary thyroid carcinoma. Surgery 2021; 170:1670-1679. [PMID: 34275617 DOI: 10.1016/j.surg.2021.06.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Isthmus-originating papillary thyroid carcinoma has unique clinicopathological characteristics. There are no specific guidelines regarding the extent of surgery for isthmic papillary thyroid carcinoma. We aimed to evaluate the characteristics of clinically lymph node-negative patients with solitary isthmic papillary thyroid carcinoma and to determine the best surgical protocol for these patients. METHODS A total of 904 patients diagnosed with solitary papillary thyroid carcinoma who underwent surgery were retrospectively reviewed. These patients were divided into the isthmic group (246 patients) or lobar group (658 patients). We compared the 2 groups and conducted a multivariate analysis to assess risk factors for ipsilateral and contralateral central lymph node metastasis in isthmic papillary thyroid carcinoma patients. Nomograms for predicting central lymph node metastasis in isthmic papillary thyroid carcinoma patients were developed and internal calibration was performed for these models. RESULTS Isthmic papillary thyroid carcinoma patients have a significantly higher incidence of extrathyroidal extension and central lymph node metastasis than do lobar papillary thyroid carcinoma patients. For isthmic papillary thyroid carcinoma patients, sex, BRAF V600E mutation, chronic lymphocytic thyroiditis, tumor size, margin, and extrathyroidal extension were independent risk factors of ipsilateral central lymph node metastasis. Body mass index, BRAF V600E mutation, tumor size, location, and extrathyroidal extension were independent risk factors of contralateral central lymph node metastasis. All the above factors were incorporated into nomograms, which showed the perfect discriminative ability. CONCLUSION Based on the predictive nomograms, we proposed a risk stratification scheme and corresponding individualized surgical treatment based on different nomogram scores. In the debate about prophylactic central neck dissection among clinically lymph node-negative patients with solitary isthmic papillary thyroid carcinoma, our nomograms provide the balance to avoid overtreatment and undertreatment through personal risk assessment.
Collapse
|
|
29
|
Comparison of Surgical Outcomes between Robotic Transaxillary and Conventional Open Thyroidectomy in Pediatric Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13133293. [PMID: 34209221 PMCID: PMC8269192 DOI: 10.3390/cancers13133293] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 12/31/2022] Open
Abstract
Thyroid cancer in children is very uncommon. For pediatric thyroid cancer, robotic surgery has served as a minimally invasive surgical alternative to conventional open surgery. Our study aimed to evaluate the results of robotic versus open surgical treatment for patients with thyroid cancer younger than 20 years of age at the time of diagnosis. This retrospective review included 161 pediatric patients who underwent robotic transaxillary or conventional open thyroidectomy at our institution from 2008 to 2019. Of these patients, 99 comprised the robotic group and 62 the open group. Patient demographics, surgical outcomes, and disease-free survival rates were compared between the two groups. Patients in the open group were more likely to have advanced stage diseases with a larger tumor size and higher tumor-node-metastasis stage than those in the robotic group. Operation time and follow-up period were similar in both groups. Patients in the robotic group had a lower rate of postoperative complications and a shorter length of hospital stay, but they also had a lower average number of retrieved central lymph nodes. However, there were no significant between group differences in recurrence rates and disease-free survival. In the hands of an experienced surgeon, robotic thyroidectomy is a feasible and safe option for pediatric patients.
Collapse
|
|
30
|
Oblak T, Perhavec A, Hocevar M, Peric B. Reduction of overtreatment without reduction of overdiagnosis in patients with differentiated thyroid cancer: mission impossible. Langenbecks Arch Surg 2021; 406:2011-2017. [PMID: 34097134 PMCID: PMC8481199 DOI: 10.1007/s00423-021-02216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 05/24/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Lateral neck nodal metastases are common in patients with differentiated thyroid cancer (DTC) and usually have an indolent nature. They may be detected via neck palpation or preoperative ultrasound (US) of the neck. We hypothesized that preoperative neck metastases detected with US did not affect regional recurrence or long-term survival. METHODS A retrospective analysis of patients' records treated for DTC at our institution between January 2006 and December 2016 was performed. Information about preoperative US of the neck, treatment, demographics, staging, and histopathology was obtained. The endpoints for the study were nodal recurrence and survival. Differences in survival were analyzed between three groups of patients divided by presence or lack of preoperative US and/or palpable cervical lymph nodes (PLN). Furthermore, the prognostic value of multiple variables was tested by univariate and multivariate analysis. RESULTS There were 1108 patients with DTC, 221 males and 887 females. The median age was 48.3 years (range 3 to 86), the median time of observation was 68 months (range 0 to 142). Eight hundred sixty-two patients without PLN or preoperative US represented group 1, 112 patients with PLN were in group 2, and 134 patients without PLN and with preoperative US were in group 3. Only five patients had a regional recurrence, one died due to distant metastases. There was no statistically significant difference in survival between the groups (p = 0.841) and neck US was not significantly associated with overall survival neither in univariate nor in multivariate analysis. CONCLUSION In patients with DTC, the benefits of preoperative US of cervical lymph nodes are probably limited and "less is more" approach is advised.
Collapse
Affiliation(s)
- Tjasa Oblak
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Andraz Perhavec
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Marko Hocevar
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Barbara Peric
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
| |
Collapse
|
|
31
|
Fanget F, Demarchi MS, Maillard L, Lintis A, Decaussin M, Lifante JC. Medullary thyroid cancer outcomes in patients with undetectable versus normalized postoperative calcitonin levels. Br J Surg 2021; 108:1064-1071. [PMID: 33899100 DOI: 10.1093/bjs/znab106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/27/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Calcitonin (Ct) is a sensitive diagnostic biomarker and one of the most important prognostic factors in medullary thyroid cancer (MTC). This study aimed to evaluate progression-free survival and recurrence rates of MTC associated with undetectable compared with normalized serum Ct levels after surgery. METHODS This retrospective observational study included patients operated for MTC at the Digestive and Endocrine Surgery Department of Lyon Sud Hospital Centre between 2000 and 2019. Clinical and pathological factors were correlated with postoperative Ct concentrations. Undetectable and normalized Ct concentrations were defined as below 2 pg/ml and 2-10 pg/ml respectively. RESULTS Overall, 176 patients were treated for MTC, and 127 were considered biochemically cured after surgery. Of these, 24 and 103 had normalized and undetectable Ct concentrations respectively. Patients with Ct level normalization had a 25 per cent risk of disease recurrence, compared with 3 per cent in patients with undetectable Ct levels after surgery. The presence of metastasis in two or more compartments was predictive of failure to achieve undetectable Ct concentrations after surgery and an increased risk of recurrence. CONCLUSION Among patients with biochemically cured MTC, those with undetectable or normalized Ct concentrations after surgery had different risks of recurrence. Simply assessing postoperative Ct normalization can be falsely reassuring, and long-term follow-up is needed.
Collapse
Affiliation(s)
- F Fanget
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - M S Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - L Maillard
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - A Lintis
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France
| | - M Decaussin
- Department of Pathology, Hospices Civils de Lyon, Lyon, France
| | - J C Lifante
- Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France.,Health Services and Performance Research Laboratory (EA 7425 HESPER), Université Claude Bernard, Lyon, France
| |
Collapse
|
|
32
|
A Randomized Controlled Clinical Trial: No Clear Benefit to Prophylactic Central Neck Dissection in Patients With Clinically Node Negative Papillary Thyroid Cancer. Ann Surg 2021; 272:496-503. [PMID: 33759836 DOI: 10.1097/sla.0000000000004345] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this prospective randomized-controlled trial was to evaluate the risks/benefits of prophylactic central neck dissection (pCND) in patients with clinically node negative (cN0) papillary thyroid cancer (PTC). BACKGROUND Microscopic lymph node involvement in patients with PTC is common, but the optimal management is unclear. METHODS Sixty patients with cN0 PTC were randomized to a total thyroidectomy (TT) or a TT+ pCND. All patients received postoperative laryngoscopies and standardized radioiodine treatment. Thyroglobulin (Tg) levels and/or neck ultrasounds were performed at 6 weeks, 6 months, and 1 year. RESULTS Tumors averaged 2.2 ± 0.2 cm and 11.9% had extra-thyroidal extension. Thirty patients underwent a pCND and 27.6% had positive nodes (all ≤6 mm). Rates of postoperative PTH < 10 (33.3% vs 24.1%, P = 0.57) and transient nerve dysfunction (13.3% vs 10.3%, P = 1.00) were not significantly different between groups. Six weeks after surgery, both TT and TT + pCND were equally likely to achieve a Tg < 0.2 (54.5% vs 66.7%, P = 0.54) and/or a stimulated Tg (sTg) <1 (59.3% vs 64.0%, P = 0.78). At 1 year, rates of Tg < 0.2 (88.9% vs 90.0%, P = 1.00) and sTg < 1 (93.8% vs 92.3%, P = 1.00) remained similar between groups. Neck ultrasounds at 1 year were equally likely to be read as normal (85.7% in TT vs 85.1% in pCND, P = 1.00). CONCLUSIONS cN0 PTC patients treated either with TT or TT + pCND had similar complication rates after surgery. Although microscopic nodes were discovered in 27.6% of pCND patients, oncologic outcomes were comparable at 1 year.
Collapse
|
|
33
|
Zhou B, Wei L, Qin J. Analyze and compare the predictors of ipsilateral central lymph node metastasis in papillary thyroid carcinoma with cT1a and cT1b stage. Asian J Surg 2021; 44:1357-1362. [PMID: 33715963 DOI: 10.1016/j.asjsur.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/09/2020] [Accepted: 02/23/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Central lymph node metastasis (CLNM) is common in papillary thyroid carcinoma (PTC). The aim of this study was to compare the cT1a and cT1b stages of PTC and to analyze the predictive factors of ipsilateral central lymph node metastasis (CLNM). METHODS In total, 212 PTC (cT1N0) patients underwent hemi-thyroidectomy with ipsilateral central lymph node dissection (CLND) between 2019 and 2020 in our hospital. Univariate and multivariate analyses identified the predictive factors for CLNM of PTC (cT1aN0 and cT1bN0), and compared the differences between the two stages. RESULTS The total rate of ipsilateral CLNM was 31.13% (66/212), and the ipsilateral CLNM rate in cT1b stage was higher than that in cT1a stage (48.84% vs. 26.63%), with significant differences (p = 0.005). cT1b stage was more prone to capsule invasion than cT1a stage (41.86% vs. 2.37%), with significant differences (p‹0.001). The multivariate analysis showed that tumor size (n > 5 mm) was an independent predictive factor for CLNM in cT1a stage (p = 0.002), with an odds ratio (OR) of 0.228 (95% confidence interval (95% CI): 0.079-0.655). Capsular invasion (p = 0.048) and tumors located in the middle and lower parts (p = 0.022) were independent predictive factors for CLNM in cT1b stage, with ORs of 0.157 (95% CI: 0.034-0.724) and 0.075 (95% CI: 0.007-0.847), respectively. CONCLUSIONS The rate of CLNM increases with increase of tumor size. Patients in cT1b stage are more prone to capsule invasion and CLNM. For the cT1b stage of PTC, predictive factors should be correctly evaluated to guide surgical treatment for PTC patients.
Collapse
Affiliation(s)
- Bin Zhou
- Department of Thyroid and Neck,The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Lin Wei
- Department of Thyroid and Neck,The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jianwu Qin
- Department of Thyroid and Neck,The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
| |
Collapse
|
|
34
|
Back K, Choe JH, Kim JS, Kim JH. Occult contralateral central neck metastasis in papillary thyroid carcinoma with preoperatively documented ipsilateral lateral neck metastasis. Eur J Surg Oncol 2021; 47:1339-1345. [PMID: 33744024 DOI: 10.1016/j.ejso.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/12/2020] [Accepted: 01/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This study was conducted to evaluate risk factors and long-term prognosis of contralateral central neck metastasis (CCNM) in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We present clinical evidence to aid in surgical decision-making regarding the extent of central neck dissection (CND), focusing on separation between ipsilateral and contralateral sides. METHODS A total of 379 PTC patients who underwent total thyroidectomy and concomitant bilateral central neck dissection with ipsilateral lateral neck dissection (LND) at a single institution was retrospectively included between January 1997 and December 2015. RESULTS The median follow-up time was 83.2 months, the mean age was 44.3 years, and the mean tumor size was 1.5 cm. Among the study sample, 266 patients were female (70.2%) and 113 (29.8%) were male. Of 379 patients, CCNM was present in 34.6%. In multivariate analysis, male sex (adjusted OR = 2.46, p = 0.002), bilaterality (adjusted OR = 2.58, p = 0.004), number of metastatic ipsilateral central lymph nodes (adjusted OR = 1.15, p = 0.002), number of metastatic lateral lymph nodes (adjusted OR = 1.48, p < 0.001), and three-level metastasis (adjusted OR = 2.46, p = 0.012) were identified as risk factors of CCNM. Overall recurrence occurred in 6.0% and 11.5% of patients in the CCNM (-) group and CCNM (+) group, respectively. In addition, contralateral recurrence was observed in 1.2% patients and 0.8% patients in the CCNM (-) group and CCNM (+) group, respectively. However, CCNM did not significantly increase risk of recurrence (adjusted HR = 1.01, p = 0.981). CONCLUSIONS Although the probability of pathological CCNM is not negligible, CCNM was not associated with higher risk of recurrence. This study suggest that central neck dissection may be limited to the ipsilateral side, and the result regarding prognosis of CCNM may help to avoid bilateral CND so that it could have potential to minimize unnecessary surgery-related complications such as recurrent laryngeal nerve(RLN) injury or hypoparathyroidism.
Collapse
Affiliation(s)
- Kyorim Back
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Jun-Ho Choe
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jee Soo Kim
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Han Kim
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| |
Collapse
|
|
35
|
Sitges-Serra A. Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy. J Clin Med 2021; 10:jcm10030543. [PMID: 33540657 PMCID: PMC7867256 DOI: 10.3390/jcm10030543] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 12/19/2022] Open
Abstract
Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy.
Collapse
|
|
36
|
Barrios L, Shafqat I, Alam U, Ali N, Patio C, Filarski CF, Bankston H, Mallen-St Clair J, Luu M, Zumsteg ZS, Adashek K, Chen Y, Jain M, Braunstein GD, Sacks WL, Ho AS. Incidental parathyroidectomy in thyroidectomy and central neck dissection. Surgery 2021; 169:1145-1151. [PMID: 33446359 DOI: 10.1016/j.surg.2020.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/26/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although higher thyroidectomy volume has been linked with lower complication rates, its association with incidental parathyroidectomy remains less studied. The volume relationship is even less clear for central neck dissection, where individual parathyroid glands are at greater risk. METHODS Patients undergoing thyroidectomy with or without central neck dissection were evaluated for incidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Univariate and multivariable analyses were performed using binary logistic regression. RESULTS Overall, 1,114 thyroidectomies and 396 concurrent central neck dissections were performed across 7 surgeons. Incidental parathyroidectomy occurred in 22.4% of surgeries (range, 16.9%-43.6%), affecting 7.1% of parathyroids at risk (range, 5.8%-14.5%). When stratified by surgeon, lower incidental parathyroidectomy rates were associated with higher thyroidectomy volumes (R2 = 0.77, P = .008) and higher central neck dissection volumes (R2 = 0.93, P < .001). On multivariable analysis, low-volume surgeon (odds ratio 2.94, 95% confidence interval 2.06-4.19, P < .001), extrathyroidal extension (odds ratio 3.13, 95% confidence interval 1.24-7.87, P = .016), prophylactic central neck dissection (odds ratio 2.68, 95% confidence interval 1.65-4.35, P <.001), and therapeutic central neck dissection (odds ratio 4.44, 95% confidence interval 1.98-9.96, P < .001) were the most significant factors associated with incidental parathyroidectomy. In addition, incidental parathyroidectomy was associated with a higher likelihood of temporary hypoparathyroidism (odds ratio 2.79, 95% confidence interval 1.45-5.38, P = .002) and permanent hypoparathyroidism (odds ratio 4.62, 95% confidence interval 1.41-5.96, P = .025), but not permanent hypocalcemia (odds ratio 1.27, 95% confidence interval 0.48-3.35, P = .63). Higher lymph node yield in central neck dissection was not associated with higher incidental parathyroidectomy rates (odds ratio 1.13, 95% confidence interval 0.85-8.81, P = .82). CONCLUSION Higher surgical volume conferred a lower rate of incidental parathyroidectomy. Nonetheless, greater lymph node yield in central neck dissections did not result in greater parathyroid-related morbidity. Such findings support the value of leveraging surgical volume to both optimize oncologic resection and minimize complication rates.
Collapse
Affiliation(s)
- Laurel Barrios
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Iram Shafqat
- University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Usman Alam
- University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Nabilah Ali
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Chrysanta Patio
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Carolyn F Filarski
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hakimah Bankston
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kenneth Adashek
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Yufei Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Monica Jain
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Glenn D Braunstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Wendy L Sacks
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA; Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
| |
Collapse
|
|
37
|
Zheng G, Wu G, Sun H, Ma C, Guo Y, Wei D, Yu W, Zheng H, Song X. Clinical Relevance and Management of Recurrent Laryngeal Nerve Inlet Zone Lymph Nodes Metastasis in Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:653184. [PMID: 34367062 PMCID: PMC8339313 DOI: 10.3389/fendo.2021.653184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Recurrent nodal disease often occurs in recurrent laryngeal nerve inlet zone (RLNIZ), leading to difficult surgical management. METHODS Medical records of 947 patients with PTC and 33 patients with recurrent PTC were retrospectively reviewed. Totally 169 sides of RLNIZ dissection in 152 patients (17 cases were bilateral and 135 cases were unilateral) with primary surgery and 4 patients with structural recurrent disease were included for the analysis. RESULTS The rate of lymph node metastasis in RLNIZ was 31.3% (47/150). The incidence of transient hypoparathyroidism was 5.9% and no RLN injury and permanent hypoparathyroidism occurred. RLNIZ lymph nodes metastasis (LNM) was significantly associated with age <45 years, larger tumor size, number of CNLNM, and lateral node metastasis. CNLNM and lateral node metastasis were independent risk factors for RLNIZ LNM. Recurrent nodal disease in RLNIZ was identified in four of 33 patients and permanent recurrent laryngeal nerve (RLN) injury was observed in one of four patients. CONCLUSION Lymph nodes in RLNIZ are usually involved in patients with heavy tumor burden and can be removed safely at initial surgery. Once central or lateral LNM was confirmed preoperatively or intraoperatively, RLNIZ lymph node dissection should be carefully performed to reduce the rate of structural recurrence in the central compartment.
Collapse
Affiliation(s)
- Guibin Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Guochang Wu
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Haiqing Sun
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Chi Ma
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Yawen Guo
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Dongmin Wei
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Jinan, China
| | - Wenbin Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Head and Neck Surgery, Peking University Cancer Hospital & Institute, Beijing, China
- *Correspondence: Xicheng Song, ; Haitao Zheng, ; Wenbin Yu,
| | - Haitao Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- *Correspondence: Xicheng Song, ; Haitao Zheng, ; Wenbin Yu,
| | - Xicheng Song
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- *Correspondence: Xicheng Song, ; Haitao Zheng, ; Wenbin Yu,
| |
Collapse
|
|
38
|
Tabriz N, Grone J, Uslar V, Tannapfel A, Weyhe D. BRAF V600E mutation correlates with aggressive clinico-pathological features but does not influence tumor recurrence in papillary thyroid carcinoma-10-year single-center results. Gland Surg 2020; 9:1902-1913. [PMID: 33447541 DOI: 10.21037/gs-20-244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background BRAF V600E mutation is common in papillary thyroid carcinoma (PTC) but its prognostic value and influence on tumor recurrence is controversial. We investigated if BRAF V600E mutation influences tumor behavior and recurrence, and if it can be used as surrogate parameter in PTC. Methods In a single center retrospective study with a median follow-up of 5 years, incidence of BRAF V600E mutation in 186 PTC specimens from 2007-2016 was investigated. Tumor outcome parameters including TNM status, multifocal and invasive growth and tumor recurrence rate were examined. Results In 98 specimens (52.7%) a BRAF V600E mutation (BRAF+), and in 88 specimens (47.3%) no mutation (BRAF-) was detected. There was no gender specific difference. BRAF+ patients were significantly older (mean 5.6 years; P=0.011). BRAF+ tumors were significantly smaller (14.4 vs. 18.3 mm; P=0.018), and more often showed a multifocal (30.6% vs. 17%; P=0.031) and extracapsular tumor growth pattern (pT3b and pT4a; BRAF+ 22.4% vs. BRAF- 10.2%; P=0.026). Although lymph node-status did not differ in both groups, BRAF+ showed a higher infiltration rate of the lateral lymph node compartment (12.2% vs. 5.7%; P=n.s.). Distant metastases occurred only in BRAF+ (3.1% vs. 0%). There was no significant difference in terms of tumor recurrence rate. Conclusions Results regarding the incidence of malignant lymph nodes, tumor growth pattern and tumor multifocality suggest a more aggressive tumor behavior in BRAF+ PTC but this fact does not affect tumor recurrence rate in a five year follow up period. Therefore, the postoperative role of BRAF V600E mutation remains unclear, and a general change of operative procedure and radicality cannot be recommended based on BRAF status alone.
Collapse
Affiliation(s)
- Navid Tabriz
- University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Johannes Grone
- University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Verena Uslar
- University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | | | - Dirk Weyhe
- University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| |
Collapse
|
|
39
|
High-risk factors for lymph node metastasis in contralateral central compartment in unilateral papillary thyroid carcinoma（cT1N0）. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 47:882-887. [PMID: 33092967 DOI: 10.1016/j.ejso.2020.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/03/2020] [Accepted: 10/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The incidence of papillary thyroid carcinoma (PTC) increases yearly. Central lymph node metastasis (CLNM) is common in PTC. Many studies have addressed ipsilateral CLNM; however, few studies have evaluated contralateral CLNM. The purpose of this study is to investigate the high-risk factors of lymph node metastasis in the contralateral central compartment of cT1 stage in PTC. METHODS In total, 369 unilateral PTC (cT1N0) patients who underwent total-thyroidectomy with bilateral central lymph node dissection (CLND) between 2013 and 2016 in our hospital were retrospectively enrolled. Univariate and multivariate analyses identified the high-risk factors for contralateral CLNM of PTC. RESULTS The total metastasis rate of the ipsilateral central neck compartment was 31.71% (117/369). The total metastasis rate of the contralateral central neck compartment was 8.13% (30/369). The multivariate analysis showed that multifocality (p = 0.009), ipsilateral CLNM (p＜0.001), number of ipsilateral CLNM ＞2 (p = 0.006), tumor located at the inferior pole (p = 0.032) and tumor diameter ＞ 1 cm (p = 0.029) were independent risk factors for contralateral CLNM at cT1 stage in PTC, with odds ratios (ORs) of,4.132 (95% confidence intervals (CI): 1.430-11.936) ，8.591 (95% CI: 3.200-23.061) ，0.174 (95% CI: 0.050-0.601) ，0.353 (95% CI: 0.136-0.917)and 0.235 (95% CI: 0.064-0863), respectively. CONCLUSION The combinational use of these risk factors will help surgeons devise an appropriate surgical plan preoperatively. This information could provide reference for the readers who are interested and help to determine the optimal extent of CLND in patients with PTC, especially for cT1b patients.
Collapse
|
|
40
|
Sahin S, Daglar G, Menekse E, Cavdarli B, Baglan T. The Effect of BRAF V600E Mutation on Lymph Node Involvement in Papillary Thyroid Cancer. Turk J Surg 2020; 36:249-255. [PMID: 33778379 PMCID: PMC7963314 DOI: 10.47717/turkjsurg.2020.4696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Papillary thyroid cancer (PTC) is the most common well-differentiated thyroid cancer. Lymph node (LN) metastasis is frequently seen in PTC. The effect of BRAFV600E mutation on PTC-associated LN metastasis has not been clearly established. Therefore, we aimed to evaluate the effect of the BRAFV600E mutation in patients with PTC on regional LN metastasis. MATERIAL AND METHODS Between January 2013 and 2017, sixty-three PTC patients who underwent central lymph node dissection were included into the study. The patients were divided into two groups according to the pathology results of the LN dissection, and these groups were compared for positive BRAFV600E mutations and other clinicopathological findings. RESULTS BRAFV600E mutation was found to be more significant in the pLN1 group (p= 0.005). Multivariate analysis revealed that nodule size, microcalcifications, and BRAFV600E mutation were associated with lymph node metastasis independent of other parameters. ROC analysis also evaluated the adequacy of the BRAFV600E mutation in predicting the presence of LN involvement. AUC: 0.738 (95%CI:0.6110.866,p: 0.002). CONCLUSION In our study, independent of other parameters, BRAFV600E gene mutation was found to be effective on lymph node involvement.
Collapse
Affiliation(s)
- Samet Sahin
- Ankara Sereflikochisar State Hospital, General Surgery, Ankara, Turkey
| | - Gul Daglar
- Ankara Numune Training And Research Hospital, General Surgery, Ankara, Turkey
| | - Ebru Menekse
- Ankara Numune Training And Research Hospital, General Surgery, Ankara, Turkey
| | - Busranur Cavdarli
- Ankara Numune Training And Research Hospital, Genetics, Ankara, Turkey
| | - Tolga Baglan
- Ankara University Faculty Of Medicine, Pathology, Ankara, Turkey
| |
Collapse
|
|
41
|
Harries V, McGill M, Wang LY, Tuttle RM, Wong RJ, Shaha AR, Shah JP, Patel SG, Ganly I. Is a Prophylactic Central Compartment Neck Dissection Required in Papillary Thyroid Carcinoma Patients with Clinically Involved Lateral Compartment Lymph Nodes? Ann Surg Oncol 2020; 28:512-518. [PMID: 32681478 DOI: 10.1245/s10434-020-08861-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/29/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND The 2015 American Thyroid Association guidelines state that a prophylactic central compartment neck dissection (PCND) should be considered for patients with papillary thyroid carcinoma (PTC) and clinically involved lateral neck lymph nodes (cN1b). The purpose of our study was to determine the rate of central neck recurrence in select cN1b patients, with no evidence of clinically involved central compartment lymph nodes, treated without a PCND. METHODS After institutional review board approval, adult PTC patients with cN1b disease who were treated with a total thyroidectomy and lateral neck dissection were identified from an institutional database of 6259 patients who underwent initial surgery for well-differentiated thyroid carcinoma from 1986 to 2015. Patients with gross extrathyroidal extension, distant metastases, or no preoperative imaging were excluded. Patients with evidence of clinically involved central compartment lymph nodes, on preoperative imaging or intraoperative evaluation, also were excluded. A total of 152 cN1b patients were included and categorized into non-PCND and PCND groups. Central neck recurrence-free probability (CNRFP) was calculated using the Kaplan-Meier method and log-rank tests. RESULTS One hundred three patients (67.8%) did not have a PCND. With a median follow-up of 65 months, the 5- and 10-year CNRFP was 98.4% in the non-PCND group and 93.6% in the PCND group (p = 0.133). CONCLUSIONS Select PTC patients with cN1b disease but no evidence of clinically involved central compartment lymph nodes, on preoperative imaging and intraoperative evaluation, appear to have a low rate of central neck recurrence. These patients may not require or benefit from a PCND.
Collapse
Affiliation(s)
- Victoria Harries
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marlena McGill
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Y Wang
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Michael Tuttle
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashok R Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Snehal G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
|
42
|
Wang B, Zhu CR, Liu H, Yao XM, Wu J. The inferior parathyroid glands preserved in site recover faster than the superior parathyroid glands preserved in site after thyroid surgery for carcinoma. Medicine (Baltimore) 2020; 99:e20886. [PMID: 32664081 PMCID: PMC7360264 DOI: 10.1097/md.0000000000020886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Due to the great difficulty in being preserved in site for the variable positions, the inferior parathyroid glands were advised to being routinely autotransplanted to prevent permanent hypoparathyroidism. The aim of this study was to compare the performance in the function of the superior parathyroid glands preserved in site with that of the inferior parathyroid glands preserved in site.We conducted a retrospective study including patients who underwent thyroid surgery for papillary thyroid carcinoma at our department between January 2014 and June 2018. According to the number and original position of the autoplastic parathyroid gland(s), patients were divided into group 1 (1 superior parathyroid gland), group 2 (1 inferior parathyroid glands), group 3 (1 superior parathyroid gland and 1 inferior parathyroid gland) and group 4 (2 inferior parathyroid glands). The postoperative complications and serum parathyroid hormone and calcium were analyzed.A total of 368 patients were included in the study, among them 27, 243, 40, and 58 patients were divided into group 1, group 2, group 3, and group 4, respectively. Compared with those in group 2, the serum parathyroid hormones were higher at 1 week (2.98 ± 1.52 vs 2.42 ± 0.89, P = .049) and 2 weeks (3.49 ± 1.42 vs 2.8 ± 0.81, P = .019) postoperatively in group 1. There was also significantly different in the serum parathyroid hormone at 2 weeks postoperatively between group 3 and group 4 (2.95 ± 0.98 vs 2.58 ± 0.82, P = .047).The inferior parathyroid glands preserved in site recover faster than the superior parathyroid glands preserved in site.
Collapse
Affiliation(s)
- Bin Wang
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu
| | - Chun-Rong Zhu
- Sichuan Key Laboratory of Medical Imaging, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan
- Department of Chemistry, School of Basic Medical Science, North Sichuan Medical College, Nanchong, China
| | - Hong Liu
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu
| | - Xin-Min Yao
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu
| | - Jian Wu
- Department of Thyroid and Breast Surgery, The Third People's Hospital of Chengdu, Chengdu
| |
Collapse
|
|
43
|
Deligiorgi MV, Panayiotidis MI, Trafalis DT. Prophylactic lymph node dissection in clinically N0 differentiated thyroid carcinoma: example of personalized treatment. Per Med 2020; 17:317-338. [PMID: 32588744 DOI: 10.2217/pme-2019-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Considering the 'differentiated thyroid carcinoma (DTC) epidemic', the indolent nature of DTC imposes a treatment paradigm shift toward elimination of recurrence. Lymph node metastases in cervical compartments, encountered in 20-90% of DTC, are the main culprit of recurrent disease, affecting 5-30% of patients. Personalized risk-stratified cervical prophylactic lymph node dissection (PLND) at initial thyroidectomy in DTC with no clinical, sonographic or intraoperative evidence of lymph node metastases (clinically N0) has been advocated, though not unanimously. The present review dissects the controversy over PLND. Weighing the benefit yielded from PLND up against the PLND-related morbidity is so far hampered by the inconsistent profit yielded by PLND and the challenging patient selection. Advances in tailoring PLND are anticipated to empower optimal patient care.
Collapse
Affiliation(s)
- Maria V Deligiorgi
- Department of Pharmacology - Clinical Pharmacology Unit, National & Kapodistrian University of Athens, Faculty of Medicine, Building 16, 1st Floor, 75 Mikras Asias, 11527-Goudi, Athens, Greece
| | - Mihalis I Panayiotidis
- Department of Applied Sciences, Group of Translational Biosciences, Faculty of Health & Life Sciences, Northumbria University, Ellison Building A516, Newcastle Upon Tyne, NE1 8ST, UK.,Department of Electron Microscopy & Molecular Pathology, Cyprus Institute of Neurology & Genetics, 1683 Nicosia, Cyprus
| | - Dimitrios T Trafalis
- Department of Pharmacology - Clinical Pharmacology Unit, National & Kapodistrian University of Athens, Faculty of Medicine, Building 16, 1st Floor, 75 Mikras Asias, 11527-Goudi, Athens, Greece
| |
Collapse
|
|
44
|
Total thyroidectomy with therapeutic level II-IV neck dissection for papillary thyroid carcinoma: level VI recurrence patterns. Eur Arch Otorhinolaryngol 2020; 277:3449-3455. [PMID: 32488373 DOI: 10.1007/s00405-020-06079-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Lateral and central compartments cervical lymph nodes metastases are common among patients with papillary thyroid carcinoma (PTC). Elective level VI neck dissection during thyroidectomy and lateral neck dissection (LND) for the treatment of PTC with lateral compartment lymph node metastases is controversial because of the uncertain benefit in clinical outcomes and increased risks of surgical morbidity. We aimed to determine the potential benefit of elective level VI neck dissection in patients with cN1 papillary thyroid carcinoma (PTC) by investigating the rate and pattern of locoregional recurrence in PTC patients who underwent total thyroidectomy and therapeutic lateral node dissection (LND; levels II-IV) without elective level VI dissection. METHODS A retrospective cohort study. Data on demographics, clinical presentation and workup, intraoperative and pathological report, postoperative course, adjuvant therapy, recurrence patterns, and overall survival were retrieved from the medical charts of patients who underwent thyroid surgery in our hospital between January 2006 and December 2017. RESULTS A total of 1415 thyroidectomies were performed during the study period, of which 802 (56.67%) were for PTC. Of those PTC patients, 228 (28.42%) also underwent LND (levels II-VI) during the same thyroidectomy procedure. Thirty-four (14.91%) of those 228 patients, underwent total thyroidectomy with therapeutic lateral ND II-IV without elective level VI ND. During the follow-up period, five (14.7%) of the latter cohort were diagnosed with recurrence in central neck (level VI) lymph nodes, and four of them (11.7%) were diagnosed with ipsilateral recurrence at level VI. CONCLUSION Our results revealed 11.7% rate of clinically significant recurrent disease in ipsilateral level VI which, in our opinion, does not justify routine prophylactic level VI ND dissection when the ipsilateral lateral neck is operated for metastases.
Collapse
|
|
45
|
Effects of active localization and vascular preservation of inferior parathyroid glands in central neck dissection for papillary thyroid carcinoma. World J Surg Oncol 2020; 18:95. [PMID: 32404116 PMCID: PMC7222446 DOI: 10.1186/s12957-020-01867-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background The purpose of present study is to assess the effects of active localization and vascular preservation of inferior parathyroid glands in central neck dissection (CND) for papillary thyroid carcinoma (PTC). Methods A classification of IPGs according to their location and vascular features was developed, and, based on this classification, a CND procedure was designed, and IPGs and their vascular were actively localized and strategically preserved. A total of 197 patients with PTC who underwent a total thyroidectomy and concomitant CND were enrolled. Eighty-nine patients with traditional meticulous fascia dissection were allocated to group A, and 108 patients with active location and vascular preservation of IPGs were allocated to group B. Those with inferior parathyroid glands auto-transplantation in each group were assigned as group At (18) and group Bt (12). Variables including serum intact parathyroid hormone (PTH), total calcium, the incidence of transient, and permanent hypoparathyroidism were studied. Results Compared with group A, serum intact PTH (P < 0.001) and total calcium levels (P < 0.05) in group B significantly improved on the first postoperative day, and the incidence of transient hypoparathyroidism significantly dropped in group B (P < 0.001). A total of 170 patients in the two groups had complete follow-up data. The incidence of permanent hypoparathyroidism significantly decreased in group B, from 8.8% to 1.0% (P = 0.017). However, there were no significant differences in all variables between group Bt and group At. Conclusion Active location and vascular preservation of inferior parathyroid glands effectively protected the function of IPGs in CND for PTC.
Collapse
|
|
46
|
Harries V, McGill M, Tuttle RM, Shaha AR, Wong RJ, Shah JP, Patel SG, Ganly I. Management of Retropharyngeal Lymph Node Metastases in Differentiated Thyroid Carcinoma. Thyroid 2020; 30:688-695. [PMID: 31910129 PMCID: PMC7232633 DOI: 10.1089/thy.2019.0359] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Retropharyngeal lymph node metastases (RPMs) from differentiated thyroid carcinoma (DTC) are rare. Treatment includes surgical resection, radioactive iodine (RAI) therapy, or external beam radiation therapy (EBRT). The objective of this study was to describe our experience in the management of DTC-associated RPMs. Methods: Patients diagnosed with a DTC-associated RPM from 1999 to 2018 were identified at our institution, using key search terms in imaging and histology reports. Patient and tumor characteristics were recorded, and patients were grouped according to RPM management: observation, nonsurgical treatment, or surgical resection. The estimated rates of local RPM control, disease-specific survival (DSS), and distant metastasis-free probability (DMFP) were calculated by using the Kaplan-Meier method. Results: Of the 65 patients identified, 53 (82%) had an RPM as a manifestation of recurrent disease. Twenty-five patients (38%) underwent observation, 13 (20%) received nonsurgical treatment (RAI, EBRT, and/or systemic therapy), and 27 (42%) underwent surgical resection. In the observation cohort, all patients had a stable RPM, which in the majority (80%) of cases remained <1.5 cm during the period of observation (median 28 months). Of the 13 patients in the nonsurgical treatment cohort, 3 received RAI therapy, 7 received EBRT, and 3 received systemic therapy only. In the surgical cohort, the median RPM maximum diameter was 2.0 cm (range 0.8-4.2 cm). The size of the RPM was predictive of surgical resection versus observation (p < 0.001). A transcervical approach was employed in 19 patients, and a transoral approach was used in 8 patients. The 5-year rate of local RPM control was 92%. For the whole cohort, the 5- and 10-year DMFP were 72% and 62%, respectively; the 5- and 10-year DSS were 93% and 81%, respectively. Conclusions: DTC-associated RPMs manifest as recurrent disease in the majority of patients. Select patients with a small-volume and nonprogressive RPM may be suitable for observation, whereas surgery is likely warranted in large or progressing RPMs. In general, the presence of an RPM from DTC appears to be associated with aggressive disease.
Collapse
Affiliation(s)
- Victoria Harries
- Department of Surgery and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marlena McGill
- Department of Surgery and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - R. Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ashok R. Shaha
- Department of Surgery and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard J. Wong
- Department of Surgery and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jatin P. Shah
- Department of Surgery and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Snehal G. Patel
- Department of Surgery and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ian Ganly
- Department of Surgery and Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
|
47
|
Hargitai L, Strobl S, Koperek O, Urach S, Raber W, Staudenherz A, Scheuba C, Riss P. Positive central lymph-nodes are underdiagnosed in patients with Bethesda V cytology in an endemic goiter region. Gland Surg 2020; 9:252-260. [PMID: 32420249 DOI: 10.21037/gs.2020.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Fine needle aspiration (FNA) is a significant diagnostic procedure for detecting malignancy in patients with nodular thyroid disease. A high proportion of patients with cytological diagnosed follicular neoplasia (Bethesda IV and V) ultimately have thyroid cancer. The aim of this study was to evaluate the incidence of preoperatively undiagnosed central lymph node metastasis in patients with multinodular goiter (MNG). Methods Patients who underwent FNA and were classified as Bethesda IV/V were included. Applying a radical approach, all patients underwent (hemi)thyroidectomy and prophylactic unilateral central neck dissection. Results During our study period 2009-2013, 60 patients (19.7%) were classified as Bethesda IV and 21 (6.9%) Bethesda V. Final histopathological results revealed malignancy in 35 (43.2%) of 81 Bethesda IV/V nodules. Of the nodules classified as Bethesda IV, 20 (33.3%) showed malignancy in the final histology. Ten patients (16.7%) had papillary micro-carcinoma (mPTC, <10 mm), 4 (6.6%) PTC and 6 (10%) follicular thyroid cancer. Fifteen of 21 (71.4%) Bethesda V nodules were revealed as PTC of whom seven (33.3%) patients also had lymph-node metastases. Conclusions While 33.3% of the patients with PTC, preoperatively classified as Bethesda V, had previously undetected positive lymph-nodes, only one patient with Bethesda IV had lymph-node metastasis.
Collapse
Affiliation(s)
- Lindsay Hargitai
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephanie Strobl
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Oskar Koperek
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Susanne Urach
- Center for Medical Statistics, Informatics, and Intelligent Systems, Institute of Medical Statistics, Vienna, Austria
| | - Wolfgang Raber
- Section of Endocrinology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Anton Staudenherz
- Clinical Institute for Nuclear Medicine, Molecular Imaging and Special Endocrinology, University Hospital St. Pölten, St. Pölten, Austria
| | - Christian Scheuba
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Riss
- Section of Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
|
48
|
Priya SR, Dravid C. Central Compartment Nodal Bulk: A Predictor of Permanent Postoperative Hypocalcaemia. Indian J Surg Oncol 2020; 11:92-100. [PMID: 32205978 PMCID: PMC7064669 DOI: 10.1007/s13193-019-01010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022] Open
Abstract
Central compartment clearance (CCC) for Papillary thyroid cancers (PTC) is one of the factors causing postoperative hypocalcaemia. We aimed to examine determinants of this major sequela. 41 patients treated for PTCs between 2014 and 2016 were studied. Surgical details, tumour and nodal characteristics, incidence of transient, temporary and permanent hypocalcaemia were noted. Central clearance was done bilaterally in 24 (58.5%) cases, ipsilaterally in 17 (41.6%). Central nodes were involved in 26 (63.4%) cases, unilaterally in 15 (36.6%), bilaterally in 11 (26.8%). Transient hypocalcaemia developed in 10 (24.4%) cases, temporary hypocalcaemia in 6 (14.6%) cases, and permanent hypocalcaemia in 2 (4.9%) cases. 17 (41%) patients were symptomatic. 9 (21.9%) patients received intravenous calcium. The only factor consistently associated with development of hypocalcaemia of all patterns, was the presence of matted central compartment nodes (p = 0.021). Matted nodes also related to a longer length of stay (p = 0.04) and requirement of intravenous calcium (p = 0.000). Extent of CCC, nodal yield, nodal positivity, perinodal extension, number of parathyroids identified, gender or pT size were not significantly associated. Symptomatic patients did not necessarily become permanently hypocalcaemic (p = 0.8). Patients requiring intravenous calcium were more likely to take oral calcium after discharge (p = 0.002). Postoperative hypocalcaemia is more likely in cases with bulky involved central nodes where extensive clearance is done. In routine CCC, even if done bilaterally, preservation of parathyroid function is possible. Permanent hypocalcaemia after CCC need not be taken as inevitable.
Collapse
Affiliation(s)
- S. R. Priya
- Head Neck Unit, Delhi State Cancer Institute, Delhi, India
| | | |
Collapse
|
|
49
|
Guan Y, Bhandari A, Xia E, Kong L, Zhang X, Wang O. Downregulating integrin subunit alpha 7 (ITGA7) promotes proliferation, invasion, and migration of papillary thyroid carcinoma cells through regulating epithelial-to-mesenchymal transition. Acta Biochim Biophys Sin (Shanghai) 2020; 52:116-124. [PMID: 31942970 DOI: 10.1093/abbs/gmz144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/19/2019] [Accepted: 11/18/2019] [Indexed: 12/14/2022] Open
Abstract
Thyroid cancer is one of the common malignancies of the endocrine system and the number of thyroid cancer cases is increasing constantly. Significant work has focused on the molecular mechanisms of thyroid cancer, but many mechanisms remain undiscovered. In this study, we employed a comprehensive analysis of whole-transcriptome resequencing derived from paired papillary thyroid cancer (PTC) and normal thyroid tissues. We performed a massive parallel whole-transcriptome resequencing of matched PTC and normal thyroid tissues in 19 patients and found that integrin subunit alpha 7 (ITGA7) was downregulated in thyroid tumor tissues, but the function of ITGA7 in this cancer is still unclear. We also discovered that ITGA7 gene in thyroid cancer tissues was downregulated compared to paired adjacent non-tumor tissues by real-time quantitative polymerase chain reaction. After transfection with small interfering RNA to knock down ITGA7, the abilities of colony formation, proliferation, migration, and invasion were enhanced in PTC cell lines (TPC1 and KTC-1). Meanwhile, ITGA7 knockdown decreased apoptotic cell death in thyroid cells but promoted the expressions of N-cadherin and vimentin and decreased E-cadherin expression by epithelial-to-mesenchymal transition, which may induce invasion and migration. In conclusion, these results indicated that ITGA7 is involved in the progress of PTC and might act as a tumor suppressor gene.
Collapse
Affiliation(s)
- Yaoyao Guan
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Adheesh Bhandari
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Erjie Xia
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Lingguo Kong
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaohua Zhang
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ouchen Wang
- Department of Thyroid & Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| |
Collapse
|
|
50
|
Nayyar SS, Thiagarajan S, Malik A, Chakraborthy A, Velayutham P, Chaukar D. Risk factors predisposing for recurrent laryngeal nerve palsy following thyroid malignancy surgery: experience from a tertiary oncology centre. Eur Arch Otorhinolaryngol 2020; 277:1199-1204. [DOI: 10.1007/s00405-020-05788-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
|