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Nassar M, Nassar O, Abosheaishaa H, Misra A. Comparative outcomes of systemic diseases in people with type 2 diabetes, or obesity alone treated with and without GLP-1 receptor agonists: a retrospective cohort study from the Global Collaborative Network : Author list. J Endocrinol Invest 2025; 48:483-497. [PMID: 39302577 DOI: 10.1007/s40618-024-02466-4] [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: 06/26/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used to manage type 2 diabetes (T2D) and obesity. Despite their recognized benefits in glycemic control and weight management, their impact on broader systemic has been less explored. OBJECTIVE This study aimed to evaluate the impact of GLP-1RAs on a variety of systemic diseases in people with T2D or obesity. METHODS We conducted a retrospective cohort study using data from the Global Collaborative Network, accessed through the TriNetX analytics platform. The study comprised two primary groups: individuals with T2D and those with obesity. Each group was further divided into subgroups based on whether they received GLP-1RA treatment or not. Data were analyzed over more than a 5-year follow-up period, comparing incidences of systemic diseases; systemic lupus erythematosus (SLE), systemic sclerosis (SS), rheumatoid arthritis (RA), ulcerative colitis (UC), crohn's disease (CD), alzheimer's disease (AD), parkinson's disease (PD), dementia, bronchial asthma (BA), osteoporosis, and several cancers. RESULTS In the T2D cohorts, GLP-1RA treatment was associated with significantly lower incidences of several systemic and metabolic conditions as compared to those without GLP-1RA, specifically, dementia (Risk Difference (RD): -0.010, p < 0.001), AD (RD: -0.003, p < 0.001), PD (RD: -0.002, p < 0.001), and pancreatic cancer (RD: -0.003, p < 0.001). SLE and SS also saw statistically significant reductions, though the differences were minor in magnitude (RD: -0.001 and - 0.000 respectively, p < 0.001 for both). Conversely, BA a showed a slight increase in risk (RD: 0.002, p < 0.001). CONCLUSIONS GLP-1RAs demonstrate potential benefits in reducing the risk of several systemic conditions in people with T2D or obesity. Further prospective studies are needed to confirm these effects fully and understand the mechanisms.
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Affiliation(s)
- Mahmoud Nassar
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Omar Nassar
- Williamsville East High School, Buffalo, NY, USA
| | - Hazem Abosheaishaa
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anoop Misra
- Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
- National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- Diabetes Foundation (India) (DFI) India, New Delhi, India
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Parsa AA, Gharib H. Thyroid Nodules: Past, Present, and Future. Endocr Pract 2025; 31:114-123. [PMID: 38880348 DOI: 10.1016/j.eprac.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/09/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Over the past millennia, the evaluation and management of thyroid nodules has essentially remained the same with thyroidectomy as the only reliable method to identify malignancy. However, in the last 30 years, technological advances have significantly improved diagnostic management of thyroid nodules. Advances in imaging have allowed development of a reliable risk- based stratification system to identify nodules at increased risk of malignancy. At the same time, sensitive imaging has caused collateral damage to the degree that we are now identifying and treating many small, low risk nodules with little to no clinical relevance. OBJECTIVE To review the history of thyroid nodule evaluation with emphasis on recent changes and future pathways. METHODS Literature review and discussion. RESULTS Thyroid ultrasound remains the best initial method to evaluate the thyroid gland for nodules. Different risk-of-malignancy protocols have been developed and introduced by different societies, reporting methods have been developed and improved each, with goals of improving the ability to recognize nodules requiring further intervention and minimizing excessive monitoring of those who do not. Once identified, cytological evaluation of nodules further enhances malignancy identification with molecular markers assisting in ruling out malignancies in indeterminate nodules preventing unneeded intervention. And all societies have urged avoidance of overdiagnosis and overtreatment of low-risk cancers of little to no clinical relevance. CONCLUSION In this review, we describe advancements in nodule evaluation and management, while emphasizing caution in overdiagnosing and overtreating low-risk lesions without clinical importance.
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Affiliation(s)
- Alan A Parsa
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii.
| | - Hossein Gharib
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, Minnesota
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Cowen J, Dave R, Neale J, Ward M, Repanos C, Nasef H, Vigneswaran G, Brennan PA, Bekker J. Comparison of British Thyroid Association and TIRADS classifications and their impact on the radiological and surgical management of indeterminate thyroid nodules. Clin Radiol 2025; 80:106725. [PMID: 39626569 DOI: 10.1016/j.crad.2024.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/08/2024] [Accepted: 08/19/2024] [Indexed: 01/18/2025]
Abstract
AIM The British Thyroid Association (BTA) Guidelines for the Management of Thyroid Cancer advocate for fine-needle aspiration cytology for all thyroid nodules graded indeterminate (U3) at ultrasound assessment. This approach raises concerns regarding potential over-diagnosis of low-risk lesions. Conversely, equivalent Thyroid Imaging Reporting and Data Systems (TIRADS) guidelines permit surveillance or discharge of indeterminate thyroid nodules of certain sizes. This service analysis analyses how guideline choice impacts the fine-needle aspiration cytology rate and subsequent surgical management of indeterminate thyroid nodules. MATERIALS AND METHODS All patients with an indeterminate (U3) thyroid nodule identified on ultrasound over a 12-month period were included. Indeterminate thyroid nodules were retrospectively rescored using three equivalent TIRADS classifications by three independent reviewers, blinded to the histopathology. Hypothetical differences in fine-needle aspiration cytology rates and surgical activity were then compared. RESULTS Ninety-six nodules were identified. Retrospective application of TIRADS guidelines resulted in a hypothetical 44.8-55.2% reduction in fine-needle aspiration cytology performed for indeterminate thyroid nodules compared to BTA. A statistically significant increase in rates of surgical activity for indeterminate thyroid nodules was observed between BTA guidance and all retrospectively applied TIRADS guidelines (p < 0.001). Of four confirmed thyroid cancers, three would have been unanimously removed. CONCLUSION Under BTA guidance, increased fine-needle aspiration cytology rates for indeterminate thyroid nodules resulted in significantly increased surgical activity in our cohort compared to retrospectively applied TIRADS guidelines.
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Affiliation(s)
- J Cowen
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK.
| | - R Dave
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - J Neale
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | - M Ward
- Department of Ear, Nose & Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - C Repanos
- Department of Ear, Nose & Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - H Nasef
- Department of Ear, Nose & Throat Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - G Vigneswaran
- Department of Radiology, Southampton General Hospital, Southampton, UK; Department of Cancer Sciences, University of Southampton, Southampton, UK
| | - P A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - J Bekker
- Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
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Dee W, Alaaeldin Ibrahim R, Marouli E. Histopathological domain adaptation with generative adversarial networks: Bridging the domain gap between thyroid cancer histopathology datasets. PLoS One 2024; 19:e0310417. [PMID: 39724083 DOI: 10.1371/journal.pone.0310417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 08/31/2024] [Indexed: 12/28/2024] Open
Abstract
Deep learning techniques are increasingly being used to classify medical imaging data with high accuracy. Despite this, due to often limited training data, these models can lack sufficient generalizability to predict unseen test data, produced in different domains, with comparable performance. This study focuses on thyroid histopathology image classification and investigates whether a Generative Adversarial Network [GAN], trained with just 156 patient samples, can produce high quality synthetic images to sufficiently augment training data and improve overall model generalizability. Utilizing a StyleGAN2 approach, the generative network produced images with an Fréchet Inception Distance (FID) score of 5.05, matching state-of-the-art GAN results in non-medical domains with comparable dataset sizes. Augmenting the training data with these GAN-generated images increased model generalizability when tested on external data sourced from three separate domains, improving overall precision and AUC by 7.45% and 7.20% respectively compared with a baseline model. Most importantly, this performance improvement was observed on minority class images, tumour subtypes which are known to suffer from high levels of inter-observer variability when classified by trained pathologists.
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Affiliation(s)
- William Dee
- Digital Environment Research Institute (DERI), Queen Mary University of London, London, United Kingdom
| | - Rana Alaaeldin Ibrahim
- Centre for Oral Immunobiology and Regenerative Medicine, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Department of Oral Pathology, Faculty of Dentistry, Mansoura University, Egypt and Queen Mary University of London, London, United Kingdom
| | - Eirini Marouli
- Digital Environment Research Institute (DERI), Queen Mary University of London, London, United Kingdom
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Cho S, Tutelman P, Chomistek T, Rahamatullah I, Ryder-Burbidge C, Schulte F, Fidler-Benaoudia MM. "No such thing as good cancer": a qualitative exploration of the experience of early-onset thyroid cancer in survivors. Support Care Cancer 2024; 32:671. [PMID: 39292348 DOI: 10.1007/s00520-024-08850-3] [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: 01/10/2024] [Accepted: 08/31/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND The incidence of thyroid cancer has increased exponentially in recent decades. At the same time, there is a growing concern surrounding the overdiagnosis of indolent thyroid cancer, leading to invasive and potentially unnecessary interventions that can significantly impact young patients' lives. Yet, the experiences of survivors of thyroid cancer have been largely understudied. The purpose of this study was to explore the experiences of survivors of early-onset thyroid cancer. METHODS The qualitative research design of hermeneutic phenomenology guided this study. Participants completed a demographic survey and semi-structured interview that was subsequently transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS Thirty-six survivors of thyroid cancer (83% female, median age at diagnosis: 37.1 years, median age at interview: 43.5 years) participated. Participants' experiences were characterized by two themes: (1) reconciling the meaning of the "c" word (cancer) as a dangerous and life-threatening diagnosis with lived experience of thyroid cancer and (2) thyroid cancer leaves patients with lifelong physical and emotional scars. CONCLUSIONS Survivors of early-onset thyroid cancer experience significant short and late effects on their physical and psychosocial well-being. Survivors shared some of the difficulties of having to reconcile what they were told was a "good cancer" and their previously held beliefs of cancer, including feeling lost in the healthcare system and like they could not access services or be impacted because they had been told they had "good cancer." Increased communication of risks and acknowledgement of the perceptions surrounding cancer is needed to help patients make better informed decisions and feel supported throughout their thyroid cancer journey. Gaps in care pathways, especially adjustments post-treatment, should be filled to help support these survivors.
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Affiliation(s)
- Sara Cho
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Perri Tutelman
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tessa Chomistek
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Iqra Rahamatullah
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Charlotte Ryder-Burbidge
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Cancer Care Alberta, Calgary, AB, Canada
| | - Fiona Schulte
- Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Hematology, Oncology, Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada.
| | - Miranda M Fidler-Benaoudia
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Cancer Care Alberta, Calgary, AB, Canada.
- Department of Oncology, Division of Preventative Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Cao M, Yu T, Miao X, Wu Z, Wang W. The preferred surgical choice for intermediate-risk papillary thyroid cancer: total thyroidectomy or lobectomy? A systematic review and meta-analysis. Int J Surg 2024; 110:5087-5100. [PMID: 38967517 PMCID: PMC11325972 DOI: 10.1097/js9.0000000000001556] [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: 02/24/2024] [Accepted: 04/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The optimal surgical approach for intermediate-risk papillary thyroid carcinoma (IR-PTC) (according to ATA definition), whether total thyroidectomy (TT) or lobectomy (LT), has remained a contentious clinical gray area for several decades. This systematic review and meta-analysis aim to provide robust evidence and address this clinical dilemma comprehensively. MATERIALS AND METHODS A comprehensive literature search was conducted in Pubmed, Embase, Web of Science, and the Cochrane Library from 1st January 2009 to 29th December 2023 to evaluate the impact of different surgical options (TT or LT) on patients with IR-PTC. The primary outcomes included survival, recurrence rates, and postoperative complications. I2 and sensitivity analysis was used to explore the heterogeneity. RESULTS A total of 8 studies involving 2984 participants were included in this meta-analysis and systematic review. The results indicated that LT was a superior choice for mitigating complications compared to TT [risk ratio (RR), 0.32; 95% CI: 0.24-0.44, P <0.01], particularly for transient complications (RR, 0.24; 95% CI: 0.08-0.65, P <0.01), such as the transient parathyroid dysfunction (RR, 0.04; 95% CI: 0.01-0.15, P <0.01). However, TT did not increase the risk of recurrent laryngeal nerve palsy (RR, 0.78; 95% CI: 0.24-2.47, P =0.67), hemorrhage/seroma (RR, 0.77; 95% CI: 0.48-1.25, P =0.30), and permanent complications (RR, 0.18; 95% CI: 0.02-1.42, P =0.10). Besides, both LT and TT presented similar effect on survival outcomes (overall survival: RR, 1.00; 95% CI: 0.97-1.03, P =0.92, disease-specific survival: RR, 0.99; 95% CI: 0.97-1.02, P =0.69, recurrence-free survival: RR, 1.00; 95% CI: 0.96-1.05, P =0.86), recurrence (RR, 1.05; 95% CI: 0.76-1.46, P =0.76). CONCLUSION The present meta-analysis revealed that TT did not yield improved outcomes in IR-PTC patients, but was associated with an increased incidence of temporary complications. In light of these findings, it may be advisable to consider LT as the optimal choice for IR-PTC patients.
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Affiliation(s)
- Mingyu Cao
- Department of General Surgery, Xiangya Hospital, Central South University
| | - Tiexin Yu
- Department of General Surgery, Xiangya Hospital, Central South University
| | - Xingyu Miao
- Department of General Surgery, Xiangya Hospital, Central South University
| | - Zhijing Wu
- Department of General Surgery, Xiangya Hospital, Central South University
| | - Wenlong Wang
- Department of General Surgery, Xiangya Hospital, Central South University
- Clinical Research Center for Breast Cancer Control and Prevention in Hunan Province, Changsha
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, Hunan, People’s Republic of China
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Duan S, Yang Z, Wei G, Chen S, Hu X, Ryu YJ, Yuan L, Bao G. Nomogram for predicting the risk of central lymph node metastasis in papillary thyroid microcarcinoma: a combination of sonographic findings and clinical factors. Gland Surg 2024; 13:1016-1030. [PMID: 39015718 PMCID: PMC11247594 DOI: 10.21037/gs-24-154] [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: 05/09/2024] [Accepted: 06/12/2024] [Indexed: 07/18/2024]
Abstract
Background A considerable controversy over performing thyroidectomy and central lymph node dissection in patients with papillary thyroid microcarcinoma (PTMC) remained. However, accurate prediction of central lymph node metastasis (CLNM) is crucial for surgical extent and proper management. The aim of this study was to develop and validate a practical nomogram for predicting CLNM in patients with PTMC. Methods A total of 1,029 patients with PTMC who underwent thyroidectomy and central lymph node dissection at Tangdu Hospital (the Second Affiliated Hospital of Air Force Medical University) and Xijing Hospital (the First Affiliated Hospital of Air Force Medical University) were selected. Seven hundred and nine patients were assigned to the training set and 320 patients to the validation set. Data encompassing demographic characteristics, ultrasonography results, and biochemical indicators were obtained. Stepwise backward selection and multiple logistic regression were used to screen the variables and establish the nomogram. Concordance index (C-index), receiver operating characteristic (ROC) curve analysis, and decision curve analysis (DCA) were employed to evaluate the nomogram's distinguishability, accuracy, and clinical utility. Results Young age, multifocality, bigger tumor, presence of microcalcification, aspect ratio (height divided by width) ≥1, loss of fatty hilum, high free thyroxine (FT4), and lower anti-thyroid peroxidase antibody (TPOAb) were significantly associated with CLNM. The nomogram showed strong predictive capacity, with a C-index and accuracy of 0.784 and 0.713 in the training set and 0.779 and 0.703 in the external validation set, respectively. DCA indicated that the nomogram demonstrated strong clinical applicability. Conclusions We established a reliable, cost-effective, reproducible, and noninvasive nomogram for predicting CLNM in patients with PTMC. This tool could be a valuable guidance for deciding on management in PTMC.
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Affiliation(s)
- Sensen Duan
- Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Zhenyu Yang
- Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Gang Wei
- Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Songhao Chen
- Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Xi’e Hu
- Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Young Jae Ryu
- Department of Surgery, Chonnam National University Medical School, Jeonnam, Republic of Korea
| | - Lijuan Yuan
- Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China
| | - Guoqiang Bao
- Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi’an, China
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Sanabria A, Ferraz C, Ku CHC, Padovani R, Palacios K, Paz JL, Roman A, Smulever A, Vaisman F, Pitoia F. Implementing active surveillance for low-risk thyroid carcinoma into clinical practice: collaborative recommendations for Latin America. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230371. [PMID: 39420909 PMCID: PMC11192484 DOI: 10.20945/2359-4292-2023-0371] [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: 09/19/2023] [Accepted: 02/08/2024] [Indexed: 08/03/2024]
Abstract
The incidence of thyroid cancer is increasing globally, but mortality rates have remained steady. Many patients with thyroid cancer have low-risk, nonmetastatic intrathyroidal tumors smaller than 2 cm. Active surveillance has shown benefits in these patients, but the adoption of this approach remains below standard in Latin America. The purpose of this article is to identify ways to improve the incorporation of active surveillance into clinical practice for patients with low-risk thyroid carcinoma in Latin America, taking into consideration cultural and geographic factors. Current recommendations include three steps involving patient participation. The first step, which consists of the initial clinical examination, has eight factors requiring special attention. Anxiety must be managed while considering individual, disease-related, cognitive, and environmental aspects. Terms like "overdiagnosis", "incidentaloma," and "overtreatment" must be explained to the patient. Implementing precise terminology contributes to adequate disease perception, substantially reducing stress and anxiety. Clarifying the nonprogressive nature of thyroid cancer helps dispel myths surrounding the disease. The second step includes advice about procedures and guidelines for patients who choose active surveillance. Flexible monitoring techniques should be implemented, with regular check-ins scheduled based on patient needs. Reasons for adjusting treatment must be clearly communicated to the patient, and changes in preference regarding active surveillance should be considered in advance. The third step includes assistance during follow-up. Patients must be educated about ultrasound results and receive surgical indications from specialized physicians. The effectiveness of active surveillance can be reinforced by explaining to the patients the dynamics of changes in nodule size using clear and concise visual aids.
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Affiliation(s)
- Alvaro Sanabria
- Universidad de AntioquiaFacultad de MedicinaDepartamento de CirugíaMedellínColombiaDepartamento de Cirugía, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
- Centro de Excelencia en Enfermedades de Cabeza y CuelloMedellínColombiaCentro de Excelencia en Enfermedades de Cabeza y Cuello (CEXCA), Medellín, Colombia
| | - Carolina Ferraz
- Irmandade da Santa Casa de Misericórdia de São PauloDivisão de EndocrinologiaDepartamento de MedicinaSão PauloSPBrasilDivisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Chih Hao Chen Ku
- Universidad de Costa RicaDepartamento de Farmacología Clínica y ToxicologíaSan JoséCosta RicaDepartamento de Farmacología Clínica y Toxicología, Universidad de Costa Rica, Clínica Los Yoses, San José, Costa Rica
| | - Rosalia Padovani
- Irmandade da Santa Casa de Misericórdia de São PauloDivisão de EndocrinologiaDepartamento de MedicinaSão PauloSPBrasilDivisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil
| | - Karen Palacios
- Clínica Diagnóstica Especializada VIDDivisión de EndocrinologíaMedellínColombiaDivisión de Endocrinología, Clínica Diagnóstica Especializada VID, Medellín, Colombia
| | - José Luis Paz
- Universidad Nacional Mayor de San MarcosHospital Nacional Edgardo Rebagliati MartinsFacultad de MedicinaLimaPerúDivisión de Endocrinología, Hospital Nacional Edgardo Rebagliati Martins, Departamento de Medicina, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - Alejandro Roman
- Universidad de AntioquiaHospital Universitario San Vicente FundaciónFacultad de MedicinaMedellínColombiaSección de Endocrinología, Departamento de Medicina, Facultad de Medicina, Universidad de Antioquia, Hospital Universitario San Vicente Fundación, Medellín, Colombia
| | - Anabella Smulever
- Universidad de Buenos AiresHospital de ClínicasDivisión de EndocrinologíaBuenos AiresArgentinaDivisión de Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Fernanda Vaisman
- Universidade Federal do Rio de JaneiroInstituto Nacional do CâncerFaculdade de MedicinaRio de JaneiroRJBrasilServiço de Oncoendocrinologia, Serviço de Endocrinologia, Faculdade de Medicina, Instituto Nacional do Câncer (Inca), Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Fabian Pitoia
- Universidad de Buenos AiresHospital de ClínicasDivisión de EndocrinologíaBuenos AiresArgentinaDivisión de Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
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Fernández Velasco P, Pérez López P, Torres Torres B, Delgado E, de Luis D, Díaz Soto G. Clinical Evaluation of an Artificial Intelligence-Based Decision Support System for the Diagnosis and American College of Radiology Thyroid Imaging Reporting and Data System Classification of Thyroid Nodules. Thyroid 2024; 34:510-518. [PMID: 38368560 DOI: 10.1089/thy.2023.0603] [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] [Indexed: 02/19/2024]
Abstract
Background: This study aimed to evaluate the clinical impact of an artificial intelligence (AI)-based decision support system (DSS), Koios DS, on the analysis of ultrasound imaging and suspicious characteristics for thyroid nodule risk stratification. Methods: A retrospective ultrasound study was conducted on all thyroid nodules with histological findings from June 2021 to December 2022 in a thyroid nodule clinic. The diagnostic performance of ultrasound imaging was evaluated by six readers on the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) before and after the use of the AI-based DSS and by AI itself. Results: A total of 172 patients (83.1% women) with a mean age of 52.3 ± 15.3 years were evaluated. The mean maximum nodular diameter was 2.9 ± 1.2 cm, with 11.0% being differentiated thyroid carcinomas. Among the nodules initially classified as ACR TI-RADS 3 and 4, AI reclassified 81.4% and 24.5% into lower risk categories, respectively. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of the readers and the AI-based DSS versus histological diagnosis. There was an increase in the area under the ROC curve (AUROC) after the use of AI (0.776 vs. 0.817, p < 0.001). The AI-based DSS improved the mean sensitivity (Sens) (82.3% vs. 86.5%) and specificity (Spe) (38.3% vs. 54.8%), produced a high negative predictive value (94.5% vs. 96.4%), and increased the positive predictive value (PPV) (14.0% vs. 16.1%) and diagnostic precision (43.0% vs. 49.3%). Based on the ACR TI-RADS score, there was significant improvement in interobserver agreement after the use of AI (r = 0.741 for ultrasound imaging alone vs. 0.981 for ultrasound imaging and the AI-based DSS, p < 0.001). Conclusions: The use of an AI-based DSS was associated with overall improvement in the diagnostic efficacy of ultrasound imaging, based on the AUROC, as well as an increase in Sens, Spe, negative and PPVs, and diagnostic accuracy. There was also a reduction in interobserver variability and an increase in the degree of concordance with the use of AI. AI reclassified more than half of the nodules with intermediate ACR TI-RADS scores into lower risk categories.
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Affiliation(s)
- Pablo Fernández Velasco
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clínica (CIENC), Facultad de Medicina Universidad de Valladolid, Valladolid, Spain
| | - Paloma Pérez López
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clínica (CIENC), Facultad de Medicina Universidad de Valladolid, Valladolid, Spain
| | - Beatriz Torres Torres
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clínica (CIENC), Facultad de Medicina Universidad de Valladolid, Valladolid, Spain
| | - Esther Delgado
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clínica (CIENC), Facultad de Medicina Universidad de Valladolid, Valladolid, Spain
| | - Daniel de Luis
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clínica (CIENC), Facultad de Medicina Universidad de Valladolid, Valladolid, Spain
| | - Gonzalo Díaz Soto
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Valladolid, Valladolid, Spain
- Centro de Investigación de Endocrinología y Nutrición Clínica (CIENC), Facultad de Medicina Universidad de Valladolid, Valladolid, Spain
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10
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Bytnar JA, Enewold L, Shriver CD, Zhu K. Incidence of papillary thyroid cancer: Comparison of the military and the general population by race and tumor stage/size. Cancer Epidemiol 2024; 89:102539. [PMID: 38340498 DOI: 10.1016/j.canep.2024.102539] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND A previous study found higher papillary thyroid cancer incidence in the US military than the general population with larger differences among Black than White individuals. This study compared the two populations in the incidence by sex, race, tumor stage, and size to assess possible factors related to identified differences. METHODS Subjects were aged 18-59 in the military and general populations. Papillary thyroid cancer patients diagnosed during 1990-2013 were identified from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Age-adjusted rates and incidence rate ratios (IRR) comparing ACTUR to SEER were calculated. RESULTS Higher incidence rates in ACTUR than SEER were more obvious for Black (IRR=2.07, 95%CI=1.56-2.70) than White men (IRR=1.17, 95%CI=1.07-1.26) and for Black (IRR=2.30, 95%CI=1.91-2.71) than White women (IRR=1.50, 95%CI=1.38-1.64). Population differences by race were observed for localized tumors among both men and women and were larger for Black individuals. Differences were observed regardless of tumor size among Black men and White women, and in smaller tumors among Black women. CONCLUSION Higher incidence in the military than general population primarily in localized tumors suggests universal healthcare in the military may lead to earlier detection. The differences were larger among Blacks than Whites, suggesting universal access in the military may be more impactful among Black persons, who are less likely to have timely care than White persons in the general population. Nevertheless, observed differences for tumors > 2 cm suggest other factors may also play a role.
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Affiliation(s)
- Julie A Bytnar
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Lindsey Enewold
- Division of Cancer Control & Population Science, National Cancer Institute, Rockville, MD, United States
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
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11
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Liu Q, Jiang X, Tu W, Liu L, Huang Y, Xia Y, Xia X, Shi Y. Comparative efficiency of differential diagnostic methods for the identification of BRAF V600E gene mutation in papillary thyroid cancer (Review). Exp Ther Med 2024; 27:149. [PMID: 38476918 PMCID: PMC10928970 DOI: 10.3892/etm.2024.12437] [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: 07/13/2023] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
V-Raf murine sarcoma viral oncogene homolog B1 (BRAF) encodes a serine-threonine kinase. The V600E point mutation in the BRAF gene is the most common mutation, predominantly occurring in melanoma, and colorectal, thyroid and non-small cell lung cancer. Particularly in the context of thyroid cancer research, it is routinely employed as a molecular biomarker to assist in diagnosing and predicting the prognosis of papillary thyroid cancer (PTC), and to formulate targeted therapeutic strategies. Currently, several methods are utilized in clinical settings to detect BRAF V600E mutations in patients with PTC. However, the sensitivity and specificity of various detection techniques vary significantly, resulting in diverse detection outcomes. The present review highlights the advantages and disadvantages of the methods currently employed in medical practice, with the aim of guiding clinicians and researchers in selecting the most suitable detection approach for its high sensitivity, reproducibility and potential to develop targeted therapeutic regimens for patients with BRAF gene mutation-associated PTC.
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Affiliation(s)
- Qian Liu
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Xue Jiang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Wenling Tu
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Lina Liu
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Ying Huang
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Yuxiao Xia
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Xuliang Xia
- Department of General Surgery, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610000, P.R. China
| | - Yuhong Shi
- Department of Nuclear Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, Sichuan 610000, P.R. China
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12
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Jacome CS, Torres DS, Fan JW, Loor-Torres R, Duran M, Zahidy MA, Cabezas E, Borras-Osorio M, Toro-Tobon D, Wu Y, Wu Y, Ospina NS, Brito JP. Thyroid Ultrasound Appropriateness Identification Through Natural Language Processing of Electronic Health Records. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2024; 2:67-74. [PMID: 38501072 PMCID: PMC10947349 DOI: 10.1016/j.mcpdig.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Objective To address thyroid cancer overdiagnosis, we aim to develop a natural language processing (NLP) algorithm to determine the appropriateness of thyroid ultrasounds (TUS). Patients and Methods Between 2017 and 2021, we identified 18,000 TUS patients at Mayo Clinic and selected 628 for chart review to create a ground truth dataset based on consensus. We developed a rule-based NLP pipeline to identify TUS as appropriate TUS (aTUS) or inappropriate TUS (iTUS) using patients' clinical notes and additional meta information. In addition, we designed an abbreviated NLP pipeline (aNLP) solely focusing on labels from TUS order requisitions to facilitate deployment at other health care systems. Our dataset was split into a training set of 468 (75%) and a test set of 160 (25%), using the former for rule development and the latter for performance evaluation. Results There were 449 (95.9%) patients identified as aTUS and 19 (4.06%) as iTUS in the training set; there are 155 (96.88%) patients identified as aTUS and 5 (3.12%) were iTUS in the test set. In the training set, the pipeline achieved a sensitivity of 0.99, specificity of 0.95, and positive predictive value of 1.0 for detecting aTUS. The testing cohort revealed a sensitivity of 0.96, specificity of 0.80, and positive predictive value of 0.99. Similar performance metrics were observed in the aNLP pipeline. Conclusion The NLP models can accurately identify the appropriateness of a thyroid ultrasound from clinical documentation and order requisition information, a critical initial step toward evaluating the drivers and outcomes of TUS use and subsequent thyroid cancer overdiagnosis.
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Affiliation(s)
- Cristian Soto Jacome
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Danny Segura Torres
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Jungwei W Fan
- Department of Artificial, Intelligence and Informatics, Mayo Clinic, Rochester, MN
| | - Ricardo Loor-Torres
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Mayra Duran
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Misk Al Zahidy
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Esteban Cabezas
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Mariana Borras-Osorio
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - David Toro-Tobon
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Yuqi Wu
- Department of Artificial, Intelligence and Informatics, Mayo Clinic, Rochester, MN
| | - Yonghui Wu
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL
| | - Juan P Brito
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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13
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Negro R. Laser Ablation for Benign and Malignant Thyroid Nodules - A Mini-Literature Review. Endocr Metab Immune Disord Drug Targets 2024; 24:394-401. [PMID: 37861031 DOI: 10.2174/0118715303275468231004105258] [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: 08/02/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Thyroid nodules are a common disease in endocrine clinical practice. They are often benign, asymptomatic, and do not require any treatment. But, in a non-negligible proportion, they can cause local symptoms of compression or esthetic concerns. In the last two decades, the advent of laser ablation (LA) has become a valid alternative to surgery for these nodules. Moreover, LA has also been successfully used to treat small thyroid cancers and neck recurrence. OBJECTIVE This study aims to review and summarize the published literature regarding LA in the treatment of benign and malignant thyroid nodules. METHODS A comprehensive literature search on PubMed from 2000 to 2023 was carried out. The search terms included: thyroid, nodules, laser, cancer, lymph node metastasis, and autonomously functioning nodules. The most relevant investigations in the field were selected. RESULTS In the last two decades, a very remarkable number of papers consistently demonstrated that LA is able to durably shrink benign nodules on average by about 50%; better results are obtained in spongiform nodules with a volume less than 15 ml; 500 J/ml of tissue should be administered. LA may be a valid option to treat autonomously functioning nodules and papillary thyroid cancers especially if they are <10 mm, and with neck recurrence in patients already submitted to surgery. LA has also been demonstrated to be cost-effective compared to surgical treatment both in benign and malignant lesions, with similar outcomes. CONCLUSION Evidence demonstrated that LA is a valid alternative to surgery in benign and malignant thyroid lesions, but also to obtain a successful treatment, a careful selection of the lesion is mandatory.
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital, Leece, Italy
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14
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Barinov L, Jairaj A, Middleton WD, D M, Beland, Kirsch J, Filice RW, Reverter JL, Arguelles I, Grant EG. Improving the Efficacy of ACR TI-RADS Through Deep Learning-Based Descriptor Augmentation. J Digit Imaging 2023; 36:2392-2401. [PMID: 37580483 PMCID: PMC10584788 DOI: 10.1007/s10278-023-00884-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/16/2023] Open
Abstract
Thyroid nodules occur in up to 68% of people, 95% of which are benign. Of the 5% of malignant nodules, many would not result in symptoms or death, yet 600,000 FNAs are still performed annually, with a PPV of 5-7% (up to 30%). Artificial intelligence (AI) systems have the capacity to improve diagnostic accuracy and workflow efficiency when integrated into clinical decision pathways. Previous studies have evaluated AI systems against physicians, whereas we aim to compare the benefits of incorporating AI into their final diagnostic decision. This work analyzed the potential for artificial intelligence (AI)-based decision support systems to improve physician accuracy, variability, and efficiency. The decision support system (DSS) assessed was Koios DS, which provides automated sonographic nodule descriptor predictions and a direct cancer risk assessment aligned to ACR TI-RADS. The study was conducted retrospectively between (08/2020) and (10/2020). The set of cases used included 650 patients (21% male, 79% female) of age 53 ± 15. Fifteen physicians assessed each of the cases in the set, both unassisted and aided by the DSS. The order of the reading condition was randomized, and reading blocks were separated by a period of 4 weeks. The system's impact on reader accuracy was measured by comparing the area under the ROC curve (AUC), sensitivity, and specificity of readers with and without the DSS with FNA as ground truth. The impact on reader variability was evaluated using Pearson's correlation coefficient. The impact on efficiency was determined by comparing the average time per read. There was a statistically significant increase in average AUC of 0.083 [0.066, 0.099] and an increase in sensitivity and specificity of 8.4% [5.4%, 11.3%] and 14% [12.5%, 15.5%], respectively, when aided by Koios DS. The average time per case decreased by 23.6% (p = 0.00017), and the observed Pearson's correlation coefficient increased from r = 0.622 to r = 0.876 when aided by Koios DS. These results indicate that providing physicians with automated clinical decision support significantly improved diagnostic accuracy, as measured by AUC, sensitivity, and specificity, and reduced inter-reader variability and interpretation times.
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Affiliation(s)
- Lev Barinov
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | | | | | | | - Beland
- Warren Alpert Medical School, Providence, RI, USA
| | | | - Ross W Filice
- MedStar Georgetown University Hospital, Washington, DC, USA
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15
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Lisco G, De Tullio A, Disoteo O, Piazzolla G, Guastamacchia E, Sabbà C, De Geronimo V, Papini E, Triggiani V. Glucagon-like peptide 1 receptor agonists and thyroid cancer: is it the time to be concerned? Endocr Connect 2023; 12:e230257. [PMID: 37656509 PMCID: PMC10563602 DOI: 10.1530/ec-23-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/01/2023] [Indexed: 09/03/2023]
Abstract
Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have changed considerably the management of type 2 diabetes (T2D). However, recently published data from retrospective cohort studies suggest that chronic exposure to GLP-1RAs in T2D may increase the risk of papillary and medullary thyroid cancer. In this perspective, the role of the incretin system in thyroid carcinogenesis has been reviewed and critically commented on, aiming to understand if the time has arrived to be concerned about the risk. Although evidence suggested, speculative hypotheses should be verified, and further studies are urgently needed to clarify the issue.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | - Olga Disoteo
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
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16
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Ribeiro AG, Ferlay J, Vaccarella S, Latorre MDRDDO, Fregnani JHTG, Bray F. Thyroid Cancer Incidence and Mortality by Socioeconomic Level in the State of São Paulo, Brazil 2001-2017. Endocr Pract 2023; 29:770-778. [PMID: 37536501 DOI: 10.1016/j.eprac.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Thyroid cancer is rising largely due to greater detection of indolent or slow-growing tumors; we sought to compare the incidence and mortality profiles of thyroid cancer in the State of São Paulo by socioeconomic status (SES). METHODS Data on thyroid cancer cases diagnosed from 2003 to 2017 in the Barretos Region and from 2001 to 2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding death data were obtained from a Brazilian public government database. Age-standardized rates were calculated and presented as thematic maps. The rates were also calculated by SES and spatial autocorrelation was assessed by global and local indices. RESULTS There were 419 cases of thyroid cancer and 21 deaths in Barretos, contrasting with the highly populated São Paulo, with 30 489 cases and 673 deaths. The overall incidence rates in São Paulo (15.9) were three times higher than in Barretos (5.7), while incidence rates in women were close to five times higher in Barretos and four times higher in São Paulo than in men. Mortality rates were, in relative terms, very low in both regions. A clear stepwise gradient of increasing thyroid cancer incidence with increasing SES was observed in São Paulo, with rates in very high SES districts four times those of low SES (31.6 vs 8.1). In contrast, the incidence rates in Barretos presented little variation across SES levels. CONCLUSION Thyroid cancer incidence varied markedly by SES in São Paulo, with incidence rates rising with increasing socioeconomic index. Overdiagnosis is likely to account for a large proportion of the thyroid cancer burden in the capital.
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Affiliation(s)
- Adeylson Guimarães Ribeiro
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France; Educational and Research Institute, Barretos Cancer Hospital, Barretos, Brazil.
| | - Jacques Ferlay
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Salvatore Vaccarella
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | | | | | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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17
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Belovarac B, Zhou F, Sharma J, Brandler TC. Indeterminate Thyroid Nodules and Advances in Molecular Pathology. Semin Diagn Pathol 2023; 40:349-352. [PMID: 37173165 DOI: 10.1053/j.semdp.2023.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
Thyroid cytology has in recent years been augmented by molecular testing for indeterminate lesions. Three commercial molecular tests are available which provide variable amounts of detail regarding the genetic alterations identified in a sample. This paper will describe these tests, as well as the common molecular drivers associated with papillary thyroid carcinoma (PTC) and follicular patterned lesions, in order to help the practicing pathologist and clinician better interpret the results of these tests and incorporate this information into their management of cytologically indeterminate thyroid lesions.
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Affiliation(s)
- Brendan Belovarac
- NYU Langone Health, Department of Pathology, 560 First Avenue 4th Floor, New York NY 10016, USA
| | - Fang Zhou
- NYU Langone Health, Department of Pathology, 560 First Avenue 4th Floor, New York NY 10016, USA
| | - Jake Sharma
- NYU Langone Health, Department of Pathology, 560 First Avenue 4th Floor, New York NY 10016, USA
| | - Tamar C Brandler
- NYU Langone Health, Department of Pathology, 560 First Avenue 4th Floor, New York NY 10016, USA; Rutgers Robert Wood Johnson Medical School, Middlesex Pavilion, 3rd floor, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901, USA.
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18
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Zhou L, Chang L, Li J, Long Q, Shao J, Zhu J, Liew AWC, Wei X, Zhang W, Yuan X. Aided diagnosis of thyroid nodules based on an all-optical diffraction neural network. Quant Imaging Med Surg 2023; 13:5713-5726. [PMID: 37711804 PMCID: PMC10498233 DOI: 10.21037/qims-23-98] [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: 01/25/2023] [Accepted: 07/12/2023] [Indexed: 09/16/2023]
Abstract
Background Thyroid cancer is the most common malignancy in the endocrine system, with its early manifestation being the presence of thyroid nodules. With the advantages of convenience, noninvasiveness, and a lack of radiation, ultrasound is currently the first-line screening tool for the clinical diagnosis of thyroid nodules. The use of artificial intelligence to assist diagnosis is an emerging technology. This paper proposes the use optical neural networks for potential application in the auxiliary diagnosis of thyroid nodules. Methods Ultrasound images obtained from January 2013 to December 2018 at the Institute and Hospital of Oncology, Tianjin Medical University, were included in a dataset. Patients who consecutively underwent thyroid ultrasound diagnosis and follow-up procedures were included. We developed an all-optical diffraction neural network to assist in the diagnosis of thyroid nodules. The network is composed of 5 diffraction layers and 1 detection plane. The input image is placed 10 mm away from the first diffraction layer. The input of the diffractive neural network is light at a wavelength of 632.8 nm, and the output of this network is determined by the amplitude and light intensity obtained from the detection region. Results The all-optical neural network was used to assist in the diagnosis of thyroid nodules. In the classification task of benign and malignant thyroid nodules, the accuracy of classification on the test set was 97.79%, with an area under the curve value of 99.8%. In the task of detecting thyroid nodules, we first trained the model to determine whether any nodules were present and achieved an accuracy of 84.92% on the test set. Conclusions Our study demonstrates the potential of all-optical neural networks in the field of medical image processing. The performance of the models based on optical neural networks is comparable to other widely used network models in the field of image classification.
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Affiliation(s)
- Lingxiao Zhou
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - 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
| | - Jie Li
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - Quanzhou Long
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - Junjie Shao
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, 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
| | - Alan Wee-Chung Liew
- School of Information and Communication Technology, Griffith University, Queensland, Australia
| | - 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
| | - Wanlong Zhang
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
| | - Xiaocong Yuan
- Nanophotonics Research Center, Institute of Microscale Optoelectronics, Shenzhen University, Shenzhen, China
- Research Center for Humanoid Sensing, Research Institute of Intelligent Sensing, Zhejiang Lab, Hangzhou, China
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19
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Bukasa-Kakamba J, Bangolo AI, Bayauli P, Mbunga B, Iyese F, Nkodila A, Atoot A, Anand G, Lee SH, Chaudhary M, Fernandes PQ, Mannam HPSS, Polavarapu A, Merajunnissa M, Azhar A, Alichetty MN, Singh G, Arana Jr GV, Sekhon I, Singh M, Rodriguez-Castro JD, Atoot A, Weissman S, M’buyamba JR. Proportion of thyroid cancer and other cancers in the democratic republic of Congo. World J Exp Med 2023; 13:17-27. [PMID: 37396884 PMCID: PMC10308319 DOI: 10.5493/wjem.v13.i3.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Cancer diagnosis is increasing around the world and in the Democratic Republic of the Congo (DRC). The proportion of thyroid cancer has increased over the past three decades. There are very few studies on cancer epidemiology, and in particular on thyroid cancer in the DRC.
AIM To establish the most recent proportion of thyroid cancer in the DRC compared to other cancers.
METHODS This is a retrospective and descriptive study of 6106 consecutive cancer cases listed in the pathological registers of 4 Laboratories in the city of Kinshasa. This study included all cancer cases recorded in the registers between 2005 and 2019.
RESULTS From a sample of 6106 patients, including all cancer types, 68.3% cases were female and 31.7% were male. Breast and cervical cancer were the most common types of cancer in women and, prostate and skin cancer were the most common types in men. Thyroid cancer was sixth in proportion in women and eleventh in men compared to all cancers. Papillary carcinoma was the most common of thyroid cancers. Rare cancers such as anaplastic and medullary thyroid carcinomas had a proportion of 7% and 2%, respectively.
CONCLUSION Newer diagnostic tools led to a surge in cancer diagnoses in the DRC. Thyroid cancer has more than doubled its proportion over the last several decades in the country.
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Affiliation(s)
- John Bukasa-Kakamba
- Endocrine and Metabolic Disorders Department, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Ayrton I Bangolo
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pascal Bayauli
- Endocrine and Metabolic Disorders Department, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Branly Mbunga
- School of Public Health, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Francis Iyese
- Endocrine and Metabolic Disorders Department, University of Kinshasa, Kinshasa Kinshasa, Congo
| | - Aliocha Nkodila
- Family Medicine, Protestant University of Congo, Kinshasa Kinshasa, Congo
| | - Ali Atoot
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gaurav Anand
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Stacy H Lee
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Maimona Chaudhary
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pamela Q Fernandes
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hari PSS Mannam
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Adithya Polavarapu
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Merajunissa Merajunnissa
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Abdullah Azhar
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mohan N Alichetty
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Gauravdeep Singh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Georgemar V Arana Jr
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Imranjot Sekhon
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Manbir Singh
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - José D Rodriguez-Castro
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Adam Atoot
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Simcha Weissman
- Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jean Rene M’buyamba
- Endocrine and Metabolic Disorders Department, University of Kinshasa, Kinshasa Kinshasa, Congo
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20
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Motaghed Z, Chegeni H, Mosadeghkhah A, Azimi Aval M, Gerami R, Ebrahiminik H. Effect of ultrasound parameters of benign thyroid nodules on radiofrequency ablation efficacy. BMC Med Imaging 2023; 23:85. [PMID: 37337132 DOI: 10.1186/s12880-023-01044-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND AND AIM Ultrasound-guided radiofrequency ablation (RFA) is a minimally invasive therapy for thyroid nodules (TNs). Understanding the determinants of RFA efficacy can improve treatment and prognosis. This study aims to investigate the relationship between ultrasound parameters of benign TNs and the efficacy of RFA. METHODS A pretest-posttest interventional study was conducted in 2021 on 250 randomly sampled patients with benign TNs, receiving RFA. For this purpose, the volume reduction (VR) and the VR ratio (VRR) of the nodules were measured at the 1-, 3-, 6-, and 12-month follow-up periods after the RFA completion. The technical success rate (TSR) of this procedure was then categorized into four states, including low (VRR < 25%), moderate (VRR = 25-49%), high (VRR = 50-74%), and very high (VRR ≥ 75). Ordered logistic regression (OLR) was further utilized to investigate the effect of the ultrasound parameters of TNs on the TSR. The analyses were notably performed using Stata 14.2. RESULTS The VRR at the 1-, 3-, 6-, and 12-month follow-up periods were 38.7%, 53.6%, 59.3%, and 59.9%, respectively. The mean VR was also statistically significant at all follow-ups (p < 0.001). At the 1-, 3-, and 6-month follow-up periods, the VR of over 50% was observed in 28.2%, 52.1%, and 65.2% of the nodules, respectively. The odds ratios (ORs) of the RFA success were found to be 4.3 times higher for the nodules in the left lobe compared to the right lobe (OR: 4.31, p = 0.002), 6.3 times greater for isoechoic nodules compared to hyperechoic nodules (OR: 6.39, p < 0.001), 6.2 times higher for hyper-vascular nodules compared to hypo-vascular nodules (OR: 6.25, p = 0.005), and 2.3 times greater for mixed nodules compared to solid ones (OR: 2.37, p = 0.049). CONCLUSION The ultrasound parameters of TNs had a statistically significant effect on the efficacy of RFA. Small-sized, isoechoic, and hyper-vascular nodules, as well as those with mixed tissue, were observed to respond better to RFA, leading to a better prognosis in terms of VR after treatment.
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Affiliation(s)
- Zahra Motaghed
- Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | | | - Ali Mosadeghkhah
- Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Azimi Aval
- Department of Interventional Radiology and Radiation Sciences Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Gerami
- Department of Radiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Hojat Ebrahiminik
- Department of Interventional Radiology and Radiation Sciences Research Center, AJA University of Medical Sciences, Tehran, Iran.
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21
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Ludwig B, Ludwig M, Dziekiewicz A, Mikuła A, Cisek J, Biernat S, Kaliszewski K. Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications. Cancers (Basel) 2023; 15:cancers15112931. [PMID: 37296896 DOI: 10.3390/cancers15112931] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Thyroid cancer is the most common cancer of the endocrine system, and, in recent years, there has been a phenomenon of overdiagnosis followed by subsequent overtreatment. This results in an increasing number of thyroidectomy complications being faced in clinical practice. In this paper, we present the current state of knowledge and the latest findings in the fields of modern surgical techniques, thermal ablation, the identification and assessment of parathyroid function, recurrent laryngeal nerve monitoring and treatment and perioperative bleeding. We reviewed 485 papers, from which we selected 125 papers that are the most relevant. The main merit of this article is its comprehensive view of the subject under discussion-both general, concerning the selection of the appropriate method of surgery, and particular, concerning the selection of the appropriate method of prevention or treatment of selected perioperative complications.
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Affiliation(s)
- Bartłomiej Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Maksymilian Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Anna Dziekiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Agnieszka Mikuła
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Jakub Cisek
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Szymon Biernat
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
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22
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Benny SJ, Boby JM, Chirukandath R, Thomas T, Vazhuthakat A, Saji E, Raju AR, Mathew A. Proportion of papillary thyroid microcarcinoma in Kerala, India, over a decade: a retrospective cohort study. Ecancermedicalscience 2023; 17:1546. [PMID: 37377678 PMCID: PMC10292854 DOI: 10.3332/ecancer.2023.1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Indexed: 06/29/2023] Open
Abstract
Background Overdiagnosis is a phenomenon where an indolent cancer is diagnosed that otherwise would not have caused harm to the patient during their lifetime. The rising incidence of papillary thyroid cancer (PTC) in various regions of the world is attributed to overdiagnosis. In such regions, the rates of papillary thyroid microcarcinoma (PTMC) are also rising. We aimed to study whether a similar pattern of rising PTMC is found in Kerala, a state in India, where there has been a doubling of thyroid cancer incidence over a decade. Methods We conducted a retrospective cohort study in two large government medical colleges, which are tertiary referral facilities in the state of Kerala. We collected data on the PTC diagnosis in Kozhikode and Thrissur Government Medical colleges from 2010 to 2020. We analysed our data by age, gender and tumor size. Results The incidence of PTC at Kozhikode and Thrissur Government Medical colleges nearly doubled from 2010 to 2020. The overall proportion of PTMC in these specimens was 18.9%. The proportion of PTMC only marginally increased from 14.7 to 17.9 during the period. Of the total incidence of microcarcinomas, 64% were reported in individuals less than 45 years of age. Conclusion The rise in the number of PTCs diagnosed in the government-run public healthcare centres in Kerala state in India is unlikely to be due to overdiagnosis since there was no disproportionate rise in rates of PTMCs. The patients that these hospitals cater to may be less likely to show healthcare-seeking behavior or ease of healthcare access which is closely associated with the problem of overdiagnosis.
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Affiliation(s)
| | | | | | - Togy Thomas
- Department of Pathology, Government Medical College, Thrissur 680596, Kerala, India
| | - Ambika Vazhuthakat
- Department of Pathology, Government Medical College, Kozhikode 673008, Kerala, India
| | - Edwin Saji
- Kerala Cancer Care, Kochi, Kerala 682024, India
| | | | - Aju Mathew
- Kerala Cancer Care, Kochi, Kerala 682024, India
- Department of Oncology, MOSC Medical College, Ernakulam 682311, Kerala, India
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Kherad O, Carneiro AV. General health check-ups: To check or not to check? A question of choosing wisely. Eur J Intern Med 2023; 109:1-3. [PMID: 36609089 DOI: 10.1016/j.ejim.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/06/2023]
Abstract
In high-income countries, regular general health check-ups are part of the fabric of the health care systems. The hidden concept of general health check-ups, promoted for more than a century, is to identify diseases at a stage at which early intervention can be effective. However, there has been little evidence to support the benefits of such checkups. Choosing wisely (CW) campaigns may represent a tremendous opportunity to eventually shift patients and physicians away from the non-evidence based yet firmly entrenched practice of the general health check-up. As campaign leaders and members of the CW working group of the European Federation of Internal Medicine, we want to join the discussion by giving our perspective based on the best available evidence.
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Affiliation(s)
- Omar Kherad
- Internal Medicine Division, La Tour Hospital and University of Geneva, Switzerland.
| | - Antonio Vaz Carneiro
- Institute for Evidence Based Healthcare, Faculdade de Medicina, Universidade de Lisboa, Portugal
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24
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When Diagnoses Overshadow Diseases. Epidemiology 2023; 34:e6. [PMID: 36722814 DOI: 10.1097/ede.0000000000001570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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25
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Aldharman SS, Albalawi DM, Daghistani G, Almutairi MS, Alharbi SA, Alreshidi NF. The Preferred Route for the Diagnosis and Management of Thyroid Carcinoma Among the General Population in Saudi Arabia. Cureus 2023; 15:e35043. [PMID: 36942190 PMCID: PMC10024201 DOI: 10.7759/cureus.35043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Papillary thyroid microcarcinoma (PTMC) is a specific subgroup of PTC. Given their small size, PTMCs are often asymptomatic and behave benignly. This puts physicians in a challenging situation about how to prevent overdiagnosis and overtreatment of PTMC. This study aimed to assess the preferences regarding the route of PTMC diagnosis and treatment among Saudi Arabia's general population. METHODS This is a cross-sectional questionnaire-based-study conducted among the general population in Saudi Arabia. The target subjects were the general population of Saudi Arabia both genders and different age groups from various regions of Saudi Arabia (Western, Central, Eastern, Southern, and North). Participants who did not complete the questionnaire or did not agree to participate were excluded. A self-administered questionnaire was distributed on different social media platforms to collect data from different regions. Data analysis was conducted by using Statistical Package for the Social Sciences (SPSS) 24.0 version (IBM Inc., Chicago, USA) statistical software. A Chi-square test was used to compare categorical variables. RESULTS A total of 1,428 participants were included. The majority of them were females (64.4%), and most of them were aged between 19 and 25 years. Moreover, we found that 4.8% of the study population had a medical history of thyroid cancer. Our results revealed that more than half of respondents (54.6%) would select surgical operation immediately if they have a thyroid nodule less than 1 cm in maximal diameter, which turns out to be a PTC. The vast majority of participants (90.1%) would prefer to do cytologic confirmation immediately if they have a thyroid nodule less than 1 cm in maximal diameter, which has suspicious characteristics of PTC in neck ultrasound examination. Regarding PTMC operation, 59.8% of responders were more concerned about complications than recurrences. We found that neither age nor gender significantly affects decision-making for management or operative extent for PTC. There was a significant difference between age and decision-making for the diagnosis of suspicious thyroid nodules (p value = 0.041). CONCLUSION Our results concluded that most of the participants preferred to select immediate surgery and cytologic confirmation regarding the management and diagnosis of PTC. More research is advised. The need to inform patients about their disease state and treatment options should be highlighted more.
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Affiliation(s)
- Sarah S Aldharman
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | | | - Sarah A Alharbi
- College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
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26
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van Dijk D, Groen AH, van Dijk BAC, van Veen TL, Sluiter WJ, Links TP, Plukker JTHM. The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines. Clin Endocrinol (Oxf) 2023; 98:123-130. [PMID: 35781313 PMCID: PMC10087791 DOI: 10.1111/cen.14795] [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: 03/11/2022] [Revised: 06/06/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch thyroid cancer guidelines (NL-15) and American Thyroid Association guidelines (ATA-15). DESIGN Retrospectively, the recommendations of the NL-15 and ATA-15 guidelines were evaluated to estimate potentially adequate, under- and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017. PATIENTS A total of 240 patients with a cT1-T3aN0-1aM0 DTC fulfilled the inclusion criteria. MEASUREMENTS After actual treatment was given, patients were again categorized according to both guidelines into low, intermediate, or high-risk based on tumour status. Next, they were categorized into a congruent low-risk (n = 60), congruent high-risk (n = 73), or incongruent risk group (n = 107). Follow-up data were used to estimate the proportion of potentially adequate, under-, and overtreatment according to both guidelines. RESULTS Comparing treatment recommended by NL-15 and ATA-15 showed significantly more over- and adequate treatment when following NL-15 recommendations, and more undertreatment following ATA-15 (all: p < .001). Subanalysis of the congruent low-risk group showed overtreatment in 64% when following NL-15 guidelines (p < .001). No treatment differences were found in the congruent high-risk group. Undertreatment was most often seen in the incongruent risk group when following ATA-15 (p < .001). CONCLUSIONS Low-risk patients were treated too aggressively when following NL-15 recommendations, where the less aggressive ATA-15 approach seemed more adequate. Treatment of intermediate risk DTC patients varies greatly, with a relative higher rate of undertreatment according to the recommendations of the ATA-15, advocating further refining of the risk classification in this patient group.
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Affiliation(s)
- Deborah van Dijk
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andries H Groen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim L van Veen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Internal Medicine, Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Internal Medicine, Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John T H M Plukker
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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27
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Dralle H, Weber F, Machens A, Brandenburg T, Schmid KW, Führer-Sakel D. [Hemithyroidectomy or total thyroidectomy for low-risk papillary thyroid cancer? : Surgical criteria for primary and secondary choice of treatment in an interdisciplinary treatment concept]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:79-92. [PMID: 36121448 DOI: 10.1007/s00104-022-01726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/21/2023]
Abstract
The increase in small intrathyroid papillary thyroid cancer (PTC) observed worldwide over the past two decades, with no increase in cancer-specific mortality, has challenged the previous concept of total thyroidectomy as a one-size-fits-all panacea. After exclusion of papillary microcarcinomas, a systematic review of 20 clinical studies published since 2002, which compared hemithyroidectomy (HT) to total thyroidectomy (TT), found comparable long-term oncological outcomes for low-risk papillary thyroid cancer (LRPTC) 1-4 cm in diameter, whereas postoperative complication rates were markedly lower for HT. To refine individual treatment plans, HT should be combined with ipsilateral central lymph node dissection and intraoperative frozen section analysis for staging. Based on recent evidence from studies and in consideration of individual risk factors, patients with LRPTC can be offered the concept of HT as an alternative to the standard TT. A prerequisite for the treatment selection and decision is a comprehensive patient clarification of the possible advantages and disadvantages of both approaches.
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Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - F Weber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Machens
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - T Brandenburg
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - K W Schmid
- Institut für Pathologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Führer-Sakel
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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28
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Bukasa JK, Bayauli-Mwasa P, Mbunga BK, Bangolo A, Kavula W, Mukaya J, Bindingija J, M’Buyamba-Kabangu JR. The Spectrum of Thyroid Nodules at Kinshasa University Hospital, Democratic Republic of Congo: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16203. [PMID: 36498276 PMCID: PMC9737877 DOI: 10.3390/ijerph192316203] [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: 08/08/2022] [Revised: 11/07/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
We analyzed the spectrum of thyroid nodules in patients attending the endocrinology unit care of the Kinshasa University Hospital and assessed their associated factors. We conducted a cross-sectional study, performing descriptive statistics and logistic regression. From the 888 enrolled patients, thyroid nodules were detected in 658 patients (74.1%), as mononodules in 22.5% and multiple nodules in 77.5%. Thyroid function was normal in 71.3% cases, while hyperthyroidism and hypothyroidism were found in 26.1% and 2.6% of cases, respectively. Women were more affected than men (75.1% vs. 63.6%; p = 0.03). Patients with thyroid nodules were older (44 ± 12 vs. 38 ± 12 years; p < 0.001), with a family history of goiter (38.3% vs. 27.4%; p = 0.003) and residence in the iodine-deficient region (51.7% vs. 38.8%; p = 0.012); they had a higher proportion of longer delays to consultation (47% vs. 20%; p < 0.001), but a higher rate of normal thyroid function (85.5% vs. 3 1.3%; p < 0.001). Thyroid nodules were associated with the delay to consultation (for duration ≥ three years, OR: 6.560 [95% CI: 3.525−12.208)], multiparity (present vs. absent: 2.863 [1.475−5.557]) and family history of goiter (present vs. absent: 2.086 [95% CI:1.231−3.534]) in female patients alone. The high frequency of thyroid nodules observed requires measures aimed at early detection in the population, the training of doctors involved in the management and the strengthening of technical platforms in our hospitals.
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Affiliation(s)
- John Kakamba Bukasa
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Endocrinology, Liège University Hospital Center, 4000 Liège, Belgium
| | - Pascal Bayauli-Mwasa
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Branly Kilola Mbunga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ayrton Bangolo
- Department of Internal Medicine, Hackensack University Medical Center/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Wivine Kavula
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean Mukaya
- Radiology and Medical Imaging Unit, Department of Internal Medicine, University Hospital of Kinshasa, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph Bindingija
- Endocrinology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-René M’Buyamba-Kabangu
- Cardiology Unit, Department of Internal Medicine, University of Kinshasa Hospital, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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29
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Gaunt A, Moore AR, Huvenne C, Dhami A, Eades M, Balasubramanian SP. Is conservative management of the indeterminate thyroid nodule [Thy3f or Bethesda category IV] safe? Eur Arch Otorhinolaryngol 2022; 279:5905-5911. [PMID: 35881191 DOI: 10.1007/s00405-022-07541-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/04/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The histological diagnosis after diagnostic thyroidectomy for indeterminate thyroid nodules is often non-malignant and some cancers detected are considered 'indolent'. The safety and effectiveness of conservative management in these patients are unclear. The aim of this study was to determine the safety of conservative management of indeterminate thyroid nodules and to explore association between clinical features and pathology in patients undergoing surgery. METHODS This is a retrospective cohort study of patients presenting to a single centre over a 4-year period (2013-2016) with thyroid nodules that were considered indeterminate (thy3f in the UK RCPath classification) on cytology. Demographic data, ultrasound features, follow-up details (in those undergoing conservative management) and histology details (in those undergoing surgery) were collected. RESULTS Of 164 patients that had Thy3f cytology, 34 were initially managed conservatively; however, 4 of these eventually had surgery (due to patient preference). No patient on conservative management had significant disease progression on ultrasound at a median (interquartile range) of 27 (16-40) months. Of the 134 patients that underwent surgery, 26 had thyroid malignancy. The BTA 'U' classification, gender and age (> 55) were not associated with malignancy in these nodules, but larger nodules (> 40 mm) were more likely to be malignant (p = 0.042). CONCLUSIONS Conservative management of indeterminate (Thy3f or Bethesda stage IV) thyroid nodules is safe in the short term and may be indicated in selected cases after appropriate discussion of risks and benefits of surgery.
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Affiliation(s)
- A Gaunt
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
| | - A R Moore
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - C Huvenne
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - A Dhami
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Eades
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - S P Balasubramanian
- Endocrine Surgery Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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30
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Trächsel B, Rapiti E, Feller A, Rousson V, Locatelli I, Bulliard JL. Predicting the burden of cancer in Switzerland up to 2025. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001112. [PMID: 36962605 PMCID: PMC10021406 DOI: 10.1371/journal.pgph.0001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/20/2022] [Indexed: 03/26/2023]
Abstract
Predicting the short-term evolution of the number of cancers is essential for planning investments and allocating health resources. The objective of this study was to predict the numbers of cancer cases and of the 12 most frequent cancer sites, and their age-standardized incidence rates, for the years 2019-2025 in Switzerland. Projections of the number of malignant cancer cases were obtained by combining data from two sources: forecasts of national age-standardized cancer incidence rates and population projections from the Swiss Federal Statistical Office. Age-standardized cancer incidence rates, approximating the individual cancer risk, were predicted by a low-order Autoregressive Integrated Moving Average (ARIMA) model. The contributions of changes in cancer risk (epidemiological component) and population aging and growth (demographic components) to the projected number of new cancer cases were each quantified. Between 2018 and 2025, age-standardized cancer incidence rates are predicted to stabilize for men and women at around 426 and 328/100,000, respectively (<1% change). These projected trends are expected for most cancer sites. The annual number of cancers is expected to increase from 45,676 to 52,552 (+15%), more so for men (+18%) than for women (+11%). These increases are almost entirely due to projected changes in population age structure (+12% for men and +6% for women) and population growth (+6% for both sexes). The rise in numbers of expected cancers for each site is forecast to range from 4.15% (thyroid in men) to 26% (bladder in men). While ranking of the three most frequent cancers will remain unchanged for men (1st prostate, 2nd lung, 3rd colon-rectum), colorectal cancer will overtake by 2025 lung cancer as the second most common female cancer in Switzerland, behind breast cancer. Effective and sustained prevention measures, as well as infrastructural interventions, are required to counter the increase in cancer cases and prevent any potential shortage of professionals in cancer care delivery.
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Affiliation(s)
- Bastien Trächsel
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Anita Feller
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), Zurich, Switzerland
- National Agency for Cancer Registration (NACR) Operated by NICER, Zurich, Switzerland
| | - Valentin Rousson
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Isabella Locatelli
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Liang MX, Fei YJ, Yang K, Tang WJ, Cao XH, Tang JH. Potential values of circulating tumor cell for detection of recurrence in patients of thyroid cancer: a diagnostic meta-analysis. BMC Cancer 2022; 22:954. [PMID: 36064384 PMCID: PMC9446830 DOI: 10.1186/s12885-022-09976-5] [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: 08/24/2020] [Accepted: 08/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Several studies have reported that circulating tumor cells (CTCs) are a promising marker for the diagnosis of thyroid cancer (TC) with recurrence or distant metastasis (DMs). However, some studies emerged with conflicting results. Therefore, we provide a meta-analysis to evaluate the diagnostic performance of CTC for detection of recurrence in patients of TC. Methods We searched PubMed, Web of Science, Cochrane library with the keywords “thyroid cancer” and “circulating tumor cells”. Data extraction and risk of bias assessment were performed independently by two reviewers. The summary receiver operating characteristic curve (SROC) and other parameters were adopted to summarize the overall test performance. The sensitivity of CTCs in the detection of recurrent TC was reviewed. All analyses were performed by STATA 12.0 and Meta-disc software. Results For CTCs expressing epithelial cell adhesion molecule (EpCAM), seven studies were included in our meta-analysis. Pooled sensitivity, specificity, and diagnostic odds ratio were 0.71 (95% CI: 0.63–0.78), 0.89 (95% CI: 0.84–0.94), and 26.75 (95% CI: 9.11–78.53); 0.78 (95% CI: 0.65–0.89), 0.88 (95% CI: 0.76–0.96), and 40.01 (95% CI: 10.49–152.63) for CTCs expressing thyroid stimulating hormone receptor (TSHR). The area under the SROC for EpCAM and TSHR were both 0.91. Conclusion CTC was a reliable marker for the diagnosis of TC patients with recurrence and DMs, and the sensitivity of CTCs expressing TSHR was higher than that of EpCAM. Additional research is warranted in order to establish uniformity in international guidelines, make up the drawbacks of conventional diagnostic methods and to prevent futile surgery.
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Affiliation(s)
- Ming-Xing Liang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 210029, Nanjing, P.R. China
| | - Yin-Jiao Fei
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 210029, Nanjing, P.R. China
| | - Kai Yang
- School of Clinical Medicine, Xuzhou Medical University, 221000, Xuzhou, P.R. China
| | - Wen-Juan Tang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 210029, Nanjing, P.R. China
| | - Xin-Hui Cao
- School of Clinical Medicine, Xuzhou Medical University, 221000, Xuzhou, P.R. China
| | - Jin-Hai Tang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 210029, Nanjing, P.R. China. .,School of Clinical Medicine, Xuzhou Medical University, 221000, Xuzhou, P.R. China.
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Horgan D, Führer-Sakel D, Soares P, Alvarez CV, Fugazzola L, Netea-Maier RT, Jarzab B, Kozaric M, Bartes B, Schuster-Bruce J, Dal Maso L, Schlumberger M, Pacini F. Tackling Thyroid Cancer in Europe-The Challenges and Opportunities. Healthcare (Basel) 2022; 10:1621. [PMID: 36141235 PMCID: PMC9498891 DOI: 10.3390/healthcare10091621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Thyroid cancer (TC) is the most common malignancy of the endocrine system that affects the thyroid gland. It is usually treatable and, in most cases, curable. The central issues are how to improve knowledge on TC, to accurately identify cases at an early stage that can benefit from effective intervention, optimise therapy, and reduce the risk of overdiagnosis and unnecessary treatment. Questions remain about management, about treating all patients in referral centres, and about which treatment should be proposed to any individual patient and how this can be optimised. The European Alliance for Personalised Medicine (EAPM) hosted an expert panel discussion to elucidate some of the challenges, and to identify possible steps towards effective responses at the EU and member state level, particularly in the context of the opportunities in the European Union's evolving initiatives-notably its Beating Cancer Plan, its Cancer Mission, and its research funding programmes. Recommendations emerging from the panel focus on improved infrastructure and funding, and on promoting multi-stakeholder collaboration between national and European initiatives to complement, support, and mutually reinforce efforts to improve patient care.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
| | - Dagmar Führer-Sakel
- Department of Endocrinology, Diabetes and Metabolism, Endocrine Tumour Center at West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45122 Duisburg, Germany
| | - Paula Soares
- Instituto de Inovação e Investigação em Saúde/Institute of Molecular Pathology and Immunology of University of Porto (I3S/IPATIMUP), 4200-465 Porto, Portugal
- Faculty of Medicine of the University of Porto, 4200-319 Porto, Portugal
| | - Clara V. Alvarez
- Neoplasia & Endocrine Differentiation, Centro de Investigación en Medicina Molecular y Enfermedades Crónicas (CIMUS), University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
- Instituto de Investigacion Sanitaria (IDIS), 15706 Santiago de Compostela, Spain
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Romana T. Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-102 Gliwice, Poland
| | - Marta Kozaric
- European Alliance for Personalised Medicine, 1040 Brussels, Belgium
| | - Beate Bartes
- Association Vivre sans Thyroïde, 31490 Léguevin, France
| | - James Schuster-Bruce
- Department of Otolaryngology, Saint George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK
| | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO), 33081 Aviano, Italy
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Institut Gustave Roussy, Université Paris Saclay, 94805 Villejuif, France
| | - Furio Pacini
- Section of Endocrinology, University of Siena, 53100 Siena, Italy
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Yao X, Zhang Q. Function and Clinical Significance of Circular RNAs in Thyroid Cancer. Front Mol Biosci 2022; 9:925389. [PMID: 35936780 PMCID: PMC9353217 DOI: 10.3389/fmolb.2022.925389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/22/2022] [Indexed: 12/28/2022] Open
Abstract
Thyroid cancer (TC) is the leading cause and mortality of endocrine malignancies worldwide. Tumourigenesis involves multiple molecules including circular RNAs (circRNAs). circRNAs with covalently closed single-stranded structures have been identified as a type of regulatory RNA because of their high stability, abundance, and tissue/developmental stage-specific expression. Accumulating evidence has demonstrated that various circRNAs are aberrantly expressed in thyroid tissues, cells, exosomes, and body fluids in patients with TC. CircRNAs have been identified as either oncogenic or tumour suppressor roles in regulating tumourigenesis, tumour metabolism, metastasis, ferroptosis, and chemoradiation resistance in TC. Importantly, circRNAs exert pivotal effects on TC through various mechanisms, including acting as miRNA sponges or decoys, interacting with RNA-binding proteins, and translating functional peptides. Recent studies have suggested that many different circRNAs are associated with certain clinicopathological features, implying that the altered expression of circRNAs may be characteristic of TC. The purpose of this review is to provide an overview of recent advances on the dysregulation, functions, molecular mechanisms and potential clinical applications of circRNAs in TC. This review also aimes to improve our understanding of the functions of circRNAs in the initiation and progression of cancer, and to discuss the future perspectives on strategies targeting circRNAs in TC.
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Batavani T, Kereselidze M, Chikhladze N, Pitskhelauri N. Early and late detection of cancer in Georgia: Evidence from a population-based cancer registry, 2018-2019. Cancer Epidemiol 2022; 80:102216. [PMID: 35841760 DOI: 10.1016/j.canep.2022.102216] [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: 04/10/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Georgia is an upper middle-income country, which has lower cancer survival rates than most of the countries in the World Health Organization European region, as well as compared to many other post-Soviet states and upper middle-income countries. The purpose of our study was to analyse the cancer stage distribution data of Georgia as a first step towards identifying the areas of early cancer detection in the country that might need improvement or require further research. METHODS Descriptive analysis of the population-based cancer registry of Georgia was performed using the data for the period of 01.01.2018-31.12.2019. RESULTS Around 57 % of cancers in males and 56 % of cancers in females were amenable to early detection. At least 35.7 % of these cancers in males and 44.2 % in females were detected early. 15.2 % (n = 964) of male and 35.3 % (n = 3179) of female cancer patients met the age criteria for the respective cancer screening programmes. Breast, colorectal, cervical and stomach cancers contributed to 58.7 % of all late-stage cancers in females. Lung, prostate, colorectal, laryngeal and stomach cancers made up 72.4 % of all late-stage cancer cases among males. At least 83.8 % (n = 1438) of thyroid cancers in females and 84.2 % (n = 246) of thyroid cancers in males were diagnosed at stage I. Moreover, stage I thyroid cancer cases made up 50.7 % of all stage I cancer cases detected in women and 25.6 % of all stage I cancers in men. At least 42.4 % of stage I thyroid cancers in females and 37.4 % of stage I thyroid cancers in males were papillary microcarcinomas. CONCLUSION The potential of early cancer detection is underutilised in Georgia and there is a need to strengthen screening and especially early diagnosis in the country. The possibility of thyroid cancer overdiagnosis requires further investigation.
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Affiliation(s)
- Tornike Batavani
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia.
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi 0198, Georgia
| | - Nino Chikhladze
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia
| | - Nato Pitskhelauri
- Department of Public Health, Faculty of Medicine, Ivane Javakhishvili Tbilisi State University, Tbilisi 0179, Georgia
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Belovarac B, Zhou F, Modi L, Sun W, Shafizadeh N, Negron R, Yee-Chang M, Szeto O, Simsir A, Sheth S, Brandler TC. Evaluation of ACR TI-RADS cytologically indeterminate thyroid nodules and molecular profiles: a single-institutional experience. J Am Soc Cytopathol 2022; 11:165-172. [PMID: 35181254 DOI: 10.1016/j.jasc.2022.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/03/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The American College of Radiology (ACR) Thyroid Imaging Reporting and Data Systems (TI-RADS) was developed to standardize thyroid ultrasound reports and predict the likelihood of malignancy. In our study, we aimed to correlate indeterminate thyroid fine needle aspiration cytology cases with preceding ultrasound (US) ACR TI-RADS scores and concurrent molecular testing results to examine how well the use of the ACR TI-RADS in our institution predicted which patients with indeterminate cytology might harbor molecular alterations. MATERIALS AND METHODS We performed a retrospective review of thyroid nodules. Patients with US reports that included TI-RADS scores, fine needle aspiration specimens with indeterminate cytology (Bethesda class III-V), and molecular testing results were included. RESULTS A total of 46 indeterminate cytology cases had had preceding US reports with TI-RADS scores and molecular testing (Bethesda class III, n = 37; Bethesda class IV, n = 6; Bethesda class V, n = 3). Most of the indeterminate cases had had a TI-RADS score of TR4 (31 of 46; 67.39%) or TR5 (9 of 46; 19.57%). RAS mutations were the most common alteration (n = 12). Of the 46 cases, 22 (47.85%) showed no alterations. Ten cases proceeded to surgery, of which seven displayed malignancies. CONCLUSIONS Molecular testing in cytologically indeterminate thyroid nodules provided valuable information for TR4 and TR5 lesions; however, the TR2 and TR3 lesions often had no molecular alterations. These findings highlight the potential value of including US imaging features when assessing the significance of indeterminate cytology findings.
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Affiliation(s)
- Brendan Belovarac
- Department of Pathology, New York University Langone Health, New York, New York
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York, New York
| | - Lopa Modi
- Department of Pathology, New York University Langone Health, New York, New York; Department of Pathology, Englewood Health, Englewood, New Jersey
| | - Wei Sun
- Department of Pathology, New York University Langone Health, New York, New York
| | - Negin Shafizadeh
- Department of Pathology, New York University Langone Health, New York, New York
| | - Raquel Negron
- Department of Pathology, New York University Langone Health, New York, New York
| | - Melissa Yee-Chang
- Department of Pathology, New York University Langone Health, New York, New York
| | - Oliver Szeto
- Department of Pathology, New York University Langone Health, New York, New York
| | - Aylin Simsir
- Department of Pathology, New York University Langone Health, New York, New York
| | - Sheila Sheth
- Department of Radiology, New York University Langone Health, New York, New York
| | - Tamar C Brandler
- Department of Pathology, New York University Langone Health, New York, New York.
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Malignancy risk of thyroid nodules: quality assessment of the thyroid ultrasound report. BMC Med Imaging 2022; 22:61. [PMID: 35366812 PMCID: PMC8976986 DOI: 10.1186/s12880-022-00789-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Thyroid nodules are a challenge in clinical practice and thyroid ultrasonography is essential for assessing the risk of malignancy. The use of ultrasound-based malignancy risk classification systems has been recommended by several scientific societies but radiologist’s adherence to these guidelines may vary. The authors aimed to analyze the quality of the information provided by the thyroid ultrasound report, to assess the malignancy risk of thyroid nodules, in Portugal.
Methods
Multicenter and retrospective study, conducted in three of the five Portuguese NUTS2 corresponding to about 88.3% of the mainland population. We included 344 consecutive unselected participants aged ≥ 18 years who underwent thyroid ultrasonography in 2019. The description of six features of the dominant thyroid nodule was analyzed: maximum size, shape, margins, composition, echogenicity and echogenic foci. A utility score, including these six features, was used as an indicator of the report’s quality. A score of 4 was considered as a minimum value.
Results
Maximum diameter was reported for all nodules. Shape, margins, composition, echogenicity and echogenic foci were reported in 8.1%, 25.0%, 76.5%, 53.2% and 20.9%, respectively. Only 21.8% of the nodules had a score ≥ 4. At least one of four suspicious features, including marked hypoechogenicity, microcalcifications, irregular margins and non-oval shape, was identified in 8.7% of the nodules. Cervical lymph nodes’ status was reported in 93% of the exams. The risk category was only reported in 7.8% of the participants.
Conclusion
The adherence of Portuguese radiologists to a standardized reporting model and to an ultrasound-based malignancy risk stratification system is still low and has implications for the correct characterization of the malignancy risk of nodules and the decision to perform fine-needle aspiration biopsy.
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Substantial interreader agreement for biopsy with reduction in biopsy rate: A multireader diagnostic performance study of ACR TI-RADS. Clin Imaging 2022; 84:93-97. [DOI: 10.1016/j.clinimag.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 12/26/2022]
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Smith JC, Sheltzer JM. Genome-wide identification and analysis of prognostic features in human cancers. Cell Rep 2022; 38:110569. [PMID: 35354049 PMCID: PMC9042322 DOI: 10.1016/j.celrep.2022.110569] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/30/2022] [Accepted: 03/03/2022] [Indexed: 12/12/2022] Open
Abstract
Clinical decisions in cancer rely on precisely assessing patient risk. To improve our ability to identify the most aggressive malignancies, we constructed genome-wide survival models using gene expression, copy number, methylation, and mutation data from 10,884 patients. We identified more than 100,000 significant prognostic biomarkers and demonstrate that these genomic features can predict patient outcomes in clinically ambiguous situations. While adverse biomarkers are commonly believed to represent cancer driver genes and promising therapeutic targets, we show that cancer features associated with shorter survival times are not enriched for either oncogenes or for successful drug targets. Instead, the strongest adverse biomarkers represent widely expressed cell-cycle and housekeeping genes, and, correspondingly, nearly all therapies directed against these features have failed in clinical trials. In total, our analysis establishes a rich resource for prognostic biomarker analysis and clarifies the use of patient survival data in preclinical cancer research and therapeutic development.
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Affiliation(s)
- Joan C Smith
- Yale University School of Medicine, New Haven, CT 06511, USA; Google, Inc., New York, NY 10011, USA
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Tarabichi M, Demetter P, Craciun L, Maenhaut C, Detours V. Thyroid cancer under the scope of emerging technologies. Mol Cell Endocrinol 2022; 541:111491. [PMID: 34740746 DOI: 10.1016/j.mce.2021.111491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/08/2021] [Accepted: 10/18/2021] [Indexed: 01/03/2023]
Abstract
The vast majority of thyroid cancers originate from follicular cells. We outline outstanding issues at each step along the path of cancer patient care, from prevention to post-treatment follow-up and highlight how emerging technologies will help address them in the coming years. Three directions will dominate the coming technological landscape. Genomics will reveal tumoral evolutionary history and shed light on how these cancers arise from the normal epithelium and the genomics alteration driving their progression. Transcriptomics will gain cellular and spatial resolution providing a full account of intra-tumor heterogeneity and opening a window on the microenvironment supporting thyroid tumor growth. Artificial intelligence will set morphological analysis on an objective quantitative ground laying the foundations of a systematic thyroid tumor classification system. It will also integrate into unified representations the molecular and morphological perspectives on thyroid cancer.
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Affiliation(s)
- Maxime Tarabichi
- Institute of Interdisciplinary Research (IRIBHM), Université Libre de Bruxelles, Brussels, Belgium.
| | - Pieter Demetter
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Ligia Craciun
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Carine Maenhaut
- Institute of Interdisciplinary Research (IRIBHM), Université Libre de Bruxelles, Brussels, Belgium.
| | - Vincent Detours
- Institute of Interdisciplinary Research (IRIBHM), Université Libre de Bruxelles, Brussels, Belgium.
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Li Y, Huang Y, He X, Han C, Wu W, Shen H, Xu Y, Liu Y, Zhu Z. The global burden of thyroid cancer in high-income Asia-Pacific: a systematic analysis of the Global Burden of Disease study. Ther Adv Endocrinol Metab 2022; 13:20420188221090012. [PMID: 35464880 PMCID: PMC9019321 DOI: 10.1177/20420188221090012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Thyroid cancer has become increasingly prevalent and threatens human health. Few studies have explored the incidence of thyroid cancer in Asia and its relationship with social-progress factors. METHODS We analyzed Global Burden of Disease (GBD) Study 2019 data specific to thyroid cancer. Incidence, prevalence, mortality, and disability-adjusted life year (DALY) rates were used to evaluate the burden of thyroid cancer. RESULTS The age-standardized incidence, prevalence, and DALY rates per 100,000 population were 1.34% (95% UI, 2.44-3.07), 2.79% (95% UI, 18.82-23.77) and 16.49% (95% UI, 14.6-18), respectively, for all of Asia in 2019. In 2019, the DALY rate of thyroid cancer in the High-income Asia-Pacific region was the highest and mortality due to thyroid cancer in the High-income Asia-Pacific region was also the highest. The growth trend of DALYs in the High-income Asia-Pacific region was much steeper than those in other Asian regions. In all Asian regions and in the High-income Asia-Pacific region, the incidence, prevalence, mortality and DALY rates of thyroid cancer in female patients were drastically higher than those in male patients. Among Asian patients with thyroid cancer, the DALY rate was higher in men aged 80-89 years than in women. The DALY rate gradually increased with age. In the High-income Asia-Pacific region, the mortality rate of patients with thyroid cancer decreased with age. The prevalence was highest in those aged 40-79 years. CONCLUSION The disease burden of thyroid cancer in the High-income Asia-Pacific region was significantly higher than those in other regions, which may be due to overdiagnosis. The increasing incidence of thyroid cancer seems to indicate that thyroid cancer is still a public health problem in Asia. Therefore, some health policy adjustments will be meaningful.
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Affiliation(s)
| | | | | | - Cheng Han
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Wei Wu
- Department of General Surgery, The Sixth People’s Hospital of Shenyang, Shenyang, China
| | - Hui Shen
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yanbing Xu
- Department of Clinical Nutrition and Metabolism, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | | | - Zizhao Zhu
- Department of General Surgery, The Sixth People’s Hospital of Shenyang, No. 85 Heping South Street, Heping District, Shenyang 110006, Liaoning, China
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Odani S, Tabuchi T, Nakata K, Morishima T, Kuwabara Y, Koyama S, Kudo H, Kato M, Miyashiro I. Incidence and relative risk of metachronous second primary cancers for 16 cancer sites, Osaka, Japan, 2000-2015: Population-based analysis. Cancer Med 2021; 11:507-519. [PMID: 34845852 PMCID: PMC8729047 DOI: 10.1002/cam4.4457] [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: 08/25/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
Background An increasing number of cancer survivors have developed multiple primaries. This study aims to describe the incidence and risk patterns of metachronous second primary cancers (SPCs) in Osaka, Japan. Methods Data were obtained from the Osaka Cancer Registry, a population‐based database of all cancers diagnosed in Osaka. The study subjects were individuals who were first diagnosed with invasive cancers in 16 major cancer sites during 2000–2014, aged 15–79 years, survived at least 3 months, and were followed up for 10 years. We measured incidence rates, cumulative risks, and standardized incidence ratios (SIRs: with the Osaka general population as the referent) of developing SPCs during 3 months to 10 years after the first diagnosis. Results During 2000–2015, among 418,791 cancer survivors, 24,368 (5.8%) developed SPCs within 10 years of first diagnosis. Males had higher incidence rates than females except among young‐onset survivors (aged 15–39 years). 10‐year cumulative risks among survivors aged 70–79 years (the most dominant age group) were 24.0% (male) and 11.8% (female). 10‐year SIRs were 1.38 (95% CI, 1.36–1.40; male) and 1.44 (95% CI, 1.41–1.48; female) with higher estimates among younger survivors in both sexes. Strong bidirectional associations were observed between oral/pharyngeal, esophageal, and laryngeal cancers. Survivors of any smoking‐related cancers had elevated SIRs of developing smoking‐related SPCs. Similar results were observed for alcohol‐related cancers. Conclusions Cancer survivors are at excess risk of developing SPCs compared to the general population. Continued surveillance is warranted to inform survivorship care through risk‐based long‐term care planning and lifestyle‐changing efforts to prevent new cancers.
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Affiliation(s)
- Satomi Odani
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.,Division of Cancer Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Yoshihiro Kuwabara
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Shihoko Koyama
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Haruka Kudo
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Mizuki Kato
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.,Division of Cancer Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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Wang M, Gu J, Zhang X, Yang J, Zhang X, Fang X. Long Non-coding RNA DANCR in Cancer: Roles, Mechanisms, and Implications. Front Cell Dev Biol 2021; 9:753706. [PMID: 34722539 PMCID: PMC8554091 DOI: 10.3389/fcell.2021.753706] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 12/28/2022] Open
Abstract
Long non-coding RNA (lncRNA) DANCR (also known as ANCR)—differentiation antagonizing non-protein coding RNA, was first reported in 2012 to suppress differentiation of epithelial cells. Emerging evidence demonstrates that DANCR is a cancer-associated lncRNA abnormally expressed in many cancers (e.g., lung cancer, gastric cancer, breast cancer, hepatocellular carcinoma). Increasing studies suggest that the dysregulation of DANCR plays critical roles in cancer cell proliferation, apoptosis, migration, invasion, and chemoresistance in vitro and tumor growth and metastasis in vivo. Mechanistic analyses show that DANCR can serve as miRNA sponges, stabilize mRNAs, and interact with proteins. Recent research reveals that DANCR can be detected in many body fluids such as serum, plasma, and exosomes, providing a quick and convenient method for cancer monitor. Thus DANCR can be used as a promising diagnostic and prognostic biomarker and therapeutic target for various types of cancer. This review focuses on the role and mechanism of DANCR in cancer progression with an emphasis on the clinical significance of DANCR in human cancers.
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Affiliation(s)
- Maoye Wang
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jianmei Gu
- Department of Clinical Laboratory Medicine, Nantong Tumor Hospital, Nantong, China
| | - Xu Zhang
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Jianping Yang
- Department of Orthopedics, Changzhou Traditional Chinese Medicine Hospital, Changzhou, China
| | - Xiaoxin Zhang
- Jiangsu Key Laboratory of Medical Science and Laboratory Medicine, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Xinjian Fang
- Department of Oncology, Lianyungang Hospital Affiliated to Jiangsu University, Lianyungang, China
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Gut L, Bernet S, Huembelin M, Mueller M, Baechli C, Koch D, Nebiker C, Schuetz P, Mueller B, Christ E, Ebrahimi F, Kutz A. Sex-Specific Differences in Outcomes Following Thyroidectomy: A Population-Based Cohort Study. Eur Thyroid J 2021; 10:476-485. [PMID: 34950600 PMCID: PMC8647072 DOI: 10.1159/000510618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/28/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Numbers of thyroidectomies and awareness of postoperative quality measures have both increased. Potential sex-specific variations in clinical outcomes of patients undergoing thyroidectomy are controversial. OBJECTIVE The aim of this study was to investigate sex-specific differences in outcomes following thyroidectomy. METHODS This is a population-based cohort study of all adult patients undergoing either hemi- or total thyroidectomy in Switzerland from 2011 to 2015. The primary outcome was all-cause 30-day readmission rate. The main secondary outcomes were intensive care unit (ICU) admission, surgical re-intervention, in-hospital mortality, length of hospital stay (LOS), postoperative calcium disorder, vocal cord paresis, and hematoma. RESULTS Of 16,776 patients undergoing thyroidectomy, the majority of patients undergoing thyroidectomy were female (79%), with a median age of 52 (IQR 42-64) years. Within 30 days after the surgery, male patients had significantly higher rates of hospital readmission (adjusted risk ratio [RR] 1.38; 95% confidence interval [95% CI] 1.11-1.72, p = 0.008) and higher risks for postoperative ICU admission (RR 1.25; 95% CI, 1.09-1.44, p = 0.003) than female patients. There were no significant differences among sexes in the LOS, rates of surgical re-interventions, or in-hospital mortality. While postoperative calcium disorders due to hypoparathyroidism were less prevalent among male patients (RR 0.63; 95% CI, 0.54-0.72, p < 0.001), a 2-fold higher incidence rate of postoperative hematoma was observed (RR 1.93, 95% CI, 1.51-2.46, p < 0.001). CONCLUSIONS Male patients undergoing thyroidectomy have higher 30-day hospital readmission and ICU admission rates. Following surgery, male patients revealed higher rates of neck hematoma, while hypocalcemia was more frequent among female patients.
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Affiliation(s)
- Lara Gut
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Selina Bernet
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Monika Huembelin
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Magdalena Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Ciril Baechli
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Nebiker
- Department of Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Fahim Ebrahimi
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
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Yang N, Yang H, Guo JJ, Hu M, Li S. Cost-Effectiveness Analysis of Ultrasound Screening for Thyroid Cancer in Asymptomatic Adults. Front Public Health 2021; 9:729684. [PMID: 34631648 PMCID: PMC8494179 DOI: 10.3389/fpubh.2021.729684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/16/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: This study evaluated the long-term cost-effectiveness of ultrasound screening for thyroid cancer compared with non-screening in asymptomatic adults. Methods: Applying a Markov decision-tree model with effectiveness and cost data from literature, we compared the long-term cost-effectiveness of the two strategies: ultrasound screening and non-screening for thyroid cancer. A one-way sensitivity analysis and a probabilistic sensitivity analysis were performed to verify the stability of model results. Results: The cumulative cost of screening for thyroid cancer was $18,819.24, with 18.74 quality-adjusted life years (QALYs), whereas the cumulative cost of non-screening was $15,864.28, with 18.71 QALYs. The incremental cost-effectiveness ratio of $106,947.50/QALY greatly exceeded the threshold of $50,000. The result of the one-way sensitivity analysis showed that the utility values of benign nodules and utility of health after thyroid cancer surgery would affect the results. Conclusions: Ultrasound screening for thyroid cancer has no obvious advantage in terms of cost-effectiveness compared with non-screening. The optimized thyroid screening strategy for a specific population is essential.
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Affiliation(s)
- Nan Yang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Han Yang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Jeff Jianfei Guo
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH, United States
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.,Chinese Evidence-Based Medicine Center, Cochrane China Center and MAGIC China Center, West China Hospital, Sichuan University, Chengdu, China
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Goldfarb DG, Colbeth HL, Skerker M, Webber MP, Prezant DJ, Dasaro CR, Todd AC, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Yung J, Kahn AR, Qiao B, Schymura MJ, Boffetta P, Hall CB, Zeig-Owens R. Impact of healthcare services on thyroid cancer incidence among World Trade Center-exposed rescue and recovery workers. Am J Ind Med 2021; 64:861-872. [PMID: 34275137 PMCID: PMC8796202 DOI: 10.1002/ajim.23277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND A recent study of World Trade Center (WTC)-exposed firefighters and emergency medical service workers demonstrated that elevated thyroid cancer incidence may be attributable to frequent medical testing, resulting in the identification of asymptomatic tumors. We expand on that study by comparing the incidence of thyroid cancer among three groups: WTC-exposed rescue/recovery workers enrolled in a New York State (NYS) WTC-medical monitoring and treatment program (MMTP); WTC-exposed rescue/recovery workers not enrolled in an MMTP (non-MMTP); and the NYS population. METHODS Person-time began on 9/12/2001 or at enrollment in a WTC cohort and ended at death or on 12/31/2015. Cancer data were obtained through linkages with 13 state cancer registries. We used Poisson regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for MMTP and non-MMTP participants. NYS rates were used as the reference. To estimate potential changes over time in WTC-associated risk, change points in RRs were estimated using profile likelihood. RESULTS The thyroid cancer incidence rate among MMTP participants was more than twice that of NYS population rates (RR = 2.31; 95% CI = 2.00-2.68). Non-MMTP participants had a risk similar to NYS (RR = 0.96; 95% CI = 0.72-1.28). We observed no change points in the follow-up period. CONCLUSION Our findings support the hypothesis that no-cost screening (a benefit provided by WTC-MMTPs) is associated with elevated identification of thyroid cancer. Given the high survival rate for thyroid cancer, it is important to weigh the costs and benefits of treatment, as many of these cancers were asymptomatic and may have been detected incidentally.
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Affiliation(s)
- David G. Goldfarb
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Environmental, Occupational and Geospatial Health Sciences, City University of New York Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Hilary L. Colbeth
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
| | - Molly Skerker
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
| | - Mayris P. Webber
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J. Prezant
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dana Kristjansson
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Oslo, Norway
- Center of Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jiehui Li
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Robert M. Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Mark R. Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - James E. Cone
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Janette Yung
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Amy R. Kahn
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Baozhen Qiao
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Maria J. Schymura
- New York State Department of Health, Bureau of Cancer Epidemiology, Albany, New York, USA
| | - Paolo Boffetta
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Charles B. Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Zeig-Owens
- Fire Department of the City of New York, Bureau of Health Services, Brooklyn, New York, USA
- Department of Medicine, Pulmonology Division, Montefiore Medical Center, Bronx, New York, USA
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
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Zhang D, Jiang F, Yin R, Wu GG, Wei Q, Cui XW, Zeng SE, Ni XJ, Dietrich CF. A Review of the Role of the S-Detect Computer-Aided Diagnostic Ultrasound System in the Evaluation of Benign and Malignant Breast and Thyroid Masses. Med Sci Monit 2021; 27:e931957. [PMID: 34552043 PMCID: PMC8477643 DOI: 10.12659/msm.931957] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/10/2021] [Indexed: 12/24/2022] Open
Abstract
Computer-aided diagnosis (CAD) systems have attracted extensive attention owing to their performance in the field of image diagnosis and are rapidly becoming a promising auxiliary tool in medical imaging tasks. These systems can quantitatively evaluate complex medical imaging features and achieve efficient and high-diagnostic accuracy. Deep learning is a representation learning method. As a major branch of artificial intelligence technology, it can directly process original image data by simulating the structure of the human brain neural network, thus independently completing the task of image recognition. S-Detect is a novel and interactive CAD system based on a deep learning algorithm, which has been integrated into ultrasound equipment and can help radiologists identify benign and malignant nodules, reduce physician workload, and optimize the ultrasound clinical workflow. S-Detect is becoming one of the most commonly used CAD systems for ultrasound evaluation of breast and thyroid nodules. In this review, we describe the S-Detect workflow and outline its application in breast and thyroid nodule detection. Finally, we discuss the difficulties and challenges faced by S-Detect as a precision medical tool in clinical practice and its prospects.
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Affiliation(s)
- Di Zhang
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
| | - Fan Jiang
- Department of Medical Ultrasound, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Rui Yin
- Department of Ultrasound, Affiliated Renhe Hospital of China Three Gorges University, Yichang, Hubei, PR China
| | - Ge-Ge Wu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Qi Wei
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Shu-E Zeng
- Department of Ultrasound, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Xue-Jun Ni
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, Jiangsu, PR China
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Zhang Q, Zhang S, Li J, Pan Y, Zhao J, Feng Y, Zhao Y, Wang X, Zheng Z, Yang X, Liu L, Qin C, Zhao K, Liu X, Li C, Zhang L, Yang C, Zhuo N, Zhang H, Liu J, Gao J, Di X, Meng F, Ji W, Yang M, Xin X, Wei X, Jin R, Zhang L, Wang X, Song F, Zheng X, Gao M, Chen K, Li X. Improved diagnosis of thyroid cancer aided with deep learning applied to sonographic text reports: a retrospective, multi-cohort, diagnostic study. Cancer Biol Med 2021; 19:j.issn.2095-3941.2020.0509. [PMID: 34491007 PMCID: PMC9196053 DOI: 10.20892/j.issn.2095-3941.2020.0509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/07/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Large volume radiological text data have been accumulated since the incorporation of electronic health record (EHR) systems in clinical practice. We aimed to determine whether deep natural language processing algorithms could aid radiologists in improving thyroid cancer diagnosis. METHODS Sonographic EHR data were obtained from the EHR database. Pathological reports were used as the gold standard for diagnosing thyroid cancer. We developed thyroid cancer diagnosis based on natural language processing (THCaDxNLP) to interpret unstructured sonographic text reports for thyroid cancer diagnosis. We used the area under the receiver operating characteristic curve (AUROC) as the primary metric to measure the performance of the THCaDxNLP. We compared the performance of thyroid ultrasound radiologists aided with THCaDxNLP vs. those without THCaDxNLP using 5 independent test sets. RESULTS We obtained a total number of 788,129 sonographic radiological reports. The number of thyroid sonographic data points was 132,277, 18,400 of which were thyroid cancer patients. Among the 5 test sets, the numbers of patients per set were 439, 186, 82, 343, and 171. THCaDxNLP achieved high performance in identifying thyroid cancer patients (the AUROC ranged from 0.857-0.932). Thyroid ultrasound radiologists aided with THCaDxNLP achieved significantly higher performances than those without THCaDxNLP in terms of accuracy (93.8% vs. 87.2%; one-sided t-test, adjusted P = 0.003), precision (92.5% vs. 86.0%; P = 0.018), and F1 metric (94.2% vs. 86.4%; P = 0.007). CONCLUSIONS THCaDxNLP achieved a high AUROC for the identification of thyroid cancer, and improved the accuracy, sensitivity, and precision of thyroid ultrasound radiologists. This warrants further investigation of THCaDxNLP in prospective clinical trials.
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Affiliation(s)
- Qiang Zhang
- Department of Maxillofacial and Otorhinolaryngology Oncology, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Sheng Zhang
- Department of Diagnostic and Therapeutic Ultrasonography, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Jianxin Li
- Department of Ultrasonography, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai 262400, China
| | - Yi Pan
- Department of Pathology, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Jing Zhao
- Department of Diagnostic and Therapeutic Ultrasonography, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Yixing Feng
- Department of Diagnostic and Therapeutic Ultrasonography, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Yanhui Zhao
- Department of Ultrasonography, Affiliated Hospital of Chifeng University, Chifeng 024000, China
| | - Xiaoqing Wang
- Department of Diagnostic and Therapeutic Ultrasonography, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Zhiming Zheng
- Department of Ultrasonography, Integrated Traditional Chinese and Western Medicine Hospital of Jilin city Jilin Province, Jilin 132000, China
| | - Xiangming Yang
- Department of Ultrasonography, Dezhou Municipal Hospital, Dezhou 253000, China
| | - Lixia Liu
- Department of Ultrasound Room of Functions Branch, Affiliated Hospital of Hebei University, Baoding 071000, China
| | - Chunxin Qin
- Department of Thyroid and Breast Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai 262400, China
| | - Ke Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300000, China
| | - Xiaonan Liu
- Department of Thyroid and Breast Surgery, Tianjin 4th Centre Hospital, Tianjin 300000, China
| | - Caixia Li
- Department of Thyroid and Breast Surgery, Tianjin 4th Centre Hospital, Tianjin 300000, China
| | - Liuyang Zhang
- Department of Thyroid Surgery, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
| | - Chunrui Yang
- Department of Pathology, The Second Hospital of Tianjin Medical University, Tianjin 300000, China
| | - Na Zhuo
- Department of Ultrasonography, The Second Hospital of Tianjin Medical University, Tianjin 300000, China
| | - Hong Zhang
- Department of Thyroid, the Second Hospital of Jilin University, Changchun 130041, China
| | - Jie Liu
- Department of Head and Neck Thyroid Surgery, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou 061000, China
| | - Jinglei Gao
- Department of Surgery of Glands, People’s Hospital of Dingzhou, Dingzhou 073000, China
| | - Xiaoling Di
- Department of Surgery of Glands, People’s Hospital of Dingzhou, Dingzhou 073000, China
| | - Fanbo Meng
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Shaoxing University, Shaoxing 312000, China
| | - Wei Ji
- Public Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Meng Yang
- Public Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Xiaojie Xin
- Department of Diagnostic and Therapeutic Ultrasonography, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Rui Jin
- Department of Maxillofacial and Otorhinolaryngology Oncology, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Lun Zhang
- Department of Maxillofacial and Otorhinolaryngology Oncology, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Xudong Wang
- Department of Maxillofacial and Otorhinolaryngology Oncology, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Fengju Song
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Xiangqian Zheng
- Department of Thyroid and Neck Cancer, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Ming Gao
- Department of Thyroid and Neck Cancer, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Kexin Chen
- Department of Epidemiology and Biostatistics, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Xiangchun Li
- Public Laboratory, National Clinical Research Center for Cancer, Key Laboratory of Molecular Cancer Epidemiology of Tianjin, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
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Dahlberg J, Adok C, Bümming P, Demir A, Hedbäck G, Nilsson B, Nilsson M, Jansson S. Incidence, detection and outcome of differentiated thyroid cancer in Western Sweden. BJS Open 2021; 5:6408929. [PMID: 34686878 PMCID: PMC8536871 DOI: 10.1093/bjsopen/zrab099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background It is unclear whether the increasing incidence of thyroid cancer (TC) due to increased diagnosis of small and indolent tumours might mask a real increase of clinically significant cancers. The aim of this study was to correlate surgery, pathology and outcome data of individual patients to the mode of primary detection (palpation, by imaging or incidental) to assess if TC incidence has increased. Methods The Swedish Cancer Registry identified all patients with TC in Västra Götaland County representing approximately 1.6 million inhabitants. Clinical information was retrieved from medical records of patient cohorts from three study intervals (2001–2002, 2006–2007 and 2011–2014) comprising 60 per cent of all TC patients. Data were also obtained from the NORDCAN registry to compare of TC incidence with other Nordic countries. Results Between 2001 and 2014, the annualized standard incidence rate/100 000 population (ASR) of TC increased from 3.14 to 10.71 in women and from 1.12 to 3.77 in men. This was higher than the mean incidence for Sweden but similar to that in Norway and Finland. Differentiated TC (DTC) increased more than threefold. The majority of tumours (64 per cent) were detected by palpation. Larger tumours (10–20, 21–40 and greater than 40 mm) increased as much as microcarcinomas (less than 10 mm). Only 5 per cent of the tumours were detected by imaging. All disease-specific deaths (8.5 per cent of DTC in the first two cohorts) and most patients with recurrent or persistent disease (6.6 per cent of DTC cases) were diagnosed due to tumour-related symptoms. Conclusion DTC in Western Sweden gradually increased between 2001 and 2014. The majority of tumours were detected by palpation suggesting a real increase in the incidence of clinically significant thyroid malignancies.
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Affiliation(s)
- J Dahlberg
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - C Adok
- Regional Cancer Centre West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P Bümming
- Department of Surgery Skaraborg Hospital, Skaraborgs Sjukhus, Skövde, Sweden
| | - A Demir
- Department of Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Hedbäck
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - B Nilsson
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - M Nilsson
- Sahlgrenska Centre for Cancer Research, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - S Jansson
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Papaleontiou M, Chen DW, Banerjee M, Reyes-Gastelum D, Hamilton AS, Ward KC, Haymart MR. Thyrotropin Suppression for Papillary Thyroid Cancer: A Physician Survey Study. Thyroid 2021; 31:1383-1390. [PMID: 33779292 PMCID: PMC8558057 DOI: 10.1089/thy.2021.0033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Current guidelines recommend against thyrotropin (TSH) suppression in low-risk differentiated thyroid cancer patients; however, physician practices remain underexplored. Our objective was to understand treating physicians' approach to TSH suppression in patients with papillary thyroid cancer. Methods: Endocrinologists and surgeons identified by thyroid cancer patients from the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles were surveyed in 2018-2019. Physicians were asked to report how likely they were to recommend TSH suppression (i.e., TSH <0.5 mIU/L) in three clinical scenarios: patients with intermediate-risk, low-risk, and very low-risk papillary thyroid cancer. Responses were measured on a 4-point Likert scale (extremely unlikely to extremely likely). Multivariable logistic regressions were performed to determine physician characteristics associated with recommending TSH suppression in each of the aforementioned scenarios. Results: Response rate was 69% (448/654). Overall, 80.4% of physicians were likely/extremely likely to recommend TSH suppression for a patient with an intermediate-risk papillary thyroid cancer, 48.8% for a patient with low-risk papillary thyroid cancer, and 29.7% for a patient with very low-risk papillary thyroid cancer. Surgeons were less likely to recommend TSH suppression for an intermediate-risk papillary thyroid cancer patient (odds ratio [OR] = 0.36 [95% confidence interval, CI, 0.19-0.69]) compared with endocrinologists. Physicians with higher thyroid cancer patient volume were less likely to suppress TSH in low-risk and very low-risk papillary thyroid cancer patients (i.e., >40 patients per year, OR = 0.53 [CI 0.30-0.96]; OR = 0.49 [CI 0.24-0.99], respectively, compared with 0-20 patients per year). Physicians who estimated higher likelihood of recurrence were more likely to suppress TSH in a patient with very low-risk papillary thyroid cancer (OR = 2.34 [CI 1.91-4.59]). Conclusions: Many patients with low-risk thyroid cancer continue to be treated with suppressive doses of thyroid hormone, emphasizing the need for more high-quality research to guide thyroid cancer management, as well as better understanding of barriers that hinder guideline adoption.
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Affiliation(s)
- Maria Papaleontiou
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Debbie W. Chen
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Mousumi Banerjee
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - David Reyes-Gastelum
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Megan R. Haymart
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Address correspondence to: Megan R. Haymart, MD, Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Building 16, Room 408E, Ann Arbor, MI 48109, USA.
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Horiguchi K, Yoshida Y, Iwaku K, Emoto N, Kasahara T, Sato J, Shimura H, Shindo H, Suzuki S, Nagano H, Furuya F, Makita N, Matsumoto F, Manaka K, Mitsutake N, Miyakawa M, Yokoya S, Sugitani I. Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults. Endocr J 2021; 68:763-780. [PMID: 33762511 DOI: 10.1507/endocrj.ej20-0692] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The incidence of thyroid carcinoma has been increasing worldwide. This is interpreted as an increase in the incidental detection of papillary thyroid microcarcinomas (PTMCs). However, mortality has not changed, suggesting overdiagnosis and overtreatment. Prospective clinical trials of active surveillance for low-risk PTMC (T1aN0M0) have been conducted in two Japanese institutions since the 1990s. Based on the favorable outcomes of these trials, active surveillance has been gradually adopted worldwide. A task force on the management of PTMC in adults organized by the Japan Thyroid Association therefore conducted a systematic review and has produced the present position paper based on the scientific evidence concerning active surveillance. This paper indicates evidence for the increased incidence of PTMC, favorable surgical outcomes for low-risk PTMC, recommended criteria for diagnosis using fine needle aspiration cytology, and evaluation of lymph node metastasis (LNM), extrathyroidal extension (ETE) and distant metastasis. Active surveillance has also been reported with a low incidence of disease progression and no subsequent recurrence or adverse events on survival if conversion surgery was performed at a slightly advanced stage. Active surveillance is a safe and valid strategy for PTMC, because it might preserve physical quality of life and reduce 10-year medical costs. However, some points should be noted when performing active surveillance. Immediate surgery is needed for PTMC showing high-risk features, such as clinical LNM, ETE or distant metastasis. Active surveillance should be performed under an appropriate medical team and should be continued for life.
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Affiliation(s)
- Kazuhiko Horiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kenji Iwaku
- Sapporo Thyroid Clinic (Ito Hospital), Sapporo 060-0042, Japan
| | - Naoya Emoto
- Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Sakura 285-0014, Japan
| | | | - Junichiro Sato
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroki Shimura
- Department of Laboratory Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan
| | - Satoru Suzuki
- Department of Thyroid and Endocrinology, Division of Internal Medicine, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Hidekazu Nagano
- Department of Molecular Diagnosis, Graduate school of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Fumihiko Furuya
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi 409-3998, Japan
| | - Noriko Makita
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Katsunori Manaka
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Norisato Mitsutake
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
| | - Megumi Miyakawa
- Department of Internal Medicine, Miyakawa Hospital, Kawasaki 210-0802, Japan
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo 113-8603, Japan
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