BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,efcient and safe technology for PTC.In this article,we report one ...BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,efcient and safe technology for PTC.In this article,we report one case of a residual tumor and central lymph node metastasis(CLNM)after TA for PTC.CASE SUMMARY A 63-year-old female underwent bilateral ultrasound(US)-guided radiofrequency ablation for PTC.Three months later,she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography.The subsequent fine-needle aspiration(FNA)biopsies were negative.Due to her strong personal preference,she underwent total thyroidectomy and central lymph node dissection.Local tissue adhesion and a difficult dissection were noted during the operation.The pathology of the frozen sections during the operation was still negative.The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.CONCLUSION TA may lead to a residual tumor in patients with PTC.Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor.TA should be carefully considered in PTC treatment.展开更多
Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultra...Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer.The localization of thyroid nodules is a recognized predictor of CLNM;however,quantifying this relationship is challenging due to variable measurements.in this study,we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules,thereby predicting CLNM.We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node(CLN)surgery and utilized these images to train our predictive model,ACE-Net.Furthermore,we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions.ACENet demonstrated superior performance in 6 external multicenter tests(AUC=0.826),surpassing the predictive accuracy of human experts(accuracy=0.561).The risk heatmap enabled the identification of high-risk areas for CLNM,likely correlating with lymphatic metastatic pathways.Additionally,it was observed that the likelihood of metastasis exceeded 80%when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm.ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%,without missing positive cases,thus offering a valuable tool for clinical decision-making.展开更多
Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed wel...Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach （BABA）, compared with conventional open procedure in papillary thyroid microcarcinoma. Methods： One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People＇s Liberation Army （PLA） were randomly assigned to robotic group or conventional open approach group （17 = 50 in each group）. The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale （VAS）, postoperative hospital stay time, complications, and numerical scoring system （NSS, used to assess cosmetic effect） were analyzed. Results： The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group （118.8± 16.5 min vs. 90.7± 10.3 min, P 〈 0.05）. The study showed significant differences between the two groups in terms of the VASs （2.1 ± 1.0 vs. 3.8 ±~ 1.2, P 〈 0.05） and NSS （8.9 ± 0.8 vs. 4.8 ± 1.7, P 〈 0.05）. The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant （all P 〉 0.05）. Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. Conclusions： Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.展开更多
Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determ...Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determine the number of the lymph nodes in the CLND and the relationship to presence of chronic lymphocytic thyroiditis (CLT) and thymic tissue (TT). Methods: Total thyroidectomy and CLND materials from 153 patients with PTC were included in this study. Two histopathologic features (presence of CLT and TT) were evaluated for their value in adequacy of CLND. Results: Histopathologic examination revealed CLT and TT in CLND materials in 70 (46%) and 63 (41%) patients, respectively. Total number of lymph nodes in CLND materials was significantly higher in CLT (+) and TT (+) groups (p Conclusions: Our study demonstrates that presence of CLT in thyroid gland has been associated with higher number of central lymph nodes mainly due to increased number of benign hyperplastic lymph nodes. It may be possible to conclude that upper limit of lymph nodes for satisfactory CLND would be higher to correctly evaluate central lymph node status in existing staging systems if specimens have CLT. Results of this study also show that the presence of TT in surgical materials may represent the adequacy of CLND.展开更多
Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-r...Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,展开更多
目的探讨腔镜下不同手术入路甲状腺切除术对cN0期甲状腺乳头状癌(PTC)的手术效果。方法回顾性分析2019年8月—2022年11月于本院就诊并接受腔镜手术治疗的118例cN0期PTC患者的临床资料,根据腔镜下不同手术入路,分为胸乳组与经口组,应用...目的探讨腔镜下不同手术入路甲状腺切除术对cN0期甲状腺乳头状癌(PTC)的手术效果。方法回顾性分析2019年8月—2022年11月于本院就诊并接受腔镜手术治疗的118例cN0期PTC患者的临床资料,根据腔镜下不同手术入路,分为胸乳组与经口组,应用倾向性评分匹配法各纳入59例患者。比较两组围术期相关指标。结果经口组术后引流量、住院时长均少于胸乳组(P<0.05),而手术时间、中央区淋巴结清扫数目多于胸乳组(P<0.05);经口组术后12、24 h VAS评分均低于胸乳组(P<0.05);术后3 d,经口组吞咽功能优于胸乳组(P<0.05);术后3个月,经口组瘢痕评估量表评分低于胸乳组(P<0.05);随访1年,组间术后复发、无进展生存期比较无明显差异(P>0.05)。结论经胸乳入路腔镜术与经口腔前庭腔镜术治疗cN0期PTC整体疗效相当,但经口腔前庭入路腔镜术后恢复更快,更值得应用。展开更多
目的:筛选与甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)颈中央区淋巴结转移(central lymph node metastasis,CLNM)相关的危险因素,并建立预测模型,以指导PTC患者的手术决策。方法:回顾并分析南京鼓楼医院1 125例接受甲状...目的:筛选与甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)颈中央区淋巴结转移(central lymph node metastasis,CLNM)相关的危险因素,并建立预测模型,以指导PTC患者的手术决策。方法:回顾并分析南京鼓楼医院1 125例接受甲状腺手术的PTC患者临床特征、超声特征和基因信息,通过单因素和多因素logistic回归分析,筛选出CLNM独立危险因素,并构建列线图模型。使用校正曲线、受试者工作特征(receiver operating characteristic,ROC)曲线和决策曲线评估该预测模型的校准度、准确度和临床实用性。随后,收集483例在南京大学附属金陵医院接受甲状腺手术的PTC患者的相关资料,用于模型的外部验证。结果:在1 125例PTC患者中,单因素回归分析结果显示CLNM阳性组与CLNM阴性组在性别、年龄、甲状腺球蛋白以及病灶超声特征(最大径、纵横比、边缘及微钙化)方面差异均有统计学意义(P<0.05)。多因素logistic回归确认患者性别、年龄以及病灶超声特征(最大径、边缘及微钙化)是CLNM的独立预测危险因素。基于独立危险因素绘制列线图模型,模型的曲线下面积(area under curve,AUC)在训练集中为0.768(95%CI0.741~0.796),在验证集中为0.822(95%CI 0.784~0.859)。结论:本研究建立的模型具有较好的预测能力和泛化能力,有望辅助临床医师为PTC患者制订个体化手术方案。展开更多
基金the Shanghai Municipal Administrator of Traditional Chinese Medicine,No.2018ZY03005.
文摘BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,efcient and safe technology for PTC.In this article,we report one case of a residual tumor and central lymph node metastasis(CLNM)after TA for PTC.CASE SUMMARY A 63-year-old female underwent bilateral ultrasound(US)-guided radiofrequency ablation for PTC.Three months later,she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography.The subsequent fine-needle aspiration(FNA)biopsies were negative.Due to her strong personal preference,she underwent total thyroidectomy and central lymph node dissection.Local tissue adhesion and a difficult dissection were noted during the operation.The pathology of the frozen sections during the operation was still negative.The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.CONCLUSION TA may lead to a residual tumor in patients with PTC.Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor.TA should be carefully considered in PTC treatment.
基金supported by the SFYF at SJTU(24X010500175)the Interdisciplinary Program of Shanghai jiao Tong University(YG2024QNA02)+5 种基金Neil Shen's SJTU Medical Research Fund,SJTU Transmed Awards Research(STAR)Grant No.20210106 the Science and Technology Commission of Shanghai Municipality(STCSM)(grant no.23JS1400700)the Innovative Research Team of High-Level Local Universities in Shanghai(SHSMU-ZDCX20212200),NSFC81903417Scientific Project of Huangpu District(grant no.HKQ201810)Shanghai Huangpu District Health Commission(Grant No.2023XD02)Xuzhou Municipal Bureau of Science and Technology Key R&D Projects Social Development Projects(KC23178)Science and Technology Special Fundation of Jiangsu Province(BE2023657).
文摘Due to the absence of definitive diagnostic criteria,there remains a lack of consensus regarding the risk assessment of central lymph node metastasis(CLNM)and the necessity for prophylactic lymph node surgery in ultrasound-diagnosed thyroid cancer.The localization of thyroid nodules is a recognized predictor of CLNM;however,quantifying this relationship is challenging due to variable measurements.in this study,we developed a differential isomorphism-based alignment method combined with a graph transformer to accurately extract localization and morphological information of thyroid nodules,thereby predicting CLNM.We collected 88,796 ultrasound images from 48,969 patients who underwent central lymph node(CLN)surgery and utilized these images to train our predictive model,ACE-Net.Furthermore,we employed an interpretable methodology to explore the factors influencing CLNM and generated a risk heatmap to visually represent the distribution of CLNM risk across different thyroid regions.ACENet demonstrated superior performance in 6 external multicenter tests(AUC=0.826),surpassing the predictive accuracy of human experts(accuracy=0.561).The risk heatmap enabled the identification of high-risk areas for CLNM,likely correlating with lymphatic metastatic pathways.Additionally,it was observed that the likelihood of metastasis exceeded 80%when the nodal margin's minimum distance from the thyroid capsule was less than 1.25 mm.ACE-Net's capacity to effectively predict CLNM and provide interpretable disease-related insights can importantly reduce unnecessary lymph node dissections by 37.9%,without missing positive cases,thus offering a valuable tool for clinical decision-making.
文摘Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach （BABA）, compared with conventional open procedure in papillary thyroid microcarcinoma. Methods： One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People＇s Liberation Army （PLA） were randomly assigned to robotic group or conventional open approach group （17 = 50 in each group）. The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale （VAS）, postoperative hospital stay time, complications, and numerical scoring system （NSS, used to assess cosmetic effect） were analyzed. Results： The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group （118.8± 16.5 min vs. 90.7± 10.3 min, P 〈 0.05）. The study showed significant differences between the two groups in terms of the VASs （2.1 ± 1.0 vs. 3.8 ±~ 1.2, P 〈 0.05） and NSS （8.9 ± 0.8 vs. 4.8 ± 1.7, P 〈 0.05）. The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant （all P 〉 0.05）. Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. Conclusions： Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.
文摘Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determine the number of the lymph nodes in the CLND and the relationship to presence of chronic lymphocytic thyroiditis (CLT) and thymic tissue (TT). Methods: Total thyroidectomy and CLND materials from 153 patients with PTC were included in this study. Two histopathologic features (presence of CLT and TT) were evaluated for their value in adequacy of CLND. Results: Histopathologic examination revealed CLT and TT in CLND materials in 70 (46%) and 63 (41%) patients, respectively. Total number of lymph nodes in CLND materials was significantly higher in CLT (+) and TT (+) groups (p Conclusions: Our study demonstrates that presence of CLT in thyroid gland has been associated with higher number of central lymph nodes mainly due to increased number of benign hyperplastic lymph nodes. It may be possible to conclude that upper limit of lymph nodes for satisfactory CLND would be higher to correctly evaluate central lymph node status in existing staging systems if specimens have CLT. Results of this study also show that the presence of TT in surgical materials may represent the adequacy of CLND.
文摘Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,
文摘目的:本研究旨在建立甲状腺乳头状癌(Papillary Thyroid Carcinoma,PTC)患者大量中央区淋巴结转移[(high-volume Central Lymph Node Metastasis,hv-CLNM)中央区淋巴结转移数量>5]的预测模型。方法:纳入2021年1月—2024年6月于石河子大学第一附属医院行手术的579例PTC患者。数据按照7∶3比例随机分为训练集(n=406例)和验证集(n=173例),根据训练集术后CLNM数量分为hv-CLNM组(n=23例)和非hv-CLNM组(n=383例)。采用独立样本t检验、曼-惠特尼检验和卡方检验等比较组间差异。运用单变量和多变量逻辑回归分析筛选独立危险因素并绘制列线图,利用ROC曲线下面积(Area Under Curve,AUC)、校准曲线和决策曲线评估列线图模型效能。结果:差异分析显示,2组间年龄、性别、肿瘤大小、病灶数目、微钙化和TSH水平差异有统计学意义(P<0.05)。单变量和多变量逻辑回归显示,男性、年龄小于55岁、肿瘤大小≥7 mm、多灶性肿瘤、伴有微钙化以及TSH水平较高是hv-CLNM的预测因子(P<0.05)。根据多因素结果构建的列线图模型具有较高的诊断效能,其训练集AUC:0.894(95%CI:0.817~0.970),验证集AUC:0.801(95%CI:0.578~1.000)。校准曲线和决策曲线验证模型较好的一致性和临床效用。结论:基于本中心数据构建的TSH联合超声特征模型对PTC患者hv-CLNM有较高的预测价值,未来还需要进一步验证和优化。
文摘目的探讨腔镜下不同手术入路甲状腺切除术对cN0期甲状腺乳头状癌(PTC)的手术效果。方法回顾性分析2019年8月—2022年11月于本院就诊并接受腔镜手术治疗的118例cN0期PTC患者的临床资料,根据腔镜下不同手术入路,分为胸乳组与经口组,应用倾向性评分匹配法各纳入59例患者。比较两组围术期相关指标。结果经口组术后引流量、住院时长均少于胸乳组(P<0.05),而手术时间、中央区淋巴结清扫数目多于胸乳组(P<0.05);经口组术后12、24 h VAS评分均低于胸乳组(P<0.05);术后3 d,经口组吞咽功能优于胸乳组(P<0.05);术后3个月,经口组瘢痕评估量表评分低于胸乳组(P<0.05);随访1年,组间术后复发、无进展生存期比较无明显差异(P>0.05)。结论经胸乳入路腔镜术与经口腔前庭腔镜术治疗cN0期PTC整体疗效相当,但经口腔前庭入路腔镜术后恢复更快,更值得应用。
文摘目的:筛选与甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)颈中央区淋巴结转移(central lymph node metastasis,CLNM)相关的危险因素,并建立预测模型,以指导PTC患者的手术决策。方法:回顾并分析南京鼓楼医院1 125例接受甲状腺手术的PTC患者临床特征、超声特征和基因信息,通过单因素和多因素logistic回归分析,筛选出CLNM独立危险因素,并构建列线图模型。使用校正曲线、受试者工作特征(receiver operating characteristic,ROC)曲线和决策曲线评估该预测模型的校准度、准确度和临床实用性。随后,收集483例在南京大学附属金陵医院接受甲状腺手术的PTC患者的相关资料,用于模型的外部验证。结果:在1 125例PTC患者中,单因素回归分析结果显示CLNM阳性组与CLNM阴性组在性别、年龄、甲状腺球蛋白以及病灶超声特征(最大径、纵横比、边缘及微钙化)方面差异均有统计学意义(P<0.05)。多因素logistic回归确认患者性别、年龄以及病灶超声特征(最大径、边缘及微钙化)是CLNM的独立预测危险因素。基于独立危险因素绘制列线图模型,模型的曲线下面积(area under curve,AUC)在训练集中为0.768(95%CI0.741~0.796),在验证集中为0.822(95%CI 0.784~0.859)。结论:本研究建立的模型具有较好的预测能力和泛化能力,有望辅助临床医师为PTC患者制订个体化手术方案。
文摘目的探究分化型甲状腺癌患者术中喉前淋巴结(delphian lymph node,DLN)及气管前淋巴结(pretracheal lymph node,PLN)冰冻病理检查对中央区淋巴结转移及复发危险分层的预测价值。方法回顾性收集2023年1月至2024年12月期间于华中科技大学同济医学院附属协和医院甲状腺乳腺外科接受首次手术治疗并行术中DLN、PLN冰冻病理检查的133例单侧分化型甲状腺癌患者的临床资料。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估DLN和PLN转移数量及转移百分比对中央区淋巴结转移及复发危险分层的预测效能,并比较术中冰冻病理与术后常规病理结果的一致性。结果多因素分析结果显示,年龄(<20岁或>50岁)是DLN、PLN转移的保护因素(OR=0.332,P=0.012),腺外侵犯是DLN、PLN转移的风险因素(OR=2.823,P=0.017)。DLN和PLN转移数量及转移百分比预测中央区淋巴结转移总数>5枚的ROC曲线下面积(area under the curve,AUC)分别为0.913[95%CI(0.841,0.986),P<0.001]和0.910[95%CI(0.837,0.983),P<0.001],最佳截断值分别为1.5枚和45.00%。DLN和PLN转移数量及转移百分比预测复发危险分层为中高危的AUC分别为0.818[95%CI(0.740,0.895),P<0.001]和0.800[95%CI(0.720,0.880),P<0.001],最佳截断值分别为0.5枚和26.79%。与术后常规病理结果比较,DLN、PLN术中冰冻病理检查的灵敏度为88.00%(66/75),特异度为100%(58/58),阳性预测值为100%(66/66),阴性预测值为86.57%(58/67)。术中冰冻与术后病理转移情况的Kappa值为0.849[95%CI(0.761,0.937),P<0.001],术中冰冻与术后病理转移百分比的组内相关系数值为0.917[95%CI(0.885,0.940),P<0.001],表明两者具有高度一致性。结论DLN、PLN术中冰冻病理检查可以较好地预测中央区淋巴结转移及复发危险分层,有助于识别可能从扩大手术范围中获益的患者。
