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Background: The treatment for papillary thyroid microcarcinoma (PTMC) is controversial. Central lymph node metastasis (CLNM) is one of the main predictors of recurrence and survival, accurate preoperative identification of CLNM is essential for surgical protocol establishment for PTMC. The objective of this study was to establish a nomogram to predict the possibility of CLNM in PTMC patients. Methods: A total of 3023 PTMC patients were randomly divided into two groups by a ratio of 7 to 3, the training group (n = 2116) and validation group (n = 907). The LASSO regression model and multivariate logistic regression analysis were performed to examine risk factors associated with CLNM. A nomogram for predicting CLNM was established and internally validated. Meanwhile, we follow-up the serum thyroid function FT3, FT4, TSH, Tg, TGAb and TPOAb in 789 PTMC patients for 4 years after surgery and compared the differences between the CLNM (+) and CLNM (-) groups, respectively. Results: The LASSO regression model and multivariate logistic regression analysis showed that younger age, lower BMI, being male, location in the lower pole, calcification, 1 ≥ diameter ≥ 0.5 cm, multifocality lesions, extra thyroidal extension (ETE), enlargement of central lymph node (ECLN), lateral lymph node metastasis (LLNM) and higher carcinoembryonic antigen were the ultimate risk factors for determining CLNM. A nomogram for predicting CLNM was constructed based on the influencing factors and internally validated. By establishing the prediction model, the AUC of CLNM in the training and validation groups were 0.73 (95% CI, 0.70-0.76) and 0.75 (95% CI, 0.71-0.79) respectively. Results of the DCA showed that the model is clinically useful when deciding on intervention in the most range of the threshold probability. A 4-year follow-up of thyroid function showed that FT3 and FT4 remained at stable levels after 3 months postoperative and were higher in the CLNM (+) group than in the CLNM (-) group. Hypothyroidism appeared predominantly within 3 months after surgery. The overall incidence of the CLNM (+) group and CLNM (-) groups were 16.46% and 12.04%, respectively. Conclusion: The nomogram model constructed in this study has a good predictive effect on CLNM in PTMC patients and provides a reasonable reference for clinical treatment. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to construct a diagnostic model by exploring the potential predictors of high-risk Papillary Thyroid Microcarcinoma (PTMC) and verifying its reliability. Methods: A retrospective analysis of PTMC patients who underwent surgical treatment from 2004 to 2015 in the SEER database (training set) and the clinical pathological ultrasound information of PTMC patients at the Sichuan Provincial People's Hospital from 2020 to 2022 (external validation set) was conducted. In the training set, univariate and multivariate logistic regression analyses were used to screen independent predictive factors for high-risk PTMC patients in pathology. A nomogram diagnostic model was further constructed. Additionally, ROC curves and calibration curves were drawn to evaluate the efficiency of the model. In the external validation set, the diagnostic model was indirectly evaluated based on preoperative ultrasound imaging features to explore the feasibility and reliability of diagnosing high-risk PTMC through preoperative ultrasound imaging features. Results: A total of 1628 patients were included in the training set, and 530 patients were included in the test set. The independent risk factors for pathological high-risk PTMC were sex, age, tumor maximum diameter, tumor invasive, and cervical lymph nodes (P<0.05). The C-index of the nomogram constructed based on these five factors was 0.947, with an optimal sensitivity of 96.7% and a specificity of 86.0%. The calibration curve showed that the model had high consistency. The area under the curve (AUC) value of the ROC curve for high-risk PTMC predicted by the risk score based on ultrasound features was 0.824 [95% CI (0.789, 0.860)], which was highly consistent with the risk score based on pathological features (k= 0.758, P<0.05). Conclusion: Indirect evaluation of a high-risk PTMC diagnostic model based on preoperative ultrasound imaging features had high predictive efficiency and potential value for clinical application. [ABSTRACT FROM AUTHOR]

Objective To compare the size discrepancy between ultrasonic and pathological measurement of solitary cN0M0 papillary thyroid microcarcinoma (PTMC), and to explore their correlation with lymph node metastasis. Methods From April 2021 to January 2022, 234 patients with solitary cN0M0 PTMC who received thyroid lobectomy or total thyroidectomy in the Department of Thyroid and Breast Surgery of Nanjing University of Chinese Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine were analyzed retrospectively. The size discrepancy between ultrasonic and pathological measurement were compared, and the risk factors of central lymph node metastasis were analyzed. Results The mean of maximum diameter of PTMC measured by ultrasound was 6.8 (range 5.6 to 8.4) mm, which was significantly bigger than that measured by pathology 5.0 (range 4.0 to 7.0) mm (P=0.000). Of them, 37.2% of the tumor size measured by ultrasound is consistent with pathology, 61.1% of the tumor size measured by ultrasound is bigger than that measured by pathology, and only 1.7% of the tumor size measured by ultrasound is smaller than that measured by pathology. There was a linear correlation between the diameter measured by ultrasound and pathology. And the regression equation can be expressed as: pathological diameter =0.799 × ultrasonic diameter -0.221. In addition, 28.6% patients had central lymph node metastasis. Multivariate Logistic regression analysis showed that the diameter measured by pathology is a risk factor for central lymph node metastasis in patients (OR=17.845, 95%CI: 2.507-127.025, P=0.004), and the cutoff value is 5.5 mm which corresponded to the diameter measured by ultrasound as 7.2 mm. Conclusions The sizes of solitary cN0M0 PTMC measured by ultrasound and pathology are different but also correlated. PMTC with pathological diameter >5.5 mm with its corresponding ultrasonic diameter as 7.2 mm indicated an increased risk of central lymph node metastasis.

Background The diagnostic accuracy of preoperative radiologic findings in predicting the tumor characteristics and clinical outcomes of papillary thyroid microcarcinoma (PTMC) was evaluated across all risk groups. Methods In total, 939 PTMC patients, comprising both low-risk and non-low-risk groups, who underwent surgery were enrolled. The preoperative tumor size and lymph node metastasis (LNM) were evaluated by ultrasonography within 6 months before surgery and compared with the postoperative pathologic findings. Discrepancies between the preoperative and postoperative tumor sizes were analyzed, and clinical outcomes were assessed. Results The agreement rate between radiological and pathological tumor size was approximately 60%. Significant discrepancies were noted, including an increase in tumor size in 24.3% of cases. Notably, in 10.8% of patients, the postoperative tumor size exceeded 1 cm, despite being initially classified as 0.5 to 1.0 cm based on preoperative imaging. A postoperative tumor size >1 cm was associated with aggressive pathologic factors such as multiplicity, microscopic extrathyroidal extension, and LNM, as well as a higher risk of distant metastasis. In 30.1% of patients, LNM was diagnosed after surgery despite not being suspected before the procedure. This group was characterized by smaller metastatic foci and lower risks of distant metastasis or recurrence than patients with LNM detected both before and after surgery. Conclusion Among all risk groups of PTMCs, a subset showed an increase in tumor size, reaching 1 cm after surgery. These cases require special consideration due to their association with adverse clinical outcomes, including an elevated risk of distant metastasis.

Background: Papillary thyroid microcarcinoma (PTMC) management has evolved, with active surveillance (AS) gaining prominence as a management option. However, a key concern for both clinicians and patients is the potential for patient loss to follow‐up during AS. Aims: This study aimed to determine adherence and loss‐to‐follow‐up rates in low‐risk PTMC patients undergoing AS versus surgical intervention, in order to gain insights into clinical pathways and safety profiles. Materials and Methods: This cohort study analyzed the 2016 data from a single registered institution of Japan's public National Cancer Registry. Results: We identified and retrospectively analyzed the cases of 327 patients diagnosed with low‐risk PTMC; 227 patients chose to undergo AS while the other 100 underwent PTMC surgery. Main outcomes were the adherence rate and loss‐to‐follow‐up rate of each group, factors influencing discontinuation, and safety considerations. The rate of AS adoption was substantial in the complete series of 327 low‐risk PTMC patients (69.4%). There was a significantly higher loss‐to‐follow‐up rate at 5 years in the AS group (28.6%) compared to the Surgery group (17.8%) (HR 1.62, 95% CI: 1.01–2.61; p = 0.046). Both univariate and multivariate analyses confirmed the significantly higher loss‐to‐follow‐up rate in the AS group as well as in older patients. No deaths due to PTMC progression were observed in the cases lost to follow‐up. Conclusion: Despite concerns about loss to follow‐up, active surveillance remains a safe option for low‐risk PTMCs. Consistent follow‐up strategies are crucial, and further research is needed to enhance patient counseling and care for the management of patients with PTMC. [ABSTRACT FROM AUTHOR]

Purpose. Interstitial fibrosis in papillary thyroid microcarcinoma is a subject which is under-investigated. The aim of this study is to determine the relationship between interstitial fibrosis, the subtypes of papillary microcarcinoma, and the established prognostic factors. Material and Methods. A total of 75 patients diagnosed with papillary microcarcinoma of the thyroid from January 2011 to December 2020 have been evaluated retrospectively, using demographic features, tumor size, subtype of the tumor, surgical margin status, unifocality, lymphovascular invasion, extracapsular spread and lymph node metastasis as parameters. Hematoxylin and eosin slides were reviewed for interstitial fibrosis. Results. The study includes 13 males and 62 females, in a total of 75 patients. There were 51 patients (68%) with interstitial fibrosis and 24 (32%) patients without interstitial fibrosis. Among them, 45 (60%) were classic, 27 (36%) were follicular variant and 3 (4%) were other subtypes. Interstitial fibrosis is significantly associated with bilaterality (p = 0.023), multifocality (p = 0.004), capsule invasion (p < 0.001) and lymph node metastasis (p = 0.043). Evaluation of tumor sub groups showed significant increased risk of lymphovascular invasion in the follicular variant (p = 0.019). Conclusion. Although the relationship of interstitial fibrosis and prognosis of other cancer types has been discussed, there are few studies in the literature regarding its effect on the prognosis of papillary microcarcinoma. Our results show that interstitial fibrosis can be used as a risk factor. However, new studies are needed to clearly reveal the physiopathology of interstitial fibrosis and its effect on tumorigenesis. [ABSTRACT FROM AUTHOR]

Background: Image-guided thermal ablation has been applied in patients with papillary thyroid microcarcinoma (PTMC) who refuse surgery or active surveillance. However, evidence to support ablation is limited by single-center designs and a lack of long-term data. The purpose of this study was to compare long-term outcomes between ablation and lobectomy for patients with solitary PTMC. Materials and methods: This multi-center retrospective study included 1021 consecutive patients with solitary PTMC who underwent ablation (n= 444) or lobectomy (n =577) at the four university-affiliated hospitals. The primary outcomes were disease progression [lymph node metastasis (LNM), recurrent tumors, persistent tumors and distant metastasis] and disease-free survival (DFS). Secondary outcomes were complications, hospitalization, procedure time, estimated blood loss and cost. The two groups were compared using propensity score matching. Results: After matching, no significant differences were observed in disease progression (4.7% vs. 3.4%, P= 0.307), LNM (1.6% vs. 1.6%, P =1.000), recurrent tumors (2.9% vs. 1.8%, P=0.269), persistent tumors(0.2% vs. 0%, P= 0.317) and DFS (95.5% vs. 97.1%, P= 0.246) between the ablation and lobectomy groups during the median follow-up of 96.5 months. The ablation group had significantly lower complication rates (0.7% vs. 5.2%, P <0.001), shorter post-treatment hospitalization {median [interquartile range (IQR)], 0 vs. 4.0 [3.0] days, P< 0.001}, shorter procedure time [8.5 (2.8) vs. 90.0 (43.8) min, P< 0.001], reduced estimated blood loss [0 vs. 20.0 (10.0) ml, P< 0.001], and lower cost [$1873.2 (254.0) vs. $2292.9 (797.8), P <0.001] than the lobectomy group. Conclusions: This study revealed comparable disease progression and survival outcomes between ablation and lobectomy for solitary PTMC. Imaged-guided thermal ablation could be effective and safe alternatives to lobectomy for properly selected patients with PTMC. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy, safety and patients' quality of life of radiofrequency ablation (RFA) and surgery in the treatment of papillary thyroid microcarcinoma (PTMC). Methods: MEDLINE, EMBASE, Cochrane, CNKI and other databases were searched for studies on radiofrequency ablation versus traditional surgery for PTMC up to October 2022. RevMan5.4 software was used for Meta-analysis. Results: 10 articles were selected from 392 articles, including 873 cases of radiofrequency ablation and 781 cases of open surgery. After meta-analysis, the incidence of postoperative complications in the radiofrequency ablation group was lower than that in the surgery group, and the difference was statistically significant [OR=0.24, 95%CI (0.14,0.41), P<0.001]. There were no significant differences in lymph node metastasis rate, local recurrence rate, and new tumor rate between the two groups [OR=1.6, 95%CI (0.21, 12.41), P>0.05; OR=0.85, 95% CI (0.05, 13.8), P>0.05; OR=0.12, 95%CI (0.01, 0.98), P>0.05]. The treatment time and hospital stay in the radiofrequency ablation group were shorter than those in the open surgery group [MD=-49.99, 95%CI (-62.02, -37.97), P<0.001; MD=-5.21, 95%CI(-7.19, -3.23),P<0.001], and the cost was significantly lower than that of the traditional surgery group [SMD=-14.97, 95%CI (-19.14, -10.81), P<0.001]. The quality of life of patients in the radiofrequency ablation group was higher than that in the surgery group [MD=-1.61, 95%CI (-2.06, -1.17), P<0.001]. Conclusion: Compared with traditional open surgery, radiofrequency ablation for papillary thyroid microcarcinoma has the advantages of less trauma, fewer complications, faster recovery and higher quality of life. The indications need to be strictly controlled in the treatment. [ABSTRACT FROM AUTHOR]

Ultrasound-guided radiofrequency ablation (RFA) emerges as a minimally invasive strategy for papillary thyroid microcarcinoma (PTMC), offering advantages over traditional surgical approaches. RFA employs high-frequency electric currents under precise ultrasound guidance to ablate cancerous tissue. Clinical trials consistently demonstrate RFA's efficacy in tumor control and patient-reported outcomes. However, long-term studies are essential to validate its durability and monitor for potential complications. Collaborative efforts among various medical disciplines ensure procedural accuracy and comprehensive postoperative care. Technological innovations, such as enhanced ultrasound imaging and temperature control, promise to refine RFA's precision and effectiveness. Nevertheless, challenges persist, including the need for standardized protocols and comparative studies with traditional treatments. Future research should focus on long-term outcomes, patient selection criteria, and optimization of procedural techniques to solidify RFA's role in PTMC management. RFA presents a promising avenue for PTMC treatment, warranting further investigation and refinement in clinical practice. [ABSTRACT FROM AUTHOR]

BackgroundThe treatment for papillary thyroid microcarcinoma (PTMC) is controversial. Central lymph node metastasis (CLNM) is one of the main predictors of recurrence and survival, accurate preoperative identification of CLNM is essential for surgical protocol establishment for PTMC. The objective of this study was to establish a nomogram to predict the possibility of CLNM in PTMC patients.MethodsA total of 3023 PTMC patients were randomly divided into two groups by a ratio of 7 to 3, the training group (n = 2116) and validation group (n = 907). The LASSO regression model and multivariate logistic regression analysis were performed to examine risk factors associated with CLNM. A nomogram for predicting CLNM was established and internally validated. Meanwhile, we follow-up the serum thyroid function FT3, FT4, TSH, Tg, TGAb and TPOAb in 789 PTMC patients for 4 years after surgery and compared the differences between the CLNM (+) and CLNM (-) groups, respectively.ResultsThe LASSO regression model and multivariate logistic regression analysis showed that younger age, lower BMI, being male, location in the lower pole, calcification, 1 ≥ diameter ≥ 0.5 cm, multifocality lesions, extra thyroidal extension (ETE), enlargement of central lymph node (ECLN), lateral lymph node metastasis (LLNM) and higher carcinoembryonic antigen were the ultimate risk factors for determining CLNM. A nomogram for predicting CLNM was constructed based on the influencing factors and internally validated. By establishing the prediction model, the AUC of CLNM in the training and validation groups were 0.73 (95% CI, 0.70-0.76) and 0.75 (95% CI, 0.71-0.79) respectively. Results of the DCA showed that the model is clinically useful when deciding on intervention in the most range of the threshold probability. A 4-year follow-up of thyroid function showed that FT3 and FT4 remained at stable levels after 3 months postoperative and were higher in the CLNM (+) group than in the CLNM (-) group. Hypothyroidism appeared predominantly within 3 months after surgery. The overall incidence of the CLNM (+) group and CLNM (-) groups were 16.46% and 12.04%, respectively.ConclusionThe nomogram model constructed in this study has a good predictive effect on CLNM in PTMC patients and provides a reasonable reference for clinical treatment.

As the global population ages,the number of elderly people with papillary thyroid microcarcinoma(PTMC) is steadily rising.The selection of a treatment plan has a direct impact on the prognosis and quality of life.A correct evaluation of lymph node metastasis before surgery is the crucial aspect that influences treatment decisions and prognosis.Currently,ultrasonography is mostly used for assessing the health of lymph nodes in clinical settings,however,its precision is limited.Hence,it is crucial to examine the lymph node metastatic pattern in older individuals with PTMC.This article examines the characteristics that increase the likelihood of lymph node metastasis in individuals with PTMC.The goal is to provide a clinical foundation for treating older people with PTMC.

Background There is debate about ultrasonography screening for thyroid cancer and its cost-effectiveness. This study aimed to evaluate the cost-effectiveness of early screening (ES) versus symptomatic detection (SD) for differentiated thyroid cancer (DTC) in Korea. Methods A Markov decision analysis model was constructed to compare the cost-effectiveness of ES and SD. The model considered direct medical costs, health outcomes, and different diagnostic and treatment pathways. Input data were derived from literature and Korean population studies. Incremental cost-effectiveness ratio (ICER) was calculated. Willingness-to-pay (WTP) threshold was set at USD 100,000 or 20,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address uncertainties of the model’s variables. Results In a base case scenario with 50 years of follow-up, ES was found to be cost-effective compared to SD, with an ICER of $2,852 per QALY. With WTP set at $100,000, in the case with follow-up less than 10 years, the SD was cost-effective. Sensitivity analysis showed that variables such as lobectomy probability, age, mortality, and utility scores significantly influenced the ICER. Despite variations in costs and other factors, all ICER values remained below the WTP threshold. Conclusion Findings of this study indicate that ES is a cost-effective strategy for DTC screening in the Korean medical system. Early detection and subsequent lobectomy contribute to the cost-effectiveness of ES, while SD at an advanced stage makes ES more cost-effective. Expected follow-up duration should be considered to determine an optimal strategy for DTC screening.

Abstract Background Thyroid carcinoma (TC) accounts for almost 0.5%–1% of total malignancies. Its incidence is increasing rapidly worldwide. Several studies have drawn up the epidemiological profile of TC and its clinical and pathological features. However, to date, no similar studies have been conducted in Tunisia. Aims To establish an epidemiological profile of TC in a Tunisian health care institute and to analyze its clinical and histopathological characteristics in our institute. Materials and Methods We present a retrospective study reviewing the cases of TC diagnosed in our institution in a 4‐year period. Results We collected a sample of 192 cases of TC. It consisted of 31 males and 161 females (83.8%) with a sex‐ratio M/F of 0.19. The mean age was 46.4 years. Papillary thyroid carcinoma was the most frequent histological subtype. The multifocality rate was 33.8%. The mean size of TC was 2.2 ± 1.9 cm. 60.9% of TC were staged pT1 and 20.3% had nodal involvement. Papillary thyroid microcarcinomas were noted in 37.5% of cases. Conclusion Our results were consistent with those of the literature. A high proportion of pT1 and pN0 tumors were noted in our series, suggesting that TC's diagnosis and management was performed at an early stage of the disease in our institution. In addition, our study enabled us to notice the impact of the Coronavirus disease 19 crisis on the management of TC in our institution. Further studies are needed to establish the epidemiological profile of TC in Tunisia and to assess its clinical and pathological features.

AbstractObjective To evaluate the outcomes of radiofrequency ablation (RFA) for papillary thyroid microcarcinoma (PTMC) adjacent to the trachea and compare them with those of PTMC distant from the trachea.Methods Patients who received RFA for solitary low-risk PTMC between June 2014 and July 2020 were reviewed and classified into adjacent and distant groups. To balance between-group confounders, the propensity score matching approach was employed. Volume, volume reduction ratio (VRR), tumor disappearance, complications, and disease progression were assessed and compared between the groups. Furthermore, factors affecting disease progression were evaluated.Results A total of 122 and 470 patients were included in the adjacent and distant groups, respectively. Overall VRR was 99.5% ± 3.1 and cumulative tumor disappearance rate was 99.4% after a mean follow-up time of 40.1 months ± 16.2. Overall disease progression and complications incidence were 3.7% and 1.0%, respectively. No substantial differences were observed between the two groups in the latest volume (0.8 mm3 ± 4.1 vs. 0.9 mm3 ± 4.2, p = .77), VRR (99.7% ± 1.6 vs. 99.5% ± 2.7, p = .75), cumulative tumor disappearance rate (92.6% vs. 94.2%, p = .58), and incidence of disease progression (4.1% vs. 4.5%, p = .70) and complication (1.7% vs. 0.8%, p = .86) after 1:2 matching. Additionally, tracheal adjacency exhibited no association with disease progression in multivariate Cox regression analysis (p = .73).Conclusion For eligible patients with PTMC located adjacent to or distant from the trachea, RFA may offer a safe and effective alternative treatment method.

Objective: This study aims to combine ultrasound (US) elastography (USE) and radiomic to predict central cervical lymph node metastasis (CLNM) in patients with papillary thyroid microcarcinoma (PTMC). Methods: A total of 204 patients with 204 thyroid nodules who were confirmed with PTMC and treated in our hospital were enrolled and randomly assigned to the training set (n = 142) and the validation set (n = 62). US features, USE (gender, shape, echogenic foci, thyroid imaging reporting and data system (TIRADS) category, and elasticity score), and radiomic signature were employed to build three models. A nomogram was plotted for the combined model, and decision curve analysis was applied for clinical use. Results: The combined model (USE and radiomic) showed optimal diagnostic performance in both training (AUC = 0.868) and validation sets (AUC = 0.857), outperforming other models. Conclusion: The combined model based on USE and radiomic showed a superior performance in the prediction of CLNM of patients with PTMC, covering the shortage of low specificity of conventional US in detecting CLNM. [ABSTRACT FROM AUTHOR]

Genetic profiling is important for assisting the management of papillary thyroid microcarcinoma (PTMC). Although whole‐exome sequencing (WES) of surgically resected PTMC tissue has been performed and revealed potential prognostic biomarkers, its application in PTMC fine‐needle aspiration (FNA) specimens has not been explored. This study aimed to evaluate the feasibility of WES using FNA specimens of PTMC. Five PTMC patients were enrolled with clinical characteristics gathered. Fine aspiration cytology needle (23 gauges) was used to collect FNA biopsy with ultrasound guidance. WES analysis of FNA specimens from five PTMC patients and matched blood samples was performed. The WES of FNA samples yielded an average sequencing depth of 281× and average coverage of 99.5%. We identified 534 somatic single‐nucleotide variants and 13 indels in total, and per sample, we found a mean of 24 exonic mutations, which affected a total of 120 genes. In the PTMC FNA samples, the most frequently mutated genes were BRAF and ANKRD18B, and the four driver genes were BRAF, AFF3, SRCAP, and EGFR. We also identified several germline cancer predisposing gene mutations. The results suggest that WES of FNA specimens is feasible for PTMC and can identify novel genetic mutations. [ABSTRACT FROM AUTHOR]

This study aims to develop and validate a computed tomography (CT)-based radiomics nomogram for pre-operatively predicting central lymph node metastasis (CLNM) in patients with papillary thyroid microcarcinoma (PTMC) and explore the underlying biological basis by using RNA sequencing data. This study trained 452 PTMC patients across two hospitals from January 2012 to December 2020. The sets were randomly divided into the training (n = 339), internal test (n = 86), external test (n = 27) sets. Radiomics features were extracted from primary lesion's pre-operative CT images for each patient. After screening for features, five algorithms such as K-nearest neighbor, logistics regression, linear-support vector machine (SVM), Gaussian SVM, and polynomial SVM were used to establish the radiomics models. The performance of these five algorithms was evaluated and compared directly to radiologist's interpretation (CT-reported lymph node status). The radiomics signature score (Rad-score) was generated using a linear combination of the selected features. By combining the clinical risk factors and Rad score, a radiomics nomogram was established and compared with Rad-score and clinical model. The performance of the nomogram was evaluated based on the receiver operating characteristic (ROC) curve, calibration curve, and the decision curve analysis (DCA). The potential biological basis of nomogram was revealed by performing genetic analysis based on the RNA sequencing data. A total of 25 radiomic features were ultimately selected to train the machine learning models, and the five machine learning models outperformed the radiologists' interpretation by achieving area under the ROC curves (AUCs) ranging from 0.606 to 0.730 in the internal test set. By incorporating the Rad score and clinical risk factors (sex, age, tumor-diameter, and CT-reported lymph node status), this nomogram achieved AUCs of 0.800 and 0.803 in the internal and external test set, which were higher than that of the Rad-score and clinical model, respectively. Calibration curves and DCA also showed that the nomogram had good performance. As for the biological basis exploration, in patients predicted by nomogram to be PTC patients with CLMN, 109 genes were dysregulated, and some of them were associated with pathways and biological processes such as tumor angiogenesis. This radiomics nomogram successfully identified CLNM on pretreatment imaging across multiple institutions, exceeding the diagnostic ability of radiologists and had the potential to be integrated into clinical decision making as a non-invasive pre-operative tool. [ABSTRACT FROM AUTHOR]

In recent decades, the prevalence of thyroid cancer has risen substantially, with papillary thyroid microcarcinoma (PTMC) constituting over 50% of cases. Although most PTMCs exhibit indolent growth and a favorable prognosis, some present an increased risk of recurrence and an unfavorable prognosis due to high-risk characteristics such as lymph node metastasis, extrathyroidal extension, and distant metastasis. The early identification of clinically progressing PTMC remains elusive. In this review, the authors summarize findings from PTMC progression-related literature, highlighting that factors such as larger tumor size, cervical lymph node metastasis, extrathyroidal extension, younger age, higher preoperative serum thyroid-stimulating hormone levels, family history, and obesity positively correlate with PTMC progression. The role of multifocality in promoting PTMC progression; however, remains contentious. Furthermore, recent studies have shed light on the impact of mutations, such as BRAF and TERT mutations, on PTMC progression. Researchers have identified several mRNAs, noncoding RNAs, and proteins associated with various features of PTMC progression. Some studies propose that peripheral and tumor tissue-infiltrating immune cells could serve as biomarkers for the clinical progression of PTMC. Collectively, these clinical and molecular features offer a rationale for the early detection and the development of precision theranostic strategies of clinically progressive PTMC. [ABSTRACT FROM AUTHOR]

Purpose: To assess tumor growth using tumor doubling rate (TDR) during active surveillance (AS) in China. Methods: Between January 2016 and June 2020, a total of 219 patients with lowrisk papillary thyroid microcarcinoma (PTMC) (aged 23-75 years) were consecutively enrolled in the AS program. Results: Four sections of TDR, >0.5, 0.1~0.5, -0.1~0.1 and <-0.1, corresponded with four categories of tumor volume kinetics: rapid growth, slow growth, stable, and decreased size. We found that 10.5% of PTMCs exhibited rapid growth, 33.33% exhibited slow growth, 26.48% were stable, and 29.68% decreased in size. Tumor growth was associated with two factors: age and volume of PTMC at diagnosis. 85.72% of elderly patients (= 61 years old) had tumors that remained stable or even shrank and rapidly growing tumors were not found in them. When the volume was small (=14.13 mm3), the proportion of rapid growth was high (41.67%), whereas when the volume was large (> 179.5 mm3), the proportion of non-growth was 68.75%. Conclusion: TDR may be a better metric for evaluating tumor growth in observational PTMCs. A certain proportion of PTMCs grow during the period of AS and tumor growth was associated with age and volume of PTMC at initial diagnosis. Therefore, how to block tumor growth during the AS period, especially for young patients and patients with early-stage PTMC (size = 5 mm), will be a new challenge. [ABSTRACT FROM AUTHOR]

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Abstract Background Papillary thyroid microcarcinoma (PTMC) management has evolved, with active surveillance (AS) gaining prominence as a management option. However, a key concern for both clinicians and patients is the potential for patient loss to follow‐up during AS. Aims This study aimed to determine adherence and loss‐to‐follow‐up rates in low‐risk PTMC patients undergoing AS versus surgical intervention, in order to gain insights into clinical pathways and safety profiles. Materials and Methods This cohort study analyzed the 2016 data from a single registered institution of Japan's public National Cancer Registry. Results We identified and retrospectively analyzed the cases of 327 patients diagnosed with low‐risk PTMC; 227 patients chose to undergo AS while the other 100 underwent PTMC surgery. Main outcomes were the adherence rate and loss‐to‐follow‐up rate of each group, factors influencing discontinuation, and safety considerations. The rate of AS adoption was substantial in the complete series of 327 low‐risk PTMC patients (69.4%). There was a significantly higher loss‐to‐follow‐up rate at 5 years in the AS group (28.6%) compared to the Surgery group (17.8%) (HR 1.62, 95% CI: 1.01–2.61; p = 0.046). Both univariate and multivariate analyses confirmed the significantly higher loss‐to‐follow‐up rate in the AS group as well as in older patients. No deaths due to PTMC progression were observed in the cases lost to follow‐up. Conclusion Despite concerns about loss to follow‐up, active surveillance remains a safe option for low‐risk PTMCs. Consistent follow‐up strategies are crucial, and further research is needed to enhance patient counseling and care for the management of patients with PTMC.

Abstract Background Whether prophylactic central lymph node dissection is necessary for patients with clinically node-negative (cN0) papillary thyroid microcarcinoma (PTMC) remains controversial. Herein, we aimed to establish an ultrasound (US) radiomics (Rad) score for assessing the probability of central lymph node metastasis (CLNM) in such patients. Methods 480 patients (327 in the training cohort, 153 in the validation cohort) who underwent thyroid surgery for cN0 PTMC at two institutions between January 2018 and December 2020 were included. Radiomics features were extracted from the US images. Least absolute shrinkage and selection operator logistic regression were utilized to generate a Rad score. A nomogram consisting of the Rad score and clinical factors was then constructed for the training cohort. Both cohorts assessed model performance using discrimination, calibration, and clinical usefulness. Results Based on the six most valuable radiomics features, the Rad score was calculated for each patient. A multivariate analysis revealed that a higher Rad score (P

Objective: Active surveillance (AS) has been suggested as a management option for low-risk papillary thyroid microcarcinoma (PTMC). However, the currently proposed selection criteria for AS application do not consider various clinical factors. The purpose of this study was to analyze clinical factors related to recurr ence that could be confirmed preoperatively in patients who underwent surgery for PTMC and to identify factors worth considering when deciding whether to apply AS. Materials and methods: Data were collected from patients with PTMC who underwent surgical treatment at Chungnam National University Hospital. A retrospective cohort was established according to the presence or absence of recurrence during the follow-up period. In total, 2717 patients were enrolled, of whom 60 experienced recurrence. Various clinical factors that could be identified before surgery were analyzed. Results: The relationship between various clinical factors that could be confirmed preoperatively and recurrence was confirmed through Cox regressi on analysis and Kaplan–Meier curve analysis. BRAF mutation and the tall cell variant were significantly more common in patients with recurrence. In patients aged 55 years or older, the risk of recurrence was lower than in younger patients, while the recurrence-free survival (RFS) rate was higher. Conclusion: When choosing between surgical treatment or AS in PTMC patients, additional consideration of the patient’s clinical factors, such as age and BRAF mutation status, may be required in addition to the existing criteria.

Background: Whether prophylactic central lymph node dissection is necessary for patients with clinically node-negative (cN0) papillary thyroid microcarcinoma (PTMC) remains controversial. Herein, we aimed to establish an ultrasound (US) radiomics (Rad) score for assessing the probability of central lymph node metastasis (CLNM) in such patients. Methods: 480 patients (327 in the training cohort, 153 in the validation cohort) who underwent thyroid surgery for cN0 PTMC at two institutions between January 2018 and December 2020 were included. Radiomics features were extracted from the US images. Least absolute shrinkage and selection operator logistic regression were utilized to generate a Rad score. A nomogram consisting of the Rad score and clinical factors was then constructed for the training cohort. Both cohorts assessed model performance using discrimination, calibration, and clinical usefulness. Results: Based on the six most valuable radiomics features, the Rad score was calculated for each patient. A multivariate analysis revealed that a higher Rad score (P < 0.001), younger age (P = 0.006), and presence of capsule invasion (P = 0.030) were independently associated with CLNM. A nomogram integrating these three factors demonstrated good calibration and promising clinical utility in the training and validation cohorts. The nomogram yielded areas under the curve of 0.795 (95% confidence interval [CI], 0.745–0.846) and 0.774 (95% CI, 0.696–0.852) in the training and validation cohorts, respectively. Conclusions: The radiomics nomogram may be a clinically useful tool for the individual prediction of CLNM in patients with cN0 PTMC. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the feasibility and safety of percutaneous radiofrequency ablation guided by ultrasound for treating papillary thyroid microcarcinoma. At our institution, fifty people who had been treated for micropapillary thyroid cancer with ultrasound-guided radiofrequency ablation were chosen. Thyroid function was evaluated after one month, and the volume of the ablation region was assessed immediately, 3, 6, and 12 months after treatment. At the same time, the complications or adverse reactions after treatment were evaluated. As time passed, the volume of the ablation area decreased gradually, showing a regression trend. There was a significant difference in the volume of the ablation area between adjacent groups (P < 0.05), and the tumor volume reduction ratio (VRR) of the ablation area was a statistically significant difference between adjacent groups (P < 0.05). There was no significant difference between the indexes related to thyroid function before and after treatment(P > 0.05). No local recurrence or distant metastasis was found during follow-up; The most common complication after the operation was a slight pain in the neck. A few patients had toothache and neck swelling symptoms, and the above symptoms subsided within 24 h after the operation. Ultrasound-guided radiofrequency ablation is safe and effective for treating single-focus micropapillary thyroid carcinoma while retaining thyroid function, with few and minor complications, which can be used as an ideal surgical option. [ABSTRACT FROM AUTHOR]

BackgroundThe relationship between Hashimoto’s thyroiditis (HT) and papillary thyroid microcarcinoma (PTMC) is controversial. These include central lymph node metastasis (CLNM), which affects the prognosis of PTMC patients. This study aimed to establish a predictive model combining ultrasonography and clinicopathological features to accurately evaluate latent CLNM in PTMC patients with HT at the clinical lymph node-negative (cN0) stage.MethodsIn this study, 1102 PTMC patients who received thyroidectomy and central cervical lymph node dissection (CLND) from the First Affiliated Hospital of Shandong First Medical University from January 2021 to December 2022 and the 960th Hospital of PLA from January 2021 to December 2022 were jointly collected. The clinical differences between PTMCs with HT and those without HT were compared. A total of 373 PTMCs with HT in cN0 were randomly divided into a training cohort and a validation cohort. By analyzing and screening the risk factors of CLNM, a nomogram model was established and verified. The predictive performance was measured by the receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve analysis (DCA).ResultsThe ratio of central lymph node metastasis (CLNMR) in PTMCs with HT was 0.0% (0.0%, 15.0%) and 7.7% (0.0%, 40.0%) in the non-HT group (P

Background The aim of this study is to design a deep learning (DL) model to preoperatively predict the occurrence of central lymph node metastasis (CLNM) in patients with papillary thyroid microcarcinoma (PTMC). Methods This research collected preoperative ultrasound (US) images and clinical factors of 611 PTMC patients. The clinical factors were analyzed using multivariate regression. Then, a DL model based on US images and clinical factors was developed to preoperatively predict CLNM. The model’s efficacy was evaluated using the receiver operating characteristic (ROC) curve, along with accuracy, sensitivity, specificity, and the F1 score. Results The multivariate analysis indicated an independent correlation factors including age ≥55 (OR = 0.309, p < 0.001), tumor diameter (OR = 2.551, p = 0.010), macrocalcifications (OR = 1.832, p = 0.002), and capsular invasion (OR = 1.977, p = 0.005). The suggested DL model utilized US images achieved an average area under the curve (AUC) of 0.65, slightly outperforming the model that employed traditional clinical factors (AUC = 0.64). Nevertheless, the model that incorporated both of them did not enhance prediction accuracy (AUC = 0.63). Conclusions The suggested approach offers a reference for the treatment and supervision of PTMC. Among three models used in this study, the deep model relied generally more on image modalities than the data modality of clinic records when making the predictions.

Abstract Background The presence of high-volume lymph node metastasis (LNM) and extranodal extension (ENE) greatly increases the risk of recurrence in patients with low-risk papillary thyroid microcarcinoma (PTMC). The goal of this research was to analyze the factors that contribute to high-risk lymph node metastasis in patients with low-risk PTMC. Methods We analyzed the records of 7344 patients who were diagnosed with low-risk PTMC and treated at our center from January 2013 to June 2018.LNM with a high volume or ENE was classified as high-risk lymph node metastasis (hr-LNM). A logistic regression analysis was conducted to identify the risk factors associated with hr-LNM. A nomogram was created and verified using risk factors obtained from LASSO regression analysis, to predict the likelihood of hr-LNM. Results The rate of hr-LNM was 6.5%. LASSO regression revealed six variables that independently contribute to hr-LNM: sex, age, tumor size, tumor location, Hashimoto’s thyroiditis (HT), and microscopic capsular invasion. A predictive nomogram was developed by integrating these risk factors, demonstrating its excellent performance. Upon analyzing the receiver operating characteristic (ROC) curve for predicting hr-LNM, it was observed that the area under the curve (AUC) had a value of 0.745 and 0.730 in the training and testing groups showed strong agreement, affirming great reliability. Conclusion Sex, age, tumor size, tumor location, HT, and microscopic capsular invasion were determined to be key factors associated with hr-LNM in low-risk PTMC. Utilizing these factors, a nomogram was developed to evaluate the risk of hr-LNM in patients with low-risk PTMC.

With the continuous development of ablation technology, ablation has become a new treatment option for papillary thyroid microcarcinoma (PTMC). Numerous clinical studies have been carried out recently to confirm the viability, safety, and long-term effectiveness of different ablation procedures in the treatment of PTMC. In order to give the most up-to-date information and treatment choices for PTMC, this article examines current ablation therapy options for PTMC and their effectiveness.

Objective To analyze the diagnostic value of color Doppler ultrasound, serum hyaluronic alkane synthase 2 (HAS2)， a disintegrin and metalloproteinase domain 9 (ADAM9) and the combination in papillary thyroid microcarcinoma (PTMC). Methods Seventy-four patients who underwent surgical treatment in 910th Hospital of Joint Logistics Support Force from October 2020 to October 2022 and confirmed PTMC by pathological results were selected as the malignant group, and 71 patients with benign thyroid nodules by postoperative pathological results during the same period were selected as the benign group. All patients were examined by color Doppler ultrasound. The levels of serum HAS2 and ADAM9 were detected by enzyme-linked immunosorbent assay (ELISA). Pearson was applied to analyze the correlation between serum HAS2 and ADAM9 in patients with PTMC. The diagnostic value of color Doppler ultrasound, serum HAS2, ADAM9 and their combination in PTMC were evaluated using receiver operating characteristic (ROC) curve. Results There were statistically significant differences between malignant group and benign group in terms of boundary, internal echo, margin, microcalcification, aspect ratio and acoustic halo (P＜0.05). The expression levels of serum HAS2 ［(97.01±21.38) pg/mL vs (66.47±10.29) pg/mL, t=10.886, P＜0.01］ and ADAM9 ［(1.96±0.50) pg/mL vs (1.33±0.28) pg/mL, t=9.308, P＜0.01］ in the malignant group were higher than those in the benign group. Serum levels of HAS2 and ADAM9 in PTMC patients were positively correlated (r=0.516, P＜0.05). The area under the curve (AUC) for diagnosing PTMC using serum HAS2 and ADAM9 was 0.929 and 0.924, respectively. The combination of color Doppler ultrasound, serum HAS2 and ADAM9 had an accuracy of 85.52% and a sensitivity of 95.95% in diagnosing PTMC, which was higher than that of a single detection method. Conclusion Color Doppler ultrasound combined with serum HAS2 and ADAM9 has a high diagnostic value for PTMC, and their combination can improve diagnosis sensitivity.

Objective To evaluate the application and value of nanocarbon tracer in the surgical treatment of papillary thyroid microcarcinoma (PTMC). Methods Retrospective analysis of clinical and pathological data of 165 PTMC patients who underwent thyroid cancer surgery at Nanjing Jiangbei Hospital from January 2017 to December 2022 was conducted. Patients were divided into the nanocarbon group (n=87) and the conventional group (n=78) based on whether carbon nanoparticles suspension was used during the surgery. Surgical data (such as operation time, blood loss, drainage volume), pathological data (number of lymph nodes and the number of positive nodes), and serological indicators (parathyroid hormone and blood calcium) were compared between the two groups. Results There was no statistically significant difference between the two groups in terms of drainage volume, length of hospital stay, blood loss, and operation time (P＞0.05). The nanocarbon group had a higher number of cleared lymph nodes (7.9±2.1 vs 5.4±1.3，t=9.069，P＜0.01) and positive lymph nodes (2.1±1.1 vs 1.4±1.0，t=4.259，P＜0.01) than the conventional group, and the levels of parathyroid hormone and blood calcium at 1 day and 1 month after surgery were higher in the nanocarbon group compared to the conventional group (P＜0.05). During the outpatient follow-up at 1 month after surgery, both groups had lower serum thyroglobulin values, but the difference was not statistically significant (P＞0.05). Conclusion Nanocarbon tracer can improve the clinical benefits of PTMC surgery and is safe and effective.

Background and purpose: Robotic thyroid surgery has been carried out worldwide since Kang first applied it to the thyroid in 2007. The proportion of axillary approach is increasing rapidly in China due to the continuous verification of safety, radicalness and cosmetic properties of cancer treatment. The advantages and clinical value of Da Vinci Xi robotic unilateral axillary approach in the treatment of unilateral papillary thyroid microcarcinoma (PTMC) was investigated by comparing and analyzing the clinical efficacy in 95 patients undergoing a gasless, unilateral axillary approach Da Vinci Xi robotic thyroid surgery for PTMC and 91 patients undergoing conventional surgery. Methods: The clinical data of 186 cases of unilateral PTMC undergoing thyroidectomy in the Department of Head and Neck Surgery of Shanghai cancer Hospital from March 2020 to November 2021 were retrospectively analyzed, and they were divided into the robotic group (95 cases) and the open group (91 cases) according to the surgical methods. The general clinical data, surgical results, postoperative complications, satisfaction of incision, learning curve and surgical costs were analyzed and compared between the two groups. Results: There was no statistically significant difference between the two groups in gender, age, incidence of Hashimoto’s thyroiditis, tumor diameter, location and number of lesions (P>0.05). However, the operation time was significantly longer in the robotic group [(126.65±34.76) min]than in the open group [(60.99±21.12) min], and after 36 operations, the operation time reached a stable level. The operation cost was significantly higher in the robotic group [(47 940.66±4 404.30) yuan] than in the open group [(15 807.73±2 295.35) yuan]. There was no significant difference in intraoperative hemorrhage [robotic group: (20.48±18.83) mL; open group: (16.15±13.95) mL], the number of removed lymph nodes (robotic group: 2.61±2.77; open group: 2.97±2.20) and the number of positive lymph nodes (robotic group: 1.01±1.61; open group: 0.78±1.36) between the two groups (P>0.05). The incidence of postoperative temporary vocal hoarseness and transient hypocalcemia was lower in the robotic group (1.10%, 2.10%, respectively) than in the open group (2.20%, 3.30%, respectively), however there was no statistically significant difference (P>0.05). The postoperative satisfaction of incision was significantly higher in the robotic group (very satisfied 87.4%, satisfied 11.6%) than in the open group (very satisfied 71.4%, satisfied 26.4%), and the difference was statistically significant (P

Active surveillance (AS) for low-risk papillary thyroid microcarcinoma (PTMC), which was initiated at Kuma Hospital (Kobe, Japan) in 1993 and Cancer Institute Hospital (Tokyo) in 1995, is now gradually being adopted worldwide, and several prospective studies have described the favorable outcomes of PTMC patients who underwent AS. The most important factor predicting PTMC growth is young age, and PTMC enlargement in young patients may be affected by high serum levels of thyroid-stimulating hormone. This review notes that one patient showed lung metastasis after conversion surgery (CS) following AS, but there are no reports of patients dying of thyroid carcinoma during or after AS. Some PTMCs enlarge or show newly appeared metastatic nodes requiring CS, and findings on the postoperative prognosis and incidence of significant surgical complications (e.g., permanent vocal cord paralysis, hypoparathyroidism) do not differ significantly between patients who underwent CS after AS and those who underwent immediate surgery (IS). IS has been associated with significantly higher incidences of these complications compared to AS as the initial management. Several studies have examined the quality of life (QoL) of patients who underwent AS versus IS, and reported discrepant findings regarding various psychological conditions (including anxiety). Medical costs for AS and IS vary regionally, and in Japan, the 10-year total cost of IS was 4.1 times greater than that of AS in 2017. Taken together, the existing findings demonstrate that AS can be appropriate for the initial management of patients with PTMC.

Papillary Thyroid Carcinoma (PTC), which is a form of thyroid cancer, originates from follicular epithelial cells and can be identified histopathologically by distinct nuclear characteristics and architecture. It is the most common thyroid neoplasm and is typically found in young females, with a good prognosis. Within the subset of PTC, exists incidentally detected lesions called papillary microcarcinomas (IPMC), having a size ≤1 cm which are usually clinically not suspected, radiologically undetected, and often missed in gross pathological examinations. The present case series highlights five cases (2 males and 3 females) of papillary microcarcinomas that were detected over the course of one year. The patients’ ages ranged from 31 to 60 years, with a mean age of 48.8±10.1 years. The male-to-female ratio was 1:1.5. These patients presented with complaints of neck swelling and were initially diagnosed with benign nodular goitre in 47 cases based on clinical and radiological evaluations. The detection rate of papillary microcarcinomas was 10.6%, with one case showing bilaterality (20%). The authors of the present case series adopted a novel approach of indiscriminate nodule sampling of thyroidectomy specimens to observe changes in detection rates. This approach facilitated a higher yield of papillary microcarcinomas. The authors also considered the dilemma of surgical measures and prognostic outcomes in such cases.

Thermal ablations are rapidly developing techniques for minimally invasive treatment, including laser ablation, radiofrequency ablation, and microwave ablation. Such remarkable success has been achieved in treatment malignant neoplasms, for instance, hepatocellular carcinoma and renal cell adenocarcinoma. In recent years, the practice has been gradually adopted into the treatment of papillary thyroid microcarcinoma (PTMC). Many reports have stated that thermal ablations have distinctive advantages over traditional thyroidectomy owing to its efficacy and safety for treatment primary PTMC, meanwhile there are many controversial issues which hotly debated regarding to first-line treatments. Recently, indications and contraindications of thermal ablation for PTMC have been successively proposed by guidelines and consensuses. Many follow-up reports related to thermal ablation in the treatment of PTMC have been reported in clinical practice as well. In this review, we summarized the principles, indications and contraindications, and the efficacy and safety of thermal ablation in the treatment of PTMC, and compared it with traditional surgery.

Purpose. Interstitial fibrosis in papillary thyroid microcarcinoma is a subject which is under-investigated. The aim of this study is to determine the relationship between interstitial fibrosis, the subtypes of papillary microcarcinoma, and the established prognostic factors. Material and Methods. A total of 75 patients diagnosed with papillary microcarcinoma of the thyroid from January 2011 to December 2020 have been evaluated retrospectively, using demographic features, tumor size, subtype of the tumor, surgical margin status, unifocality, lymphovascular invasion, extracapsular spread and lymph node metastasis as parameters. Hematoxylin and eosin slides were reviewed for interstitial fibrosis. Results. The study includes 13 males and 62 females, in a total of 75 patients. There were 51 patients (68%) with interstitial fibrosis and 24 (32%) patients without interstitial fibrosis. Among them, 45 (60%) were classic, 27 (36%) were follicular variant and 3 (4%) were other subtypes. Interstitial fibrosis is significantly associated with bilaterality (p = 0.023), multifocality (p = 0.004), capsule invasion (p < 0.001) and lymph node metastasis (p = 0.043). Evaluation of tumor sub groups showed significant increased risk of lymphovascular invasion in the follicular variant (p = 0.019). Conclusion. Although the relationship of interstitial fibrosis and prognosis of other cancer types has been discussed, there are few studies in the literature regarding its effect on the prognosis of papillary microcarcinoma. Our results show that interstitial fibrosis can be used as a risk factor. However, new studies are needed to clearly reveal the physiopathology of interstitial fibrosis and its effect on tumorigenesis.

Thirty to 50% of differentiated thyroid carcinomas include papillary thyroid microcarcinomas (mPTC). Most of these tumors remain clinically silent, have a bright prognosis and a disease-specific mortality

Objective: To assess the long-term efficacy and safety of microwave ablation (MWA) in treating low-risk papillary thyroid microcarcinomas (PTMC) and to identify predictive factors for the postoperative local tumor progression of PTMC. Methods: A total of 154 low-risk PTMC patients treated with MWA who were followed up for at least 3 months were retrospectively recruited. Ultrasonography was performed after MWA to assess the local tumor progression. Adverse events associated with MWA were recorded. The ablated volume (Va) and initial ablation ratio (IAR) were measured to assess their influences on the recurrence risk of PTMC. Results: The mean tumor volume of PTMC before MWA was 0.071 (0.039, 0.121) cm3, with a maximum diameter of 0.60 ± 0.18 cm. All PTMC patients were followed up for 6 (3, 18) months. Va increased immediately after MWA, then gradually decreased over time, till significantly smaller at 12 months than that before MWA (P < 0.05). The median volume reduction ratio at 24 months reached 100%, which was maintained during a 60-month follow-up. A total of 7 (4.55%) cases of local tumor progression were recorded during the follow-up. Kaplan–Meier survival analysis revealed that the rate of local tumor progression was significantly lower in PTMC patients with a maximum tumor diameter < 0.70 cm than in those with ≥0.70 cm (P = 0.031). A significant better prognosis was achieved in PTMC patients with IAR ≥ 15 than in those with IAR < 15 (P = 0.015). Sex, age (2.0 mU/L) of PTMC patients were not correlated with local tumor progression. Conclusion: MWA is an effective therapeutic strategy for low-risk PTMC with high safety. The maximum tumor diameter and IAR are predictive factors for the local tumor progression of PTMC after MWA.

Abstract Background Identifying risk factors for occult lateral lymph node metastasis (LLNM) in papillary thyroid microcarcinoma (PTMC) can provide valuable insights into the necessity of lateral neck dissection (LND). The objective of this study was to develop a nomogram for predicting the probability of LLNM in patients with cN0 unifocal PTMC. Methods We conducted a retrospective analyzed a total of 4872 patients with cN0 unifocal PTMC who were treated at our center from January 2013 to June 2018. Logistic regression analysis was used to determine the risk factors for LLNM, and a nomogram was constructed based on these risk factors. Results The rate of LLNM was 3.2%. Tumors located in the upper lobe(odds ratio [OR] = 2.56, 95% confidence interval [CI] 1.80–3.62; p

Background: Thermal ablation (TA) modalities such as radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) have been widely used in the treatment of papillary thyroid microcarcinoma (PTMC) patients. Based on previous small-sample meta-analyses, this network meta was designed to further compare the efficacy and safety of these thermal ablation methods in PTMC patients. Methods: China National Knowledge Infrastructure (CNKI), Wanfang, PubMed, Embase, and the Cochrane Library databases were searched to retrieve relevant studies published before May 2022. The efficacy outcomes was recurrence and lymph node metastasis (LNM), the safety outcome included operation time, intra-operative blood loss, hospital stays and complications. The Newcastle-Ottawa Scale (NOS) was selected for the risk of bias assessment. Stata 14.0 was used for statistical analysis. Results: Twenty-nine articles were included. Based on as least 6 months follow up, our analysis discovered no significant statistical differences in all efficacy and safety outcomes between MWA, RFA, and LA groups. Moreover, three TA treatments all produced significant least operation time, hospital stays, and complications than surgery group. Additionally, our study found that RFA showed relatively less complications, LNM, operation time and intra-operative blood loss, compared with other TA treatments. MWA indicated the lowest probability of recurrence, LA showed the longest hospital stays. Conclusions: MWA, RFA, and LA are all effective treatment strategies for patients with PTMC, but could not completely replace conventional surgical treatment.

AbstractThermal ablation (TA) has harvested favorable outcomes in treating low-risk papillary thyroid microcarcinoma (PTMC). Preoperative assessment, intraoperative procedures and postoperative follow-up are all closely linked with the success and safety of TA on PTMC. However, many details in these aspects have not been systematically reviewed. This review firstly described the influence of preoperative assessment, especially for the risk of lymph node metastasis (LNM), as well as the molecular testing on the selection of TA for PTMC. Besides, we also summarized the experiences in treating special PTMC cases by TA, like multifocal lesions, PTMC located in the isthmus or adjacent to the dorsal capsule. At last, we discussed the follow-up strategies, the influence of the thyroid-stimulating hormone (TSH) level on the prognosis of PTMCs, and the management for recurrent cases. In conclusion, the procedures during the entire perioperative period should be standardized to improve the outcomes of TA in treating PTMC patients.

Background: The presence of high-volume lymph node metastasis (LNM) and extranodal extension (ENE) greatly increases the risk of recurrence in patients with low-risk papillary thyroid microcarcinoma (PTMC). The goal of this research was to analyze the factors that contribute to high-risk lymph node metastasis in patients with low-risk PTMC. Methods: We analyzed the records of 7344 patients who were diagnosed with low-risk PTMC and treated at our center from January 2013 to June 2018.LNM with a high volume or ENE was classified as high-risk lymph node metastasis (hr-LNM). A logistic regression analysis was conducted to identify the risk factors associated with hr-LNM. A nomogram was created and verified using risk factors obtained from LASSO regression analysis, to predict the likelihood of hr-LNM. Results: The rate of hr-LNM was 6.5%. LASSO regression revealed six variables that independently contribute to hr-LNM: sex, age, tumor size, tumor location, Hashimoto's thyroiditis (HT), and microscopic capsular invasion. A predictive nomogram was developed by integrating these risk factors, demonstrating its excellent performance. Upon analyzing the receiver operating characteristic (ROC) curve for predicting hr-LNM, it was observed that the area under the curve (AUC) had a value of 0.745 and 0.730 in the training and testing groups showed strong agreement, affirming great reliability. Conclusion: Sex, age, tumor size, tumor location, HT, and microscopic capsular invasion were determined to be key factors associated with hr-LNM in low-risk PTMC. Utilizing these factors, a nomogram was developed to evaluate the risk of hr-LNM in patients with low-risk PTMC. [ABSTRACT FROM AUTHOR]

Background: Because the diameter of the suspicious lymph nodes is less than 1 cm and adjacent to important structures in the neck, the diagnosis of small LLNM is important but difficult without the help of fine needle aspiration (FNA). There are no relevant reports of risk factors that predict the risk of suspicious <1 cm LLNM. Methods: A total of 159 PTMC patients with suspicious <1 cm LLNM were included in the study. Multivariate logistic regression analysis was used to identify ultrasound independent predictors of LLNM. A predictive model was developed according to multivariate logistic regression and evaluated by Hosmer-Lemeshow fit test. Results: Age ≤ 38 years old, the largest PTMC was located in the upper part, and the presence of liquefaction or microcalcification in suspicious lymph nodes were independent risk factors for LLNM (univariate analysis P = 0.00, 0.00, 0.00; multivariate analysis P = 0.00, 0.02, 0.00. OR = 4.66 [CI: 1.78-12.21], 3.04 [CI: 1.24-7.46], 6.39 [CI: 1.85-22.00]). The predictive model for the diagnosis of suspicious <1 cm lymph nodes was established as: P = ex/(1 + ex). X = -1.29 + (1.11 × whether the largest tumor is located in the upper part) + (1.54 × whether the age is ≤ 38 years) + (1.85 × whether the suspicious lymph nodes have liquefaction/microcalcification). The Hosmer-Lemeshow fit test was used to test the predicted ability, and it found that the predictive model had a good fit and prediction accuracy (X2 = 6.214, P = 0.623 > 0.05). Chi squared trend analysis showed that the increase in the number of risk factors gradually increased the malignancy possibility of suspicious <1 cm lymph nodes (chi squared trend test, P = 0.00). Conclusions: Age ≤ 38 years old, the largest PTMC located in the upper part, and the presence of liquefaction or microcalcification in suspicious lymph nodes were independent risk factors for suspicious <1 cm LLNM in PTMC patients. Our result show that it is feasible to evaluate the malignant possibility of these lymph nodes using the number of risk factors. [ABSTRACT FROM AUTHOR]

Background and purpose: Robotic thyroid surgery has been carried out worldwide since Kang first applied it to the thyroid in 2007. The proportion of axillary approach is increasing rapidly in China due to the continuous verification of safety, radicalness and cosmetic properties of cancer treatment. The advantages and clinical value of Da Vinci Xi robotic unilateral axillary approach in the treatment of unilateral papillary thyroid microcarcinoma (PTMC) was investigated by comparing and analyzing the clinical efficacy in 95 patients undergoing a gasless, unilateral axillary approach Da Vinci Xi robotic thyroid surgery for PTMC and 91 patients undergoing conventional surgery. Methods: The clinical data of 186 cases of unilateral PTMC undergoing thyroidectomy in the Department of Head and Neck Surgery of Shanghai cancer Hospital from March 2020 to November 2021 were retrospectively analyzed, and they were divided into the robotic group (95 cases) and the open group (91 cases) according to the surgical methods. The general clinical data, surgical results, postoperative complications, satisfaction of incision, learning curve and surgical costs were analyzed and compared between the two groups. Results: There was no statistically significant difference between the two groups in gender, age, incidence of Hashimoto's thyroiditis, tumor diameter, location and number of lesions (P＞0.05). However, the operation time was significantly longer in the robotic group ［(126.65±34.76) min］than in the open group ［(60.99±21.12) min］, and after 36 operations, the operation time reached a stable level. The operation cost was significantly higher in the robotic group ［(47 940.66±4 404.30) yuan］ than in the open group ［(15 807.73±2 295.35) yuan］. There was no significant difference in intraoperative hemorrhage ［robotic group: (20.48±18.83) mL; open group: (16.15±13.95) mL］, the number of removed lymph nodes (robotic group: 2.61±2.77; open group: 2.97±2.20) and the number of positive lymph nodes (robotic group: 1.01±1.61; open group: 0.78±1.36) between the two groups (P＞0.05). The incidence of postoperative temporary vocal hoarseness and transient hypocalcemia was lower in the robotic group (1.10%, 2.10%, respectively) than in the open group (2.20%, 3.30%, respectively), however there was no statistically significant difference (P＞0.05). The postoperative satisfaction of incision was significantly higher in the robotic group (very satisfied 87.4%, satisfied 11.6%) than in the open group (very satisfied 71.4%, satisfied 26.4%), and the difference was statistically significant (P＜0.05). Conclusion: Da Vinci Xi robot in thyroid surgery using a gasless, unilateral axillary approach has not only good cosmetic effect and high patient satisfaction, but also short learning curve. The amount of bleeding during the surgery, the lymph node detection and the occurrence of postoperative complications are comparable to the traditional surgery. [ABSTRACT FROM AUTHOR]

Context: To date there is no study on the feasibility of radiofrequency ablation (RFA) for papillary thyroid microcarcinomas (PTMCs) with BRAF V600E mutation. Objective: This study was designed to evaluate the efficiency, safety, and prognosis of ultrasound (US)-guided percutaneous RFA for unifocal PTMCs with BRAF V600E mutation. Materials and Methods: Sixty patients with 60 unifocal BRAF V600E mutation-positive PTMCs who received US-guided RFA between January 2020 and December 2021 were retrospectively analyzed. The mean maximum PTMC tumor diameter was 5.8 ± 1.7 mm (range, 2.5-10.0 mm). All PTMCs were pathologically confirmed by fine needle aspiration or core needle biopsy, and BRAF V600E mutation was confirmed to be positive by real-time fluorescent quantitative polymerase chain reaction. Contrast-enhanced ultrasound (CEUS) was performed immediately after RFA to evaluate whether PTMCs were extendedly ablated. Ultrasound was performed 1, 3, 6, and 12 months after RFA and every 6 months thereafter to evaluate the changes in the ablation zone, local recurrence, and cervical lymph node metastasis (LNM). The complications were recorded and evaluated. Results: Extended ablation was achieved in all enrolled patients. The ablation zone sizes increased immediately after RFA compared with those of tumors before treatment. One month later, the ablation zone sizes were smaller than immediately after RFA. At the last follow-up assessment, 42 nodules (70.0%) completely disappeared and the ablation zones of 18 nodules (30.0%) showed fissure-like changes. No local recurrence or cervical LNM was detected. Voice change (1.7%) was the only major complication. Conclusion: RFA is effective and safe in treating unifocal PTMCs with BRAF V600E mutation, especially when surgery is not feasible or refused by patients who are unwilling to continue active surveillance. [ABSTRACT FROM AUTHOR]

Background & Objective: The most frequent type of cancer found in the endocrine system is thyroid carcinoma. Among well-differentiated thyroid malignancies, the most commonly occurring type is identified as papillary thyroid carcinoma (PTC), which makes up 70-90% of the cases. A subtype of PTC is papillary thyroid microcarcinoma (PTMC), which includes tumors smaller than 10 mm in diameter. Due to the advancements in diagnostic techniques, the incidence of this type of cancer is on the rise. In this study, we aimed to analyze the factors worsening the PTMC prognosis. Methods: In the first step, we searched various databases for the factors affecting this tumor. The relevant articles were collected and different outcomes of this tumor and its associated factors which were studied in more than one article, were classified. Finally, we conducted a meta-analysis of these outcomes and their related factors. Results: In the meta-analysis, a significantly association was found between the following factors: recurrence with gender (P<0.001) lymph node metastasis (LNM) (P= 0.003), and extrathyroidal invasion (P<0.001); lymph node metastasis with extrathyroidal invasion (P<0.001), and multifocality (P<0.001); central lymph node metastasis (CLNM) with gender (P=0.001), tumor size (P<0.001), extracapsular invasion (P<0.001), lateral cervical lymph node metastasis (P<0.001), and extrathyroidal invasion (P<0.001); lymph node metastasis resulted in poor outcomes (P<0.001); and finally tumor size with BRAFV600E mutation (P<0.001). Conclusion: In conclusion, it is essential to note that greater awareness and understanding of this tumor characteristics and special and separate attention to PTMC can significantly improve the society overall health. [ABSTRACT FROM AUTHOR]

To develop a multimodal ultrasound radiomics nomogram for accurate classification of thyroid micronodules. A retrospective study including 181 thyroid micronodules within 179 patients was conducted. Radiomics features were extracted from strain elastography (SE), shear wave elastography (SWE) and B-mode ultrasound (BMUS) images. Minimum redundancy maximum relevance and least absolute shrinkage and selection operator algorithms were used to select malignancy-related features. BMUS, SE, and SWE radiomics scores (Rad-scores) were then constructed. Multivariable logistic regression was conducted using radiomics signatures along with clinical data, and a nomogram was ultimately established. The calibration, discriminative, and clinical usefulness were considered to evaluate its performance. A clinical prediction model was also built using independent clinical risk factors for comparison. An aspect ratio ≥ 1, mean elasticity index, BMUS Rad-score, SE Rad-score, and SWE Rad-score were identified as the independent predictors for predicting malignancy of thyroid micronodules by multivariable logistic regression. The radiomics nomogram based on these characteristics showed favorable calibration and discriminative capabilities (AUCs: 0.903 and 0.881 for training and validation cohorts, respectively), all outperforming clinical prediction model (AUCs: 0.791 and 0.626, respectively). The decision curve analysis also confirmed clinical usefulness of the nomogram. The significant improvement of net reclassification index and integrated discriminatory improvement indicated that multimodal ultrasound radiomics signatures might work as new imaging markers for classifying thyroid micronodules. The nomogram combining multimodal ultrasound radiomics features and clinical factors has the potential to be used for accurate diagnosis of thyroid micronodules in the clinic. [ABSTRACT FROM AUTHOR]

Objective: Active surveillance (AS) has been recommended as the first-line treatment strategy for low-risk (LR) papillary thyroid microcarcinoma (PTMC) according to the guidelines. However, preoperative imaging and fine-needle aspiration could not rule out a small group of patients with aggressive PTMC with large-volume lymph node micro-metastasis, extrathryoidal invasion to surrounding soft tissue, or high-grade malignancy from the AS candidates. Methods: Among 2,809 PTMC patients, 2,473 patients were enrolled in this study according to the inclusion criteria. Backward stepwise multivariate logistic regression analysis was used to filter clinical characteristics and ultrasound features to identify independent predictors of high-risk (HR) patients. A nomogram was developed and validated according to selected risk factors for the identification of an HR subgroup among "LR" PTMC patients before operation. Results: For identifying independent risk factors, multivariable logistic regression analysis was performed using the backward stepwise method and revealed that male sex [3.91 (2.58--5.92)], older age [0.94 (0.92--0.96)], largest tumor diameter [26.7 (10.57--69.22)], bilaterality [1.44 (1.01--2.3)], and multifocality [1.14 (1.01-- 2.26)] were independent predictors of the HR group. Based on these independent risk factors, a nomogram model was developed for predicting the probability of HR. The C index was 0.806 (95% CI, 0.765--0.847), which indicated satisfactory accuracy of the nomogram in predicting the probability of HR. Conclusion: Taken together, we developed and validated a nomogram model to predict HR of PTMC, which could be useful for patient counseling and facilitating treatment-related decision-making. [ABSTRACT FROM AUTHOR]

We aimed to investigate the association between iodine intake and nodal metastasis stratified by central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) of papillary thyroid microcarcinoma (PTMC). Urinary iodine concentration (UIC) and clinicopathological characteristics were used to identify factors associated with CLNM and LLNM using logistic regression analysis. A sum of 3,858 PTMC patients were enrolled. The median UIC (MUI) of patients with CLNM or LLNM was not statistically different from those without nodal metastasis. Male patients had a higher MUI than females (183.4 μg/L vs. 173.6 μg/L). Female patients with extracapsular extension had a higher MUI than those without it (210.0 μg/L vs. 172.1 μg/L). Male patients with LLNM had a significantly lower MUI than those without LLNM (134.7 μg/L vs. 187.9 μg/L). Female patients with more than adequate iodine intake were more likely to present with CLNM and extrathyroidal extension than those with adequate iodine intake with an odds ratio (95% confidence interval) of 1.23 (1.01-1.51) and 1.59 (1.09-2.32) after adjustment. Iodine nutrition was not found to be associated with LLNM. In addition, patients with a younger age, larger tumors, extrathyroidal extension, and intrathyroidal spread were more likely to be CLNM, whereas nodular goiter presented with a protective factor; CLNM was the only factor associated with LLNM of PTMC in both genders. In conclusion, iodine nutrition has a much closer association with female than male patients, and high iodine intake may be associated with CLNM and extrathyroidal extension in female PTMC patients. [ABSTRACT FROM AUTHOR]

Abstract Background To investigate the effect of central lymph node dissection on the prognosis of patients with papillary thyroid microcarcinoma (PTMC) without clinical lymph node metastasis (cN0). Methods According to the inclusion and exclusion criteria, 462 patients with cN0 PTMC underwent surgery in the Second Department of General Surgery, Zhongshan City People’s Hospital from January 1, 2007, to June 31, 2017. They were divided into two groups: the undissection group (262 cases) and the dissection group (170 cases). A comparison was made between the two groups in terms of postoperative complications, recurrences, metastases, etc., as well aslymph node metastasis risk factors in the central region of cN0 PTMC. Results There was no lymphatic leakage or death in all patients after the operation. In the dissection group, 64 cases (37.6%) of central lymph node metastasis were found after the postoperative pathological examination. The undissection group was followed up for (92 ± 28.7) months, and the dissection group was followed up for (86 ± 25.4) months (t=-2.165, P = 0.031). In the two groups, there were no lung metastases, bone metastases, or other distant metastases during the follow-up period. In the undissection group, there were 7 cases, while in the dissection group, there were just 2. Recurrence rates between the two groups did not differ significantly (χ2 = 0.126, P = 0.169); Similarly, disease-free survival curves did not differ significantly (χ2 = 2.565, P = 0.708). Hypoparathyroidism and Hypocalcemia also had no difference between the group. In comparison to the undissection group, the capsular invasion rate (P = 0.026), calcification rate(P 5 mm (OR = 5.46, P = 0.019) were the independent risk factors for central lymph node metastasis in cN0 PTMC. Conclusions Thyroidectomy alone is safe for cN0 PTMC, but longer-term follow-up is still required for changes in central lymph nodes. For cN0 PTMC patients with tumor diameter > 5 mm, multifocal, and capsular invasion, central lymph node metastasis is more likely to occur. Comprehensive evaluation and individualized and precise treatment are essential.