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Objectives: To elucidate whether occupational exposure to soft paper dust increases the incidence of cancer. Methods: We studied 7988 workers in Swedish soft paper mills from 1960 to 2008, of whom 3233 (2 187 men and 1046 women) had more than 10 years of employment. They were divided into high exposure (>5 mg/m3 for >1 year) or lower exposure to soft paper dust based on a validated job‐exposure matrix. They were followed from 1960 to 2019, and person‐years at risk were stratified according to gender, age, and calendar‐year. The expected numbers of incident tumors were calculated using the Swedish population as the reference, and standardized incidence ratios (SIR) with 95% confidence intervals (95% CI) were assessed. Results: Among high‐exposure workers with more than 10 years of employment, there was an increased incidence of colon cancer (SIR 1.66, 95% CI 1.20−2.31), small intestine cancer (SIR 3.27, 95% CI 1.36−7.86), and thyroid gland cancer (SIR 2.68, 95% CI 1.11−6.43), as well as lung cancer (SIR 1.56, 95% CI 1.12−2.19). Among the lower‐exposed workers there was an increased incidence of connective tissue tumors (sarcomas) (SIR 2.26, 95% CI 1.13−4.51) and pleural mesothelioma (SIR 3.29, 95% CI 1.37−7.91). Conclusion: Workers in soft paper mills with high exposure to soft paper dust have an increased incidence of large and small intestine tumors. Whether the increased risk is caused by paper dust exposure or some unknown associated factors is unclear. The increased incidence of pleural mesothelioma is probably linked to asbestos exposure. The reason for increased incidence of sarcomas is unknown. [ABSTRACT FROM AUTHOR]

The incidental thyroid nodule (ITN) is one of the most common incidental findings on imaging studies that include the neck. An ITN is defined as a nodule not previously detected or suspected clinically, but identified by an imaging study. The workup of ITNs has led to increased costs from additional procedures, and in some cases, to increased risk to the patient because physicians are naturally concerned about the risk of malignancy and a delayed cancer diagnosis. However, the majority of ITNs are benign, and small, incidental thyroid malignancies typically have indolent behavior. The ACR formed the Incidental Thyroid Findings Committee to derive a practical approach to managing ITNs on CT, MRI, nuclear medicine, and ultrasound studies. This white paper describes consensus recommendations representing this committee’s review of the literature and their practice experience. [ABSTRACT FROM AUTHOR]

Introduction: The majority of patients with Differentiated Thyroid Cancer (DTC) diagnosis have long-term survival, a considerable number may have a persistent or recurrent illness, and some may ultimately succumb to their thyroid cancer. The present study aimed to determine the disease-specific mortality and to identify the risk factors for recurrence. Material and Methods: This cohort research was conducted in the King Fahad Specialist Hospital in Dammam, Saudi Arabia. The electronic and paper files of all patients with a DTC diagnosis were reviewed. All 460 eligible individuals were risk-stratified using the 2015 American Thyroid Association. The Kaplan-Meier estimator was used to assess the Overall Survival (OS). Results: Out of 460 patients 369 (80.8%) were female. The median age 43.2 years (20 years-85 years). Patients were risk stratified using tumour node and metastasis (TNM) staging as well as American Thyroid Association (ATA) guidelines, based on that 270 (58.6%) patients were low risk, 146 (31.7%) patients intermediate risk and 44 (9.6%) patients fell in the high-risk category. The four patients who died were classified as high risk from the beginning with the following statistically significant risk factors for mortality, the median age of 66 years (p-value= 0.005), N1b lymph nodes metastasis (p-value 0.05) and unstimulated thyroglobulin level >5 (p-value 0.003). Conclusions: Differentiated thyroid cancer is common, the vast majority are low risk, and with the current strategy of management, the prognosis is excellent. Age > 55 years, presence of distant metastasis, and unstimulated thyroglobulin of >5 were considered factors that negatively influenced the survival. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, and its distant metastasis (PTCDM), although uncommon, seriously affects the survival rate and quality of life of patients. With the rapid development of science and technology, research in the field of PTCDM has accumulated rapidly, presenting a complex knowledge structure and development trend. Methods: In this study, bibliometric analysis was used to collect 479 PTCDMrelated papers published between 2004 and 2023 through the Web of Science (WoS) Core Collection (WoSCC) database. Keyword clustering analysis was performed using VOSviewer and citespace, as well as dual-map overlay analysis, to explore knowledge flows and interconnections between different disciplines. Results: The analysis indicated that China, the United States, and South Korea were the most active countries in conducting research activities. Italy's research was notable due to its higher average citation count. Keyword analysis revealed that "cancer," "papillary thyroid carcinoma," and "metastasis" were the most frequently used terms in these studies. The journal co-citation analysis underscored the dominant roles of molecular biology, immunology, and clinical medicine, as well as the growing importance of computer science in research. Conclusion: This study identified the main trends and scientific structure of PTCDM research, highlighting the importance of interdisciplinary approaches and the crucial role of top academic journals in promoting high-quality research. The findings not only provide valuable information for basic and clinical research on thyroid cancer but also offer guidance for future research directions. [ABSTRACT FROM AUTHOR]

Ultrasound is the most commonly used imaging technique for the evaluation of thyroid nodules. Sonographic findings are often not specific, and definitive diagnosis is usually made through fine-needle aspiration biopsy or even surgery. In reviewing the literature, terms used to describe nodules are often poorly defined and inconsistently applied. Several authors have recently described a standardized risk stratification system called the Thyroid Imaging, Reporting and Data System (TIRADS), modeled on the BI-RADS system for breast imaging. However, most of these TIRADS classifications have come from individual institutions, and none has been widely adopted in the United States. Under the auspices of the ACR, a committee was organized to develop TIRADS. The eventual goal is to provide practitioners with evidence-based recommendations for the management of thyroid nodules on the basis of a set of well-defined sonographic features or terms that can be applied to every lesion. Terms were chosen on the basis of demonstration of consistency with regard to performance in the diagnosis of thyroid cancer or, conversely, classifying a nodule as benign and avoiding follow-up. The initial portion of this project was aimed at standardizing the diagnostic approach to thyroid nodules with regard to terminology through the development of a lexicon. This white paper describes the consensus process and the resultant lexicon. [ABSTRACT FROM AUTHOR]

Thyroid nodules are a frequent finding on neck sonography. Most nodules are benign; therefore, many nodules are biopsied to identify the small number that are malignant or require surgery for a definitive diagnosis. Since 2009, many professional societies and investigators have proposed ultrasound-based risk stratification systems to identify nodules that warrant biopsy or sonographic follow-up. Because some of these systems were founded on the BI-RADS® classification that is widely used in breast imaging, their authors chose to apply the acronym TI-RADS, for Thyroid Imaging, Reporting and Data System. In 2012, the ACR convened committees to (1) provide recommendations for reporting incidental thyroid nodules, (2) develop a set of standard terms (lexicon) for ultrasound reporting, and (3) propose a TI-RADS on the basis of the lexicon. The committees published the results of the first two efforts in 2015. In this article, the authors present the ACR TI-RADS Committee's recommendations, which provide guidance regarding management of thyroid nodules on the basis of their ultrasound appearance. The authors also describe the committee's future directions. [ABSTRACT FROM AUTHOR]

IOS Press has retracted the following publication from its online content: [Cancer Biomarkers, 24(4) (2019), 497-508, DOI: 10.3233/CBM-182222] B Schizandrin A inhibits proliferation, migration and invasion of thyroid cancer cell line TPC-1 by down regulation of microRNA-429 b Qiuli Ding, Xiaoyan Li, Yongcun Sun and Xinru Zhang I Department of Ultrasound, Jining No.1 People's Hospital, Jining, Shandong 272000, China i This paper belongs to a set of papers allegedly linked to a paper mill, as described in [[1]]. The editorial office contacted the authors to clarify the allegations, but to date there was no response; therefore the article has been retracted. [Extracted from the article]

Background: The purpose of this study was to assess the current status of the clinical thyroidology literature using bibliographic analysis. Methods: The subject 'clinical thyroidology' was divided into six broad topics: iodine deficiency/iodine nutrition, hypothyroidism, hyperthyroidism/thyrotoxicosis, thyroiditis/autoimmune thyroid disease, thyroid nodules/multinodular goiter, and thyroid cancer. Using Scopus, an online bibliographic searching tool, this study sought to examine the trends in the publication of clinical thyroid disease-related research articles over the decade from 2006 through the end of 2015. Citation counts were also retrieved for individual research papers in order to find papers that might have had a bigger impact on clinical practice. Review articles, guidelines, and editorials were excluded. Results: A total of 19,055 articles were published in the broad area of clinical thyroid disease. The largest proportion was in the topic of thyroid cancer, accounting for >30% of the total. The numbers of papers published annually on thyroid nodules and thyroid cancer increased progressively over the decade. The largest proportion of clinical thyroid publications emanated from the United States, and the majority of papers were published in subspecialty journals. Within each clinical thyroid topic, the most highly cited papers published from 2006 to 2015 were identified, and outliers-that is, papers that had been cited far more often that others in the topic-were also identified. The most highly cited paper in all of clinical thyroidology was a 2006 study describing the increase in thyroid cancer incidence in the United States ( JAMA 295:2164-2167). Most of the highly cited clinical papers were case series or cohort studies, rather than randomized controlled trials. Conclusions: The number of papers in clinical thyroid disease is expanding rapidly, with >1000 papers published annually over the last decade. Research papers on thyroid nodules and cancer accounted for 51% of all clinical thyroid disease-related papers. More randomized controlled trials have been published in the last few years, portending a bright future for clinical thyroidology. [ABSTRACT FROM AUTHOR]

Iodine deficiency-induced goiter continues to be a global public health concern, with varying manifestations based on geography, patient's age, and sex. To gain insights into clinical occurrences, a retrospective study analyzed medical records from patients with iodine deficiency-induced goiter or thyroid cancer who underwent surgery at the Community Hospital in Riehen, Switzerland, between 1929 and 1989. Despite today's adequate iodine supplementation, a significant risk for iodine-independent goiter remains in Switzerland, suggesting that genetic factors, among others, might be involved. Thus, a pilot study exploring the feasibility of genetic analysis of blood spots from these medical records was conducted to investigate and enhance the understanding of goiter development, potentially identify genetic variations, and explore the influence of dietary habits and other environmental stimuli on the disease. Blood prints from goiter patients' enlarged organs were collected per decade from medical records. These prints had been made by pressing, drawing, or tracing (i.e., pressed and drawn) the removed organs onto paper sheets. DNA analysis revealed that its yields varied more between the prints than between years. A considerable proportion of the samples exhibited substantial DNA degradation unrelated to sample collection time and DNA mixtures of different contributors. Thus, each goiter imprint must be individually evaluated and cannot be used to predict the success rate of genetic analysis in general. Collecting a large sample or the entire blood ablation for genetic analysis is recommended to mitigate potential insufficient DNA quantities. Researchers should also consider degradation and external biological compounds' impact on the genetic analysis of interest, with the dominant contributor anticipated to originate from the patient's blood. Highlights: DNA can be extracted from paper-derived historical blood spots using a commercial kit. Strong fluctuation in DNA quantity and quality over and within decades due to storage and samples' age. DNA mixtures are to be expected due to the handling of patient files by multiple individuals. Analysis of blood ablations should be considered individually and holistically. [ABSTRACT FROM AUTHOR]

Background: Liquid biopsy is a method that could potentially improve the management of thyroid cancer (TC) by enabling the detection of circulating tumor DNA and RNA (ctDNA, ctRNA). The BRAFV600E mutation appears to be the most representative example of a biomarker in liquid biopsy, as it is the most specific mutation for TC and a target for molecular therapeutics. The aim of this review is to summarize the available data on the detection of the BRAFV600E mutation in liquid biopsy in patients with TC. Methods: A comprehensive analysis of the available literature on the detection of the BRAFV600E mutation in liquid biopsy in TC was performed. Thirty-three papers meeting the inclusion criteria were selected after full-text evaluation. Results: Eleven papers discussed correlations between BRAF mutation and clinicopathological characteristics. Nine studies tested the utility of BRAFV600E detection in the assessment of residual or recurrent disease. Seven studies investigated BRAF-mutated circulating tumor nucleic acids (ctNA) as a marker of response to targeted therapy. In seven studies the method did not detect the BRAFV600E mutation. Conclusions: This review shows the potential of BRAFV600E-mutated ctNA detection in monitoring disease progression, particularly in advanced TC. The diagnostic value of BRAFV600E-mutated ctNA detection appears to be limited to advanced TC. The choice of the molecular method (quantitative PCR [qPCR], droplet digital polymerase chain reaction [ddPCR], and next-generation sequencing [NGS]) should be made based on the turnaround time, sensitivity of the test, and the clinical indications. Despite the promising outcomes of some studies, there is a need to verify these results on larger cohorts and to unify the molecular methods. [ABSTRACT FROM AUTHOR]

The risk of post-operatory hypothyroidism and hypocalcaemia, along with recurrent laryngeal nerve injury, is lower following a less-than-total thyroidectomy; however, a previously unsuspected carcinoma or a disease progression might be detected after initial surgery, hence indicating re-intervention as mandatory (so-called "redo" surgery) with completion. This decision takes into consideration a multidisciplinary approach, but the surgical technique and the actual approach is entirely based on the skills and availability of the surgical team according to the standard protocols regarding a personalised decision. We aimed to introduce a review of the most recently published data, with respect to redo thyroid surgery. For the basis of the discussion, a novel vignette on point was introduced. This was a narrative review. We searched English-language papers according to the key search terms in different combinations such as "redo" and "thyroid", alternatively "thyroidectomy" and "thyroid surgery", across the PubMed database. Inclusion criteria were original articles. The timeframe of publication was between 1 January 2020 and 20 July 2024. Exclusion criteria were non-English papers, reviews, non-human studies, case reports or case series, exclusive data on parathyroid surgery, and cell line experiments. We identified ten studies across the five-year most recent window of PubMed searches that showed a heterogeneous spectrum of complications and applications of different surgeries with respect to redo interventions during thyroid removal (e.g., recurrent laryngeal nerve monitoring during surgery, other types of incision than cervicotomy, the use of parathyroid fluorescence, bleeding risk, etc.). Most studies addressing novel surgical perspectives focused on robotic-assisted re-intervention, and an expansion of this kind of studies is expected. Further studies and multifactorial models of assessment and risk prediction are necessary to decide, assess, and recommend redo interventions and the most adequate surgical techniques. [ABSTRACT FROM AUTHOR]

Simple Summary: The main topic of this present paper is an analysis of the performance of FAPi agents in cases of thyroid cancer, both in diagnosis and therapy. Up to 50% of instances of thyroid cancer lose their avidity to 131I and become more aggressive. In this scenario, [18F]FDG PET/CT is used for evaluating the widespread nature of the disease, despite its low sensitivity. FAPi agents represent a promising novel class of tracers and a valid alternative to [18F]FDG and 131I scans. They also represent a thriving future perspective in theranostics. This systematic review aims to examine and discuss the advantages and pitfalls of FAPi agents presented in the literature in the context of the diagnosis and treatment of thyroid cancer. (1) Background: Thyroid cancer (TC) is often treated with surgery followed by iodine-131. Up to 50% of the instances of TC lose their avidity to 131I, becoming more aggressive. In this scenario, [18F]FDG PET/CT imaging is used for evaluating the widespread nature of the disease, despite its low sensitivity and a false negative rate of 8–21.1%. A novel class of PET agents targeting the fibroblast activation protein inhibitor (FAPi) has emerged, studied particularly for their potential application to theranostics. (2) Methods: A search of the literature was performed by two independent authors (P.G. and L.E.) using the PubMed, Scopus, Web of Science, Cochrane Library, and EMBASE databases. The following terms were used: "FAP" or "FAPi" or "Fibroblast activating protein" and "thyroid" or "thyroid cancer", in different combinations. The included papers were original articles, clinical studies, and case reports in the English language. No time limits were used. Editorials, conference papers, reviews, and preclinical studies were excluded. (3) Results: There were 31 papers that were selected. Some studies reported a low or absent FAPi uptake in TC lesions; others reported promising findings for the detection of metastases. (4) Conclusions: The preliminary results are encouraging. FAPI agents are an alternative to [18F]FDG and a promising theranostic tool. However, further studies with a larger population are needed. [ABSTRACT FROM AUTHOR]

Objective: To provide a comprehensive overview of the current knowledge structure and research hotspots of Cowden syndrome via bibliometrics. Methods: The articles and reviews related to Cowden syndrome were included from the Web of Science Core Collection (WoSCC) database. VOSviewer, CiteSpace and GraphPad Prism were used to conduct the bibliometric analysis. Results: The number of papers focusing on Cowden syndrome was relatively low initially but increased rapidly from 1997 to 1999, and then maintained small-scale fluctuation. A total of 1,557 papers from 65 countries/regions and 1,762 institutions were identified. The USA was the most productive country, and Ohio State University was the most productive institution. In terms of the number of publications, Human Molecular Genetics ranked first, and Cancer Research was the most frequently cited journal. Eng was the most productive author, and Liaw was the most co-cited author. Phosphatase and tensin homologue (PTEN), germline mutations, gene, cancer, mutations, tumour suppressor gene and breast were high-frequency key words in this field. Conclusion: This study was the first comprehensive bibliometric overview of the current state and development of Cowden disease. The mutation of PTEN and associated cancers, especially breast, thyroid and endometrial cancer, could be the focus of future research in this field. [ABSTRACT FROM AUTHOR]

Papillary thyroid microcarcinoma (PTMC) has indolent features and low mortality. Recently, active surveillance (AS) instead of early surgery (ES) has been introduced as one treatment option but economical preference has not been established. The study objective was to systemically review the literature relating to cost-effectiveness of AS compared to ES for PTMC. Keywords were selected through PICO (Population, Intervention, Comparison, and Outcomes) tools. The search was conducted using PubMed, Cochrane, EMBASE, and Elsevier databases. Papers that had irrelevant titles were written in foreign languages, or had no original results were excluded. Out of the 62 papers extracted, five relevant to the subject matter of this study were identified. Three papers made their own decision models and proceeded with cost-effectiveness analysis (CEA), but the remaining two simply compared costs rather than cost-effectiveness. In terms of cost-effectiveness, three papers preferred AS, one preferred ES, and one preferred neither. The major differences in the CEA might arise from variations in each country's medical insurance system, the utility score systems, and decision models used. In subgroup analysis, two papers preferred AS to ES for patients at a younger age at diagnosis in terms of cost-effectiveness as well as tumor biological characteristics. Although AS has been generally more cost-effective than ES in previous publications, younger age at diagnosis could be one factor contributing to preference for ES. The CEA of prospective cohorts based on the decision model and utility score for thyroid cancer should be undertaken to confirm the cost-effectiveness of AS. [ABSTRACT FROM AUTHOR]

Background: The need to call out and expose authors for their persistence in improperly using epidemiology has been previously noted. Tsuda et al. have done well to expose Schüz et al.'s arguments/assertions in their recent publication in Environmental Heath. In this Comment, I point out that, also warranting being called out, are the arguments/assertions of Cléro et al. who, in their recent response to an article by Tsuda et al., reiterated the conclusions and recommendations derived from their European project, which were published in Environment International in 2021. Tsuda et al. had critiqued the Cléro et al. 2021 publication in their 2022 review article. However, in their response to it, Cléro et al. deflected by not addressing any of the key points that Tsuda et al. had made in their review regarding the aftermath of the Chernobyl and Fukushima nuclear accidents. In this Comment, I critique Cléro et al.'s inadequate response. Publication of this Comment will help in routing out the improper use of epidemiology in the formulation of public health policy and thereby reduce the influence of misinformation on both science and public policy. My critique of Cléro et al. is not dissimilar from Tsuda et al.'s critique of Schüz et al.: in as much as Schüz et al. should withdraw their work, so should Cléro et al.'s article be retracted. Main body: The response by Cléro et al. consists of four paragraphs. First was their assertion that the purpose of the SHAMISEN project was to make recommendations based on scientific evidence and that it was not a systematic review of all related articles. I point out that the Cléro et al. recommendations were not based on objective scientific evidence, but on biased studies. In the second paragraph, Cléro et al. reaffirmed the SHAMISEN Consortium report, which claimed that the overdiagnosis observed in non-exposed adults was applicable to children because children are mirrors of adults. However, the authors of that report withheld statements about secondary examinations in Fukushima that provided evidence against overdiagnosis. In the third paragraph, Cléro et al. provided an explanation regarding their disclosure of conflicting interests, which was contrary to professional norms for transparency and thus was unacceptable. Finally, their insistence that the Tsuda et al. study was an ecological study susceptible to "the ecological fallacy" indicated their lack of epidemiological knowledge about ecological studies. Ironically, many of the papers cited by Cléro et al. regarding overdiagnosis were, in fact, ecological studies. Conclusion: Cléro et al. and the SHAMISEN Consortium should withdraw their recommendation "not to launch a mass thyroid cancer screening after a nuclear accident, but rather to make it available (with appropriate information counselling) to those who request it." Their recommendation is based on biased evidence and would cause confusion regarding public health measures following a nuclear accident. Those authors should, in my assessment, acquaint themselves with modern epidemiology and evidence-based public health. Like Tsuda et al. recommended of Schüz et al., Cléro et al. ought also to retract their article. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid cancer (PTC) is the most common endocrine malignancy worldwide. The treatment of PTC has attracted extensive attention and discussion from the public and scholars. However, no article has systematically assessed the related literature. Therefore, we conducted a bibliometric and knowledge map analysis to reveal the dynamic scientific developments in the PTC therapy field. Methods: We retrieved publications related to PTC therapy from the Web of Scientific Core Collection (WoSCC) on May 1, 2023. The bibliometric package in R software, VOSviewer and CiteSpace software were used to analyze countries/ regions, institutions, journals, authors, references, and keywords. Then, we systematized and summarized the research landscape, global trends and hot topics of research. Results: This bibliometric analysis spanned from 2012 to 2022 and involved 18,501 authors affiliated with 3,426 institutions across 87 countries/regions, resulting in the publication of 3,954 papers in 860 academic journals. Notably, the number of publications and citations related to PTC therapy research has exhibited a steady increase over the past decade. China and the United States have emerged as leading contributors in terms of publication count, with the United States also being the most cited country. Furthermore, among the top 10 institutions with the highest number of published papers, half were located in China. Among the journals, Thyroid is ranked first in terms of total publications and citations. The most productive individual author was Miyauchi Akira. While previous research primarily focused on surgery and radioactive iodine therapy, the increasing emphasis on health awareness and advancements in medical technology have led to the emergence of active surveillance, thermal ablation, and genomic analysis as prominent areas of research. Conclusion: In conclusion, this comprehensive and quantitative bibliometric analysis elucidates the research trends and hotspots within PTC therapy, drawing rom a substantial body of publications. This study provides valuable insights into the historical and current landscape of PTC therapy research while also offering guidance for future research directions. This study serves as a valuable resource for researchers and practitioners seeking new avenues of exploration in the field. [ABSTRACT FROM AUTHOR]

In the era of advanced machine learning techniques, the development of accurate predictive models for complex medical conditions, such as thyroid cancer, has shown remarkable progress. Accurate predictivemodels for thyroid cancer enhance early detection, improve resource allocation, and reduce overtreatment. However, the widespread adoption of these models in clinical practice demands predictive performance along with interpretability and transparency. This paper proposes a novel association-rule based feature-integratedmachine learning model which shows better classification and prediction accuracy than present state-of-the-artmodels. Our study also focuses on the application of SHapley Additive exPlanations (SHAP) values as a powerful tool for explaining thyroid cancer prediction models. In the proposed method, the association-rule based feature integration framework identifies frequently occurring attribute combinations in the dataset. The original dataset is used in trainingmachine learning models, and further used in generating SHAP values fromthesemodels. In the next phase, the dataset is integrated with the dominant feature sets identified through association-rule based analysis. This new integrated dataset is used in re-training the machine learning models. The new SHAP values generated from these models help in validating the contributions of feature sets in predicting malignancy. The conventional machine learning models lack interpretability, which can hinder their integration into clinical decision-making systems. In this study, the SHAP values are introduced along with association-rule based feature integration as a comprehensive framework for understanding the contributionsof feature sets inmodelling the predictions. The studydiscusses the importance of reliable predictive models for early diagnosis of thyroid cancer, and a validation framework of explainability. The proposed model shows an accuracy of 93.48%. Performance metrics such as precision, recall, F1-score, and the area under the receiver operating characteristic (AUROC) are also higher than the baseline models. The results of the proposed model help us identify the dominant feature sets that impact thyroid cancer classification and prediction. The features {calcification} and {shape} consistently emerged as the top-ranked features associated with thyroid malignancy, in both association-rule based interestingnessmetric values and SHAPmethods. The paper highlights the potential of the rule-based integrated models with SHAP in bridging the gap between the machine learning predictions and the interpretability of this prediction which is required for real-world medical applications. [ABSTRACT FROM AUTHOR]

The incidence of thyroid nodules is increasing year by year. Accurate determination of benign and malignant nodules is an important basis for formulating treatment plans. Ultrasonography is the most widely used methodology in the diagnosis of benign and malignant nodules, but diagnosis by doctors is highly subjective, and the rates of missed diagnosis and misdiagnosis are high. To improve the accuracy of clinical diagnosis, this paper proposes a new diagnostic model based on deep learning. The diagnostic model adopts the diagnostic strategy of localization-classification. First, the distribution laws of the nodule size and nodule aspect ratio are obtained through data statistics, a multiscale localization network structure is a priori designed, and the nodule aspect ratio is obtained from the positioning results. Then, uncropped ultrasound images and nodule area image are correspondingly input into a two-way classification network, and an improved attention mechanism is used to enhance the feature extraction performance. Finally, the deep features, the shallow features, and the nodule aspect ratio are fused, and a fully connected layer is used to complete the classification of benign and malignant nodules. The experimental dataset consists of 4021 ultrasound images, where each image has been labeled under the guidance of doctors, and the ratio of the training set, validation set, and test set sizes is close to 3:1:1. The experimental results show that the accuracy of the multiscale localization network reaches 93.74%, and that the accuracy, specificity, and sensitivity of the classification network reach 86.34%, 81.29%, and 90.48%, respectively. Compared with the champion model of the TNSCUI 2020 classification competition, the accuracy rate is 1.52 points higher. Therefore, the network model proposed in this paper can effectively diagnose benign and malignant thyroid nodules. [ABSTRACT FROM AUTHOR]

Although the focus in the last decades has been on the overdiagnosis of incidentally detected thyroid carcinomas in early stages, the other extreme of the disease is represented by locally advanced tumors with the invasion of neighboring structures. These are infrequent tumors, but they have a high complexity and a poor prognosis. In the absence of effective therapies allowing preoperative tumor reduction, in order to achieve a more restricted surgery, treatment was limited to aggressive surgery with resection of the aerodigestive tract and major vascular structures or palliative treatment. However, due to the increased knowledge of tumor biology and the results that tyrosine kinase inhibitors have achieved in the treatment of radioactive iodine-refractory tumors, neoadjuvant therapy with a curative intent has emerged as a reality to be taken into account when dealing with these patients. This paper presents a narrative review of the current scientific evidence regarding neoadjuvant treatment in locally advanced thyroid cancer. [ABSTRACT FROM AUTHOR]

Papillary thyroid cancer (PTC) is the most common type of primary thyroid cancer. Despite the low malignancy and relatively good prognosis, some PTC cases are highly aggressive and even develop refractory cancer in the thyroid. Growing evidence suggested that microenvironment in tumor affected PTC biological behavior due to different immune states. Different interconnected components in the immune system influence and participate in tumor invasion, and are closely related to PTC metastasis. Immune cells and molecules are widely distributed in PTC tissues. Their quantity and proportion vary with the host's immune status, which suggests that immunotherapy may be a very promising therapeutic modality for PTC. In this paper, we review the role of immune cells and immune checkpoints in PTC immune microenvironment based on the characteristics of the PTC tumor microenvironment. [ABSTRACT FROM AUTHOR]

We performed a systematic review and meta-analysis of the literature regarding cardiovascular outcomes of differentiated thyroid cancer (DTC) patients who are on long term thyroid stimulating hormone suppression. Searches were carried out using Prisma guidelines in Medline, Embase, CENTRAL, CINAHL and Scopus databases. Eligible papers were those which investigated discrete cardiovascular clinical outcomes in TSH suppressed patients and meta-analysis of selected studies was performed using Revman 5.4.1. We found a total of 195 879 DTC patients with median length to follow up of 8.6 years (range 5–18.8 years). Analysis showed DTC patients to be at higher risk of atrial fibrillation (HR 1.58, 95% CI 1.40, 1.77), stroke (HR 1.14, 95% CI 1.09, 1.20) and all-cause mortality (HR 2.04, 95% CI 1.02, 4.07). However, there was no difference in risk of heart failure, ischemic heart disease or cardiovascular mortality. These findings suggest that degree of TSH suppression must be titrated to accommodate risk of cancer recurrence and cardiovascular morbidity. [ABSTRACT FROM AUTHOR]

Purpose: Compared with other types of thyroid carcinoma, patients with medullary thyroid carcinoma (MTC) are more likely to develop cervical lymph node metastasis. This study was conducted to clarify the risk factors for cervical lymph node metastasis (central lymph node metastasis or lateral cervical lymph node metastasis) in MTC by meta-analysis, and to provide evidence-based basis for the treatment and prognosis of MTC. Methods: The literatures related to cervical lymph node metastasis in medullary thyroid carcinoma were searched in PubMed, Embase, Web of Science, Cochrane, CNKI and Wanfang databases, and statistical analysis was performed using Revman 5.3 and Stata 14.0 software. Results: A total of 28 papers were included in this paper, and meta-analysis showed that the occurrence of central lymph node metastasis (CLNM) in MTC patients was significantly associated with tumor size (OR = 3.07, 95%CI: 2.04–4.63, P < 0.00001), multifocality (OR = 0.29, 95%CI: 0.19–0.44, P < 0.00001), bilaterality (OR = 3.75, 95% CI: 1.95–7.14, P < 0.0001), capsular invasion (OR = 9.88, 95% CI: 5.93–16.45, P < 0.00001) and extrathyroidal extension (OR = 5.48, 95% CI: 2.61–11.51, P < 0.00001). While the occurrence of lateral cervical lymph node metastasis (LLNM) in MTC patients was strongly correlated with gender (OR = 2.97, 95%CI: 2.46–3.58, P < 0.00001), tumor size (OR = 3.88, 95%CI: 1.90–7.92, P = 0.0002 < 0.05), multifocality (OR = 0.43, 95%CI: 0.35–0.51, P < 0.00001), bilaterality (OR = 2.93, 95% CI: 1.72–4.98, P < 0.0001), capsular invasion (OR = 8.44, 95% CI: 6.11–11.64, P < 0.00001), extrathyroidal extension (OR = 7.04, 95% CI: 5.54–8.94, P < 0.00001), margin of the tumor (OR = 4.47, 95% CI: 2.37–8.44, P < 0.00001), shape of the tumor (OR = 6.81, 95% CI: 3.64–12.73, P < 0.00001), preoperative calcitonin level (SMD = 1.39, 95% CI: 0.98–1.80, P < 0.00001), preoperative carcinoembryonic antigen level (SMD = 0.97, 95% CI: 0.74–1.20, P < 0.00001) and CLNM (OR = 19.70, 95% CI: 14.16–27.43, P < 0.00001). Conclusion: Tumor size, multifocality, bilaterality, capsular invasion and extrathyroidal extension are the main risk factors for developing CLNM in MTC patients; And risk factors for developing LLNM in MTC patients include: gender, tumor size, multifocality, bilaterality, capsular invasion, extrathyroidal extension, margin of the tumor, shape of the tumor, preoperative calcitonin level, preoperative carcinoembryonic antigen level and central lymph node metastasis. These risk factors can guide the individualized treatment plan and improve the prognosis of MTC patients. [ABSTRACT FROM AUTHOR]

Objectives: In this meta-analysis study, the main objective was to determine the accuracy of S-detect in effectively distinguishing malignant thyroid nodules from benign thyroid nodules. Methods: We searched the PubMed, Cochrane Library, and CBM databases from inception to August 1, 2021. Meta-analysis was conducted using STATA version 14.0 and Meta-Disc version 1.4 softwares. We calculated summary statistics for sensitivity (Sen), specificity (Spe), positive and negative likelihood ratio (LR+/LR−), diagnostic odds ratio(DOR), and receiver operating characteristic (SROC) curves. Cochran's Q-statistic and I2 test were used to evaluate potential heterogeneity between studies. A sensitivity analysis was performed to evaluate the influence of single studies on the overall estimate. We also performed meta-regression analyses to investigate the potential sources of heterogeneity. Results: In this study, a total of 17 studies meeting the requirements of the standard were used. The number of benign and malignant nodules analyzed and evaluated in this paper was 1595 and 1118 respectively. This paper mainly completes the required histological confirmation through s-detect. The pooled Sen and pooled Spe were 0.87 and 0.74, respectively, (95%CI = 0.84–0.89) and (95%CI = 0.66–0.81). Furthermore, the pooled LR+ and negative LR− were determined to be 3.37 (95%CI = 2.53–4.50) and 0.18 (95%CI = 0.15–0.21), respectively. The experimental results showed that the pooled DOR of thyroid nodules was 18.83 (95% CI = 13.21–26.84). In addition, area under SROC curve was determined to be 0.89 (SE = 0.0124). It should be pointed out that there is no evidence of bias (i.e. t = 0.25, P = 0.80). Conclusions: Through this meta-analysis, it can be seen that the accuracy of s-detect is relatively high for the effective distinction between malignant thyroid nodules and benign thyroid nodules. [ABSTRACT FROM AUTHOR]

Thyroid cancer is a tumour with a steadily increasing incidence. It accounts for 7% to 15% of focal lesions detected by ultrasound, depending on age, gender and other factors affecting its occurrence. Fine-needle aspiration biopsy is an essential method to establish the diagnosis but, in view of its limitations, sonoelastography is seen as a non-invasive technique useful in differentiating the nature of lesions and monitoring them after fine-needle aspiration biopsy. This paper presents a literature review on the role of both sonoelastographic techniques (relative strain sonoelastography, shear wave sonoelastography) to assess the deformability of focal thyroid lesions. Ultrasound examination is a relatively subjective method of thyroid imaging, depending on the skills of the examiner, the experience of the centre, and the quality of equipment used. As a consequence, there are inconsistencies between the results obtained by different examiners (inter-observer variability) and by the same examiner (intra-observer variability). In this paper, the authors present a review of the literature on inter-observer and intra-observer variability in the assessment of individual features of ultrasound imaging of focal lesions in the thyroid. In addition, the authors report on an analysis of cut-off thresholds for the size of lesions constituting the basis for fine-needle aspiration biopsy eligibility assessment. The need to diagnose carcinomas up to 10 mm in diameter is highlighted, however a more liberal approach is recommended in terms of indications for biopsy in lesions associated with a low risk of malignancy, where, based on consultations with patients, active ultrasound surveillance might even be considered. [ABSTRACT FROM AUTHOR]