We conducted the systematic review and meta-analysis to comprehensively compare ablation and surgery in terms of effectiveness, safety and multiple factors affecting life quality of patients with papillary thyroid cancer (PTC).

PubMed, Embase, Scopus, Web of Science and EBSCO were searched for relevant studies published between January 1980 and September 2023. Two reviewers independently extracted data according to the PRISMA recommendations and assessed the quality of each study with the Cochrane Risk of Bias Tool. Pooled analyses were performed using random or fixed-effects models, as appropriate.

A total of 4829 patients with PTC from 19 eligible studies were included. Through the meta-analysis, similar tumor progression (OR: 1.07; 95% CI 0.78, 1.48; p = 0.66) and recurrence-free survival (OR: 0.86; 95% CI, 0.55, 1.34; p = 0.50) were found between the patients undergoing ablation and those undergoing surgery. More strikingly, the lower risk of major complications (OR: 0.31; 95% CI 0.24, 0.41; p < 0.001), the shorter hospital stay (MD = 3.67 d; 95% CI, -4.89, -2.44; p < 0.001), the abbreviated procedure time (MD: -66.33 min, 95% CI, -77.08, -55.59; p < 0.001), the less intraoperative blood loss (MD: -27.43 ml, 95% CI, -34.60, -20.27; p < 0.001) and the lower treatment cost (MD: -860.42 USD, 95% CI, -1008.03, -712.81; p < 0.001) were noticed in ablation techniques compared to surgical operation. Thermal ablation has shown multiple advantages by virtue of its percutaneous puncture compared with surgical resection.

As an effective, safe, minimally invasive and economical modality, thermal ablation might be a promising alternative to existing PTC management options.

In this study, the response to treatment in patients with extra-thyroid extension (ETE) of papillary thyroid cancer (PTC) was compared between different radioiodine treatment doses.

In this retrospective cross-sectional study, patients with pathology-proven ETE who were hospitalized for radioiodine therapy from December 2015 to May 2018 at a referral university hospital were identified. Demographic data, radioiodine doses, and off-levothyroxine thyroglobulin and antithyroglobulin levels, before and after treatment, were collected. Alterations in thyroglobulin levels before and after treatment were compared between patients receiving different doses of radioiodine.

Sixty patients were analyzed (mean age: 44.1 ± 14.4 years; 61.7% females). On average, the thyroglobulin levels were 59.1 ± 92.0 and 45.7 ± 81.5 ng/mL at baseline and after treatment, respectively. The thyroglobulin levels decreased from 6.2 ± 6.3 to 1.7 ± 0.2 ng/mL ( p  = 0.510), 55.8 ± 101.3 to 11.5 ± 17.2 ng/mL ( p  = 0.07), and 62.8 ± 91 to 60.9 ± 93.1 ng/mL ( p  = 0.83) in the 100- to 149-, 150- to 199-, and 200- to 250-mCi iodine therapy groups, respectively. Treatment with doses of less than 200 mCi were significantly more effective in reducing posttreatment thyroglobulin levels compared with higher doses ( p  = 0.05). In the subgroup analysis, nonmetastatic cases treated with less than 200 mCi iodine had significantly greater thyroglobulin reduction compared with metastatic patients treated with ≥200 mCi iodine ( p  = 0.05). Macroscopic (vs. microscopic) invasion into adjacent tissues had no impact on thyroglobulin decrease.

The administration of higher radioiodine doses for the treatment of PTC patients with ETE does not yield additional therapeutic benefits in terms of posttreatment thyroglobulin reduction.

The incidence of papillary thyroid cancer has fluctuated, partly due to advancements in neck ultrasonography and fine-needle aspiration (FNA). Identifying additional markers to differentiate benign from malignant thyroid nodules could optimize patient management and reduce unnecessary procedures. This retrospective study included 355 patients categorized into those without nodules (group 1) and those with nodules (group 2). FNA results classified nodules as benign (group A) or malignant (group B). The Pearson and Spearman correlations, Student t test, Mann-Whitney U test, and receiver operating characteristic curve analysis calculated and compared inflammatory markers across groups. The study cohort included 126 patients without nodules (group 1), and 229 patients with nodules (group 2) of whom 39 were diagnosed with papillary thyroid cancer. The median age was 56, with 54.4% females and 45.6% males. Receiver operating characteristic analysis revealed significant but poor diagnostic performance for mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR), with optimal cutoff values of 10.1 and 1.60, respectively (P < .001; area under the curve: 0.30), and P < .001, area under the curve: 0.24, respectively). Patients with MPV ≥ 10.1 fL had a higher prevalence of thyroid cancer (17.1%) compared to those with MPV < 10.1 fL (5.4%). Patients with NLR ≥ 1.6 exhibited a higher prevalence of thyroid cancer (54.7%) compared to those with NLR < 1.6 (4.6%). Higher MPV and NLR values were also significantly associated with higher thyroid imaging reporting and data system classifications (P < .001 and P = .05, respectively). Elevated MPV and NLR are significantly associated with thyroid cancer and higher thyroid imaging reporting and data system classifications. These markers, combined with ultrasonography and FNA, may aid in differentiating benign from malignant thyroid nodules, potentially improving patient management and reducing unnecessary procedures.

Partial patients with biochemical incomplete response (BIR) after initial therapy for differentiated thyroid cancer (DTC) may progress to structural recurrence during follow-up. For better-individualized care, this study analyzed predictors of structural recurrence in patients with BIR after initial radioactive iodine therapy (RAIT).

A retrospective study was conducted on 4,263 patients with DTC who underwent thyroidectomy and initial RAIT between June 2009 and August 2023. Patients with either suppressed thyroglobulin (Sup-Tg) > 1 ng/mL or stimulated Tg (Sti-Tg) > 10 ng/mL and negative anti-Tg antibodies (TgAb < 40 IU/mL) without structural disease were enrolled. Pathological examination or imaging confirmed structural recurrence. Sup-Tg change level [ΔSup-Tg% = (Sup-Tg3rd - Sup-Tg2nd)/Sup-Tg2nd × 100%] and other clinicopathological parameters were used to predict structural recurrence in patients with BIR.

We enrolled 161 patients with a median follow-up of 6.3 years. Fourteen patients (8.7%) progressed to structural disease, 80 (49.7%) remained in BIR status, and 67 (41.6%) recovered with long-term remission. ΔSup-Tg%≥17.08% displayed high specificity (84.4%) for structural recurrence prediction (AUC = 0.705, p = 0.011). Extrathyroid extension, stage III and ΔSup-Tg% were independent predictors of structural recurrence (OR = 4.568, p = 0.038; OR = 9.594, p = 0.015; and OR = 18.781, p < 0.001, respectively). Kaplan-Meier analysis showed that these factors were associated with structural recurrence-free survival. Cox regression analysis found that patients with stage III and ΔSup-Tg%≥17.08% have a higher risk of recurrence (HR = 4.818, p = 0.015 and HR = 10.173, p < 0.001, respectively).

Longitudinal monitoring of Tg is essential and Tg change level could be used as a predictor of structural recurrence in patients with BIR.

Tall cell papillary thyroid cancer (tcPTC) is traditionally considered to be an aggressive subtype of differentiated thyroid cancer, although its independent prognostic value is unclear. To investigate the independent prognostic value of tall cell morphology a tcPTC cohort was compared with a classical PTC (cPTC) cohort.

A retrospective longitudinal study was performed using a cohort of tcPTC patients treated at Royal North Shore Hospital and Westmead Hospital in Sydney, Australia, and a cohort of cPTC patients treated at Westmead Hospital. Clinicopathological tumour characteristics and treatment pathways were analysed. Thyroglobulin and thyroglobulin antibody levels and further neck surgeries in the two years post thyroidectomy were used as a surrogate marker for early disease recurrence.

Presentation and treatment were analysed for 51 tcPTC patients and a comparator group of 365 cPTC patients. On univariate analysis, tcPTC was found to present at an older age (53.6 years v 46.4 years, p < 0.01), with greater rates of positive surgical margins (31.37% v 16.44%, p < 0.05), and greater rates of microscopic (47.06% v 22.74%, p < 0.001) and gross extrathyroidal extension (15.69% v 6.30%, p < 0.05). Longitudinal analysis was conducted for 236 patients (n = 24 for tcPTC, n = 212 for cPTC). Multivariate analysis found no difference in the odds of developing early recurrence between the tcPTC cohort and the cPTC cohort (OR = 0.65, p > 0.1).

tcPTC is associated with more aggressive features compared with cPTC. Tall cell morphology was not found to be an independent predictor of early recurrence.

The role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma is debated. This study presents the findings from a 10-year follow-up of a single-institution randomized controlled trial assessing the role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma.

Between 2008 and 2010, a total of 196 patients with clinically node-negative papillary thyroid carcinoma were randomly assigned to 2 groups in a 1:1 ratio to undergo total thyroidectomy (group A) or total thyroidectomy with prophylactic central compartment lymph node dissection (group B). Patients received low-dose radioactive iodine treatment (30 mCi) postoperatively, with additional doses as needed. Monitoring included serum thyroglobulin, thyroglobulin antibodies, and neck ultrasound imaging.

At the end of the follow-up, 151 patients were analyzed, after 28 from group A and 17 from group B were excluded. The 2 groups were similar in age at diagnosis (P = .643), sex distribution (P = .735), body mass index (P = .134), ultrasound-estimated thyroid volume (P = .650), and histologic tumor features. After >10 years (12.9 ± 2 years), no significant differences were observed in surgical and oncologic outcomes. The mean thyroglobulin levels were 0.1 ± 0.1 ng/mL in group A and 0.3 ± 1.3 ng/mL in group B (P = .146). Both groups showed similar findings in the need for further surgery (P = .917), for additional radioactive iodine (P = .979), and mean radioactive iodine dosage (P = .822). No difference was documented in permanent recurrent laryngeal nerve palsy (P = .640), permanent hypocalcemia (P = .238), and serum calcium level (P = .181). The only observed distinction was more parathyroid removal in prophylactic central compartment lymph node dissection cases based on histologic examination (P = .005).

Prophylactic central compartment lymph node dissection does not significantly affect surgical and oncologic outcomes in patients with clinically node-negative small papillary thyroid carcinoma after long-term follow-up.

The rising detection rate of papillary thyroid microcarcinoma (PTMC) necessitates effective management strategies to prevent overtreatment. Active surveillance (AS) has emerged as a potential solution; however, its applicability and cost-effectiveness within China's healthcare system need further investigation. This study aims to evaluate the feasibility and economic benefits of AS for Chinese patients with PTMC.

This prospective study enrolled 145 PTMC patients at Ruijin Hospital, Shanghai. We analyzed progression risk factors and compared 5-year medical costs between AS and immediate surgery (IS), employing SPSS 26 and R for Kaplan-Meier and COX survival analyses.

Among the 145 participants, 105 completed the study. According to the Kaplan-Meier analysis, the cumulative progression rate in our study was 13% (95% CI: 0.05-0.20) over 35 months. Among these patients, 26 underwent surgery, and a higher lymph node metastasis rate was observed in patients with disease progression (61.5%) compared to those without progression (7.7%). Risk factors for PTMC progression included calcification, age, and tumor size. Economically, AS was theoretically more cost-effective than IS. The medical expense of IS with subsequent 5 years follow-up was approximately 6 times higher than that of a 5-year regimen of AS.

AS is a cost-effective option for managing low-risk PTMC in China. High resolution ultrasonography allowed to detect disease progression. Patients younger than 40 years, the presence of initial tumor microcalcifications, and tumor size exceeding 7 mm were significantly associated with disease progression. Further validation of these findings is needed with larger sample sizes.

Treatment options for low-risk differentiated thyroid cancer (DTC) include active surveillance (AS), hemithyroidectomy (HT), or total thyroidectomy (TT). Improved understanding of patient values and preferences is required to inform shared decision-making. This study examined factors influencing patient treatment preferences and trade-offs for low-risk DTC.

Adult participants with benign thyroid nodules or low-risk DTC completed an online discrete choice experiment (DCE). Utilizing the scenario of a 50-year-old person with a small solitary DTC, participants chose between three unlabeled treatment options (representing AS, HT, and TT). Risk profiles varied across 5 domains: voice change, thyroid hormone supplementation, hypocalcaemia, chance of future thyroid surgery, and 10-year risk of cancer recurrence. Participants self-reported demographics, disease factors, and answered a decisional regret scale. A conditional logit model was utilized.

The DCE was completed by 143 patients across three sites. The conditional logit model demonstrated that participants preferred AS (49%) over TT (29%) or HT (22%). All five domains influenced choices (all p < 0.001), but perceived risk of cancer recurrence exerted most influence. Cancer survivors chose AS less often than those with benign disease (46% vs. 57%), driven by perceived risks of further surgery and cancer recurrence. As the perceived risk of cancer recurrence increased, more participants preferred HT over AS.

This study demonstrates that when blinded to the actual treatment, patients prefer the trade-offs associated with AS rather than TT or HT. Perceived risk of cancer recurrence exerted the greatest influence. Accurate risk stratification for cancer recurrence is critical to shared decision-making.

This study aimed to evaluate the outcomes and effectiveness of active surveillance (AS) in patients with low-risk papillary thyroid carcinoma (PTC) and compare them to those of immediate surgery (IS).

A systematic review and meta-analysis, including 14 comparative studies and 7 noncomparative studies, was conducted, encompassing a total of 9,397 patients.

AS was associated with lower rates of familial history of thyroid cancer, multiplicity, and overall mortality compared to IS. The disease progression rate during AS was 14.53% (95% CI, 9.59-21.43%), and the delayed surgery rate was 14.91% (95% CI, 8.35-25.21%). No thyroid cancer-related mortality was observed in either the AS and IS groups. Clinicopathological characteristics showed no significant differences between delayed surgery and IS, except for higher rates of extrathyroidal extension and multiplicity in the delayed surgery group. Overall complication and recurrence rates were higher in the delayed surgery group than in the IS group. Quality of life and anxiety levels were similar between AS and IS, except for interest in sex, where AS was more beneficial.

AS is a feasible and reliable option for managing low-risk PTC, with a relatively low rate of disease progression and no thyroid cancer-related mortality. However, AS should be undertaken with caution, given the higher rates of overall complications and recurrence in the delayed surgery group compared to the IS group. Further studies with larger sample sizes and long-term follow-up are needed to clarify the role and effectiveness of AS.

Thyroid cancer incidence has risen in both the United States and Canada, despite differing healthcare systems. While overdiagnosis likely partly explains this trend in adults, its impact on younger populations is unclear. We used the North American Association of Central Cancer Registries, which included 133,808 thyroid cancer cases from the United States and Canada, to assess incidence trends among pediatric, adolescent, and young adult (PAYA) populations.

Age-adjusted incidence rates (AAIR) per 100,000 person-years (PY) were compared using rate ratios (RR), stratified by sex, age, race/ethnicity (United States only), and histology. Joinpoint regression estimated annual percentage changes (APC) and average APCs (AAPC) in AAIRs. From 1995 to 2014, thyroid cancer incidence increased by 137%. Significant increases occurred across all age groups (0-14, 15-24, 25-34, 35-39 years). The rate increase was highest for papillary thyroid cancer (AAPC = 5.50, 95% CI 5.06, 5.94), and among individuals aged 35-39 years (AAPC = 5.99, 95% CI 4.84, 7.15). Of racial/ethnic groups in the United States, non-Hispanic White individuals had the highest AAIR (6.22 per 100,000 PY). Mortality has changed minimally.

Over the past two decades, thyroid cancer incidence has increased in individuals under 40. While evidence suggests that overdiagnosis primarily accounts for this trend, other contributing factors cannot be ruled out. Further research and surveillance of the drivers of increased incidence are critical.

The 2022 WHO Classification categorizes oncocytic (OTC) and follicular thyroid carcinoma (FTC), based on the degree of capsular and vascular invasion, into minimally invasive (MI), encapsulated angio-invasive (EA), and widely invasive tumors (WI). While associations with clinical outcomes have been studied extensively in FTC, robust clinical data are lacking for OTC. We aimed to investigate the impact of the reclassification of OTC and FTC by the 2022 WHO Classification on clinical outcomes.

All adult OTC and FTC patients treated at the Erasmus MC (the Netherlands) between 2000 and 2016 were retrospectively included. All tumors were extensively revised by 2 independent pathologists, facilitated by Palga: Dutch Pathology Databank. Kaplan-Meier curves were used to study the association of the 2004 and 2022 WHO Classification with overall survival, disease-specific survival (DSS), recurrence-free survival, and radioactive iodine (RAI)-refractory disease.

Among 52 OTC and 89 FTC patients, 15 (28.8%) OTC and 34 (38.2%) FTC tumors were reclassified as EAOTC or EAFTC. The 2022 WHO Classification substantially improved risk stratification in both subtypes for DSS, compared to the 2004 edition. Ten-year DSS rates were 100% for MIOTC, 92.9% for EAOTC, and 56.5% for WIOTC, compared to 100% (MIOTC) and 64.2% (WIOTC) following the 2004 WHO Classification. For FTC and RAI-refractory disease, similar trends were observed.

Classification of OTC and FTC into 3 subcategories as defined by the 2022 WHO Classification substantially improves discrimination between low-, intermediate-, and high-risk patients, especially for DSS and RAI-refractory disease.

Despite progress in recruiting representative patient samples for clinical trials, disparities persist. This study quantifies the representation of historically marginalized groups-female patients, members of racial/ethnic minority groups, and older patients-in thyroid cancer clinical trials and proposes strategies for improving their participation.

We performed a systematic review and meta-analysis of thyroid cancer treatment studies conducted in the United States and published between January 2018 and December 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Studies were sourced from EMBASE and PubMed. Independent and duplicate screening and data extraction were conducted to ensure accuracy. Extracted data included trial interventions, clinical phases, sample sizes, demographic characteristics of participants, and funding sources. Studies were evaluated using the Clinical Trial Diversity Rating framework to assess the inclusion rates of diverse participant groups compared to their prevalence rates for thyroid cancer.

We found that US-based clinical trials for thyroid cancer frequently underrepresented female and non-white individuals. In over half of studies, male participants outnumbered female participants. Reporting of race and ethnicity information was inadequate, with 9/13 studies failing to provide any demographic breakdown. Among the four studies that did report race and ethnicity data, none achieved adequate representation of minority patients. Additionally, there was a notable lack of reporting on participant age bands, despite the relatively high incidence of thyroid cancer in adults aged 60 and above.

Our findings highlight the persistent underrepresentation of women, non-white racial/ethnic groups, and older adults in thyroid cancer trials. Urgent efforts are needed to address these disparities, particularly given the increasing rates of thyroid cancer among women and the healthcare access disparities in marginalized communities.

Microwave ablation (MWA) is a relatively new, well-tolerated, minimally invasive approach, developed in recent years as an alternative to surgery for low-risk papillary thyroid microcarcinoma (PTMC). We describe an 81-year-old patient with unifocal PTMC who refused active surveillance and underwent percutaneous MWA. Two weeks after the procedure, the patient presented dyspnea and cough, and delayed tracheal perforation was confirmed by computed tomography. Conservative therapy was chosen as the initial treatment, and the tracheal defect was confirmed healing successfully 1 month later. Radiologists should be aware of the possibility of delayed tracheal perforation following MWA even in the absence of unusual intraoperative events.

Background/Objectives: Thyroid nodules are commonly observed in neck ultrasonography. Most nodules are benign; hence, several nodules require biopsy to accurately identify the malignant ones. Numerous risk classification guidelines have been developed for thyroid nodules, varying in their indications for fine-needle aspiration biopsy (FNAB). The aim of this study is to evaluate the performances of three internationally recognized thyroid imaging reporting and data systems (TIRADS) for risk stratification of malignancy in comparison to one another. Methods: A total of 225 thyroid nodules with definitive FNAB cytology or histopathological diagnoses were included in this study. Various ultrasound (US) features were classified into categories based on three TIRADS editions. The guidelines were assessed regarding sensitivity, specificity, predictive values, and diagnostic accuracy to compare diagnostic value. Results: The American College of Radiology (ACR)-TIRADS demonstrated the best diagnostic accuracy (63.1%), the highest specificity (58.7%) and positive predictive value (36.3%), among three different TIRADS systems. Korean (K)-TIRADS exhibited the highest sensitivity (94.2%), negative predictive value (96.1%), and the most favorable negative likelihood ratio (0.13). The European (EU)-TIRADS had a sensitivity of 90.4%, specificity of 48.6%, and diagnostic accuracy of 58.2%, ranking between the other two guidelines across most parameters. Conclusions: The rigorous use of the guidelines established by each of the three TIRADS systems would have markedly reduced the number of FNABs performed. The comparison of the three guidelines in our study indicated that they are effective screening methods for identifying malignant thyroid nodules. Among them, K-TIRADS showed the most effective diagnostic performance in sensitivity, while ACR-TIRADS yielded the best specificity.

Papillary thyroid cancer (PTC) is the most frequent malignant thyroid tumor in Germany. The diagnosis can only be confirmed by histological examination of the suspicious tissue. The clinical signs, sonographic findings, and the results of fine-needle aspiration, possibly supplemented by subsequent molecular genetic analysis, can confirm the suspected diagnosis before surgery. The prognosis is very good if the diagnosis is made early and, depending on the size of the tumor, complete surgical removal is achieved, with a 10-year survival rate of more than 90%; however, histologically PTC has several variants that are associated with either a high or low risk of metastases and recurrence in patients. Therefore, the extent of necessary treatment, in particular surgical interventions for PTC has been discussed for years. This article provides an overview of the current knowledge on the diagnosis, treatment and prognosis of PTC.

In rats, thyroid tumors are common age-related findings with reported incidence rates up to 8.1% and 11.86% for follicular and C-cell adenomas, respectively. Increases of thyroid follicular neoplasms in rodents via the induction of hepatic UDP-glucuronosyltransferase (UGT) enzymes, resulting in elevated thyroid hormone (TH) metabolism, excretion, and subsequent follicular cell proliferation are generally accepted to have little or no relevance to humans due to species differences in sensitivity to this pathophysiologic process. In this analysis, we reviewed approved drugs that resulted in thyroid tumors in 2-year rat carcinogenicity studies and summarized the positioning of these findings in product labeling language and human risk assessments in the United States and Europe. Overall, although thyroid follicular cell tumors are commonly observed, the labels reviewed listed no suspected human risk or directly state the absence of human relevance for these findings. Like follicular cell tumors, thyroid C-cell tumors are common background findings in rats but comparatively are not as commonly increased in frequency as drug-related findings in 2-year rodent carcinogenicity studies. These findings are most notably observed with GLP-1 agonists and their human relevance is a topic of ongoing clinical safety surveillance analysis. Thyroid follicular cell hyperplasia, when specifically occurring through hepatic enzyme induction and/or enhanced TH clearance, should be evaluated for anticipated human translational relevance using nonclinical and clinical data. If no human relevance is anticipated, this rationale should be incorporated into a weight of evidence approach for carcinogenicity studies as outlined in the ICH S1B addendum.

The study evaluates the appropriateness and reliability of thyroid nodule cancer risk assessment recommendations provided by large language models (LLMs) ChatGPT, Gemini, and Claude in alignment with clinical guidelines from the American Thyroid Association (ATA) and the National Comprehensive Cancer Network (NCCN). A team comprising a medical imaging informatics specialist and two radiologists developed 24 clinically relevant questions based on ATA and NCCN guidelines. The readability of AI-generated responses was evaluated using the Readability Scoring System. A total of 322 radiologists in training or practice from the United States, recruited via Amazon Mechanical Turk, assessed the AI responses. Quantitative analysis using SPSS measured the appropriateness of recommendations, while qualitative feedback was analyzed through Dedoose. The study compared the performance of three AI models ChatGPT, Gemini, and Claude in providing appropriate recommendations. Paired samples t-tests showed no statistically significant differences in overall performance among the models. Claude achieved the highest mean score (21.84), followed closely by ChatGPT (21.83) and Gemini (21.47). Inappropriate response rates did not differ significantly, though Gemini showed a trend toward higher rates. However, ChatGPT achieved the highest accuracy (92.5%) in providing appropriate responses, followed by Claude (92.1%) and Gemini (90.4%). Qualitative feedback highlighted ChatGPT's clarity and structure, Gemini's accessibility but shallowness, and Claude's organization with occasional divergence from focus. LLMs like ChatGPT, Gemini, and Claude show potential in supporting thyroid nodule cancer risk assessment but require clinical oversight to ensure alignment with guidelines. Claude and ChatGPT performed nearly identically overall, with Claude having the highest mean score, though the difference was marginal. Further development is necessary to enhance their reliability for clinical use.

The role of prophylactic central neck dissection (pCND) in differentiated thyroid cancer (DTC) is still controversial.

In a cohort of 274 DTC cN0 patients with a high rate of tumor recurrence, who underwent total thyroidectomy with or without pCND, clinical and histopathological features were retrospectively analyzed.

In our cohort, no clinical or histopathological features are able to predict the presence of central lymph node metastases (CLNM) at diagnosis, which instead represents the only variable significantly associated with a higher risk of long-term tumor relapse, independently from age, sex, BMI and radioiodine treatment (OR=1.03, 95% CI: 1.002-1.074, P<0.05). Moreover, our study demonstrates that pCND does not significantly increase the risk of post-surgical complications.

In our setting, pCND could have a key role in the management of DTC. The risks and benefits of pCND should be evaluated for each population to make the most appropriate therapeutic choice.

The thyroid imaging reporting and data system (TIRADS) was developed as a standard global term to describe thyroid nodule risk features, aiming to address issues such as variability and low reproducibility in nodule feature detection and interpretation by different physicians. The objective of this study is to comprehensively study articles that utilize AI techniques to design and develop decision support systems for classifying thyroid nodule risk on the basis of various TIRADS guidelines from ultrasound images.

This protocol includes five steps: identification of key research questions of the review, descriptions of the systematic literature search strategies, criteria for study inclusion and exclusion, study quality measures, and the data extraction process. We designed a complete search string using PubMed, Scopus, and Web of Sciences to retrieve all relevant English language studies up to January 2024. A PRISMA diagram was constructed, inclusion and exclusion criteria were defined, and after a quality assessment of the included papers, relevant data were extracted. The protocol of this systematic review was registered in the PROSPERO database (CRD42024551311).

We anticipate that our findings will assist researchers in creating higher-quality systems with increased efficiency, reducing unnecessary biopsies, improving the reproducibility and reliability of thyroid nodule diagnostics, and providing good educational opportunities for less experienced physicians.

In this study, a protocol was used for performing a systematic review to evaluate the diagnostic performance and other various aspects used in the design and development of artificial intelligence CAD systems based on various thyroid imaging reporting and data systems (TI-RADSs).

Adolescent and young adult (AYA) cancer incidence rates are rising, and survivors are at risk for numerous cancer- and treatment-related consequences. Despite growing attention to this population, prevalence estimates are lacking.

To estimate the number of individuals living in the United States with a history of cancer diagnosed during the AYA period.

Prevalence of cancer survivors diagnosed between the ages of 15 and 39 years was estimated using data from the Surveillance, Epidemiology, and End Results (SEER) program as of January 1, 2020. Limited duration prevalence data were also used to generate complete prevalence by sex, years since diagnosis (0-<1, 1-<5, 5-<10, 10-<15, 15-<20, 20+), and attained age (15-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70+) for the 15 most common AYA cancer sites.

There were an estimated 2 111 838 survivors of AYA cancers in the United States as of January 1, 2020. More survivors were female (66%) and long-term (>5 years from diagnosis, 83%) or very long-term survivors (>10 years from diagnosis, 68.8%). A large percentage (44%) were more than 20 years from diagnosis. The most common cancer sites among female survivors were breast (24%) and thyroid cancers (23%) and, among male survivors, testicular cancer (31%). Across the population, the highest percentage of survivors of AYA cancers were 40 to 49 years of age (25.3%).

There are more than 2.1 million cancer survivors diagnosed in the AYA period who are living in the United States; most are more than 10 years from diagnosis.

Thyroid cancer (TC) is the most common malignancy of the endocrine system and head-and-neck region, yet data on its burden in adolescents and young adults (AYAs) is lacking. This study aimed to estimate the global burden of TC among AYAs from 1990 to 2021.

Utilizing the Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized rates of incidence, prevalence, and disability-adjusted life-years (DALYs) on global, regional, and national scales. Joinpoint regression was employed to determine average annual percentage change (AAPC), with frontier analysis revealing regions for improvement. Decomposition analysis assessed the impacts of population aging, growth, and epidemiological changes. Projections for disease burden extending to 2040 were generated using the Bayesian Age-Period-Cohort model.

In 2021, there were 48.2 thousand incident cases, 436.1 thousand prevalent cases, and 183.5 thousand DALYs worldwide. Meantime, the age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR), and age-standardized DALYs rates (ASDR) were 1.6, 14.3 and 6.1 per 100 000, respectively. From 1990 to 2021, the ASIR, ASPR and ASDR increased with AAPCs of 1.73, 1.77, and 0.38, respectively. Socio-demographic resources in Saudi Arabia, Taiwan (Province of China), Iceland, United Arab Emirates, and United States Virgin Islands have the potential to lower ASDR due to TC among AYAs. Furthermore, 13.3 thousand and 34.9 thousand new cases occurred in the males and females in 2021. Among 5 age groups, the highest numbers of incidence, prevalence, and DALYs, along with ASRs, were observed in the 35-39 age group. Global projections indicated a continuous rise in numbers of incidence, prevalence, and DALYs, with estimates of 60.2 thousand, 558.4 thousand, and 199.7 thousand by 2040, respectively.

The global burden of TC among AYAs was on the rise, with significant disparities by regions, genders, and age groups, highlighting the necessity for targeted and effective interventions.

Incidence and mortality are fundamental epidemiologic measures of cancer burden, yet few studies have examined individual cancers to determine how these measures correlate across place. We assessed the relationship between incidence and mortality for commonly diagnosed cancers in the USA.

Population-based observational study of US counties.

The Surveillance, Epidemiology and End Results (SEER) database was used to obtain incidence (2000-2016) and mortality (2002-2018) data for the 12 most commonly diagnosed non-haematologic cancers.

County-level correlation between cancer incidence and mortality. Cancers were grouped into terciles based on the population-weighted correlation coefficient (r). We also examined the 10 year risk of death, both from the diagnosed cancer and other causes.

County-level incidence and mortality were strongly correlated in some cancers, yet uncorrelated in others. Cancers in the high-correlation tercile (r range: 0.96 to 0.78) included lung, stomach, liver and pancreas. For patients with these cancers, the risk of death from the diagnosed cancer was >4-times the risk of death from other causes. The moderate-correlation tercile (r: 0.75 to 0.58) included cancers of the colon, bladder, kidney and uterus. There was little or no relationship between incidence and mortality for cancers in the low-correlation tercile (r: 0.33 to -0.10): melanoma, prostate, breast and thyroid. The risk of death from the diagnosed cancer for these patients was either lower or no different than their risk of death from other causes.

For some cancers in the USA, the fundamental epidemiologic measure of disease frequency-incidence-now has little relationship with cancer death (mortality). Low correlations are most likely explained by differences in diagnostic practice leading to variable amounts of cancer overdiagnosis between different US counties.

Oncocytic thyroid carcinoma (OTC) is a rare subtype of thyroid cancer known for its distinctive morphology and high likelihood of recurrence, setting it apart from follicular thyroid carcinoma (FTC). Despite this, there is limited research comparing the clinicopathological characteristics and outcomes of OTC and FTC.

We retrospectively searched through the Surveillance, Epidemiology, and End-Results (SEER) database (2004-2015) for histologically diagnosed OTC and FTC patients. Kaplan-Meier analysis, propensity score matching (PSM), univariate Cox proportional risk regression model, and subgroup analysis were employed to investigate the prognostic effect of clinicopathological features and treatment regimens on survival outcomes of OTC and FTC patients.

2329 OTC patients and 5679 FTC patients were included in the study. OTC patients were prone to older age, white race, lymph node metastasis, distal metastasis, extension and multiple primary tumors compared with FTC patients. After using a 1:1 PSM matching ratio, there were no significant differences in demographic and clinicopathological characteristics between the matched groups. Further Cox regression analysis showed that OTC patients had lower overall survival (OS) and cancer-specific survival (CSS) in contrast with FTC patients. Subgroup survival analysis suggested that the OTC patients were related to lower OS in subgroups including those over 55 years old, male sex, white ethnicity, extrathyroidal extension, single primary tumor, surgery and without chemotherapy compared with the FTC patients in these subgroups. In addition, the OTC patients were connected with lower CSS in subgroups including male sex, white ethnicity, married status, tumor size is less than 20 mm or more than 40 mm, N0 stage, localized stage, single primary tumor, surgery, radiotherapy, and without chemotherapy compared with the FTC patients in these subgroups. Meanwhile, the OTC patients had lower CSS compared to FTC patients regardless of age and extrathyroidal extension.

The results suggested that OTC patients have unique clinical features and poorer prognoses compared to FTC patients. Surgical resection and radioactive iodine therapy are recommended for OTC patients and FTC patients. It is worth noting that the prognosis of OTC relies largely on the selection of treatment strategies. Therefore, our results highlighted the clinical significance of the early distinguishment and the correct choice of treatment in OTC patients.

Radiology departments are increasingly tasked with managing growing demands on services including long waitlists for scanning and interventional procedures, human health resource shortages, equipment needs, and challenges incorporating advanced imaging solutions. The burden of system inefficiencies and the overuse of "low-value" imaging causes downstream impact on patients at the individual level, the economy and healthcare system at the societal level, and planetary health at an overarching level. Low value imaging includes those performed for an inappropriate clinical indication, with little to no value to the management of the patient, and resulting in healthcare resource waste; it is estimated that up to a quarter of advanced imaging studies in Canada meet this criterion. Strategies to reduce low-value imaging include the development and use of referral guidelines, use of appropriateness criteria, optimization of existing protocols, and integration of clinical decision support tools into the ordering provider's workflow. Additional means of optimizing system efficiency such as centralized intake models, improved access to electronic medical records and outside imaging, enhanced communication with patients and referrers, and the utilization of artificial intelligence will further increase the value of radiology provided to patients and care providers.

Endocrine surgery is a core component of general surgery training. The landscape of endocrine surgery education in surgical residency and association with entrance into endocrine surgery fellowships is unknown.

In total, 353 Accreditation Council for Graduate Medical Education-accredited general surgery program websites were identified and categorized by US region, program type and size, and endocrine surgery educational experience type. Self-identified endocrine surgeons were defined as American Association of Endocrine Surgeons members or fellowship graduates (American Association of Endocrine Surgeons surgeons) or having a thyroid/parathyroid/adrenal practice. Programs that graduated an American Association of Endocrine Surgeons fellow from 2012 onwards were identified, and characteristics associated with endocrine surgery-experience type, self-identified endocrine or American Association of Endocrine Surgeons faculty, and entrance into endocrine surgery fellowship were assessed.

In total, 353 programs were studied. The median number of general surgery residents per program was 25, with 165 (46.7%) small programs (<25 residents) and 188 (53.3%) large (≥25) programs. There were 122 (34.6%) university-based programs, 82 (23.2%) community-based, 139 (39.4%) community-based/university-affiliated, and 10 (2.8%) military. A total 665 self-identified endocrine surgeons were identified at 303 (85.8%) programs; 15 (14.2%) programs had no self-identified endocrine surgeon. There were 361 American Association of Endocrine Surgeons surgeons located at 163 (46.2%) residency programs. In total, 323 (91.5%) programs had information on curriculum/rotations available, 58 (17.9%) with dedicated endocrine surgery educational experiences, 226 (70%) with rotations mixed with other subspecialties, and 39 (12.1%) with none reported. A total 113 (35%) general surgery programs produced a future endocrine surgery fellow and were most likely to be large (81%, P < .001), university-based (64%, P < .001) programs and were more likely to have a self-identified endocrine (102, 90.3%, P = .016) or an American Association of Endocrine Surgeons surgeon (82, 72.6%, P = .004).

Program size and type were strongly associated with endocrine surgery exposure, presence of a self-identified endocrine surgeon, and same-site American Association of Endocrine Surgeons fellowship. Endocrine surgery educational experiences are inconsistent across residencies, and efforts are needed to ensure that surgical residents receive comprehensive, equitable endocrine surgery education.

The primary treatment for locoregional recurrent/persistent differentiated thyroid cancer (DTC) is repeated lymph node dissection; however, there are limited reports on the safety and long-term efficacy of multiple operations.

Patients who underwent a cervical lymph node dissection between 1998 and 2022 were included in this study. Demographics, initial thyroid surgery, subsequent lymph node dissections, follow up information, and response to therapy were acquired.

After one, two, three and four re-operations, 112/314 (35.7 ​%), 16/79 (20.3 ​%), 3/25 (12 ​%), and 0/3 (0 ​%) patients (p ​< ​0.001) had an excellent response, respectively, resulting in a cumulative rate of 41.7 ​% (131/314). The risk for permanent hypoparathyroidism (2.9 ​%) or recurrent laryngeal nerve injury (2.2 ​%) was 5.1 ​% (14/272). This was higher in patients undergoing re-operative central neck dissection (CNDx) (8.7 ​%, 10/114) versus those who did not undergo a previous CNDx (2.5 ​%, 4/158, p ​< ​0.02).

Surgery remains the primary treatment for recurrent/persistent DTC, however, the likelihood of an excellent response decreases with additional operations. The risk of permanent complications is low but is more likely to occur during redo CNDx.

Although many parathyroid and thyroid operations are performed by nonfellowship-trained general surgeons in the United States, there is growing uncertainty of whether graduating residents can perform these procedures competently. This study investigates trends in competency and autonomy among general surgery residents performing parathyroid and thyroid operations using a national survey-based dataset.

A retrospective analysis of the Society for Improving Medical Professional Learning database was performed. Case data from categorical general surgery residents performing parathyroidectomy or thyroidectomy between 2015 and 2023 were included. Competent performance and meaningful autonomy were dichotomized on the basis of faculty surgeon responses. Agreement between resident and faculty evaluations were assessed. Logistic regression was used to examine resident performance and autonomy using postgraduate year level and case complexity as covariates.

The study included 907 parathyroidectomies and 1,555 thyroidectomies from 724 residents at 77 residency programs. Competent performance was observed in 34.0% of parathyroidectomies and 38.6% of thyroidectomies. Meaningful autonomy was observed in 31.6% of parathyroidectomies and 32.3% of thyroidectomies. Residents and faculty agreed on performance (50.3%) and autonomy (59.1%) in most cases, however when discordant residents often underestimated their performance (44.7%) or autonomy (25.3%). The likelihood of postgraduate year 5 residents demonstrating competent performance or meaningful autonomy was 65.9% and 51.6%, respectively for parathyroidectomy and 77.2% and 58.4%, respectively for thyroidectomy.

Many graduating residents do not demonstrate competent performance or meaningful autonomy in parathyroidectomy and thyroidectomy. Further initiatives are needed to improve graduating general surgeons' competence for these operations, given access disparities to high-volume endocrine surgeons.

Thyroid cancer (TC) is the prevailing malignancy that impacts the endocrine system, accounting for 1% of all recently diagnosed malignancies in humans. The incidence of TC has been continuously increasing, which can be attributed to advancements in clinical diagnostic technology. However, the mechanisms behind the development of TC are still not well understood. TC is classified into four pathological forms: medullary thyroid cancer, papillary thyroid cancer (PTC), follicular thyroid cancer, and poorly differentiated TC. PTC constitutes more than 80% of all TC cases globally. Current research indicates that complex genetic and cellular processes could be responsible for the growth and spread of TC. Next-generation sequencing (RNA-seq) of 79 PTC samples and their corresponding normal thyroid tissues was performed to investigate the molecular mechanisms of PTC. An analysis of RNA-seq data from a local cohort from The Cancer Genome Atlas (TCGA) revealed that, compared with normal tissues, PTC tissues presented elevated FAM20C expression levels. In vitro, the function of FAM20C was validated with small interfering RNA (siRNA). Gene set enrichment analysis (GSEA) revealed the pathways influenced by FAM20C. A western blot experiment was used to investigate protein expression levels associated with epithelial‒mesenchymal transition (EMT). In conclusion, by regulating EMT, FAM20C facilitates PTC cell proliferation and metastasis.

Well-differentiated thyroid cancer includes papillary thyroid, follicular thyroid, and Hurthle cell cancers, comprising approximately 95% of all thyroid cancers in the United States. This study aims to understand well-differentiated thyroid cancer in the Asian population.

We analyzed the National Cancer Database from 2004 to 2019, categorizing the Asian population based on the available ethnicities. Multivariable logistic regression assessed the associations between ethnic groups and disease stage/nodal positivity. Survival outcomes were evaluated using the Kaplan-Meier and Cox regression analyses.

A total of 364,604 adult patients were analyzed. The Asian ethnic groups included were Chinese (n = 3,851), Japanese (n = 740), Filipino (n = 3,466), Korean (n = 1,567), Vietnamese (n = 1,517), Laotian (n = 101), Hmong (n = 50), Kampuchean (n = 166), Thai (n = 160), Asian Indian (n = 1,526), Pakistani (n = 167), and Pacific Islander (n = 446). Japanese, Korean, and Laotian had higher percentages of stage III disease, whereas Japanese, Filipino, and Laotian had higher proportions of stage IV disease than the White population. Most Asian ethnicities had more patients with metastasis than the White population. Korean patients exhibited a 15% increased likelihood of metastasis (odds ratio: 1.15, confidence interval: 1.03-1.28, P < .05), whereas Pakistani patients were at 40% higher odds (odds ratio: 1.40, confidence interval: 1.03-1.91, P < .05), compared with White patients. Japanese, Laotian, and Kampuchean patients experienced worse 5- and 10-year overall survival than the White population.

Our study revealed substantial variation in well-differentiated thyroid cancer characteristics and outcomes among diverse Asian ethnicities. This challenges the notion of Asians as a homogeneous population, emphasizing tailored disease management for this heterogeneous group of patients.

To assess the prevalence of psychological distress (PD) among thyroid cancer patients (TCPs) and identify clinical, demographic, and socioeconomic factors associated with PD.

Retrospective population-based cohort study.

2016 to 2018 National Health Interview Survey.

Adults with cancer were included. The primary outcome measure was moderate-to-severe psychological distress (MSPD), defined as a respondent score ≥5 on the validated K6 Psychological Distress Scale. χ2 tests were used to assess differences in MSPD by cancer type. Weighted multivariable logistic regression was used to elucidate factors associated with MSPD among TCPs.

The majority of TCPs (n = 684,674) were white (75.4%), female (78.5%), and on average 55.65 years old (SD = 13.2). 28.4% reported MSPD. On weighted analysis, TCPs were more likely to have MSPD than prostate (14.9%, P < .001), bladder (16.4%, P = .011), and nonmelanoma skin cancer (16.3%, P < .001) patients but less likely than pancreatic cancer (30.0%, P = .030) patients. TCPs who were older when surveyed (odds ratio [OR], 0.93; 95% confidence interval [CI, 0.88-0.98), previously drank alcohol (OR, 0.23; 95% CI, 0.06-0.91), and saw a general physician (GP) in the past year (OR, 0.14; 95% CI, 0.03-0.56) were less likely to have MSPD. Female sex (OR, 8.12; 95% CI, 1.61-40.89), increased number of medical comorbidities (OR, 1.46; 95% CI, 1.00-2.14), and functional limitations (OR, 4.55; 95% CI, 1.33-15.74) were associated with increased likelihood of MSPD.

Nearly 30% of TCPs have MSPD, especially younger patients who do not regularly see GPs. Future work to identify the most at-risk patients is needed to improve prevention and develop meaningful psychosocial interventions.

The long-term incidence trends of 32 cancers in China remained unclear. Cancer statistics for young population were often presented in aggregate, masking important heterogeneity. We aimed to assess the incidence trends of 32 cancers in China from 1983 to 2032, stratified by sex and age groups. Data on cancer incidence from 1983 to 2017 were extracted from Cancer Incidence in Five Continents Volumes VI-XII. The age-period-cohort model was utilized to assess age and birth cohort effects on the temporal trends of 32 cancers in China, while the Bayesian age-period-cohort model was utilized to project future trends from 2018 to 2032. An increase in cohort effects is observed in some cancers such as thyroid and kidney cancers. Eight of the 12 obesity-related cancers may rise in the 0-14 age group, and nine in the 15-39 age group from 2013 to 2032. Liver and stomach cancers show an increasing trend among the younger population, contrasting with the observed declining trend in the middle-aged population. There has been a significant rise in the proportions of cervical cancer among females aged 40-64 (4.3%-19.1%), and prostate cancer among males aged 65+ (1.1%-11.8%) from 1983 to 2032. Cancer spectrum in China is shifting toward that in developed countries. Incidence rates of most cancers across different age groups may increase in recent cohorts. It is essential to insist effective preventive interventions, and promote healthier lifestyles, such as reducing obesity, especially among younger population.

Objective: To determine the cancer risk in thyroid nodules using ACR TI-RADS. Methods: A retrospective analysis of all thyroid biopsies was performed over a 3-year period (2021 to 2023). Variables including gender, age, history of thyroid cancer or neck irradiation, nodule size and location, TR level, and sonographic features such as punctate echogenic foci (PEF), a very hypoechoic appearance, taller-than-wide shape, and suspected extrathyroidal extension were analyzed. Results: A total of 1140 nodules were assessed in 993 patients, including 740 females (74.5%) and 253 males (25.5%). The mean patient age was 57.1 ± 15.4 years. Variables significantly associated with nodule malignancy included (1) younger age, (2) a prior history of thyroid cancer or neck irradiation, (3) a higher TR level, (4) a taller-than-wide shape in nodules <1 cm, (5) PEF, (6) a very hypoechoic appearance, and (5) suspected extrathyroidal extension (p < 0.05). Gender, nodule location and size were not associated with a higher cancer risk (p > 0.05). Malignancy was found in 40.7% of TR5, 4.8% of TR4, 0.3% of TR3, and 0% of TR1 and 2 nodules. The odds ratios (ORs) for cancer were as follows: TR4 or 5, OR = 19; PEF, OR = 11; a very hypoechoic appearance, OR = 13.3; and suspected extrathyroidal extension, OR = 27.2 (p < 0.01). Conclusions: Higher TR levels, PEF, a very hypoechoic appearance, and suspected extrathyroidal extension are important features for predicting cancer risk. These findings affirm the effectiveness of ACR TI-RADS in nodule risk stratification.

Papillary thyroid carcinoma (PTC) is the most common malignant tumor of the endocrine system globally. Formononetin (FMNT), an isoflavonoid, exerts anti-tumorigenic effects and chromobox homolog 4 (CBX4) exerts tumor-promoting effect in specific types of tumors. Nevertheless, the predictive values and biological functions of FMNT and CBX4 in the pathological progress of PTC have not been fully understood till now. In the present study, the human PTC cell line TPC-1 was exposed to 0, 10, 30 and 100 µM FMNT for 24 h to elucidate the precise effects of FMNT on the biological behaviors of PTC cells. Moreover, FMNT-treated TPC-1 cells were transfected with oe-CBX4 to evaluate whether CBX4 was implicated in the anticarcinogenic effects of FMNT against PTC. It was demonstrated that FMNT treatment suppressed the proliferation, clone formation, migration, invasion, EMT, angiogenesis and stemness of PTC cells in a dose-dependent manner. Furthermore, it was verified that FMNT targeted CBX4 to downregulate its expression in a dose dependent manner. The suppressive effects of FMNT on the proliferation, clone formation, migration, invasion, EMT, angiogenesis and stemness of PTC cells were partially reversed by CBX4 overexpression. Upregulation of CBX4 abolished the tumor suppression effects of FMNT in the malignant progression of PTC. In conclusion, FMNT might act as a promising anti-tumorigenic agent in PTC, which depends on the downregulation of CBX4.

Thyroid cancer has an overall favorable prognosis, but no pre-operative biochemical marker has been shown to distinguish between low and high-risk disease or predict response to therapy.

We retrospectively reviewed 162 patients that underwent thyroid surgery for thyroid cancer between 2006 and 2022 in whom a pre-operative thyroglobulin level (Tg) was measured. We subdivided patients into low, intermediate and high-risk thyroid cancer and based on their response to therapy per ATA guidelines.

We showed that as pre-operative Tg level increased, patients were more likely to have high-risk disease (p ​< ​0.01). We found a linear association between the primary tumor size and high-risk histology with pre-operative Tg (p ​< ​0.01). Pre-operative Tg level was significantly associated with response to therapy following initial surgical management. Specifically, as pre-operative Tg increases, patients were less likely to achieve an excellent response (p ​< ​0.01).

Our retrospective analysis demonstrated that pre-operative Tg is significantly associated with ATA structural risk of recurrence and response to therapy and may have the potential to guide initial therapy and follow-up management.

Background: Expanding ultrasound use has increased the detection of thyroid cancer. Incidence has always been higher among females, a disparity that has grown over time. The sex difference in thyroid cancer is understudied in the context of diagnostic testing, particularly among privately insured adults in whom thyroid cancer is most common. We evaluated the association between thyroid ultrasound, fine needle aspiration biopsy (FNAB), and cancer incidence by sex in a large, integrated health system. Methods: This longitudinal retrospective cohort study included Kaiser Permanente of Washington enrollees aged 18 and over who underwent thyroid ultrasound from 1997 to 2019. Data included electronic billing claims for patients linked to tumor registry diagnoses. We estimated (1) annual overall ultrasound, FNAB, and cancer incidence rates; (2) the proportion of ultrasound requiring FNAB; and (3) cancer diagnoses per FNAB. A Poisson model with offset determined the relationship between sex and the proportion of ultrasound requiring FNAB adjusting for patient and sociodemographic characteristics. Results: A total of 33,589 patients underwent ultrasound (78% females; mean age 56). Ultrasound rates per 100,000 covered lives, defined as insured individuals per year, increased five-fold among males (111.11-490.97) and >four-fold among females (382.27-1331.14) between 1997 and 2019. FNAB rates also increased over time (rates per 100,000: 174.09-430.37 in females vs. 58.38-189.13 in men). Overall, FNAB rates per ultrasound changed little over time, and FNAB per ultrasound was greater in males compared with females (Adj rate ratio = 1.06 [confidence interval 1.01-1.11]). Cancer incidence was higher in females over the study period, but cancer incidence per FNAB was similar between sexes (both 0.06, p = 0.4). Conclusions: Sex disparities in thyroid ultrasound rates are stark and are a likely driver of sex disparities in thyroid cancer incidence. Interestingly, ultrasound-triggered FNAB was more common in males and changed little over time, challenging the prevailing understanding that females have much higher rates of thyroid cancer. Although the population-based differences between sexes for FNAB and cancer were large, the differences among people who had ultrasound were small.

To compare the eighth and seventh editions of TNM staging (TNM-8 and TNM-7) on disease-related mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer (DTC).

We studied 400 patients (79% female) with DTC with a mean age of 40.93±14.11 years. TNM staging was recorded according to the 7th and 8th editions and patients were followed for at least 1 year and response to therapy was recorded according to ATA response categorization.

The mean follow up time was 42.5±15.24 months. Overall, 108 patients (27%) were down-staged using the TNM-8, mainly due to the changes in the age cut-off (14.5%), N (9.25%), and T categorization (3.25%). All patients in stage III and 82.8% in stage IV were down-staged. The mean Tg levels were significantly higher in stages III and IV in TNM-8 compared to TNM-7. Four disease-related death were recorded during follow up, all in stage IV according to TNM-7, while one was in stage II according to TNM-8. One year after treatment, persistent disease was detected in 12% and 77% of patients in stage III according to the 7th and 8th editions, respectively (P= 0.04). Similarly, biochemical incomplete response one year after treatment was seen in 7.3% and 87% in stage III disease using 7th and 8th editions (P = 0.006) that fell to 2.4% and 22% in the last visit respectively (P = 0.04).

Persistent disease and incomplete response to therapy were more common in stages III and IV in TNM-8 compared to TNM-7. The eighth edition was a better predictor of persistent disease in stages III and IV disease.

The rapid evolution of ultrasound (US) technology has dramatically changed the medical field. Ideally suited for evaluation of anatomic disorders of the thyroid, coupled with its ease of use at the bedside, US has become an essential tool for endocrinologists over the last 50 years. This noninvasive technology provides a sensitive and specific instrument for malignancy risk prediction of thyroid nodules, surveillance for recurrent thyroid cancer, and diagnosis of autoimmune thyroid disorders. While US has proven invaluable for such diagnostic purposes, its extensive use also has resulted in important negative consequences. This review will discuss the evolution of US equipment for the evaluation of thyroid disorders, its use in interventional procedures, and the unintended outcomes from the widespread adoption of this technology. Finally, this article will explore the potential future applications for US technology and its related advancements.

Aberrant protein glycosylation is a hallmark alteration of cancer and is highly associated with cancer progression. Papillary thyroid cancer (PTC) is the most common type of thyroid cancer, but the N-glycosylation of its glycoproteins has not been well characterized. In this work, we analyzed multiple freshly prepared PTC specimens along with paired normal tissue obtained from thyroidectomies. Glycomic analyses focused on Asn-linked (N)-glycans and employed mass spectrometry (MS), along with Western blot approaches of total solubilized materials that were examined for binding by specific lectins and a monoclonal antibody (mAb) O6, specific for 3-O-sulfated galactose residues. We observed major differences in PTC versus paired normal specimens, as PTC specimens exhibited higher levels of N-glycan branching and bisection with N-acetylglucosamine residues, consistent with RNAseq data. We also found that 3-O-sulfated galactose was present in N-glycans of multiple glycoproteins from both PTC and control specimens, as recognized by the O6 mAb and as confirmed by MS analyses. These results provide new insights into the N-glycans present in glycoproteins of thyroid cancer and context for further studies of these altered glycans as biomarkers and targets for therapeutics.

Risk factors for radioactive iodine (RAI)-refractory disease in follicular (FTC) and oncocytic thyroid carcinoma (OTC) are unknown.

The aim of this study is to identify clinical and histopathological risk factors for RAI-refractory disease in FTC and OTC patients, facilitated by an extensive histopathological revision.

All adult FTC and OTC patients treated at Erasmus MC (the Netherlands) between 2000 and 2016 were retrospectively included. The 2015 American Thyroid Association guidelines were used to define RAI-refractory disease. An extensive histopathological revision was performed applying the 2022 World Health Organization Classification using PALGA, the Dutch Pathology Databank. Logistic regression was used to identify risk factors for RAI-refractory disease, stratified by histological subtype.

Ninety FTC and 52 OTC patients were included, of whom 14 FTC (15.6%) and 22 OTC (42.3%) patients developed RAI-refractory disease over a follow-up time of 8.5 years. RAI-refractory disease occurred in OTC after fewer cycles than in FTC (2.0 [interquartile range (IQR): 1.0-2.0] vs 2.5 [IQR: 2.0-3.75]), and it substantially decreased 10-year disease-specific survival, especially in OTC (46.4%; FTC 85.7%). In FTC, risk factors were higher age at diagnosis, pT3/pT4 stage, N1 stage, widely invasive tumors, and extrathyroidal extension. N1 stage and M1 stage were the strongest risk factors in OTC, rather than histopathological characteristics of the primary tumor.

To our knowledge, this is the first study that correlates clinical and histopathological risk factors with RAI-refractory disease in FTC and OTC, facilitated by a histopathological revision. In FTC, risk factors for RAI-refractory disease were foremost histopathological characteristics of the primary tumor, whereas in OTC presentation with lymph node and distant metastasis was associated with RAI-refractory disease. Our data can help clinical decision-making, particularly in patients at risk for RAI-refractory disease.

To compare the safety and efficacy of ultrasound-guided radiofrequency ablation (RFA) in the treatment of T1N0M0 papillary thyroid carcinoma (PTC) with adjacent and non-adjacent danger triangle area (DTA).

This retrospective study involved collecting clinical data of all T1N0M0 PTC patients who underwent RFA between January 2018 and December 2020 at the hospital. A total of 211 patients were enrolled in the study (mean age 43.25 ± 12.30 years, male-to-female ratio = 1:3). Among them, 91 had adjacent DTA involvement, while 120 had non-adjacent DTA involvement. Comparisons were made between the two groups patients regarding tumor volume changes, technical success rates, tumor disappearance, disease progression, complications.

In both groups, the technical success rate was 100%, with a median follow-up period of 30 months. The rates of complete tumor disappearance were 78% (71/91) and 74.2% (89/120) for the adjacent and non-adjacent DTA(p = .517). Disease progression rates were 2.2% (2/91) and 1.7% (2/120) (p > .99), Complication rates were 3.3%(3/91) in the adjacent DTA group and 1.7% (2/120) in the non-adjacent DTA group (p = .654). At 6th month after ablation, the volume reduction rate (VRR) in the non-adjacent DTA group (42.3%) was higher than in the adjacent DTA group (37.3%) (p = .002). However, no significant differences were observed in VRR between the two groups at 1, 3, 12, 18, 24, 30, and 36 months (p > .05).

In the treatment of T1N0M0 PTC, the complication rates and short-term efficacy of RFA in adjacent to the DTA did not differ from those of non-adjacent DTA.

Introduction Fine-needle aspiration cytology (FNAC) is an effective tool in the diagnostic work-up of patients with thyroid nodules. The aim of our study was to assess the diagnostic sensitivity of FNAC in thyroid cancer (TC) in Sweden by correlating the findings of preoperative FNAC with those obtained through final histology of the surgical specimen. Methods A Swedish nationwide cohort of patients having surgery for TC (n = 2519) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal surgery between 2004 and 2013 was obtained. Data was validated through scrutinizing patient FNAC and histology reports. Results Among the 2519 cases operated with a final diagnosis of TC, the diagnosis was substantiated and validated through the histology report in 2332 cases (92.6%), included in the present study. Among these, 1679 patients (72%) were female and the median age at TC diagnosis was 52.3 years (range 18-94.6). In 353 cases (15.1%) FNAC was not performed at all; whereas in the remaining 1965 cases, the diagnostic sensitivity of FNAC was 81.6%. In lesions > 1 cm, FNAC diagnostic sensitivity reached 86.5%, whereas in lesions < 1 cm, FNAC yielded a sensitivity of 61.5%. Approximately 85% of FNACs (n = 1981/2332) were performed using ultra-sonographic (US) guidance. In TC lesions > 1 cm, the diagnostic sensitivity of US-guided FNAC (n = 1504) was 86.9% as compared to 76.9% in clinically applied FNAC without US utilization (n = 118). Conclusions FNAC is performed in most patients operated for TC in Sweden (85%) and retains its value as a tool in TC diagnostic work-up with an overall sensitivity of 82%, reaching 87% in lesions > 1 cm, that harbor clinically relevant TC.