Papillary Thyroid Microcarcinoma Research Articles

Risk nomogram for papillary thyroid microcarcinoma with central lymph node metastasis and postoperative thyroid function follow-up

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

Multi-gene mutations in ultrasound-guided fine-needle aspiration specimens of thyroid micronodules and diagnostic value in thyroid microcarcinomas using next-generation sequencing

Objective: To explore the detection of BRAF, RAS, TERT promoter, and TP53 gene mutations in solitary thyroid micronodule (TMN) specimens obtained by ultrasound-guided fine-needle aspiration (US-FNA) using next-generation sequencing (NGS) technology and assess its diagnostic value in thyroid microcarcinomas (TMC). Methods: On-site recruitment of 428 patients with single suspicious TMC who underwent thyroid ultrasound examination, US-FNA, and NGS from September 2018 to July 2021 at Beijing Tongren Hospital affiliated to Capital Medical University. A total of 147 patients were finally included. NGS was used to detect mutations in the BRAF, RAS, TERT promoter, and TP53 genes in the US-FNA specimens. Comparisons were made between patients with and without gene mutations in terms of age, gender, and the maximum diameter of nodules. The diagnostic efficiency of BRAF mutation for TMC was calculated using the receiver operating characteristic (ROC) curve, with postoperative pathology as the gold standard. Results: The age [M (Q1, Q3)] of the 147 patients was 43.0 (32.0, 51.0) years, and 37 were male (25.2%). Among the 147 US-FNA specimens, 97 (66.0%) were detected with BRAF gene mutations, all of which were p.V600E point mutation; 6 (4.1%) were detected with RAS gene mutation, and no TERT promoter or TP53 gene mutations were detected. Postoperative pathology confirmed that 136 cases were TMC, all of which were papillary thyroid microcarcinomas (PTMC); 11 cases (7.5%)were benign. Among 136 TMC samples, BRAF gene mutations were detected in 97 cases (71.3%). There were no statistically significant differences in age, gender, and maximum nodule diameter between patients with and without BRAF gene mutations (all P>0.05). The sensitivity and specificity of BRAF gene mutation in diagnosing TMC were 71.3% and 100.0%, respectively, with an area under the ROC curve (AUC) (95%CI) of 0.857 (0.789-0.925). For nodules classified as Bethesda Ⅲ-Ⅴ, the sensitivity and specificity were 63.0% and 100.0%, respectively, with an AUC (95%CI) of 0.815 (0.680-0.950). Conclusions: NGS technology can successfully detect multiple gene mutations in US-FNA specimens from TMN patients, especially BRAF gene mutation, and BRAF gene mutation has certain value in diagnosing TMC.

Construction and validation of a diagnostic model for high-risk papillary thyroid microcarcinoma.

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

Effects of endoscopic lobectomy and conventional lobectomy on psychological and sleep quality in patients with papillary thyroid microcarcinoma-a prospective observational study.

Both endoscopic thyroid lobectomy and conventional thyroid lobectomy are effective modalities for treating papillary thyroid microcarcinoma (PTMC). However, their respective psychological and sleep quality ramifications in patients remain largely unexplored. Patients diagnosed with PTMC who underwent thyroid lobectomy at our institution between July 15, 2021, and July 15, 2022, were prospectively recruited. Psychological distress and sleep quality were assessed at five intervals (hospital admission, hospital discharge, and 1, 3, and 6 months posttreatment) utilizing four validated scales. The PTMC patients who completed the questionnaires diligently were subsequently categorized into either the endoscopic thyroid lobectomy group (trial group) or the conventional thyroid lobectomy group (control group). A propensity score matching (PSM) cohort was then established to examine longitudinal and cross-sectional alterations in psychological parameters. Out of 602 eligible PTMC patients, 560 individuals completed all the questionnaires diligently during the follow-up period (response rate: 93.02%). This cohort comprised 176 patients (31.43%) who underwent endoscopic thyroid lobectomy and 384 patients (68.57%) who underwent conventional thyroid lobectomy. Following PSM, a comprehensive set of 176 matched patient pairs was successfully established. Both groups of patients exhibited a decline in sleep quality throughout the 6-month postoperative follow-up period; however, patients in the control group experienced concomitant elevation in anxiety levels. The PSQI scores of patients in the control group were markedly higher than those in the trial group across all follow-up time points, whereas the HAMA, HADS, and HEI scale scores did not significantly differ between the two groups. In terms of sleep quality and psychological well-being, endoscopic thyroid lobectomy is superior to conventional thyroid lobectomy for PTMC patients.

Comparison of Patient-Reported Outcomes Between Active Surveillance and Immediate Lobectomy in Patients with Low-Risk Papillary Thyroid Microcarcinoma: Initial Findings from the KoMPASS Cohort.

Background: Patients diagnosed with low-risk papillary thyroid microcarcinoma (PTMC) face the decision between thyroid lobectomy and active surveillance (AS). This study aimed to investigate the factors influencing treatment decisions in low-risk PTMC and to compare the quality of life (QoL) according to the treatment plan. Methods: The multicenter prospective cohort study comparing AS and thyroid lobectomy was conducted. Clinical characteristics were compared between the AS and Lobectomy groups. QoL questionnaires were administered every 6 months in the initial year and annually thereafter. Results: A total of 927 patients (453 in the AS group and 474 in the Lobectomy group) with low-risk PTMC were included in this study. The mean age was 47.4 ± 12.2 years, and 72.2% of the patients were women. Older age (odd ratio [OR] 1.04, confidence interval [CI] 1.02-1.05, p < 0.001), smaller tumor size (OR 0.78, CI 0.69-0.87, p < 0.001), family history of thyroid cancer (OR 1.48, CI 1.03-2.12, p = 0.035), prior awareness of AS (OR 1.53, CI 1.16-2.02, p = 0.003), and higher income (OR 1.79, CI 1.13-2.83, p = 0.013) were significantly associated with a higher likelihood of choosing AS. The median follow-up was 27.3 months (23.9-43.9) in the AS group and 28.7 months (20.4-44.5) in the Lobectomy group. During the follow-up period, the AS group showed significantly better QoL scores compared with the Lobectomy group (β 0.17, CI 0.02-0.33, p = 0.029). Although baseline QoL scores favored the AS group significantly (7.1 ± 1.2 vs. 6.7 ± 1.2, p < 0.001), no significant difference was observed after 12 months (7.2 ± 1.2 vs. 7.1 ± 1.2, p = 0.592). Conclusions: This study demonstrated that age, tumor size, family history of thyroid cancer, awareness of AS, and income were associated with patients' treatment choices. Although the overall QoL scores were significantly higher in the AS group, the QoL became similar between the two groups after 12 months. Clinical Trial Registration: KCT0004935.

8728 Radiofrequency Thermal Ablation in Thyroid Microcarcinomas: Experience of the Brazilian Group with 143 Cases

Abstract Disclosure: L.G. Amato: None. P.H. Carani: None. L.D. Volpi: None. A. Rahal: None. E.M. Volpi: None. Introduction: Thyroid nodules are quite prevalent worldwide, with papillary thyroid carcinoma (PTC) being the most common histological subtype of thyroid malignant neoplasm, accounting for approximately 85% of thyroid cancers. When this carcinoma is less than 10 mm in its longest axis, it is defined as papillary thyroid microcarcinomas (mPTCs) which has had an increasing proportion of thyroid cancers and with a disease-specific survival of patients having this diagnosis more than 99% after 10 years of follow-up. Most guidelines concerning thyroid cancer care recommend a lobectomy as the first-line treatment strategy for low-risk unifocal mPTC but often results in aggressive overtreatment. Thyroid surgery comes with significant costs and morbidity rates caused by iatrogenic hypothyroidism and recurrent laryngeal nerve damage, resulting in poor quality of life, justifying the growing search for minimally invasive and effective methods in the treatment of mPTC and in this context Radiofrequency thermal ablation (RFA), a minimally invasive treatment that preserves thyroid function have been proposed for patients with low-risk mPTC. Clinical case: From April 2018 to January 2024, 143 patients with mPTC, were submitted to RFA and patient's follow-up were dated 1, 3, 6, 12 and 18 months after the procedure. During the follow-up we observed 3 (2%), complications, 1 case of permanent paralysis unilateral vocal cord, 1 Horner Syndromes and 1 case of transient paralysis, with total reversal. In all cases there was a reduction in the volume of the node after 6 months of the procedure. Conclusion: The reported incidence rate of postoperative hypothyroidism in patients underwent hemithyroidectomy is 10.9-48.8%, therefore, risks of complications with radioablation in our series were lower than those previously described during hemithyroidectomy. Radiofrequency thermal ablation (RFA) is a minimally invasive treatment that preserves thyroid function with a lower incidence of complications compared to thyroidectomy or lobectomy, and and should be considered the selection procedure for low-risk thyroid microcarcinomas. Presentation: 6/3/2024

Analysis and prediction of ablation zone absorption in papillary thyroid microcarcinoma undergoing microwave ablation.

This study aims to investigate the factors that influence the absorption of the ablation zone in patients with papillary thyroid microcarcinoma (PTMC) following microwave ablation (MWA) and construct a nomogram for predicting the absorption of the ablation zone. Data from 150 patients with 187 PTMCs who received MWA between April 2020 and April 2023 were analyzed. PTMCs were randomly divided into training and validation sets in a 7:3 ratio. Univariable and multivariable analyses of Cox regression were utilized to identify the independent variables associated with the absorption of the ablation zone in PTMC post-MWA, and a nomogram was established. The discrimination and calibration performance of the nomogram was assessed using the time-dependent receiver operating characteristic curves and calibration curves. At 12 months post-MWA, a 53% proportion of complete disappearance of the ablation zone was observed. Energy delivered per milliliter of volume measured in contrast-enhanced ultrasound (CEUS) mode immediately post-MWA (Edv) and the CEUS margin at 1-month post-WMA were identified as independently correlated with the ablation zone absorption post-MWA (P = 0.001, P < 0.001 respectively). A nomogram incorporating these two factors was constructed. The areas under the receiver operating characteristic curve were all above 0.78 in the training and validation sets. Edv and the CEUS margin at 1-month post-MWA were found to be significantly associated with complete absorption of the ablation zone in PTMC patients following MWA. The established nomogram can assist practitioners in formulating more appropriate ablation strategies and provide a clinical basis for explaining the recovery status to patients.

Clinical values of preoperative red blood cell distribution width and platelet parameters in patients with papillary thyroid carcinoma.

The prevalence of thyroid carcinoma is increasing, and papillary thyroid carcinoma (PTC) is the most frequent subtype. More and more attention is being concentrated on the association between inflammation indicators and malignant tumors. The aim of the present study was to analyze whether the preoperative red blood cell distribution width (RDW) and platelet parameters, including mean platelet volume (MPV) and platelet distribution width (PDW), can be applied to distinguish between patients with PTC or papillary thyroid microcarcinoma (PTMC) and healthy controls, and to explore the associations with clinicopathological characteristics. The study retrospectively compared the RDW, MPV and PDW values of 780 patients with PTC or PTMC against a healthy control group. Receiver operating characteristic (ROC) curves were conducted to determine diagnostic accuracy. Furthermore, the clinicopathological features of the patients with PTC or PTMC were compared between higher and lower platelet parameter groups based on the RDW, MPV and PDW values. Significantly higher preoperative RDW, MPV and PDW values were found in patients with PTC or PTMC compared with those of the healthy group. ROC curve analysis showed that the area under the curve (AUC) plus 95% confidence interval (95% CI) values of RDW, MPV and PDW were 0.808 (0.780-0.835), 0.771 (0.743-0.799) and 0.711 (0.681-0.742), respectively. When RDW and MPV were combined together, the AUC (95% CI) value was enhanced to 0.858 (0.835-0.881) for the patients with PTC. For the patients with PTMC, RDW, MPV and PDW had AUC (95% CI) values of 0.812 (0.783-0.840), 0.779 (0.749-0.808) and 0.718 (0.685-0.751), respectively. When RDW and MPV were combined together, the AUC (95% CI) value was enhanced to 0.858 (0.835-0.881). A higher RDW was significantly associated with being female, deeper tumor infiltration, and normal FT3 and FT4 levels. A higher PDW was significantly associated with elevated thyrotropin receptor antibody levels. In conclusion, as convenient and available inflammation indicators, RDW, PDW and MPV have diagnostic ability and can distinguish between patients with PTC or PTMC and healthy controls. In addition, the combined application of RDW and MPV can improve the diagnostic power. The values of RDW and MPV were associated with clinicopathological characteristics. To the best of our knowledge, this is the first study to prove the usefulness of preoperative RDW combined with MPV in diagnosing patients with PTC or PTMC.

8742 Exploring the Clinical Landscape of Papillary Thyroid Microcarcinoma with Lymph Node Metastasis: A Single-Institution Case Series and Implications for Treatment Decisions

8742 Exploring the Clinical Landscape of Papillary Thyroid Microcarcinoma with Lymph Node Metastasis: A Single-Institution Case Series and Implications for Treatment Decisions

Surgical approach selection and prognosis analysis of papillary thyroid microcarcinoma in the isthmus

Objective:To compare the prognosis of papillary thyroid microcarcinoma of the isthmus（PTMCI） after different surgical methods, and to investigate the most appropriate surgical plan for it, so as to provide reference for the selection of clinical surgical plan. Methods:The clinical data of 106 PTMCI patients diagnosed with postoperative pathology after surgical treatment in Department of Otolaryngology Head and Neck Surgery, Ningbo Medical Center Lihuili Hospital from January 2016 to June 2023 were retrospectively analyzed. The patients were divided into 3 groups according to whether there were nodules in the lateral lobe of the thyroid gland, namely, isolated PTMCI group, PTMCI group with unilateral lobe nodules, and PTMCI group with bilateral lobe nodules. Combined with follow-up information, the differences of recurrence rate, survival rate and postoperative complications after different surgical methods were compared among all groups. The surgical procedures included isthmic thyroidectomy, isthmic + unilateral lobectomy, and total thyroidectomy. All patients underwent central lymph node dissection at the same time. Results:There were no significant difference in recurrence rate, survival rate and postoperative complications among all groups and between groups. Postoperative recurrence occurred in 2 patients, among which 1 patient was PTMCI with multiple focal tumors in unilateral lobe undergoing isthmus + unilateral lobectomy + ipsilateral central lymph node dissection. The recurrence was manifested as contralateral cervical lymph node metastasis. Another case of PTMCI with bilateral benign nodules underwent isthmus + unilateral lobe（larger nodule） resection + ipsilateral central lymph node dissection, and the recurrence was manifested as residual glandular recurrence. One patient developed permanent hoarseness after surgery. The postoperative pathology of 31 patients（29.2%） indicated multiple focal thyroid carcinoma. Postoperative pathology of 41 patients（38.7%） suggested lymph node metastasis in the central region of neck. The disease-specific survival rate was 100%. Conclusion:Isthmic thyroidectomy is recommended for isolated PTMCI. Isthmus of thyroid+ unilateral lobectomy is feasible for PTMCI with unilateral lobectomy. If multiple suspicious malignant nodules（≥3） occur in unilateral lobectomy, total thyroidectomy is recommended. Total thyroidectomy is feasible for PTMCI with bilateral nodules. All PTMCI patients should undergo prophylactic central cervical lymph node dissection at the same time.

The Implications of Micro-Papillary Thyroid Carcinoma in Surgical Treatment of Multi-nodular Goiter

Background: papillary thyroid micro-carcinoma (PTMC) is defined as papillary thyroid carcinoma less than 10mm in diameter, it is common pathology and form one third of PTC, its management is debatable due to its aggressive behavior in some cases. its diagnosis are done incidentally in most of cases but recent ultrasound with FNCA increase the incidence of diagnosis. Patients and methods: The Study is conducted on 147 cases of papillary thyroid carcinoma (PTC) that operated upon between 2018-2022 for goiter randomly. The type of surgery is either lobectomy, total thyroidectomy or partial thyroidectomy. The pathologist decreases the thyroid lesion to less than few mm in diameter instead of more than 10 mm that done previously. the cases are divided into 3 group: group A include micro-carcinoma; group B include malignant nodule more than 1 cm in multi-nodular goiter (MNG) and group C that include single papillary nodule. Result: of 149 cases with PTC, 47 cases are PTMC (group A), 27 cases are in group B that include PTC more than one centimeter in diameter and group C that present with solitary malignant nodules that include 75 cases. Of 47 cases with PTMC, 27 cases contain malignant foci between 1-3 mm while in 11 cases, the size between 4-5 mm and 9 cases with diameter between 6 to 9 mm. Thirty–nine of PTMC cases are seen in MNG, 7 cases in Hashomoto s thyroiditis and one case in graves’ disease. Ten of 16 cases of colloid MNG are between, the size of malignant nodule are in range of 1-1.5 cm. seven of 11 cases of PTC in Hashomoto s are multifocal. Conclusion: PTMC is common pathology, mainly seen in MNG, and in most of the cases, they are small in size 3mm or less in diameter and difficult to recognize by ultrasound so adoption of total lobectomy or total thyroidectomy instead of partial thyroidectomy ensure complete excision of this pathology which may have unexpected behavior in some cases. PTC (more than 1 cm) on background of MNG, mainly are of small size and present in non-dominant nodule.

Active surveillance of papillary thyroid carcinoma in Latin America: a scoping review.

Thyroid nodules are a very common finding and have a malignancy rate of 7%-15%. Some malignant nodules have an indolent behavior and may not affect mortality if left untreated. Active surveillance (AS) is a strategy to prevent overtreatment in patients with papillary thyroid microcarcinomas (PTMCs). This review was conducted to evaluate the status of AS for low-risk PTMC in Latin America, including cultural and logistical challenges, disease progression data, and financial viability. We searched PubMed (MEDLINE), SciELO, LILACS, and Web of Science for articles published after 2014 and enrolling adult Latin American patients. Articles cited in the selected studies were also retrieved. We analyzed the AS protocols, technical or logistical challenges, patient adherence, reasons for AS interruption, surgical conversion rates, duration of AS, and disease progression during AS in our region. Three articles were included in the analysis, all of which considered AS a viable option and reported tumor progression and outcomes similar to those reported in other countries. Neck ultrasound and serum levels of thyroglobulin, thyroid-stimulating hormone (TSH), thyroxine (T4), and antithyroglobulin antibodies were included in the follow-up. No cases of new distant metastases were reported, and the outcomes were favorable when surgery was required. Anxiety was the main reason for AS interruption. We conclude that AS can be an acceptable approach and is safe and effective in Latin America, although more prospective studies are needed to consolidate this strategy in our region. Adequate infrastructure, follow-up, and patient education, as well as multidisciplinary healthcare teams trained in conducting AS must be ensured for successful results.

Decisional Conflicts in Patients With Low-Risk Papillary Thyroid Microcarcinomas Considering Active Surveillance

Internationally, active surveillance has been shown to be beneficial and safe in the management of low-risk papillary thyroid microcarcinomas. However, choosing active surveillance is a difficult treatment decision for patients with low-risk papillary thyroid microcarcinomas. To identify and analyze the antecedents and mediating processes of decisional conflicts when patients consider active surveillance as an alternative to surgery. In this qualitative study, semistructured interviews were conducted between April 2023 and December 2023 at 3 tertiary hospitals in China. Thirty-one participants who were diagnosed with low-risk papillary thyroid microcarcinomas, who had experienced considering active surveillance as an alternative to surgery and who scored above 25 on the decision conflict scale were purposively recruited. Inductive content analysis led to emergent themes. Data analysis was performed from April 2023 to February 2024. Methods used to protect the trustworthiness of the study results included audit trails and member checks. Patients' experience of decisional conflicts and the antecedents and mediating processes relating to these decisional conflicts. Among 31 participants (median [range] age, 39.2 [22-63] years; 22 [71%] were female and 9 [29%] were male), 3 themes were classified: (1) decisional conflicts in decision preparation, (2) decisional conflicts in decision-making, and (3) decisional conflicts in decision implementation. The patient's experiences of decisional conflicts were diverse and occurred throughout the entire decision-making process. The antecedents of the decisional conflicts included personal influencing factors, system-level influencing factors, and the relational-situational context. Patients with low-risk papillary thyroid microcarcinomas interacted with these antecedents in the process of decision-making and eventually failed to mediate, leading to decisional conflicts. This qualitative study found that patients with low-risk papillary thyroid microcarcinomas experienced clinically significant decisional conflicts and experienced considerable challenges and psychological problems in decision-making. The antecedents of decisional conflicts and accompanying mediating processes can provide guidance for individuals, health care professionals, and health care systems to provide decision support for patients with low-risk papillary thyroid microcarcinomas.

Investigating metastatic potential in papillary thyroid microcarcinoma (PTMC)

Investigating metastatic potential in papillary thyroid microcarcinoma (PTMC)

Incidental papillary thyroid microcarcinoma: implications of recurrence and survival on management recommendations

Incidental papillary thyroid microcarcinoma: implications of recurrence and survival on management recommendations

Thermal Ablation for Benign Thyroid Nodules and Papillary Thyroid Microcarcinoma.

Ultrasound-guided minimally invasive thermoablative (MIT) therapies are a therapeutic option for selected patients with large, hypoenhancing, benign thyroid nodules that cause compression disorders or aesthetic discomfort. MIT, which does not require general anaesthesia, causes thermal necrosis of the treated nodule, which is reduced in size by 50 % without functional consequences, and is indicated for patients who are not too young or in the presence of anaesthesia-related risk factors or recurrence following thyroidectomy or refusal of surgery. For the above indications, MIT complements surgery but does not replace it; it must always be performed in centres and by surgeons with proven technical skills and clinical experience. Subject to appropriate informed consent, the treatment is short-duration, well-tolerated by the patient, safe, and non-invasive. It does not require anaesthesia and complications are rare and transient. MIT, and in particular laser-based procedures (TAL), can also be effective and safe for the treatment of potentially destructible papillary microcarcinoma, as shown by the limited but sufficient literature, including the most recent guidelines, which consider it to be a therapeutic alternative that requires a better understanding of its efficacy and safety.

A Prospective Clinical Trial of Radiofrequency Ablation in Patients with Low-Risk Unifocal Papillary Thyroid Microcarcinoma Favoring Active Surveillance Over Surgery.

Background: Active surveillance (AS) of papillary thyroid microcarcinomas (PTMC) is emerging as an alternative to immediate surgery. While thermal ablation has also shown promise for low-risk PTMC, it has not been prospectively studied in patients appropriate for AS. This study aimed to evaluate the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) for tumor control and quality of life (QoL) management in patients with PTMC who favored AS over immediate surgery. Methods: This prospective clinical trial was conducted at a single tertiary referral hospital from 2018 to 2021. Of 227 adult patients aged ≤60 years with low-risk unifocal PTMC favoring AS over immediate surgery, 100 patients underwent RFA for their management. The primary endpoint was the disease progression rate, and secondary endpoints were technical success, volume reduction rate (VRR), complication rates, and QoL. Results: The median age of the study population was 42 years (range, 27-59 years), and 83% (83/100, [CI: 66.1-100]) were female. The median follow-up was 30 months (range, 12-56 months). All 100 patients underwent RFA with technical success. Most of the ablation zones showed continuous volume reduction, and 95.9% (94/98, [CI: 77.5-100.0]) showed complete disappearance at the last follow-up. The median VRR was 100.0% at 1-year follow-up and persisted throughout the last follow-up. The cumulative disease progression rate among 98 patients who underwent at least 1-year follow-up was 3.1% (3/98, [CI: 0.6-9.0]); one patient had lymph node metastasis (treated with surgery), and two patients had new PTMC (1 treated with RFA, 1 ongoing AS). Major complications were not observed. Psychological (baseline vs. last follow-up, 7.3 vs. 8.0, p = 0.002) and social (8.0 vs. 8.7, p = 0.005) QoL scores significantly improved during follow-up without compromising physical QoL (8.6 vs. 8.5, p = 0.99). Conclusions: RFA can be a reasonable strategy for effectively and safely controlling tumors and improving QoL in non-elderly patients with low-risk PTMC appropriate for AS. Clinical Trial registration: This trial is registered with ClinicalTrials.gov: NCT03432299.

Impact of a simple informative leaflet on Brazilian doctors' attitudes towards active surveillance of thyroid microcarcinomas

IntroductionActive surveillance (AS) is increasingly recognized as an appropriate strategy for selected patients with papillary thyroid microcarcinomas (PTMC). However, some factors, including physician-related ones, hinder its widespread adoption. MethodsTo explore the prevailing barriers and the impact of information on attitudes towards AS implementation, we developed a questionnaire that was completed before and after reading a simple information leaflet by 317 doctors working in different work environments. This leaflet provides information about the overdiagnosis of PTMC, the concept of AS, results of early studies, and main advantages and disadvantages of AS. ResultsWe observed a greater resistance to AS among male physicians who were more likely to maintain the initial recommendation for surgery or referral to a head and neck surgeon than female physicians (77 % vs. 46 %, p = 0.01), regardless of their medical specialty. Fear of disease progression and of the patient losing follow-up were the main concerns. Reading the educational material significantly increased the number of physicians who endorsed AS as an initial approach to PTMC without risk factors from 14 % to 34 % (p < 0,001). This change in attitude was even more significant when doctors were confronted with a case of PTMC in an elderly patient. Gender, medical specialty, age range and academic environment were the factors that were determinants on the influence of the informative leaflet on the decision-making. The leaflet also increased the number of doctors who considered themselves capable of dealing with this patient profile; however, 17 % declared that the place where they worked would not be able to meet the need for periodic assessments and necessary examinations. This was particularly true for the 20 % of the professionals working in rural areas. ConclusionA simple educational leaflet with basic information presented via social media increased the number of Brazilian physicians who endorsed AS for PTMC management and proved to be a facilitating tool for understanding and accepting it. Our results suggest that this method can be easily extended to larger population.

Comparison of Ultrasound-Guided Percutaneous Microwave Ablation and Conventional Thyroidectomy in the Treatment of Papillary Thyroid Microcarcinoma: Meta-Analysis.

Purpose: To perform a meta-analysis of clinical trials comparing percutaneous microwave ablation (PMWA) guided by ultrasound with conventional thyroidectomy for the management of papillary thyroid microcarcinoma (PTMC), analyzing feasibility, safety, and long-term efficacy, and to provide clinical guidance for the treatment selection of PTMC. Methods: Embase, PubMed, Cochrane Library, Web of Science, CNKI, VIP Database, and Wanfang Database were systematically searched to identify clinical studies of PMWA or thyroidectomy for PTMC up to December 2023. The relevant data from the articles were extracted, and the data analysis was performed using RevMan 5.4 software. Results: A total of 442 articles were identified and subsequently screened based on the inclusion and exclusion criteria, 9 clinical studies involving a total of 1577 patients were included, with 788 patients in the PMWA group and 789 patients in the surgery group. Following data extraction and statistical analysis, in comparison to the surgery group, the PMWA group had shorter operation time [mean differences (MD) = -36.36; 95% CI -55.66 to -17.06; P = .0002], shorter hospital stay (MD = -3.93; 95% CI -5.55 to -2.30; P < .00001), less intraoperative bleeding (MD = -21.25; 95% CI -27.36 to -15.15; P < .00001), and lower hospital costs (MD = -1.00; 95% CI -1.33 to -0.66; P < .00001), all with statistical significance. The comparison of postoperative complications revealed a lower incidence of complications in the PMWA group compared to the surgery group [relative risk (RR) = 0.29; 95% CI 0.21 to 0.40; P < .00001], with statistical significance. Thyroid-related hormone analysis showed that the free triiodothyronine (MD = 0.61; 95% CI 0.33 to 0.90; P < .00001) and free thyroxine (MD = 1.81; 95% CI 0.94 to 2.68; P < .0001) levels in the PMWA group were higher than those in the traditional surgery group, while the levels of thyroid-stimulating hormone were lower than those in the traditional surgery group (MD = -7.63; 95% CI -10.25 to -5.01; P < .00001), with statistically significant differences, indicating that PMWA had a smaller impact on thyroid function. In 2 studies, there were no statistically significant disparities in postoperative recurrence or lymph node metastasis (LNM) between the 2 cohorts (RR = 0.70; 95% CI 0.33 to 1.50; P = .36). There were no statistically significant differences in physiological health score between different groups and different time points before and after treatment (P > .05); However, the mental component score and the total score of the Medical Outcomes Study (MOS) item short-form health survey were significantly elevated in the ablation group compared to the excision group post-treatment (P < .05). Conclusion: For patients with low-risk PTMC with definitive diagnosis and precise risk stratification, PMWA can be selected. PMWA treatment for patients with PTMC is comparable to conventional surgical treatment and has the advantages of minimal trauma, rapid recovery, no scarring, and fewer complications, which are superior to open surgery to a certain extent. For patients with ambiguous preoperative diagnosis and uncertainty regarding LNM status, surgical intervention is the optimal choice.

Artificial neural network prediction of postoperative complications in papillary thyroid microcarcinoma based on preoperative ultrasonographic features.

To predict post-thyroidectomy complications in papillary thyroid microcarcinoma (PTMC) patients using a deep learning model based on preoperative ultrasonographic features. This study addresses the global rise in PTMC incidence and the challenges in treatment decision-making with high-resolution ultrasonography. This study enrolled 1638 patients with clinically staged cN0 PTMC who received surgical treatment from 1997 to 2019 at Beijing Friendship Hospital. Deep learning model was developed using fully connected neural network. Feature selection included 1000 iterations of Bootstrap sampling and Recursive Feature Elimination (RFE) to identify the top 10 features. Data preprocessing involved normalization and imputation for missing values. SMOTE addressed class imbalance. The model was trained and tested on random data split, with performance metrics including Accuracy (ACC), Area Under the Curve (AUC), Sensitivity (SEN), and Specificity (SPE), visualized through a ROC curve and confusion matrix. The fully connected deep neural network model demonstrated high accuracy (ACC 0.81), Area Under the Curve (AUC 0.74), sensitivity (SEN 0.65), and specificity (SPE 0.83) and visualized by ROC curve and confusion matrix. These results highlight the model's reliability and potential as an effective tool in predicting postoperative complications and assisting in clinical decision-making for PTMC patients. This study highlights the potential of deep learning in enhancing medical predictions and personalized healthcare. Despite promising results, limitations include a single-center data source and unconsidered factors like lifestyle and genetics. Future research should expand data sources, include more influencing factors, and refine algorithms to improve accuracy and applicability in thyroid cancer treatment.