Catheter Ablation ; Humans ; Thyroid Nodule ; surgery

OBJECTIVE: To explore the protocol for diagnosing thyroid nodules based on core needle biopsy (CNB) and study the biomarkers' application in distinguishing indeterminate samples. METHODS: Patients with thyroid nodules treated at Peking University First Hospital from 2015 to 2020 were reviewed. In the study, 598 cases with CNB and matched resected specimens were retrieved. According to "diagnostic categories of thyroid CNB" proposed by the Korean Endocrine Pathology Thyroid Core Needle Biopsy Study Group, the CNB samples were diagnosed as follows: Ⅰ, unsatisfactory; Ⅱ, benign; Ⅲ, indeterminate; Ⅳ, follicular neoplasm; Ⅴ, suspicious for malignancy; and Ⅵ, malignant. The samples of CNB Ⅲ were stained by immunohistochemistry (IHC) using antibodies against CK19, Galectin-3, HBME-1, and CD56, and detected by next-generation sequencing (NGS) using an OncoAim^® thyroid cancer multigene assay kit (Singlera Genomics) that detected 26 genes. Taking the resected specimens' classification as the gold standard, the predictive value of CNB for determining the malignancy of thyroid nodules and the biomarkers for distinguishing the samples of CNB Ⅲ was calculated. RESULTS: The study included 598 patients, of which none were CNB Ⅰ, 40 cases were CNB Ⅱ, 40 cases were CNB Ⅲ, 32 cases were CNB Ⅳ, 35 cases were CNB Ⅴ, and 451 cases were CNB Ⅵ. The predictive value of CNB Ⅳ for determining follicular neoplasm was sensitivity (Sen) 100.00% and specificity (Sep) 100.00%, CNB Ⅴ-Ⅵ for determining malignancy was Sen 94.55% and Sep 100.00%, CNB Ⅱ for determining benign lesions was Sen 75.00% and Sep 99.80%. The predictive value of biomarkers for determining malignancy in cases of CNB Ⅲ was Sen 96.30% and Sep 92.31% by NGS, and Sen 81.48% and Sep 92.30% by IHC. CONCLUSION The Korean "diagnostic categories of thyroid CNB", which considers the histological specificity of CNB samples and the habits of clinicians, have strong operability, high diagnosis rate, and high clinical value. Under this framework, the cases of CNB Ⅵ should be treated with surgical operation, the cases of CNB Ⅴ-Ⅵ are recommended to be treated as malignant neoplasms, and the major cases of CNB Ⅱ could be followed up without worrisome except the one considered malignant by ultrasound. The value of biomarkers in distinguishing the cases of CNB Ⅲ is significant.
Humans ; Thyroid Nodule/surgery* ; Biopsy, Large-Core Needle/methods* ; Thyroid Neoplasms/surgery* ; Biomarkers

Although ethanol ablation has been successfully used to treat cystic thyroid nodules, this procedure is less effective when the thyroid nodules are solid. Radiofrequency (RF) ablation, a newer procedure used to treat malignant liver tumors, has been valuable in the treatment of benign thyroid nodules regardless of the extent of the solid component. This article reviews the basic physics, techniques, applications, results, and complications of thyroid RF ablation, in comparison to laser ablation.
*Catheter Ablation/methods ; Humans ; *Laser Therapy/methods ; Thyroid Nodule/*surgery/ultrasonography

OBJECTIVE: To explore the clinical effect of ultrasound guided microwave ablation in the treatment 01 recurrent thyroid nodules. METHOD: Seventy-five cases of recurrent thyroid nodules were treated with ultrasound guided microwave ablation(MWA) under local anesthesia. All the patients underwent biopsy puncture, then the microwave ablation needle puncted in the center site of nodule with energy of 25-35 W, and the center tempera- ture could reach to 70-95 °C. RESULT: MWA were successfully performed in all the patients without significant com- plications. Temporary hoarseness occurred in 5 cases and dispeared after 1-3 weeks, choking water occurred in 2 patients and recovered 3-5 days later. Ultrasound examination showed that the bloodstream of thyroid nodules disappeared in all the patients, and the nodules diminuted with varying degrees at 3-month and at 6-month follow- up Serum FT4 and TSH did not change significantly. CONCLUSION Ultrasound guided MWA could be effective in the treatment of recurrent thyroid nodule with minimal invasive technology.
Anesthesia, Local ; Catheter Ablation ; Humans ; Microwaves ; Recurrence ; Thyroid Nodule ; surgery ; Treatment Outcome ; Ultrasonics

OBJECTIVEThis systematic review examined whether radiofrequency ablation (RFA) is a safe treatment modality for benign thyroid nodules (BTNs).

DATA SOURCESPubMed, Embase, and the Cochrane Library database were searched for articles that (a) targeted human beings and (b) had a study population with BTNs that were confirmed by fine-needle aspiration cytology and/or core needle biopsy.

STUDY SELECTIONThirty-two studies relating to 3409 patients were included in this systematic review.

RESULTSBased on literatures, no deaths were associated with the procedure, serious complications were rare, and RFA appears to be a safe and well-tolerated treatment modality. However, a broad spectrum of complications offers insights into some undesirable complications, such as track needle seeding and Horner syndrome.

CONCLUSIONSRFA appears to be a safe and well-tolerated treatment modality for BTNs. More research is needed to characterize the complications of RFA for thyroid nodules.

Catheter Ablation ; methods ; Female ; Humans ; Male ; Thyroid Nodule ; surgery ; Treatment Outcome

OBJECTIVETo compare the advantages and shortcomings of the endoscopic thyroid surgery by trans-subclavian approach and trans-areolar approach.

METHODSTwelve patients received the trans-areolar approach and 10 patients were given the trans-subclavian approach procedure.

RESULTSWith the trans-areolar approach: the mean size of tumor was 1.8 cm, the mean operating time was 115 min, the mean blood loss during operation was 63 ml. Two patients converted to the conventional operation. With the trans-subclavian procedure: the mean size of tumor was 4.2 cm, the mean operating time was 85 min, the mean blood loss during operation was 66 ml. No complications were found in all of the patients and they were satisfied with the cosmetic effects of the procedures. There were significant differences in tumor size and operating time between the two operation types.

CONCLUSIONSCompared with the trans-areolar approach, the trans-subclavian approach comes with less trauma, higher success rate and it fits for bigger tumor.

Adult ; Aged ; Endoscopy ; Humans ; Middle Aged ; Retrospective Studies ; Thyroid Nodule ; surgery ; Thyroidectomy ; methods ; Treatment Outcome

Because mammary glands are regulated by endocrine factors, they are prone to various abnormalities and disorders. Breast nodules are common and occur frequently in clinical practice. The clinical management of breast nodules mainly includes follow-up observation, lesion biopsy, and surgical intervention, and surgical intervention is an effective treatment. Ultrasound-guided percutaneous microwave ablation is a new minimally invasive treatment technology developed in recent years. It has the advantages of short operation time, no scarring, less damage to the lactiferous duct, quick recovery, and good curative effects without bleeding. The establishment of an expert consensus on microwave ablation for benign breast nodules aims to provide a reliable clinical basis for microwave ablation of benign breast nodules, standardize the treatment process, and improve treatment efficacy, so as to serve as a reference for physicians in clinical practice.
Humans ; Consensus ; Microwaves/therapeutic use* ; Catheter Ablation ; Thyroid Nodule/surgery* ; Radiofrequency Ablation ; Treatment Outcome

OBJECTIVE: To assess the safety and efficacy of"leverage pry-off method"for preventing thermal injury during microwave ablation of benign thyroid nodules. METHODS: From July, 2017 to September, 2019, a total of 348 patients with benign thyroid nodules underwent ultrasound-guided microwave ablation. For protecting from thermal injury during the ablation, "hydrodissection technique" was used in 174 of the patients (admitted from July, 2017 to August, 2018) and "leverage pry-off method" in the other 174 patients (admitted from September, 2018 to September, 2019). All the patients were followed up for 1 to 12 months after the operation for observation of severe complications and nodular residues. RESULTS: Ultrasound-guided microwave ablation was completed in all the 348 patients. The most common severe complication associated with the ablation was voice change, occurring in 3 cases (1.7%) in "hydrodissection technique" group and in 4 (2.3%) in the "leverage pry-off method" group, showing no significant difference between the two groups (P>0.05). During the follow-up, no significant difference was found in the rate of nodular residues between the "hydrodissection technique" group and "hydrodissection technique" group (9.8% vs 10.9% (P>0.05). CONCLUSIONS The "leverage pry-off method" is simple and effective for preventing thermal injury during microwave ablation of benign thyroid nodules.
Humans ; Microwaves/therapeutic use* ; Thyroid Nodule/surgery* ; Burns ; Hospitalization ; Radiofrequency Ablation

OBJECTIVETo evaluate the efficacy and the limitation of ultrasound-guided core-needle biopsy, ultrasound-guided core-needle aspiration and ultrasound-guided fine-needle aspiration in micro-nodules of thyroid.

METHODSA retrospective was performed in 92 patients with suspectable malignent micro-nodules in thyroid. Of them, 52 patients underwent US-CNB and US-FNA and 40 patients underwent US-CNA and US-FNA. The diagnoses for the micro-nodules were identified by histopathlogical examination after surgery.

RESULTAmong 52 cases with both US-CNB and US-FNA, 41 got nondiagnostic US-CNB and 11 cases successfully got the correct diagnoses of US-CNB; 6 cases got the incorrect diagnosis of US-FNA and 46 cases got the correct diagnosis of US-FNA. Of 40 cases with US-CNA and US-FNA, unsatisfactory specimen of US-CNA occurred in 14 cases and satisfactory specimen of US-CNA were got in 26 cases; unsatisfactory specimen of US-FNA occurred in 4 cases and satisfactory specimen of US-FNA. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US-FNA in 92 cases for the diagnosis of malignancy were 93.4%, 86.7%, 97.3%, 72.2% and 92.3%, respectively.

CONCLUSIONSUS-FNA is the most valuable method for the diagnosis of suspectable malignent micro-nodules in thyroid before operation.

Biopsy, Fine-Needle ; methods ; Biopsy, Needle ; Humans ; Needles ; Retrospective Studies ; Sensitivity and Specificity ; Thyroid Neoplasms ; Thyroid Nodule ; diagnostic imaging ; surgery ; Ultrasonography

Objective: To evaluate the effect of ultrasound diagnosis of thyroid micro-malignant nodules and accumulate practical experience for the management of active surveillance for them, so as to avoid overtreatment. Methods: A total of 949 patients who were diagnosed with thyroid malignant nodules using ultrasonography, with the nodules being less than 1 cm in size and without regional lymph node metastasis or distant metastasis, were included. They were treated by the same surgeon of the Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from February 2014 to December 2020. 112 patients chose immediate surgery. The rest patients were asked to accept ultrasound examination every 6 months to 1 year. Follow-up endpoints: tumor size growth of 3 mm, tumor volume increase greater than 50%, lymph node metastasis or distant metastasis. Results: The median follow-up time was 19 months. 713 patients underwent surveillance for more than 6 months. Of the 713 patients, 570 (79.9%) were women, with mean age at 43.5 years old. Tumor progression was observed in 47 (6.6%) patients with a cumulative incidence of 2.7% (1 year), 7.2% (2 years) and 9.5% (3 years). In multivariate analysis, patient age [HR=0.508, 95%CI: 0.275-0.939, P=0.031], lesion number [HR=2.945, 95%CI: 1.593-5.444, P=0.001] and tumor size [HR=2.245, 95%CI: 1.202-4.192, P=0.011] at the beginning of observation were independent risk factors for tumor progression in patients with minimal thyroid malignant nodules during follow-up. During a median (range) active surveillance of 19 (6-80) months, 74 patients chose surgery during the surveillance. Among the 186 patients who underwent surgery, only 3 patients were diagnosed with fibrotic nodules in pathology, while the rest were papillary thyroid carcinoma. The ultrasound accuracy reached 98.4%(183/186). Conclusions: Ultrasonography is an effective method of diagnosing malignant thyroid nodules. Thyroid micro-malignant nodules progress slowly. As a result, it is safe to observe them instead of taking immediate surgery. Patient age, lesion number and tumor size at the beginning of observation are independent risk factors for the tumor progression of malignant nodules.
Humans ; Female ; Adult ; Male ; Thyroid Nodule/surgery* ; Carcinoma, Papillary/surgery* ; Lymphatic Metastasis ; Thyroid Neoplasms/surgery* ; Thyroidectomy/methods* ; Watchful Waiting ; Ultrasonography ; Retrospective Studies