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25 November 2023, Volume 28 Issue 06 Previous Issue   

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Editorial

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Advances in minimally invasive surgery for thyroid tumors JIANG Hongyi, ZHENG Chuanming, GE Minghua 2023, 28 (06):  491-495.  DOI: 10.16139/j.1007-9610.2023.06.01 Abstract ( 36 )   HTML ( 6 )   PDF (826KB) ( 34 )   The incidence of thyroid tumors has been increasing recent years, the importance of quality of life has been more concerned in addition to radical treatment. Traditional open surgery has been unable to meet the needs of all patients. In recent years, the continuous innovation and vigorous development of minimally invasive techniques, including endoscopy, ablation, and robotics, have expanded the range of available surgical options. In this review, we summarized the advancements in minimally invasive surgery for thyroid tumors, focusing on how to select the most appropriate surgical approach based on the patient's condition and develop personalized treatment plans. References | Related Articles | Metrics

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Challenges and opportunities in the diagnosis and treatment of thyroid carcinoma in children and young adolescents WANG Zhuoying, SHI Yuan, GUO Kai, QIAN Kai 2023, 28 (06):  496-500.  DOI: 10.16139/j.1007-9610.2023.06.02 Abstract ( 35 )   HTML ( 11 )   PDF (827KB) ( 25 )   Thyroid carcinoma in children and young adolescent is a special type of thyroid carcinoma, which has received more and more attention. In recent years, confusion and difficulties continue to emerge in understanding the disease. This article reviewed these clinical challenges and summarized recent research progress at home and abroad, with a view to identifying valuable opportunities to improve the diagnosis and treatment of thyroid carcinoma in children and young adolescents. References | Related Articles | Metrics

Experts forum

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Update of pathology in medullary thyroid carcinoma LIU Zhiyan, YU Yaling, KAKUDO Kennichi 2023, 28 (06):  501-506.  DOI: 10.16139/j.1007-9610.2023.06.03 Abstract ( 47 )   HTML ( 2 )   PDF (10867KB) ( 20 )   Medullary thyroid carcinoma (MTC) is a rare thyroid malignancy, which is more aggressive with high metastasis and recurrence rate. Surgical treatment is the preferred treatment option for MTC. Targeted therapy and immunotherapy have gradually become new treatment strategy for MTC. The pathology of MTC was updated in the 5th edition WHO classification of endocrine and neuroendocrine tumor in 2022. This review summarized the update of MTC pathology focusing on the histologic grading schemes, gene screening and genetic counseling. Figures and Tables | References | Related Articles | Metrics

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Consensus and controversy in postoperative thyroid stimulating hormone suppression therapy for differentiated thyroid carcinoma LIU Jie, XIAN Keyao 2023, 28 (06):  507-511.  DOI: 10.16139/j.1007-9610.2023.06.04 Abstract ( 32 )   HTML ( 0 )   PDF (765KB) ( 24 )   Differentiated thyroid carcinoma (DTC) is the most common thyroid carcinoma, with a generally favorable prognosis for most patients. At present, Surgery, 131I and thyroid stimulating hormone (TSH) suppression are the main therapeutic means among which, TSH suppression therapy plays an important role in the postoperative management of DTC patients, which has the effect of decreasing the risk of recurrence, slowing down the progression of the disease, and improving long-term survival. However, excessive TSH suppression can increase the risk of adverse events in the cardiovascular and skeletal systems. Currently, there is ongoing debate regarding the optimal target range for serum TSH suppression in patients of all types. In clinical practice, it is important to carefully balance the benefits and potential risks of TSH suppression, and to personalize the target range for serum TSH based on dynamic assessments during patient follow-up. This article aimed to discuss the intensity, benefits, and risks of TSH suppression after surgery for DTC patients, as well as the current controversies about this topic. Figures and Tables | References | Related Articles | Metrics

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Interpretation of the 2022 edition of “guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis in China” XU Bojin, PENG Wenfang, HUANG Shan 2023, 28 (06):  512-519.  DOI: 10.16139/j.1007-9610.2023.06.05 Abstract ( 110 )   HTML ( 1 )   PDF (889KB) ( 358 )   “Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis in China” (2022) (referred to as the “guidelines”) was officially published in August 2022 in the Chinese Journal of Endocrine Metabolism. These guidelines have been extensively updated from the 2007 version, with 15 sections covering the etiology, clinical manifestations, diagnosis, evaluation, and treatment of hyperthyroidism, as well as the management of specific types of thyrotoxicosis. The new version guidelines proposed 107 recommended opinions supported by stronger evidence, offering comprehensive and reliable guidance for clinical doctors and medical professionals dealing with thyrotoxicosis. This article aimed to extract the key points and recommended strategies from the guidelines to help clinical doctors better understand and apply the latest guiding principles. Figures and Tables | References | Related Articles | Metrics

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Combination of targeted multikinase inhibitor and radioiodine: a new strategy of treatment for advanced differentiated thyroid carcinoma LIU Wei 2023, 28 (06):  520-523.  DOI: 10.16139/j.1007-9610.2023.06.06 Abstract ( 21 )   HTML ( 1 )   PDF (752KB) ( 13 )   Advanced differentiated thyroid carcinoma (ADTC) lacks effective treatment options, and has a poor prognosis, which is an urgent clinical problem to be resolved. Targeted multikinase inhibitor(MKI) has been approved for the treatment of radioiodine refractory differentiated thyroid carcinoma, and have recently been recommended as a preoperative neoadjuvant therapy agents for locally ADTC. Although radioiodine therapy is the standard postoperative treatment for ADTC, it has certain limitations. MKI combined with radioiodine therapy is expected to become a new strategy of treatment for ADTC. Figures and Tables | References | Related Articles | Metrics

Original article

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Study on invasive histopathological features of papillary thyroid carcinoma with tall cell variant LIAO Zhenyu, ZHAO Qiwu, KUANG Jie, LIU Zhuoran, SUN Hanxing, WANG Yue, QIU Weihua, CHEN Xi, YAN Jiqi 2023, 28 (06):  524-528.  DOI: 10.16139/j.1007-9610.2023.06.07 Abstract ( 28 )   HTML ( 0 )   PDF (775KB) ( 15 )   Objective To study the invasive histopathological features of papillary thyroid carcinoma(PTC) with tall cell variant(TCV). Methods A retrospective analysis of 19 170 cases of PTC in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2018 to May 2023 was performed to analyze and the clinicopathological features between TCV-PTC group and classic PTC (cPTC) group. Results Pathological results showed 1 380 cases in TCV-PTC group and 15 578 cases in cPTC group. TCV-PTC had higher proportion and (or) mean value in patients' age, extraglandular invasion, nerve invasion, vascular invasion, maximum diameter of cancer focus, multifocality，lymph node metastasis and BRAF mutation, but the proportion of patients with coexistent Hashimoto's thyroiditis was lower than cPTC， and all results had significant difference (P<0.05). Conclusions Compared with the cPTC, TCV-PTC has stronger local invasive characteristics and lymph node metastasis rate, which provides the basis for the subsequent clinical treatment. Figures and Tables | References | Related Articles | Metrics

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Papillary thyroid microcarcinoma should not be used as the basis for postoperative 131I therapy CAI Xiaoyu, ZHANG Ruiguo, HU Yujing, WANG Renfei, BIAN Yanzhu 2023, 28 (06):  529-535.  DOI: 10.16139/j.1007-9610.2023.06.08 Abstract ( 22 )   HTML ( 0 )   PDF (911KB) ( 11 )   Objective To analyze the clinicopathological data of patients with papillary thyroid microcarcinoma (PTMC) and papillary thyroid non-microcarcinoma (non-PTMC) who received 131I therapy retrospectively, and compare the therapeutic response of the two groups of patients, so as to guide 131I therapy decisions for PTMC patients. Methods A total of 1 118 patients with papillary thyroid carcinoma (PTC) underwent 131I therapy in the Department of Nuclear Medicine, Tianjin Medical University General Hospital from January 2015 to December 2020 were enrolled. Chi-square test and Mann-Whitney U test were used to compare the differences of clinicopathological features and 131I therapy， therapeutic response between two groups. The incomplete response （IR）rate curves of the two groups were plotted by Kaplan-Meier analysis.Results The proportion of patients with multifocal, involvement of bilateral thyroid lobes in PTMC group were higher than those in non-PTMC group, and the proportion of patients with extra-thyroid extension, T4, N1b, stimulated thyroglobulin(sTg)>10 μg/L, and high risk stratified were lower than those in non-PTMC group (P<0.05). Most patients in PTMC group received remnant ablation for the first time, while more patients in non-PTMC group received adjuvant therapy and therapy for known disease (P<0.05). There was no statistically significant difference in 131I therapeutic response, the rates of excellent response(ER) and IR in two groups, and the differences in curves of IR rate between the two groups were also no statistically significance (P>0.05). Conclusions PTMC has a certain degree of invasiveness. As long as the patients were comprehensively evaluated and the standard 131I therapy was adopted, the treatment outcomes of patients with PTMC and non-PTMC were roughly the same. Therefore, the clinical value of the definition of PTMC is extremely limited in the formulation of 131I therapeutic dose regimens. Figures and Tables | References | Related Articles | Metrics

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Analysis of tumor recurrence factors of the patients with intermediate risk papillary thyroid carcinoma after radioactive iodine treatment TANG Linglin, LI Li, LAI Yi, LIU Jianjun, ZHOU Xiang 2023, 28 (06):  536-539.  DOI: 10.16139/j.1007-9610.2023.06.09 Abstract ( 25 )   HTML ( 1 )   PDF (869KB) ( 20 )   Objective To analyze the recurrence factors of the patients with intermediate risk papillary thyroid carcinoma (PTC) after radioactive iodine treatment (RAIT). Methods A total of 254 intermediate risk PTC patients after RAIT from January 2018 to May 2020 in our hospital were enrolled into this study. Chi square test and multivariate analysis were applied to analyze the main recurrence factors after RAIT. Results Thirty four (13.4%) patients with intermediate risk PTC relapsed after RAIT. The primary tumor size, lymph node metastasis staging, and pre-ablation stimulated thyroglobulin (psTg) were associated with tumor recurrence. According to the receiver operating characteristic （ROC） curve, psTg 25.6 μg/L was the best cutoff value for predicting recurrence. Further multivariate analysis revealed that lymph node metastasis staging and psTg levels were independent factors of predicting PTC recurrence. When the patients with N1b and psTg≥25.6 μg/L, the incidence of tumor recurrence after RAIT was 58.3%. While the patients with N1a and psTg<25.6 μg/L, the incidengce of tumor recurrence was only 2.3%. Conclusions Lymph node metastasis staging and psTg level are the important indicators of PTC recurrence, and combining these two indicators can help predict tumor recurrence after RAIT. Figures and Tables | References | Related Articles | Metrics

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Efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network meta-analysis QI Yang, YAO Wenfei, LI Qianyi, YAO Wei, KONG Lei, XU Ruiyun, WU Yuquan, LI Nengping 2023, 28 (06):  540-550.  DOI: 10.16139/j.1007-9610.2023.06.010 Abstract ( 26 )   HTML ( 0 )   PDF (1281KB) ( 13 )   Objective To assess the comparative efficacy of different methods for difficult biliary cannulation in endoscopic retrograde cholangio-pancreatography (ERCP) through a network meta-analysis. Methods Randomized controlled trials (RCTs) that compared the efficacy of different adjunctive methods (early or late needle-knife technique, pancreatic guidewire-assisted technique, pancreatic stent-assisted technique, transpancreatic sphincterotomy, persistent standard cannulation technique) for difficult biliary cannulation with each other were identified. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) were the outcomes of interest. Pairwise and network meta-analysis and ranking according to surface under the cumulative ranking curve(SUCRA) for all methods were performed. Results Eighteen RCTs were identified according to selection criteria, and 2 033 patients were enrolled. The use of transpancreatic sphincterotomy over persistent standard cannulation technique (RR=1.34, 95% CI: 1.02-1.77) and over pancreatic guidewire-assisted technique（RR=1.26, 95% CI: 1.00-1.60）significantly increased the success rate of biliary cannulation. Based on SUCRA ranking, transpancreatic sphincterotomy followed by early needle-knife techniques were ranked highest in terms of increasing the success rate of biliary cannulation. Only early needle-knife technique significantly decreased PEP rate when compared with persistent standard cannulation technique (RR=0.53, 95％CI: 0.30-0.94), whereas both early needle-knife techniques and transpancreatic sphincterotomy led to lower PEP rates as compared with pancreatic guidewire-assisted technique (RR=0.41， 95％CI: 0.17-0.99; RR=0.49， 95％CI: 0.25-0.96; respectively). Based on SUCRA ranking, early needle-knife technique followed by transpancreatic sphincterotomy were ranked highest for decreasing the PEP rate of biliary cannulation. Conclusions Transpancreatic sphincterotomy increases the success rate of difficult biliary cannulation in ERCP; early needle-knife technique and transpancreatic sphincterotomy are superior to other interventions in decreasing PEP rates and should be considered as a choice of difficult biliary cannulation. Figures and Tables | References | Related Articles | Metrics

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Propensity score matching method evaluate the clinical efficacy of comprehensive treatment for synchronous primary advanced gastric and esophageal cancer ZHANG Peichan, LUO Chunyang, WU Wenya, WU Zhenfeng, CAO Qinhong, CHEN Che, WU Xiaoyu, YAO Xuequan, LIU Fukun 2023, 28 (06):  551-555.  DOI: 10.16139/j.1007-9610.2023.06.011 Abstract ( 23 )   HTML ( 1 )   PDF (809KB) ( 14 )   Objective To evaluate the clinical efficacy of comprehensive treatment for synchronous primary advanced gastric and esophageal cancer by propensity score matching (PSM). Methods A total of 2 551 patients with advanced gastric cancer admitted to Jiangsu Province Hospital of Chinese Medicine from January 2013 to December 2022 were retrospectively analyzed. Among them, 45 patients with synchronous primary esophageal cancer were distributed to the observation group, and 2 506 patients without esophageal cancer were distributed to the control group. Through the PSM method, the control group was matched with the observation group and the equilibrium samples of covariates between two groups were obtained. The overall survival(OS) between the two groups were compared. Results Both observation and control group contained 45 patients in this study. According to the treatment regimen, the patients in the observation group was divided into radical resection treatment subgroup (n=22) and chemoradiotherapy (CRT) subgroup (n=23). In the radical resection subgroup, 4 patients underwent the simultaneous surgical resection of gastric and esophageal tumors through proximal gastrectomy with the Ivor Lewis operation. Eighteen patients underwent endoscopic submucosal dissection(ESD) of their esophageal tumors and gastric cancer radical resection. Radical resection of gastric cancer combined with preoperative chemoradiotherapy of esophageal cancer was performed in the CRT subgroup. Survival analysis showed that OS in the observation group was significantly shorter than that in the control group (P=0.042) and there was no significant difference in OS between the radical resection subgroup and the control group (P=0.799). The 1 -, 3 -, and 5-year survival rates of the patients in the CRT subgroup were significantly lower than those of the control group (P=0.003). While the 1 -, 3 -, and 5-year survival rates of the patients in the radical resection subgroup were not statistically significant, compared to those of the CRT subgroup (P=0.071).Conclusions Multidisciplinary and comprehensive treatment can significantly improve the prognosis of patients with synchronous primary advanced gastric and esophageal cancer. Radical resection of gastric cancer combined with ESD of esophageal cancer is an optional treatment for patients with gastric cancer complicated with early esophageal cancer. Radical resection of gastric cancer combined with CRT of esophageal cancer can improve the prognosis of patients with advanced gastric cancer complicated with unresectable esophageal cancer. Figures and Tables | References | Related Articles | Metrics

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Value of contrast-enhanced ultrasound in differentiating benign and malignant gallbladder lesions which diameter more than 1 cm FENG Meijing, REN Xinping, ZHAN Weiwei, ZHENG Lili, LI Junjian 2023, 28 (06):  556-562.  DOI: 10.16139/j.1007-9610.2023.06.012 Abstract ( 20 )   HTML ( 1 )   PDF (1568KB) ( 15 )   Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS) in differential diagnosis between benign and malignant gallbladder lesions which diameter more than 1 cm. Methods A retrospective analysis included CEUS data of 142 cases with gallbladder lesions diameter more than 1 cm. All lesions were confirmed by surgical pathology, enhanced CT/MRI or clinical diagnosis with following up more than 2 years. To summarize the CEUS characteristics of benign and malignant gallbladder lesions over 1 cm in diameter, the CEUS characteristics of benign and malignant gallbladder lesions diameter more than 1 cm were analyzed, referring to the gallbladder CEUS guidelines. The contrast medium washout before 35 s and 60 s were used as the combined diagnosis with CEUS standard to identify gallbladder cancer, and the diagnostic efficiency was calculated respectively. Results There were statistical differences between the malignant group and the benign group in terms of CEUS enhancement pattern, contrast arrival time, washout time, and gallbladder wall continuity, as well as enhancement levels (P<0.001). The sensitivity, specificity, accuracy in the diagnosis of gallbladder malignant lesions were 93.0%, 83.8%, and 86.6% based on CEUS standard. The sensitivity, specificity and accuracy of diagnosis gallbladder malignant lesions were increased to 93.0%, 92.9% and 93.0% when combined with washout before 35 s of contrast medium. Conclusions CEUS is highly valuable in differentiating benign and malignant gallbladder lesions diameter more than 1 cm. Combined with contrast medium washout before 35 s is helpful to improve the ability of differentiating benign and malignant gallbladder lesions. Figures and Tables | References | Related Articles | Metrics

Review

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Advances of protein lysine methyltransferases in thyroid carcinoma HE Xi, SHI Yuan, QIAN Kai, WANG Zhuoying 2023, 28 (06):  563-567.  DOI: 10.16139/j.1007-9610.2023.06.013 Abstract ( 32 )   HTML ( 2 )   PDF (842KB) ( 22 )   Protein lysine methyltransferases (PKMT) catalyze methylation of lysine residues on histone tails and non-histone targets. These important post-translational modifications affect the structure and compactness of chromatin, which in turn affects gene expression. There is growing evidence that genetic alterations in PKMT affect the normal expression of PKMT in tissues and thus exert oncogenic or tumor suppressor functions. The expression of PKMT has been found to be associated with the prognosis of tumor patients in a variety of solid tumors. In this review, we summarized the functions of three major PKMT, including EZH2, KMT2 family and SMYD family, and their roles in thyroid carcinoma. References | Related Articles | Metrics

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Controversy and progress in parathyroidectomy for the treatment of secondary hyperparathyroidism WANG Qiang, ZHA Siluo, ZHANG Wei 2023, 28 (06):  568-573.  DOI: 10.16139/j.1007-9610.2023.06.14 Abstract ( 24 )   HTML ( 1 )   PDF (788KB) ( 17 )   Secondary hyperparathyroidism is one of common complications of long-term dialysis patients. Although medical treatment schemes such as calcimimetics and vitamin D analogues can be selected, patients refractory to drug treatment can still refer to parathyroidectomy as a treatment choice. At present, the surgical treatment include subtotal parathyroidectomy, total parathyroidectomy with or without auto-transplantation and purge parathyroidectomy. Because the etiology of this disease is related to hyperplasia of parathyroid tissue stimulated with metabolic disorder of calcium, phosphorus and vitamin D in dialysis patients, the course of disease and target indexes of surgical treatment might still be difficult to control, and there still lies controversies in surgical therapeutic strategy. However, with updating of clinical data, the emergence of new concepts and the introduction of new technologies, reasonable drug selection and appropriate timing of surgical intervention will further improve the treatment efficacy and safety. References | Related Articles | Metrics

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Physiological function of polyploid hepatocytes and pathological changes in its associated diseases ZHANG Yifan, LU Yiquan, HAO Fengjie, WANG Junqing 2023, 28 (06):  574-579.  DOI: 10.16139/j.1007-9610.2023.06.015 Abstract ( 30 )   HTML ( 1 )   PDF (857KB) ( 48 )   Liver is a unique organ with polyploidy. About 20 to 50 percent of hepatocytes in adult human are polyploid cells, which contain more than two sets of chromosomes. Hepatocytes polyploidization is triggered by the changes in insulin signal during weaning, and regulated by various cell cycle regulator genes to ensure the polyploid cells proportion, ploidy and zonation. The regulation of polyploid hepatocytes is crucial for liver's metabolic and regenerative function, and protecting liver from tumorigenesis. However, in chronic virus hepatitis and nonalcoholic fatty liver disease, the pathological hepatocytes polyploidization can be found in disease progression because of cell cycle checkpoint inhibition and oxidative stress. Distinguishing physiological and pathological hepatocyte polyploidization will be helpful for the understanding the relationship between chronic liver disease and tumorigenesis. References | Related Articles | Metrics