Search

Purpose: Telomerase reverse transcriptase (TERT) has been reported in papillary thyroid carcinoma (PTC). This study aimed to investigate the correlation of TERT promoter mutations with clinical and ultrasound (US) features in PTC and to develop a model to predict TERT promoter mutations., Methods: Preoperative US images, postoperative pathological features, and TERT promoter mutation information were evaluated in 365 PTC patients confirmed by surgery. Univariate and multivariate factor analyses were performed to identify risk factors for TERT promoter mutations. A predictive model was established to assess the clinical predictive value., Results: Of the 365 patients with PTC (498 nodules), the number of those with TERT promoter mutations was 67 cases (75 nodules), and the number of those without mutations was 298 cases (423 nodules). The median age was 40 years in the wild-type group and 60 years in the mutant group. Male patients made up 35.82% of the mutant group and 22.82% of the wild-type group. Multivariate analysis revealed that the independent risk factors associated with the occurrence of TERT promoter mutation in PTC were as follows: older age (odds ratio (OR) = 1.07; p = 0.002), maximum diameter of ≥ 10 mm (OR = 3.94; p < 0.0001), unilateral (OR = 4.15; p < 0.0001), multifocal (OR = 7.69; p < 0.0001), adjacent to the thyroid capsule (OR = 1.94; p = 0.044), and accompanied by other benign nodules (OR = 1.94, p = 0.039). A predictive model was established, and the area under the curve (AUC) of the receiver operating characteristic was 0.839. TERT promoter mutations were associated with high-risk US and clinical features compared with the wild-type group., Conclusion: TERT promoter mutations were associated with older ages. They were also found to be multifocal, with a maximum diameter of ≥ 10 mm, unilateral, adjacent to the thyroid capsule, and accompanied by other benign nodules. The predictive model was of high diagnostic value., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hu, Xu, Dong, Pan, Zhang and Zhan.)

Background: To investigate sonographic features of cervical lymph node metastases from medullary thyroid cancer (LNM-MTC), as compared with lymph node metastases from papillary thyroid cancer (LNM-PTC)., Methods: A total of 42 MTC patients with 52 metastatic LNs and 222 PTC patients with 234 metastatic LNs who were confirmed by fine needle aspiration and post-operative pathology, were enrolled in this study. The clinical characteristics and sonographic features of LNs were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were performed on the sonographic features of LNs, including short and long-axis diameter, long-axis diameter/short-axis, shape, border, hilum, echogenicity, calcifications, cystic change and vascularity pattern. The discriminating performance was assessed with the area under the receiver operating characteristic curve (AUC)., Results: The mean age of patients with LNM-MTC was older than that of patients with LNM-PTC (46.81 ± 13.05 vs 39.09 ± 12.05, P < 0.001). No differences were observed in gender, location, long-axis diameter/short-axis, shape, border, echogenicity, cystic change and vascularity pattern between LNM-MTC and LNM-PTC groups (P > 0.05, for all). However, long-axis and short-axis diameter, hilum and calcifications were statistically different between these two groups (P < 0.05, for all). The AUC of discriminate value between LNM-MTC and LNM-PTC was 0.808 (95% confidence interval 0.739-0.877)., Conclusion: Compared with LNM-PTC, LNM-MTC tended to have the sonographic characteristics of larger size, absence of hilum, and less calcifications, and awareness of these features might be helpful to in the diagnosis of LNM-MTC., (© 2022. The Author(s).)

Background: Our purpose is to assess the effectiveness and safety of ultrasound-guided percutaneous microwave ablation (MWA) for lymph node metastases (LNMs) from papillary thyroid carcinomas (PTC)., Methods: In total, 14 patients with recurrent PTC were enrolled in this retrospective study. The vascularity within the ablation zone was evaluated by contrast-enhanced ultrasonography (CEUS) after MWA. Patients were followed up with measurement of the size and volume of tumor, serum thyroglobulin, and clinical evaluation at 7 days, 1, 3, 6 months, and every 6 months thereafter., Results: Twenty-one LNMs were confirmed by biopsy and successfully treated by MWA in a single session. No incomplete ablation was detected by CEUS after treatment. The average largest diameter and volume of the tumors were reduced from 10.1 ± 4.7 mm (range, 3.1-20.0 mm) and 291.9 ± 255.6 mm 3 (range, 11.6-766.6 mm 3 ) to 0.9 ± 1.6 mm (range, 0-4.1 mm; p < 0.05) and 4.0 ± 9.0 mm 3 (range, 0-31.6 mm 3 ; p < 0.05) at the final follow-up. Neither progression of treated tumors nor newly suspicious LNMs could be detected after treatment. The overall complication rate was 7.1% (1/14)., Conclusions: Ultrasound-guided MWA can effectively control LNMs from PTC, but it is less safe for tumors in the central compartment. MWA may become an alternative therapy in selected PTC patients, who were ineligible or refused to undergo repeated neck explorations.

Objectives: To compare the clinical outcomes of ultrasound-guided laser ablation (LA) and surgery for treatment of solitary papillary thyroid microcarcinoma (PTMC). Methods: A total of 81 consecutive patients with solitary PTMC were included in this retrospective study. Among them, 36 received LA and 45 underwent surgery. Surgery was performed by hemithyroidectomy with unilateral central neck dissection. The follow-up consisted of a physical examination, neck ultrasonography, chest X-ray or CT scan and thyroid function tests. The procedure time, hospital stay, complication and recurrence rates were compared between the two groups after treatment. Results: The follow-up period for the LA and surgical group were 49.2 ± 4.5 months (range, 30-54 months) and 48.5 ± 6.2 months (range, 24-54 months), respectively. The mean hospital stay and procedure time in the LA group were shorter than those in the surgical group. After LA, the largest diameter and average volume decreased from 4.7 ± 1.4 mm to 0.2 ± 0.8 mm, and from 43.2 ± 38.8 mm 3 to 0.7 ± 4.1 mm 3 ( p  < .05 for both), respectively. The complication rates and recurrence rates did not differ between the LA group (2.8% [1 of 36] and 5.6% [2 of 36]) and the surgical group (6.7% [3 of 45] and 6.7% [3 of 45]) ( p  > .05 for both). No distant metastasis occurred in the either group during the follow-up period. Conclusions: Compared with hemithyroidectomy with unilateral central neck dissection, ultrasound-guided LA was also a safe and effective therapy for treating solitary PTMC, and it may be considered as a treatment alternative for patients who are ineligible or refusal to undergo surgery.

Purpose: To investigate the use of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in assessing local therapeutic response of percutaneous laser ablation (PLA) for papillary thyroid microcarcinoma (PTMC)., Methods: Sixty-four patients with 64 PTMCs who were referred to our hospital from November 2013 to July 2016 were treated with PLA. The extent of ablation was assessed by CEUS at 10-20 min and 7 days after PLA. The size and volume of the ablation zone were evaluated on conventional ultrasound at 1 h, 1, 3, 6 and 12 months, and every half-year thereafter, and recurrences were also recorded. Ultrasound-guided fine needle aspiration biopsy (FNAB) of the ablated area was performed at 1, 6 and 12 months after PLA., Results: Two incomplete ablations were detected by CEUS, and a second ablation was performed. The mean largest diameter and volume of the ablated area on CEUS at 10-20 min and 7 days after PLA were significantly larger than those of pre-treatment on conventional ultrasound (p < 0.05, for both). At the last follow-up, the mean largest diameter was reduced from 4.6 ± 1.5 to 0.6 ± 1.3 mm (p < 0.0.5), and the average volume was 41.0 ± 40.4 mm 3 , which decreased to 1.8 ± 6.7 mm 3 (p < 0.0.5). A cervical metastatic lymph node was detected on ultrasound and confirmed by ultrasound-guided FNAB at 30 months after PLA., Conclusions: CEUS could play a crucial role in assessing the completeness of PLA for treating PTMC, and conventional ultrasound can not only guide the FNAB process but also is important in the follow-up of PTMC after PLA.

Objectives: To evaluate the efficacy and safety of percutaneous laser ablation (PLA) for unifocal T1N0M0 papillary thyroid microcarcinoma(PTMC)., Methods: A retrospective study was conducted in 30 patients with single PTMC which was diagnosed by fine-needle aspiration biopsy (FNAB). PLA was performed for proper time to achieve adequate ablation zones. The extent of ablation was assessed by contrast-enhanced ultrasound (CEUS) immediately and 7 days after PLA. Complications were recorded. The size and volume of the ablation area and thyroid hormones were measured, and clinical evaluations were performed at 1, 3, 6 and12 months, and every half year thereafter., Results: The procedure was well tolerated without serious complications. Of the 30 patients, 29 were treated successfully under local anaesthesia in a single session. Only one incomplete ablation was detected by immediate CEUS after PLA, and a second ablation was performed. At the last follow-up, ten (33.3 %) ablation zones had disappeared, and 20 (66.67 %) ablation zones remained as scar-like lesions. No regrowth of treated tumours, local recurrence or distant metastases were detected., Conclusions: During the short-term follow-up period, ultrasound-guided PLA appears to be effective and safe for treating solitary T1N0M0 PTMC in selected patients who are ineligible for surgery., Key Points: • Ultrasound is a useful tool in percutaneous laser ablation (PLA). • PLA is safe for treating papillary thyroid microcarcinoma. • PLA is effective for single papillary thyroid microcarcinoma.