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Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78·6%] female patients and 4922 [21·4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p

Children are more likely to experience recurrent laryngeal nerve (RLN) injury during thyroid surgery. Intraoperative nerve monitoring (IONM) may assist in nerve identification and surgical decision making. A literature review of pediatric IONM was performed and used to inform a monitoring technique guide and expert opinion statements. Pediatric IONM is achieved using a variety of methods. When age-appropriate endotracheal tubes with integrated surface electrodes are not available, an alternative method should be used. Patient age and surgeon experience with laryngoscopy influence technique selection; four techniques are described in detail. Surgeons must be familiar with the nuances of monitoring technique and interpretation; opinion statements address optimizing this technology in children. Adult IONM guidelines may offer strategies for surgical decision making in children. In some cases, delay of second-sided surgery may reduce bilateral RLN injury risk.

ImportanceIdentification and preservation of parathyroid glands (PGs) remain challenging despite advances in surgical techniques. Considerable morbidity and even mortality result from hypoparathyroidism caused by devascularization or inadvertent removal of PGs. Emerging imaging technologies hold promise to improve identification and preservation of PGs during thyroid surgery.ObservationThis narrative review (1) comprehensively reviews PG identification and vascular assessment using near-infrared autofluorescence (NIRAF)—both label free and in combination with indocyanine green—based on a comprehensive literature review and (2) offers a manual for possible implementation these emerging technologies in thyroid surgery.Conclusions and RelevanceEmerging technologies hold promise to improve PG identification and preservation during thyroidectomy. Future research should address variables affecting the degree of fluorescence in NIRAF, standardization of signal quantification, definitions and standardization of parameters of indocyanine green injection that correlate with postoperative PG function, the financial effect of these emerging technologies on near-term and longer-term costs, the adoption learning curve and effect on surgical training, and long-term outcomes of key quality metrics in adequately powered randomized clinical trials evaluating PG preservation.

Radioiodine treatment (RAI) represents the most widespread and effective therapy for differentiated thyroid cancer (DTC). RAI goals encompass ablative (destruction of thyroid remnants, to enhance thyroglobulin predictive value), adjuvant (destruction of microscopic disease to reduce recurrences), and therapeutic (in case of macroscopic iodine avid lesions) purposes, but its use has evolved over time. Randomized trial results have enabled the refinement of RAI indications, moving from a standardized practice to a tailored approach. In most cases, low-risk patients may safely avoid RAI, but where necessary, a simplified protocol, based on lower iodine activities and human recombinant TSH preparation, proved to be just as effective, reducing overtreatment or useless impairment of quality of life. In pediatric DTC, RAI treatments may allow tumor healing even at the advanced stages. Finally, new challenges have arisen with the advancement in redifferentiation protocols, through which RAI still represents a leading therapy, even in former iodine refractory cases. RAI therapy is usually well-tolerated at low activities rates, but some concerns exist concerning higher cumulative doses and long-term outcomes. Despite these achievements, several issues still need to be addressed in terms of RAI indications and protocols, heading toward the RAI strategy of the future.

Histologic and pTNM classification of differentiated thyroid cancer (DTC) is mandatory to assess risk of relapse, risk of death, and radioactive iodine administration. The impact of an expert central review of external pathology reports has not yet been reported.Monocentric retrospective study to evaluate the difference between initial and second-opinion histopathologic diagnosis for DTC patients referred for post-operative radioactive iodine administration between January 2014 and December 2016. We evaluated major discordance (change of diagnosis from malignant to benign or in main histological subtype or a description of aggressive pathological subtypes), minor discordance (change in histological subtype or description of an aggressive component, multifocality or extrathyroidal extension), and change in ATA classification.A second-opinion histological diagnosis was available for 199 patients. A major discordance was observed in 42 (21%) cases (changes in malignancy in 4 cases, changes in main histological subtype in 22, changes in aggressive pathology variants of PTC in 16). One hundred and four minor discordances were observed regarding 92 patients. These histopathological changes led to changes in the ATA 2015 risk stratification classification in 61 (31%) of cases. There were no predictive factors of major/minor histologic changes or ATA risk stratification changes.Expert central review of pathology has an impact on the 2015 ATA risk stratification classification that can lead to changes in the management of patients with differentiated thyroid cancer.

Anaplastic thyroid carcinoma (ATC) is a rare and undifferentiated form of thyroid cancer. Its prognosis is poor: the median overall survival (OS) of patients varies from 4 to 10 months after diagnosis. However, a doubling of the OS time may be possible owing to a more systematic use of molecular tests for targeted therapies and integration of fast-track dedicated care pathways for these patients in tertiary centers. The diagnostic confirmation, if needed, requires an urgent biopsy reread by an expert pathologist with additional immunohistochemical and molecular analyses. Therapeutic management, defined in multidisciplinary meetings, respecting the patient’s choice, must start within days following diagnosis. For localized disease diagnosed after primary surgical treatment, adjuvant chemo-radiotherapy is recommended. In the event of locally advanced or metastatic disease, the prognosis is very poor. Treatment should then involve chemotherapy or targeted therapy and decompressive cervical radiotherapy. Here we will review current knowledge on ATC and provide perspectives to improve the management of this deadly disease.

A 59-year-old woman with locally invasive poorly differentiated thyroid cancer with synchronous lung, mediastinal, and bone metastases and a somatic

Treatment of differentlated thyroid cancers. Surgery is the first - and sometimes the only - treatment of differentiated thyroid cancers. The main goal is to resect all macrospcopic disease with low permanent morbidity. Total thyroidectomy is most often the recommended treatment, but in some cancers active surveillance or lobectomy can also be performed. Neck dissections are recommended in case of macroscopic lymph node metastases, but in the absence of known neck lymph node metastases, prophylactic neck dissection is controversial. Following initial surgery the administration of radioactive iodine (RAI) is not systematic due to the absence of demonstrated benefits on overall survival or on disease-free survival in most patients. Indications for RAI are based on the risk of post-operative persistent disease or relapse during further follow-up. This risk is based on the pathology of the thyroid cancer and on the results of post-operative neck ultrasonography and thyroglobulin levels. In the absence of prospective randomized studies on the utility of RAI, indications and administration modalities can vary from one center to another. Indications for RAI are discussed for each patient in multidisciplinary teams. Follow- up is based on the results of neck ultrasonography and thyroglobulin measurement performed 6 to 12 months after initial treatment. Patients are then classified into 4 categories: excellent response, indeterminate response, biochemical incomplete response, or structural incomplete response. Further management is based on the response category.Prise en charge des cancers différenciés de la thyroïde. La chirurgie est la première (et parfois la seule) étape thérapeutique des cancers thyroïdiens différenciés. Elle a pour principal objectif de réséquer la maladie macroscopique tout en minimisant les morbidités permanentes liées au traitement. La thyroïdectomie totale est le traitement le plus souvent recommandé. Cependant, la lobectomie ou une surveillance active peuvent également être proposées pour certains cancers. Les curages ganglionnaires sont recommandés lorsqu’il existe des métastases ganglionnaires cervicales connues (cN1) et ils doivent alors être les plus complets possible, alors qu’en absence d’adénopathie métastatique (cN0) leur réalisation est discutée. À la suite d’un traitement chirurgical complet, l’administration postopératoire d’iode radioactif (iode 131) n’est pas systématique, en l’absence de bénéfice démontré sur la survie et sur le risque de récidive chez la plupart des patients. Les indications d’iode 131 sont fondées sur le risque de maladie résiduelle postopératoire et sur le risque de rechute ultérieure. Ce risque peut être fondé sur les caractéristiques histologiques du cancer ou sur les résultats d’une échographie cervicale et d’un taux de thyroglobuline postopératoires. En l’absence d’études prospectives randomisées statuant sur les indications et les modalités d’administration d’iode 131, celles-ci peuvent varier d’un centre à l’autre et sont posées en réunion multidisciplinaire. La surveillance ultérieure repose sur l’échographie cervicale et le dosage de thyroglobuline réalisés 6 à 12 mois après la chirurgie. Selon ce bilan, les patients sont classés en quatre catégories : excellente réponse au traitement, anomalies de signification inconnue, anomalies biologiques sans anomalies morphologiques et anomalies morphologiques. La prise en charge et la surveillance ultérieure sont adaptées à chacune de ces catégories.

The purpose of this publication was to inform surgeons as to the modern state-of-the-art evidence-based guidelines for management of the recurrent laryngeal nerve invaded by malignancy through blending the domains of 1) surgical intraoperative information, 2) preoperative glottic function, and 3) intraoperative real-time electrophysiologic information. These guidelines generated by the International Neural Monitoring Study Group (INMSG) are envisioned to assist the clinical decision-making process involved in recurrent laryngeal nerve management during thyroid surgery by incorporating the important information domains of not only gross surgical findings but also intraoperative recurrent laryngeal nerve functional status and preoperative laryngoscopy findings. These guidelines are presented mainly through algorithmic workflow diagrams for convenience and the ease of application. These guidelines are published in conjunction with the INMSG Guidelines Part I: Staging Bilateral Thyroid Surgery With Monitoring Loss of Signal. Level of Evidence: 5 Laryngoscope, 128:S18-S27, 2018.

Introduction HPV-driven oropharyngeal cancer (OPC) patients have a better prognosis than their HPV-negative counterparts but several studies have suggested that among HPV-positive patients those with a smoking history had worse oncological outcomes. The aim of our study is to characterize the interplay between tobacco consumption, patient and disease characteristics, and disease control. Materials and methods All patients diagnosed with HPV-driven OPC and treated with curative intent between 2007 and 2009 and 2011–2016 at Gustave Roussy cancer center were included (n = 282). Demographic, clinical, morphological and tobacco consumption were correlated with oncologic outcomes. Results 157 (56%) patients had a positive smoking history, including 23.8% who were smoking at the time of diagnosis and 37.6% who had a tobacco consumption exceeding 20 pack-years. In multivariate analysis, the strongest prognostic factor for survival was smoking status at cancer diagnosis, with a hazard ratio (HR) for non-smokers compared to smokers of 0.25 ([0.12, 0.50], p = 0.0001). Smoking history, either more than 20 pack-years or smoking at diagnosis, was associated with local relapse and distant relapse. There was no difference in terms of comorbidity (p = 0.32) and radiotherapy duration (p = 0.93) according to tobacco consumption. Discussion Smoking is frequent among patients with HPV-driven OPC and increases the risk of death and oncologic failure.

To evaluate the added value ofWe included 27 consecutive patients with primary HPT (19 F; median age: 58 years), with either (i) non-conclusive pre-surgical localization with

Aims: The BRAFV600E oncogene, reported in 40%–60% of papillary thyroid cancer (PTC), has an important role in the pathogenesis of PTC. It is associated with the loss of thyroid iodide-metabolizing genes, such as sodium/iodide symporter (NIS), and therefore with radioiodine refractoriness. Inhibition of mitogen-activated protein kinase (MAPK) pathway, constitutively activated by BRAFV600E, is not always efficient in resistant tumors suggesting that other compensatory mechanisms contribute to a BRAFV600E adaptive resistance. Recent studies pointed to a key role of transforming growth factor β (TGF-β) in BRAFV600E-induced effects. The reactive oxygen species (ROS)-generating NADPH oxidase NOX4, which is increased in PTC, has been identified as a new key effector of TGF-β in cancer, suggestive of a potential role in BRAFV600E-induced thyroid tumors.

The objective of this article is to summarize the knowledge as for the side effects related to axitinib in terms of incidence, etiology and symptoms for the effects requiring a specific management.This article follows upon the recommendations for the clinical practice, published in 2011, which detailed the management of secondary specific toxicities related to targeted therapies prescribed for the treatment of metastatic renal cell carcinoma with a focus on axitinib.Overall, the toxicity profile of axitinib is better the other tyrosine kinase inhibitors. The ENT side effects and polycythemia, which had not been initially described with other molecules, seem more frequent. Regarding management and follow-up of side effects with axitinib, as for the other targeted therapies used in metastatic renal carcinoma, there are no crucial changes since the recommendations of 2011.The management of side effects remains similar to the recommendations published in 2011. Only preventive measures and management of ENT side effects and polycythemia must be integrated in new thesaurus.

Medullary thyroid carcinoma (MTC) is rare in children. MTC is almost always inherited and occurs as part of a multiple endocrine neoplasia type 2A and B, due to germline mutation in the RET proto-oncogene. MTC in the pediatric population is most often diagnosed in the course of a familial genetic investigation. But when the child is the proband, a de novo mutation is most often founded. The main aim is to treat MTC before extrathyroidal extension occurs because when distant metastases are present, it is rarely curable. Treatment is based on total thyroidectomy with cervical lymph node dissection.

Thyroid carcinoma is a rare disease in children, and is mostly of the papillary histological type. Lymph node metastases are frequent at diagnosis, being present in 23 to 74% of the cases and can reveal the cancer in about one fourth of cases. Lung metastases are present at initial diagnosis in 6 to 20% of cases. The main known risk factor for thyroid cancer is a previous history of radiation exposure. Treatment includes surgery with total thyroidectomy and lymph node dissection and radioiodine therapy in case of extensive disease and distant metastases. Life-long thyroxine treatment is given to all patients. Long term prognosis is favourable, but thyroid cancer related deaths have been reported some decades after initial treatment.

Sinonasal cancers are rare and associated with a poor prognosis. The purpose of this study was to report our experience and analyze the risk factors for oncologic failures.A retrospective review of 156 consecutive patients treated with curative intent for sinonasal malignancy between 1995 and 2005 at tertiary cancer center was performed. Demographic, clinical, morphological, and pathological parameters were correlated with oncologic outcomes.Complete response was obtained for 134 patients. Sixty-eight patients relapsed, among which 51 had local recurrence. Nine of these 51 patients (17.6%) underwent successful salvage therapy. Five-year local failure and overall survival rates were 50.0% and 61.1%, respectively. Maxillary sinus tumors, intracranial invasion, and N 0 classification at initial diagnosis were significantly and independently associated with local failure and survival in multivariate analysis.Local control after initial treatment is primordial to optimizing outcomes because of the poor results of salvage therapy.

Transoral laser surgery has become a therapeutic option and even a standard for certain tumors of the larynx and pharynx. The postoperative course after this type of minimally invasive surgery has been shown to be significantly simpler, with less need for temporary tracheotomy and enteral feeding. For selected tumors amenable to this approach, the oncologic results have been shown to be equivalent to those obtained by classic external approaches. Transoral laser surgery requires specific equipment and training of the surgeon, the anaesthesiologist, the operating room team and the pathologist. Despite this specificity, but because of the simplified postoperative course, transoral laser surgery has already supplanted several external approaches and will in the future probably replace other techniques, as experience with the technique increases and the indications evolve.

Mathematical models are being developed at a fast rate in industry thanks to computer technology; they are used to simulate motion and deformation over time to test materials and objects in a virtual manner. These modeling techniques are being developed in medicine, but they remain, at this time, in the domain of biomechanica. research. We report a mathematical model for cutaneous excision and suture, which we have used to predict the deformations and tensions that result when using four different forms of excision. The results are expressed in numerical and graphic form. The results obtained corresponded with our experience in dermatologic surgery. Uses and limits of this model are discussed.