Current surgical status of thyroid diseases

Thyroid nodules are a common clinical problem for surgeons. The clinical importance of nodules is the need to exclude thyroid cancer, which occurs in 5%–15% of patients. If fine needle aspiration cytology is positive, or suspicious for malignancy, surgery is recommended. During the past decade, with the tendency to develop smaller incisions, an endoscopic approach has been applied to thyroid surgery, called minimally invasive video-assisted thyroidectomy. This approach was immediately followed by other minimally invasive or scarless neck techniques, such as the breast approach, axillary-breast approach, and robot-assisted method. All these techniques follow the same principles of surgery and oncology. This review presents the current surgical management of the thyroid gland, including the surgical techniques and compares them by describing benefits and drawbacks of each one

Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer : Management in the HPV Era

Background Patients with metastases in the lymph nodes of the neck and no obvious primary tumor, neck cancer with unknown primary (NCUP), represent a management challenge. A majority of patients have metastatic squamous cell carcinoma (SCC), although other histologies do occur. Methods We comprehensively reviewed the literature, compared available guidelines, and conferred with an international team of experts. Results Positron emission tomography-computed tomography (PET-CT) and fine needle aspiration (FNA) under ultrasound guidance increase accuracy of diagnosis. Immunohistochemistry (IHC), determination of human papilloma virus (HPV) status, by p16 staining or by in situ hybridization (ISH), and next-generation gene sequencing can guide us regarding probable primary sites and tumor biology. Narrow Band Imaging (NBI) has been introduced for the early detection of subtle mucosal lesions. Direct laryngoscopy (DL) and tonsillectomy have long been procedures used in the search for a primary site. More recently, TransOral Robotic Surgery (TORS) or Transoral LASER Microsurgery (TLM) have been introduced for lingual tonsillectomy. Conclusions New technologies have been developed which can better detect, diagnose, and treat occult primary tumors. Decisions regarding therapy are based on the primary tumor site (if discovered) and N stage. Options include neck dissection with or without postoperative adjuvant therapy, primary irradiation, or combined chemotherapy with irradiation. The preferred treatment of patients whose primary remains unidentified is controversial.Peer reviewe

Risk of Complications in Patients Undergoing Completion Thyroidectomy after Hemithyroidectomy for Thyroid Nodule with Indeterminate Cytology: An Italian Multicentre Retrospective Study

There is still controversy as to whether patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery. The main aim of this study was to investigate this topic. Patients undergoing a thyroidectomy for thyroid nodular disease with an indeterminate cytology in four high-volume thyroid surgery centres in Italy, between January 2017 and December 2020, were retrospectively analysed. Based on the surgical procedure performed, four groups were identified: the TT Group (total thyroidectomy), HT Group (hemithyroidectomy), CT Group (completion thyroidectomy) and HT + CT Group (hemithyroidectomy with subsequent completion thyroidectomy). A total of 751 patients were included. As for the initial surgery, 506 (67.38%) patients underwent a total thyroidectomy and 245 (32.62%) a hemithyroidectomy. Among all patients submitted to a hemithyroidectomy, 66 (26.94%) were subsequently submitted to a completion thyroidectomy. No statistically significant difference was found in terms of complications comparing both the TT Group with the HT + CT Group and the HT Group with the CT Group. The risk of complications in patients undergoing a completion thyroidectomy after a hemithyroidectomy for a thyroid nodule with an indeterminate cytology was comparable to that of patients submitted to primary thyroid surgery (both a total thyroidectomy and hemithyroidectomy)

Thyroglossal duct cyst carcinoma

Not required for Clinical Vignette

An anthropomorphic thyroid phantom for ultrasound-guided radiofrequency ablation of nodules

Background: Needle-based procedures such as fine needle aspiration (FNA) and thermal ablation, are often applied for thyroid nodule diagnosis and therapeutic purposes, respectively. With blood vessels and nerves nearby, these procedures can pose risks in damaging surrounding critical structures. Purpose: The development and validation of innovative strategies to manage these risks require a test object with well-characterized physical properties. For this work, we focus on the application of ultrasound-guided thermal radio-frequency ablation (RFA). Methods: We have developed an anthropomorphic phantom mimicking the thyroid and surrounding anatomical and physiological structures that are relevant to ultrasound-guided thermal ablation. The phantom was composed of a mixture of polyacrylamide, water, and egg white extract and was cast using molds in multiple steps. The thermal, acoustical, and electrical characteristics were experimentally validated. The ablation zones were analyzed via non-destructive T2-weighted MRI scans utilizing the relaxometry changes of coagulated egg albumen, and the temperature distribution was monitored using an array of fiber Bragg sensors. Results: The physical properties of the phantom were verified both on ultrasound as well as its response to thermal ablation. The final temperature achieved (92{\deg}C), the median percentage of the nodule ablated (82.1%), the median volume ablated outside the nodule (0.8 mL), and the median number of critical structures affected (0) were quantified. Conclusion: An anthropomorphic phantom that can provide a realistic model for development and training in ultrasound-guided needle-based thermal interventions for thyroid nodules has been presented. In the future, this model can also be extended to novel needle-based diagnostic procedures.Comment: 19 pages, 10 figures, 3 table

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63263/1/thy.2006.16.109.pd

FULLY AUTOMATED REAL-TIME PCR IN MOLECULAR PATHOLOGY: NOVEL APLLICATIONS

A deeper knowledge of cancer biology, alongside advances in diagnostic technologies, has led to much more effective therapeutic strategies in Indeed, over the last decade or so, the incessant quest for new genetic alterations capable of predicting patient response to treatments, has given rise to the development of highly sophisticated molecular tests Accordingly, many sequencing platforms can nowadays detect multiple driver mutations simultaneously thanks to fully automated procedures which drastically reduce turnaround time and costs. A case in point is the Idylla™ system (Biocartis NV, Mechelen, Belgium. This system is a fully automated sample-to-result Real-Time PCR with all reagents integrated in a single-use cartridge; it consists of a console which displays results as either "mutation" or "no mutation" when DNA quality is adequate, or as "invalid" when it is. What is most striking about this platform is that the cartridge can run multiple sample types, including solid and liquid biopsies, yielding results within approximately two hours. Another advantage is its ease of use taking up only a couple of minutes of hands-on time to prepare samples and load the cartridge. This fascinating assay has been validated for the identification of many driver genes, both on tissue and on plasma specimens. In particular Idylla™ EGFR, Idylla™ BRAF, Idylla™ KRAS, Idylla™ NRAS-BRAF, and Idylla™ MSI have been validated on formalin fixed paraffin embedded (FFPE) samples; instead, Idylla™ ctKRAS and Idylla™ ctNRAS-BRAF have been validated on plasma samples. Many more are currently in the pipeline. The aim of my PhD project was to develop and validate novel clinical applications of the the Idylla™ system. I divided my thesis into four chapters. The first chapter focuses on the performance of the Idylla™ EGFR Assay on cytological non-small cell lung cancer samples. This test was specifically designed to process formalin-fixed, paraffin-embedded sections without requiring preliminary DNA extraction. On the other hand, my PhD work has demonstrated that this assay can also be used to process archival smears from patients with NSCLC by scraping the stained cellular material directly into the cartridge. The second chapter focuses on the viable application of Idylla™ NRAS-BRAF Assay to cytological thyroid fine-needle aspirates (FNAs) with undetermined morphology. Our research demonstrated that FNA needle rinses can be genotyped by the same cytopathologist who performs the FNA, a procedure that is commonly called rapid on-site molecular evaluation (ROME). The third chapter, instead, discusses the feasibility of using Idylla™ to analyze liquid biopsy specimens. Such application is highly important, given the scant availability of tissue specimens in advanced NSCLC patients. Our laboratory results have indeed demonstrated the efficiency of the Idylla™ ctKRAS Assay in detecting plasma the KRAS p.G12C mutation, a novel target in NSCLC patients. Finally, in the fourth chapter, I explore the analytical and clinical performance of the Idylla™ SARS-CoV-2 test on previously tested SARS-CoV-2 people by conventional RT-PCR based approach in different settings, including initial diagnosis and clinical follow-up. In this regard, I provide substantial evidence that this assay may represent a valid, fast, and highly sensitive and specific RT-PCR test for the identification of SARS-CoV-2 infection