Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background 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.Methods 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.Findings 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 center dot 6%] female patients and 4922 [21 center dot 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 center dot 4 [IQR 0 center dot 6-3 center dot 4]) compared with the prepandemic phase (2 center dot 0 [0 center dot 9-3 center dot 7]; p<0 center dot 0001) and pandemic decrease phase (2 center dot 3 [1 center dot 0-5 center dot 0]; p<0 center dot 0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69 center dot 0%] of 3704 vs 1515 [71 center dot 5%] of 2119; OR 1 center dot 1 [95% CI 1 center dot 0-1 center dot 3]; p=0 center dot 042), lymph node metastases (343 [9 center dot 3%] vs 264 [12 center dot 5%]; OR 1 center dot 4 [1 center dot 2-1 center dot 7]; p=0 center dot 0001), and tumours at high risk of structural disease recurrence (203 [5 center dot 7%] of 3584 vs 155 [7 center dot 7%] of 2006; OR 1 center dot 4 [1 center dot 1-1 center dot 7]; p=0 center dot 0039).Interpretation Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.Funding None.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved

Role of Malondialdehyde (Mda) in Patients with Breast Cancer Diseases

Background: Breast cancer is one of the most common cancers as well as one of the leading causes of cancer mortality in women worldwide. Cancer risk potentially continues to increase because of the many sources of exposure to carcinogenic chemical compounds. Carcinogenic compounds can contribute to free radical formation which might further interact and damage biomolecules such as lipids. Lipid peroxidation will increase malondialdehyde (MDA) levels, triggering gene mutations that leads to cancer. Objective: The purpose of this research was to measure and compare MDA levels between breast cancer patients and control.Methods: This research was observational research using a cross-sectional comparative design of 30 breast cancer patients and 30 healthy controls. The place of this research is in Ropanasuri specialized surgery hospital and biochemical laboratory, Faculty of Medicine, Andalas University, Padang. This research was conducted from August to September 2019. The MDA was measured using a spectrophotometer and an independent T-test was done.Results: The result of this research showed the mean MDA level of breast cancer patients was 3.98 ± 0.35 nmol/ml, higher than controls was 3.04 ± 0.36 nmol/ml with p-value = 0.001.Conclusion: There were significant differences in MDA levels among breast cancer patients and control in Ropanasuri specialized surgery hospital, Padang

Metilasi Promoter Gen BRCA1 dan Pengaruhnya terhadap Karakteristik Kanker Payudara Premenopausal Sporadik Etnis Minang

Karsinoma payudara sporadik merupakan kanker yang paling sering pada wanita premenopause etnis Minang. Terdapat perbedaan faktor risiko dan karakteristik tumor jika dibandingkan dengan pasien Kaukasian. Diduga faktor metilasi pada promoter BRCA1 berperan dalam kejadian ini. Penelitian ini bertujuan untuk mendeskripsikan kejadian metilasi promoter gen BRCA1 pada pasien kanker payudara premenopause sporadik etnis Minang. Penelitian menggunakan metoda deskriptif analitik pemeriksaan metilasi dengan teknik Bisulfit PCR pada promoter gen BRCA1 pada 43 jaringan kanker payudara sporadik usia premenopause etnis Minang yang diobati di RS M Jamil Padang. Faktor prognosis yang diperiksa adalah stadium, gradasi tumor, indeks mitosis, dan pemeriksaan imunohistokimia (Er,Pr,HER2,Ki67). Didapatkan 35 pasien kanker payudara yang memenuhi syarat, dengan perincian: 17,2% stadium II, 71,4% stadium III, dan 11,4% stadium IV. Subtipe adalah Luminal A 16 orang (17,1%), Luminal B 9 orang (25,7 %), HER2 3 orang (8,6%) dan TNBC 17 orang (48,6%). Metilasi pada jaringan kanker didapatkan pada 21 pasien (60 %). Metilasi berhubungan dengan derajat proliferasi tinggi (Ki67 >14%), stadium lanjut, dan subtipe jenis TNBC. Kanker payudara dengan metilasi pada promoter gen BRCA1 memiliki prognosis lebih buruk. Perlu penelitian lebih lanjut untuk melihat dampak klinis obat anti-metilasi pada penderita KPD dengan metilasi pada promoter BRCA1. Sporadic breast carcinoma is the most common cancer among premenopausal Minang ethnic women. There are differences of risk factors and tumor characteristics compared with Caucasian patients. It was assumed that promoter methylation in BRCA1 plays a role in this differences. This descriptive analytic study aimed to describe the incidence of promoter methylation in the BRCA1 gene in sporadic premenopausal ethnic Minang breast cancer patients. This research used methylation with bisulfate PCR technique method in the BRCA1 promoter in 43 sporadic premenopausal ethnic Minang breast cancer patients at M Djamil Hospital Padang. Stage, tumor grading, mitotic index, and immunohistochemical examination (Er, Pr, HER2, Ki67) are examined prognostic factor. Among eligible 35 breast cancer patients, 17.2% are stage II, 71.4% are stage III and 11.4% are stage IV. Cancer subtypes were Luminal A in 16 patients (17.1%), Luminal B in 9 patients (25.7%), HER2 in 3 patients (8.6%), and TNBCin 17 patients (48.6%). Methylation in cancer tissue was found in 21 patients (60%). Methylation associated with a high degree of proliferation (Ki67>14%), advanced stage and type of TNBC subtypes. Breast cancer with promoter methylation in the BRCA1 gene have a worse prognosis. Further research is needed to study the clinical impact of antimethylation in breast cancer patients with BRCA1 promoter methylation

Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Background: 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. Methods: 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. Findings: 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<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). Interpretation: Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. Funding: None