Preoperative comprehensive malignancy risk estimation for thyroid nodules: Development and verification of a network-based prediction model

BackgroundIn order to avoid excessive treatment of thyroid nodules in the clinic, it is necessary to find a simple and practical analysis method to comprehensively and accurately reflect benign or malignant thyroid nodules. This study aimed to construct and validate a comprehensive and reliable network-based predictive model using a variety of imaging and laboratory criteria for thyroid nodules to stratify the risk of malignancy prior to surgery.MethodsWe retrospectively analyzed data from patients who underwent surgical treatment for thyroid nodules at the Thyroid and Breast Diagnosis and Treatment Center of Weifang Hospital of Traditional Chinese Medicine between January 2018 and December 2020. Binary logical regression analysis was performed to predict whether nodules were malignant or benign. The developmental dataset included 457 patients (January 2018–December 2020). The validation set included separate data points (n = 225, January 2018–December 2020).ResultsIn this study, criteria that showed significant predictive value for malignant nodules included TI-RADS: 4b (p = 0.065); Bethesda IV, Bethesda V, Bethesda VI (P < 0.0001); BRAF^V600E mutation (P < 0.0001); Calcitonin>5 pg/ml (p = 0.0037); and FNA-Tg>30 ng/ml (p = 0.0003). A 10-grade risk scoring system was developed. The risk of malignancy risk ranged from 2.06% to 100% and was positively associated with increasing risk grade. The areas under the receiver-operating characteristic curve of the development and validation sets were 0.972 and 0.946, respectively.ConclusionA simple, comprehensive and reliable web-based predictive model was designed using a variety of imaging and laboratory criteria to stratify thyroid nodules by probability of malignancy.     

Findings from an OMFS journal club: is COVID-19 the catalyst we have needed to embrace technology?

The COVID-19 outbreak has rapidly progressed into a worldwide pandemic, and the need for social distancing has changed the way we learn and work. Our monthly OMFS journal club has been no different, and is currently meeting on the video conferencing application Microsoft Teams. The use of a virtual setting for training in medicine and dentistry is not new and, as in the case of our recent move to a virtual medium, it may be that COVID-19 has fast-tracked this digital transformation. There are of course disadvantages to online teaching that traditional face-to-face teaching overcomes. We conducted a survey to examine how trainees' attitudes and experiences have altered with this change, and to understand whether some elements of this new style of training may be advantageous in the post-pandemic world. We aimed to assess trainees’ attitudes towards online teaching, and which elements, if any, would be beneficial once face-to-face teaching becomes possible again. A survey was created for all trainees taking part in journal club meetings at Bradford Teaching Hospitals. Multiple-choice and Likert scale questions were designed to ascertain the differences in experience between online and face-to-face settings. A Wilcoxon matched pairs signed test was used to analyse the results. Responses were kept anonymous. Results showed that the majority of trainees found it easier to attend the online journal club, and also indicated that the most found Microsoft Teams easy to use, though we did not have another online application for comparison. There was no significant difference in participation comfort between the two settings, though trainees felt that the online setting considerably improved learning effectiveness. Furthermore, 79% (11/14) thought that online tutorials and meetings should replace traditional face-to-face meetings in the future. The use of internet technology such as video conferencing is not new, and although journal clubs are typically held in academic institutions, online and virtual clubs are flourishing. With an array of advantages, there is no shying away from the trend to move our teaching to a virtual medium. COVID-19 may have just provided the stimulus that has forced this transformation to accelerate.     

Use of the Rocket Technique after Failure of the Direct Aspiration First-Pass Technique in Acute Stroke Thrombectomy

The technical feasibility of the rocket technique was evaluated for patients treated for stroke where the direct aspiration first-pass technique (ADAPT) failed to reach the occlusion site. This single-center retrospective study included data on consecutive patients with a large vessel occlusion of the anterior circulation who underwent mechanical thrombectomy. Of 138 patients, 100 met the inclusion criteria. In 84 patients, a large 0.072-inch inner lumen aspiration catheter was able to reach the occlusion site when deployed with a coaxial microcatheter. In 16 patients, this technique failed, and the microcatheter was replaced with a compliant balloon inflated at the extremity of the aspiration catheter (rocket technique). In 15 of these 16 patients, the rocket technique brought the catheter into contact with the thrombus. In conclusion, when deployment of the ADAPT with a coaxial microcatheter fails to reach the clot site, the rocket technique can safely advance the aspiration catheter to the clot.     

Anaplastic thyroid carcinoma: diagnostic challenges,histopathologic features and ancillary testing

Anaplastic thyroid carcinoma (ATC) is an aggressive thyroid malignancy with high mortality rate. This malignancy arises in thyroid follicular cells either denovo or with an associated differentiated thyroid carcinoma component. Clinically, it usually presents as a rapidly enlarging mass, pain and locally compressive symptoms. Histopathologic variability and heterogeneity often pose diagnostic challenges, especially in scant and paucicellular specimens. This article describes the clinical, histopathologic and molecular features of ATC and also addresses the associated diagnostic limitations and challenges.     

Thyroid Embolization for Nonsurgical Treatment of Nodular Goiter: A Single-Center Experience in 56 Consecutive Patients

PurposeTo investigate the safety and efficacy of thyroid artery embolization (TAE) in the treatment of nodular goiter (NG).MethodsDuring a 5.5-year period, 56 consecutive patients with a NG underwent TAE. In Group A, there were 20 patients with a solitary/dominant 5–11-cm nodule, and in Group B, there were 36 patients with numerous nodules. Of the 56 patients, 47 (84%) had a retrosternal goiter and 25 had hyperthyroidism. In all patients, clinical and radiological evaluations were made at baseline and 6 months after TAE, and these parameters were statistically compared.ResultsIn 56 patients, 145 of the 146 thyroid arteries were successfully embolized. The 30-day mortality rate was 1.8%. Minor and major complications occurred in 25 and 2 patients, respectively. Six months after the TAE, the mean nodule volume was reduced from 80.2 mL to 25.0 mL, the mean thyroid volume was reduced from 147.0 mL to 62.6 mL, and the mean intrathoracic extension was reduced from 31.7 mm to 15.9 mm (P < .001). Of the 22 patients with non–Graves hyperthyroidism, 19 (86%) became euthyroid. The mean thyroid-related patient-reported outcome scores improved from 155.4 to 70.4 (P < .001). Of the 51 patients, 50 (98%) declared that they would recommend TAE to other patients with NG.ConclusionsTAE is safe and effective for the treatment of NG, with a significant volume reduction of the nodule(s) and thyroid gland.