Background: Radiofrequency ablation (RFA) for huge thyroid nodules often requires multiple sessions to achieve long-term efficacy. We present our experience with a stepwise approach utilizing a nodule margin-preserving ablation, termed the Eggshell technique, in the treatment of a thyroid nodule exceeding 9 cm in diameter.
Case description: A 44-year-old woman presented with compressive symptoms due to a large left thyroid solid nodule measuring 5.81 cm × 3.19 cm × 9.26 cm, with a volume of 90.84 mL. Cytopathology, including core needle biopsy, confirmed Bethesda Category II in two separate evaluations. RFA was performed under local anesthesia using the Eggshell technique, which preserved the nodule margin while ablating the internal tissue. The procedure lasted 83 minutes, delivering a total energy of 38.59 kJ. At 6 months, the nodule volume decreased to 29.75 mL [volume reduction ratio (VRR) 67.25%]. After three additional sessions, the volume further reduced to 1.59 mL (VRR 98.25%) at 42 months. The patient experienced minimal pain (pain score 1), with no hemorrhage, post-ablation edema, or nodule rupture. Serial ultrasonography allowed precise visualization of residual tissue, optimizing the timing of subsequent ablations.
Conclusions: This case suggests that the Eggshell technique, an evenly margin-preserving RFA strategy, may be a valuable option for managing huge thyroid nodules that inevitably require multiple sessions. By minimizing patient discomfort and complications, and facilitating decision-making during follow-up, this approach can complement conventional RFA techniques for large nodules.
Background: The 2015 American Thyroid Association (ATA) guidelines recommended hemithyroidectomy as an acceptable treatment for patients with differentiated thyroid cancer (DTC) tumors 1-4 cm. The primary objectives of this study were to trace the accumulation of evidence supporting hemithyroidectomy prior to the release of the 2015 ATA guidelines and to synthesize the available data on surgical outcomes for hemithyroidectomy and total thyroidectomy.
Methods: PubMed was systematically searched for studies comparing hemithyroidectomy and total thyroidectomy among adult patients with DTC ≥1 cm, focusing on patient outcomes including recurrence rates, overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS). Fixed-effects or random-effects models were applied as appropriate to estimate risk ratios (RRs) and hazard ratios (HRs) based on the Woolf test. Cumulative meta-analyses were also performed to illustrate changes in pooled estimates as studies were added incrementally by year of publication.
Results: The 14 studies, including 176,238 patients, were analyzed. Of these, 88.4% underwent total thyroidectomy and 11.6% (n=20,435) underwent hemithyroidectomy, with a mean follow-up time of 8 years. We found no significant differences between hemithyroidectomy and total thyroidectomy in recurrence rates [RR: 1.036, 95% confidence interval (CI): 0.698-1.538], OS (RR: 0.995; 95% CI: 0.985-1.006), or DSS (RR: 1.001; 95% CI: 0.998-1.005). Total thyroidectomy was associated with marginally better DFS compared to hemithyroidectomy (RR: 0.980, 95% CI: 0.963-0.997).
Conclusions: This systematic review and meta-analysis found that total thyroidectomy was associated with slightly greater DFS relative to hemithyroidectomy, but no statistically significant differences were observed in recurrence, OS, and DSS between the two procedures. The accumulation of evidence supporting hemithyroidectomy may have prompted the ATA to revise their guidelines and encouraged surgeons to increasingly consider hemithyroidectomy as a safe procedure for treating patients with DTC ≥1 cm.
Background: Breast reconstruction after mastectomy is crucial for physical and psychological recovery. While reconstruction rates have risen globally under supportive policies, utilization in China remains low, and nationwide data on patterns, costs, and access are scarce. This study aims to provide the first comprehensive analysis of the current status, costs, and regional disparities of breast reconstruction in Chinese plastic surgery department based on national quality control databases.
Methods: We analyzed three national databases [the National Clinical Improvement System (NCIS), the National Medical Quality Control Platform of Plastic and Aesthetic Medicine (QCP-PAM), and the Hospital Quality Monitoring System (HQMS)]. Variables included surgical volume, reconstruction type, perioperative antibiotic usage, surgical site infection rate, hospitalization cost, and self-pay ratio. Descriptive statistics, cross-database comparisons, and Pearson's correlations with socioeconomic indicators [per capita gross domestic product (GDP), urbanization rate] were performed.
Results: In 2022, NCIS recorded 30,530 breast cancer surgeries, with a phase I reconstruction rate of 6.4%. HQMS identified 490 reconstructions across 15 China's provincial-level administrative divisions (PLADs) in 2023, with mean hospitalization cost of CNY 53,695 and self-pay of 61.7%. Regional disparities were striking, with self-pay ranging from <10% to 100%. GDP correlated positively with cost (r=0.45) and negatively with self-pay (r=-0.60); urbanization was also negatively correlated with self-pay (r=-0.50).
Conclusions: This first nationwide analysis highlights low reconstruction rates, heavy financial burden, and marked geographic inequities. Expanded insurance, stronger infrastructure, and quality monitoring are needed to improve access. Limitations include incomplete provincial coverage, lack of detailed outcomes, and potential underreporting.
Background: Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, representing approximately 85-90% of cases. Galectin-3 (GAL-3) is a well-established histologic marker of thyroid cancer that is not expressed by normal thyroid cells. Our study aims to explore the potential utility of serum GAL-3 in differentiating PTC from benign thyroid tumors.
Methods: According to the postoperative pathology results, patients were divided into a benign thyroid tumor group (95 cases) and a PTC group (165 cases). Serum GAL-3 was detected by chemiluminescence immunoassay. Additionally, other markers, including human epidermal growth factor receptor 2 (HER2), Ki-67, cytokeratin 19 (CK19), thyroid peroxidase (TPO), and CD56, were detected by enzyme-linked immunosorbent assay (ELISA). Serum levels were compared between the two groups using SPSS 22.0.
Results: In patients with PTC, serum GAL-3 levels were significantly higher than those in patients with benign thyroid tumors (P=0.045). Similarly, serum HER2 and Ki-67 levels in PTC patients were also markedly higher than those in patients with benign thyroid tumors (P<0.05). However, no significant differences were found between the two groups in CK19, TPO, and CD56 (P>0.05). Multivariable analyses indicated that high GAL-3 [odds ratio (OR), 1.134; 95% confidence interval (CI): 1.046-1.228; P=0.002] and high Ki-67 (OR, 5.754; 95% CI: 2.947-11.234; P<0.001) levels were independent risk factors for PTC. The receiver operating characteristic (ROC) curve analysis revealed that GAL-3 and Ki-67 had an area under the curve (AUC) of 0.645 (sensitivity 60.9% and specificity 76.8%; P<0.001) and 0.764 (sensitivity 64.3% and specificity 81.4%; P<0.001) for distinguishing between benign thyroid tumors and PTC, respectively. When two markers were combined, the AUC increased to 0.785 (sensitivity 70.6% and specificity 87.4%; P<0.001).
Conclusions: Our results suggest that the combination of serum GAL-3 and Ki-67 may serve as a useful adjunct to existing diagnostic methods of thyroid cancer, such as ultrasonography and fine-needle aspiration biopsy (FNAB).
Background: Tissue expanders are widely used in both immediate and delayed breast reconstruction after mastectomy. With advances in surgical techniques and biomaterials, this field has seen continuous development. This study aimed to analyze the top 100 most-cited articles on tissue expanders in breast reconstruction to identify research trends and progress in this field.
Methods: The top 100 most cited articles were selected from the Web of Science Core Collection (WoSCC) for a systematic search. Comprehensive bibliometric analyses were conducted using VOSviewer, CiteSpace, and Bibliometrix. Additionally, clinical trial data were retrieved from ClinicalTrials.gov (https://www.clinicaltrials.gov) and the World Health Organization International Clinical Trials Registry Platform (ICTRP) (https://trialsearch.who.int).
Results: The top-cited articles span multiple disciplines, with the USA contributing the highest number of publications. China, Canada, and the UK ranked second in terms of publication volume. Representative institutions included the University of Michigan and Memorial Sloan Kettering Cancer Center. Key authors included Cordeiro PG and Wilkins EG. Frequent keywords were "implant", "mastectomy", "complications", and "radiotherapy". The most cited article was by Chun YS et al. [2010]. Of the clinical trials, 66 were retrieved from ClinicalTrials.gov and 37 from ICTRP. After removing duplicates, a total of 78 trials focused on tissue expanders in breast reconstruction were included.
Conclusions: Research on tissue expanders in breast reconstruction focuses on surgical optimization, complication management, biomaterials, and patient-reported outcome measures (PROMs). Current trends emphasize personalized reconstruction strategies and improved postoperative care. Challenges remain in addressing patient variability and biomaterial safety. Further research is needed to refine individualized approaches and improve clinical outcomes.
This investigation assesses the safety and practicality of using robotic assistance for harvesting the latissimus dorsi muscle flap (LDMF) for immediate reconstruction after breast-conserving surgery in breast cancer patients. A retrospective analysis was conducted on the medical records of 27 women who underwent immediate reconstruction using robot-assisted LDMF harvesting at our hospital between August 2019 and April 2024. Participants in this study had a mean age of 47.6±8.7 years. The average amount of breast tissue removed, encompassing the tumor, was 133.2±53.0 g. Tumors were most commonly found in the upper outer quadrant, accounting for 37% of cases. The total time required to complete breast-conserving surgery, lymph node evaluation or dissection, robot-assisted LDMF harvest, and subsequent breast reconstruction was, on average, 459.1±120.8 minutes. The average time for robot docking was 30 minutes, with a mean flap harvesting time of 201.1±74.7 minutes. Aside from seroma formation at the donor site, there were no other complications or delays in starting adjuvant treatment. No locoregional or systemic recurrence was observed over the mean follow-up period of 31.8±13.1 months. Overall patient-reported satisfaction was excellent or good in 88.9% of cases, with particularly high satisfaction regarding the absence of scarring. Robot-assisted LDMF harvesting is a safe and effective option for partial breast reconstruction, providing high patient satisfaction and minimal scarring.
Background: Bethesda IV follicular neoplasms [2-25% of fine-needle aspiration (FNA) diagnoses] pose significant diagnostic challenges due to their malignant potential. Thermal ablation (TA) has emerged as a minimally invasive alternative to surgery, though its safety for follicular neoplasms remains controversial given cytology's inability to assess capsular/vascular invasion-the diagnostic gold standard.
Case description: This case report analyzes two patients with Bethesda IV nodules treated with microwave ablation (MWA). Case 1 involved a 26-year-old female with a 5.1 cm nodule undergoing two MWA sessions, while Case 2 featured a 12-year-old female with a 2.6 cm nodule receiving single-session MWA. Both cases deviated from guideline-recommended dual preoperative FNAs. Both patients developed recurrence: Case 1: progression of thyroid carcinoma within the ablation zone and metastatic papillary carcinoma in cervical lymph nodes were surgically confirmed two years post-ablation. Case 2: a recurrent cystic-solid nodule (1.8 cm) was detected adjacent to the ablation zone during 9-month post-procedural surveillance. Notably, neither recurrence displayed typical follicular carcinoma histology, suggesting ablation-induced diagnostic obscuration.
Conclusions: These first-reported recurrence cases after TA for Bethesda IV nodules underscore critical limitations: violations of pre-ablation diagnostic protocols [dual FNA/core needle biopsy (CNB)] exacerbated malignancy risks, while TA-induced obscuration of histopathological evaluation delayed cancer diagnosis. Current guidelines appropriately exclude follicular neoplasms from TA indications, with surgical resection remaining the gold standard. TA should be restricted to validated research protocols pending establishment of robust risk-stratification criteria.
Background: Clinical investigations have demonstrated that the potential efficacy and safety of thermal ablation (TA) in treating papillary thyroid carcinoma in the isthmus (PTCI). However, almost all studies were non-randomized controlled trials with small sample sizes. This meta-analysis aims to comprehensively and systematically evaluate its effectiveness.
Methods: A systematic search for related studies was conducted in PubMed, EMBASE, and Cochrane Library from the database establishment to Jan 31, 2025. Outcomes including local tumor progression (LTP), postoperative volume, complete disappearance rate (CDR), locoregional recurrence (LRR), distant metastasis (DM) and complication, were evaluated for further analysis.
Results: The meta-analysis included 560 unifocal PTCI from seven studies. No LTP was found in all patients. It was found that tumor volume had decreased significantly at 12 and 18 months following TA, in contrast to baseline measurements (P<0.05). The pooled analysis demonstrated an 88.10% CDR for PTCI [95% confidence interval (CI): 66.20-99.87%], with an overall complication incidence of 0.89% (95% CI: 0.13-2.08%). Six patients developed new tumors (0.77%; 95% CI: 0.04-2.06%). Lymph node metastasis (LNM) was documented in a single case (1/468; 95% CI: 0.00-0.56%). During the follow-up period, no patients were found to have DM.
Conclusions: This meta-analysis indicated that TA possesses promising efficacy and safety for individuals with PTCI. Multinational, prospective studies are warranted to confirm its generalizability in the future.
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