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Frontiers in Endocrinology 2022This study is a meta-analysis based on evidence-based medicine to explore the long-term (≥3 years) efficacy of thermal ablation in the treatment of papillary thyroid... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study is a meta-analysis based on evidence-based medicine to explore the long-term (≥3 years) efficacy of thermal ablation in the treatment of papillary thyroid carcinoma (PTC).
METHODS
We searched the PubMed, Embase, and Cochrane Library databases for studies published during the time between the establishment of the databases through June 2022. We included 13 non-randomized-controlled trials (non-RCTs) that reported the application of ultrasound-guided thermal ablation in PTC. We excluded studies that were repeated publications, research without full text, contained incomplete information, lacked data extraction, involved animal experiments, reviews, and systematic reviews. STATA 15.1 software was used to analyze the data.
RESULTS
Tumor volume after thermal ablation at 3-year follow-up was significantly lower than pre-ablation (standardized mean difference [SMD] = -1.06, 95% CI: -1.32~-0.80). The pooled results indicated that the maximum diameter after thermal ablation at 3-year follow-up was significantly lower than pre-ablation (SMD = -1.93, 95% CI: -12.13~-1.73). The pooled results indicated that volume reduction rate (VRR) after thermal ablation at 3-year follow-up was 98.91% (95% CI: 97.98-99.83%), and complete disappearance rate (CDR) after thermal ablation at 3-year follow-up was 83% (95% CI: 67-94%). In addition, the incidence of newly discovered mPTC and lymph node metastases after thermal ablation was 0.3% (95% CI: 0.0-1.0%) and 0.0% (95% CI: 0.0-0.0%), respectively.
CONCLUSION
Overall, the long-term (≥3 years) efficacy of ultrasound-guided thermal ablation in the treatment of PTC was significant, with favorable disease progression. Ultrasound-guided thermal ablation can be considered an alternative approach for patients with PTC who refuse surgery or are unable to undergo surgery.
Topics: Humans; Thyroid Cancer, Papillary; Carcinoma, Papillary; Thyroid Neoplasms; Follow-Up Studies; Radiofrequency Ablation
PubMed: 36353232
DOI: 10.3389/fendo.2022.971038 -
Human Pathology Oct 2015Fine needle aspiration (FNA) with cytologic analysis is an initial step in diagnosing thyroid nodules that are suspicious for cancer. We systematically reviewed the test... (Meta-Analysis)
Meta-Analysis Review
Fine needle aspiration (FNA) with cytologic analysis is an initial step in diagnosing thyroid nodules that are suspicious for cancer. We systematically reviewed the test accuracy of B-type Raf kinase (BRAF(V600E)) gene mutation analysis plus conventional FNA in the diagnosis of papillary thyroid cancer. We identified studies reporting BRAF(V600E) mutation analysis after FNA for evaluation of thyroid nodules through searching MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, scanning reference lists of relevant studies, and contacting experts. Two independent reviewers screened literature results, abstracted data, and appraised study quality. When appropriate, bivariate and univariate random-effects meta-analyses of sensitivity and specificity were considered for all outcomes. Forty-seven studies met our inclusion criteria after screening 1560 citations and 169 full-text articles. The included studies enrolled approximately 16170 patients with 9924 FNA samples evaluated for BRAF(V600E) mutation. Univariate pooled sensitivity was 69% (95% confidence interval, 61%-76%) for papillary thyroid cancer. For thyroid nodules that were diagnosed cytologically as suspicious for papillary thyroid cancer, univariate pooled sensitivity using FNA and BRAF(V600E) results was 52% (95% confidence interval, 39%-64%). Despite its high specificity, our meta-analysis shows that BRAF(V600E) mutation analysis has a low sensitivity in diagnosing papillary thyroid cancer in thyroid nodules. The feasibility of this test as a single molecular tool is not well established, which indicates the need for well-designed prospective clinical studies.
Topics: Area Under Curve; Biopsy, Fine-Needle; Carcinoma; Carcinoma, Papillary; DNA Mutational Analysis; Humans; Proto-Oncogene Proteins B-raf; ROC Curve; Sensitivity and Specificity; Thyroid Cancer, Papillary; Thyroid Neoplasms
PubMed: 26232865
DOI: 10.1016/j.humpath.2015.06.001 -
Frontiers in Endocrinology 2022To evaluate the safety and efficacy of radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) for the treatment of cervical metastatic lymph... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To evaluate the safety and efficacy of radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA) for the treatment of cervical metastatic lymph nodes (CMLNs) of papillary thyroid carcinoma (PTC).
METHODS
The Pubmed, EMBASE, Web of Science, and Cochrane Library databases were searched for studies on the safety and efficacy of thermal ablations (RFA, MWA, and LA) for the treatment of CMLNs of PTC until March 30, 2022. A review of 334 potential papers identified 17 eligible papers including 312 patients. Fixed-effects model or random-effects model was used to evaluate the pooled proportions of volume reduction rate (VRR), complete disappearance, and recurrence, and pooled estimates of changes in the largest diameter, volume, and serum after ablation. The pooled proportions of overall and major complications were calculated. Subgroup analysis based on treatment modalities. The heterogeneity among studies was analyzed by using statistics and inconsistency index . MINORS scale was used to evaluate the quality of the studies.
RESULTS
17 eligible studies were finally identified, including 312 patients and 559 CMLNs. The pooled proportions of VRR, complete disappearance and recurrence of CMLNs were 91.28% [95% confidence interval : 86.60-95.97%], 67.9% [95% : 53.1-81.1%] and 7.8% [95%: 3.0-14.1%], respectively. The pooled estimates of changes in the largest diameter, volume and serum were 8.12 mm [95%: 6.78-9.46 mm], 338.75 mm [95%: 206.85 -470.65 mm] and 5.96 ng/ml [95%: 3.68-8.24 ng/ml], respectively. The pooled proportions of overall and major complications were 2.9% [95%: 0.3-7.1%] and 0.3% [95%: 0-1.9%], respectively. Significant between-study heterogeneity was observed for complete disappearance (<0.01, 88.6%), VRR (<0.001, 99.9%), recurrence (=0.02, 47.76%), overall complications (<0.02, 44.8%), and changes in the largest diameter ( < 0.001, 82.6%), volume (<0.001, 97.0%), and serum ( < 0.001, 93.7%). Subgroup analysis showed heterogeneity of the VRR among the treatment modality ( range: 84.4-100%). The VRR of MWA was the highest (97.97%), followed by RFA (95.57%) and LA (84.46%) ( < 0.001).
CONCLUSION
All thermal ablations were safe and effective for the treatment of CMLNs of PTC. However, each treatment had significant heterogeneity in VRR. Compared with RFA and MWA, LA was less effective in reducing the volume of CMLNs of PTC.
Topics: Catheter Ablation; Humans; Lymph Nodes; Radiofrequency Ablation; Thyroid Cancer, Papillary; Thyroid Neoplasms
PubMed: 36072932
DOI: 10.3389/fendo.2022.967044 -
World Journal of Surgery Sep 2018Central neck dissection and total thyroidectomy are standard treatments for patients with papillary thyroid carcinoma (PTC) with clinically involved central nodes.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Central neck dissection and total thyroidectomy are standard treatments for patients with papillary thyroid carcinoma (PTC) with clinically involved central nodes. However, prophylactic central neck dissection (pCND) in patients with clinically uninvolved cN0 has been beneficial in some studies but ineffective in others. We conducted a meta-analysis to evaluate the efficacy and safety of pCND in patients with central neck lymph nodes cN0 PTC.
METHODS
The PubMed, EMBASE, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were electronically searched for studies published until September 2017. The meta-analysis was conducted to calculate the pooled effect size by using random-effects model. Treatment efficacies were measured by determining locoregional recurrence (LRR). Secondary outcomes included transient recurrent laryngeal nerve (RLN) injury, permanent RLN injury, transient hypocalcemia, and permanent hypocalcemia.
RESULTS
Twenty-three retrospective and prospective cohort studies involving 18,376 patients were reviewed. Patients who underwent pCND had significantly lower LRR (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.48-0.88) but significantly higher incidence rates of transient RLN injury (OR 2.03; 95% CI 1.32-3.13), transient hypocalcemia (OR 2.23; 95% CI 1.84-2.70), and permanent hypocalcemia (OR 2.22; 95% CI 1.58-3.13) than that of no pCND group.
CONCLUSION
Compared with no pCND, pCND significantly reduces LRR but is accompanied by numerous adverse effects. The clinical decision should be made after the shared decision-making process of clinicians and patients.
Topics: Carcinoma, Papillary; Decision Making; Female; Humans; Hypocalcemia; Lymph Nodes; Male; Neck; Neck Dissection; Odds Ratio; Postoperative Complications; Recurrent Laryngeal Nerve Injuries; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroidectomy; Treatment Outcome
PubMed: 29488066
DOI: 10.1007/s00268-018-4547-4 -
Annals of Surgical Oncology Feb 2022The consensus guidelines for branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas are mostly based on imaging features. This study aimed to... (Meta-Analysis)
Meta-Analysis Review
Imaging Features for Predicting High-Grade Dysplasia or Malignancy in Branch Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Systematic Review and Meta-Analysis.
BACKGROUND
The consensus guidelines for branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas are mostly based on imaging features. This study aimed to determine imaging features and their diagnostic accuracy for predicting high-grade dysplasia (HGD)/malignancy in BD-IPMN, including mixed type.
METHODS
The PubMed, Embase, and Cochrane databases were searched, and data were extracted from relevant studies. As the main diagnostic accuracy index, diagnostic odds ratios (DORs) of imaging features for diagnosing HGD/malignancy in BD-IPMNs were pooled using the random-effects model. A bivariate random-effects approach was used to construct summary receiver operating characteristic curves for sensitivity and specificity estimation.
RESULTS
The pooled DOR was the highest for the enhanced solid component/mural nodule (MN) (DOR, 12.21; 95 % confidence interval [CI], 6.14-24.27), followed by a main pancreatic duct (MPD) diameter of 10 mm or greater (DOR, 7.93; 95 % CI, 3.02-20.83), solid component (DOR, 4.85; 95 % CI, 2.49-9.42), lymphadenopathy (DOR, 4.84; 95 % CI, 1.11-21.06), MN (DOR, 4.48; 95 % CI, 3.15-6.39), an MPD diameter of 5 mm or greater (DOR, 3.69; 95 % CI, 2.62-5.19), abrupt change in MPD caliber with distal pancreatic atrophy (DOR, 2.65; 95 % CI, 1.66-4.24), thickened/enhancing walls (DOR, 2.38; 95 % CI, 1.57-3.60), and cyst size of 3 cm or larger (DOR, 1.98; 95 % CI, 1.48-2.64). The largest area under the curve (0.89 and 0.95, respectively) and high specificity (0.95 and 0.98, respectively) also were found for enhanced solid component/MN and an MPD diameter of 10 mm or greater, albeit with low sensitivity (0.38 and 0.14, respectively).
CONCLUSIONS
The aforementioned imaging features could aid in predicting HGD/malignancy of BD-IPMN. Furthermore, enhanced solid component/MN and an MPD diameter of 10 mm or greater were the most important predictors of HGD/malignancy in BD-IPMN and should be considered as indications for surgery.
Topics: Adenocarcinoma, Mucinous; Carcinoma, Pancreatic Ductal; Humans; Pancreas; Pancreatic Ducts; Pancreatic Neoplasms; Retrospective Studies
PubMed: 34554343
DOI: 10.1245/s10434-021-10662-2 -
Pancreas Oct 2016This study aimed to evaluate the accuracy of the risk factors proposed by Fukuoka guidelines in detecting malignancy of branch-duct intraductal papillary mucinous... (Meta-Analysis)
Meta-Analysis Review
Risk Factors for Malignancy of Branch-Duct Intraductal Papillary Mucinous Neoplasms: A Critical Evaluation of the Fukuoka Guidelines With a Systematic Review and Meta-analysis.
OBJECTIVES
This study aimed to evaluate the accuracy of the risk factors proposed by Fukuoka guidelines in detecting malignancy of branch-duct intraductal papillary mucinous neoplasms.
METHOD
Diagnostic meta-analysis of cohort studies. A systematic literature search was conducted using MEDLINE, the Cochrane Library, Scopus, and the ISI-Web of Science databases to identify all studies published up to 2014.
RESULTS
Twenty-five studies (2025 patients) were suitable for the meta-analysis. The "high risk stigmata" showed the highest pooled diagnostic odds ratio (jaundice, 6.3; positive citology, 5.5; mural nodules, 4.8) together with 2 "worrisome features" (thickened/enhancing walls, 4.2; duct dilatation, 4.0) and 1 "other parameters" (carbohydrate antigen 19-9 serum levels, 4.6).
CONCLUSIONS
An "ideal risk factor" capable of recognizing all malignant branch-duct intraductal papillary mucinous neoplasms was not identified and some "dismal areas" remain. However, "high risk stigmata" were strongly related to malignancy, mainly enhancing mural nodules. Among the "worrisome features," duct dilatation and thickened/enhancing walls were underestimated, and their diagnostic performance was similar to those of "high risk stigmata." The carbohydrate antigen 19-9 serum level should be added to the Fukuoka algorithm because this value could help in carrying out correct management.
Topics: Adenocarcinoma, Mucinous; Carcinoma, Pancreatic Ductal; Humans; Pancreatic Neoplasms; Risk Factors
PubMed: 27776043
DOI: 10.1097/MPA.0000000000000642 -
Endocrine Pathology Sep 2019A re-named diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) likely impacts the prevalence of thyroid cancer and risk of... (Meta-Analysis)
Meta-Analysis
Systematic Review and Meta-analysis of the Impact of Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP) on Cytological Diagnosis and Thyroid Cancer Prevalence.
A re-named diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) likely impacts the prevalence of thyroid cancer and risk of malignancy in populations based on the established Bethesda System of Reporting Thyroid Cytopathology (TBSRTC). This study was done to investigate the prevalence and cytological distribution of NIFTP. PRISMA guided systematic review was done from a database search of Pubmed, EMBASE, and Medline using the search terms "non-invasive follicular thyroid neoplasm with papillary-like nuclear features", "non-invasive follicular variant of papillary carcinoma", "niftp", and "Bethesda" until November 2018. Original articles with surgically proven diagnoses of NIFTP using strict NIFTP criteria were included. Twenty-nine studies with 1563 cases of NIFTP were included. The pooled prevalence of NIFTP in cases which would be classified previously as the follicular variant of papillary thyroid cancer (FVPTC) and papillary thyroid cancer (PTC) were 43.5% (95% CI 33.5-54.0%) and 4.4% (95% CI 2.0-9.0%) respectively. The pooled TBSRTC distribution of cases diagnosed as NIFTP was: from the non-diagnostic category 3.6% (95% CI 2.4-5.3%), benign 10.0% (95% CI 7.2-13.6%), AUS/FLUS 34.2% (95% CI 28.2-40.8%), FN/SFN 22.7% (95% CI 17.2-29.4%), suspicious for malignancy 22.4% (95% CI 17.7-27.9%), and malignant 7.5% (95% CI 4.2-12.9%). While a significant reduction in FVPTC prevalence is anticipated, a modest reduction of PTC prevalence is also expected with adoption of the NIFTP terminology that would be distributed mainly among lesions classified as indeterminate thyroid nodules. Further studies are needed to identify unique clinical characteristics of these lesions preoperatively.
Topics: Biopsy, Fine-Needle; Carcinoma, Papillary, Follicular; Cell Nucleus; Cytodiagnosis; Diagnosis, Differential; Guideline Adherence; Humans; Predictive Value of Tests; Prevalence; Thyroid Cancer, Papillary; Thyroid Neoplasms; Thyroid Nodule
PubMed: 31338752
DOI: 10.1007/s12022-019-09583-4 -
Calcified Tissue International Jul 2024This study aimed to evaluate the prevalence and risk of malignant neoplasm in primary hyperparathyroidism (PHPT) patients. Potentially eligible studies were retrieved... (Meta-Analysis)
Meta-Analysis Review
This study aimed to evaluate the prevalence and risk of malignant neoplasm in primary hyperparathyroidism (PHPT) patients. Potentially eligible studies were retrieved from PubMed and Embase databases from inception to November 2023 using search strategy consisting of terms for "Primary hyperparathyroidism" and "Malignant neoplasm". Eligible study must report prevalence of malignant neoplasm among patients with PHPT or compare the risk of malignant neoplasm between patients with PHPT and comparators. Point estimates with standard errors were extracted from each study and combined using the generic inverse variance method.A total of 11,926 articles were identified. After two rounds of systematic review, 50 studies were included. The meta-analysis revealed that pooled prevalence rates of overall cancer was 0.19 (95%CI: 0.13-0.25; I 94%). The two most prevalent types of malignancy among patients with PHPT ware papillary thyroid cancer (pooled prevalence: 0.07; 95%CI: 0.06-0.08; I 85%) and breast cancer (pooled prevalence: 0.05; 95%CI: 0.03-0.07; I 87%). Subgroup analysis of studies focusing on patients undergoing parathyroidectomy reported a fourfold higher prevalence of papillary thyroid cancer than the remaining studies (0.08 versus 0.02). The meta-analysis of cohort studies found a significant association between PHPT and overall cancer with the pooled risk ratio of 1.28 (95%CI: 1.23-1.33; I 66.9%).We found that the pooled prevalence of malignant neoplasm in PHPT was 19%, with papillary thyroid cancer and breast cancer being the most prevalent types. The meta-analysis of cohort studies showed that patient with PHPT carried an approximately 28% increased risk of malignancy.
Topics: Humans; Hyperparathyroidism, Primary; Risk Factors; Prevalence; Parathyroidectomy; Breast Neoplasms; Thyroid Cancer, Papillary; Thyroid Neoplasms
PubMed: 38772934
DOI: 10.1007/s00223-024-01219-y -
Pancreatology : Official Journal of the... 2016The current management of pancreatic mucinous cystic neoplasms (MCN) is defined by the consensus European, International Association of Pancreatology and American... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The current management of pancreatic mucinous cystic neoplasms (MCN) is defined by the consensus European, International Association of Pancreatology and American College of Gastroenterology guidelines. However, the criterion for surgical resection remains uncertain and differs between these guidelines. Therefore through this systematic review of the existing literature we aimed to better define the natural history and prognosis of these lesions, in order to clarify recommendations for future management.
METHODS
A systematic literature search was performed (PubMed, EMBASE, Cochrane Library) for studies published in the English language between 1970 and 2015.
RESULTS
MCNs occur almost exclusively in women (female:male 20:1) and are mainly located in the pancreatic body or tail (93-95%). They are usually found incidentally at the age of 40-60 years. Cross-sectional imaging and endoscopic ultrasound are the most frequently used diagnostic tools, but often it is impossible to differentiate MCNs from branch duct intraductal papillary mucinous neoplasms (BD-IPMN) or oligocystic serous adenomas pre-operatively. In resected MCNs, 0-34% are malignant, but in those less than 4 cm only 0.03% were associated with invasive adenocarcinoma. No surgically resected benign MCNs were associated with a synchronous lesion or recurrence; therefore further follow-up is not required after resection. Five-year survival after surgical resection of a malignant MCN is approximately 60%.
CONCLUSIONS
Compared to other pancreatic tumors, MCNs have a low aggressive behavior, with exceptionally low rates of malignant transformation when less than 4 cm in size, are asymptomatic and lack worrisome features on pre-operative imaging. This differs significantly from the natural history of small BD-IPMNs, supporting the need to differentiate mucinous cyst subtypes pre-operatively, where possible. The findings support the recommendations from the recent European Consensus Guidelines, for the more conservative management of MCNs.
Topics: Humans; Neoplasms, Cystic, Mucinous, and Serous; Pancreatic Cyst; Pancreatic Neoplasms
PubMed: 27681503
DOI: 10.1016/j.pan.2016.09.011 -
Diagnostic Cytopathology Dec 2023Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) poses diagnostic challenge in fine needle aspiration cytopathology (FNAC). We aimed...
Detailed fine needle aspiration cytopathology findings of noninvasive follicular thyroid neoplasm with papillary-like nuclear features with nuclear grading correlated to that of biopsy and Bethesda category and systematic review.
BACKGROUND
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) poses diagnostic challenge in fine needle aspiration cytopathology (FNAC). We aimed first to document our FNAC Bethesda categories (BCs) for all of our NIFTPs and compare our findings with those in the literature with series containing at least 14 cases each.
METHODS
Cases with final histopathological diagnoses of NIFTP and their preoperative FNAC were retrieved from 2006 to 2022 and our cytopathological BCs were documented. Then the slides were re-reviewed in a blinded manner for detailed classification and the results of both the BCs and blinded reclassification were compared with series in the literature for both BCs and detailed cytopathological review of the cases.
RESULTS
Thyroid FNACs of 43 out of 86 patients with final NIFTP diagnoses were obtained. Females composed 72.1% (F/M: 31/12); mean age and mean tumor diameter was 47.6 (19-72 years) and 23.4 mm (7-60 mm), respectively. Totally 81.4% (35/43) were classified in the "indeterminate" diagnostic categories; namely 44.2% (19/43) were reported as atypia of undetermined significance (AUS; BC III), 20.9% (9/43) were follicular neoplasm (FN; BC IV), and 16.3% (7/43) were suspicious for malignancy (SM; BC V). No patient was diagnosed as positive for malignancy (BC VI), preoperatively. Detailed cytomorphologic reevaluation revealed heterogeneous cytopathologic findings and nuclear grade (especially nuclear enlargement, membrane irregularity and elongation) significantly increased with respect to BCs. Systematic review confirmed extremely heterogeneous cytomorphologic nature of NIFTP.
CONCLUSIONS
NIFTPs were categorized most frequently as AUS, followed by FN and SM on FNAC. Our re-review were not able to specify features solely unique to NIFTP alone but may distinguish these cases from classic papillary thyroid carcinoma.
Topics: Female; Humans; Biopsy, Fine-Needle; Adenocarcinoma, Follicular; Cytology; Thyroid Neoplasms; Retrospective Studies
PubMed: 37688282
DOI: 10.1002/dc.25219