Search Results (264)

Background: Papillary thyroid cancer (PTC) is the most common form of thyroid malignancy, with an incidence that has been steadily rising globally. Early and accurate diagnosis remains crucial for effective treatment and improved outcomes. MicroRNAs (miRNAs), small non-coding RNA molecules that regulate gene expression, have emerged as promising biomarkers in cancer research due to their stability and accessibility in serum. In this pilot study we compared the expression of 84 consistently reported, malignancy-associated serum miRNAs in patients with PTC (PTC group) and benign thyroid disease (Control group) as potential PTC markers. Methods: A focused panel containing primer assays for 84 human miRNAs that are consistently reported in the literature as being detectable and differentially expressed in serum in various organ-specific cancers was used to measure miRNA levels in serum samples from PTC (n = 8) and benign thyroid disease (n = 6) patients prior to thyroidectomy. Results: Among the 84 miRNAs analyzed, a panel of ten miRNAs showed numerical trends of differential expression between the two groups, including three upregulated (hsa-miR-150-5p, hsa-miR-21-5p, hsa-miR-23a-3p) and seven downregulated miRNAs (hsa-miR-17-5p, hsa-miR-17-3p, hsa-miR-200c-3p, hsa-miR-296-5p, hsa-miR-574-3p, hsa-miR-885-5p, hsa-miR-130-3p). The serum expression levels of hsa-miR-23a-3p were markedly elevated in patients with malignant nodules compared with those with benign lesions, while hsa-miR-574-3p was significantly downregulated in the PTC group. Conclusions: These findings warrant further investigation of hsa-miR-23a-3p and hsa-miR-574-3p in larger cohorts of patients with PTC to validate their potential clinical relevance. Full article

Background: Fine-needle aspiration biopsy (FNAB) is the standard initial diagnostic procedure for thyroid nodules; however, a considerable proportion of results are non-diagnostic or indeterminate, often requiring repeat procedures and delaying management. Core needle biopsy (CNB) has been proposed as a second-line option. This study evaluated the frequency of non-conclusive FNAB and CNB results and assessed the diagnostic contribution of CNB in nodules with initially non-conclusive FNAB findings. Methods: A retrospective–prospective study was conducted between 2019 and 2025 at a tertiary referral center, including 434 thyroid nodules. Ultrasound risk stratification followed ACR TI-RADS criteria. FNAB was performed in 430 nodules, and CNB in 85 nodules, including 82 evaluated by both methods. Biopsy results were classified according to the Bethesda system as conclusive or non-conclusive. Paired comparisons were analyzed using the McNemar test, and associations with ultrasound risk were assessed. Results: FNAB produced non-conclusive results in 56.5% of cases, compared with 23.5% for CNB. In paired analysis, 53.7% of nodules with non-conclusive FNAB were reclassified as conclusive after CNB (p < 0.001). CNB significantly distinguished benign from malignant lesions, unlike FNAB. Hypoechogenicity, irregular margins, and punctate echogenic foci were independent predictors of malignancy. Minor complications were more frequent after CNB, while major complications were rare in both groups. Conclusions: CNB improves diagnostic yield when used as a second-line procedure in nodules with non-conclusive FNAB findings. Selective use in higher-risk nodules may reduce repeat procedures and facilitate more structured clinical management. Full article

Background: We report a rare case of a metastatic neoplasm in the regional lymph nodes and peritoneum whose histopathologic and immunophenotypic profiles were most consistent with a diagnosis of medullary thyroid carcinoma (MTC), although a primary tumor was not histologically demonstrated in the thyroidectomy specimen. Case presentation: A 64-year-old man presented with abdominal pain and was found to have increased calcitonin level and a 20 mm lesion in the peritoneum. Peritoneum biopsy revealed plasmacytoid tumor cells which were positive for calcitonin and synaptophysin staining. The patient had a past history of neck dissection due to left side neck mass. The histology revealed metastatic carcinoma with a nested pattern surrounded by fibrous stroma with stromal amyloid deposition. With immunohistochemistry, the findings were most consistent with metastatic MTC, but following total thyroidectomy showed no malignancy. Next-generation sequencing identified a pathogenic HRAS mutation, but RET mutation was not identified. Despite vandetanib treatment, the disease progressed and the patient expired. Conclusions: This case highlights a rare presentation of a metastatic neoplasm highly suggestive of RET wild-type MTC with peritoneal involvement, despite the absence of an identifiable primary lesion. Full article

Background: Risk stratification of indeterminate thyroid nodules (Bethesda III–IV) remains difficult and often triggers unnecessary procedures. Ultrasound-based ACR TI-RADS and the 2023 Bethesda System are widely used, but the incremental value of combining them and the role of size thresholds needs prospective validation. Objective: The objective of this study was to prospectively compare the diagnostic performance of ACR TI-RADS and the 2023 Bethesda System, alone and in combination, for predicting malignancy in thyroid nodules, with dedicated analyses of indeterminate lesions (Bethesda categories III–IV), including subtypes of Bethesda III (nuclear atypia vs. other atypia), and the impact of nodule size. Methods: Histopathology was available for 131 nodules. Diagnostic metrics (sensitivity, specificity, PPV, NPV), ROC curves (DeLong comparison), and Youden indices were calculated for individual and combined thresholds; a 16 mm size cut-off was explored. Results: Malignancy was confirmed in 105/131 nodules (80.2%). Bethesda outperformed TI-RADS (AUC 0.87 vs. 0.69; DeLong p = 0.041). Malignancy rates rose with higher categories (e.g., TI-RADS 5: 93.6%; Bethesda category V: 100%; Bethesda category VI: 100%) and were markedly elevated in the histologically confirmed subset for Bethesda category III (32/41; 78.0%) and IV (6/8; 75.0%). The combined requirement of TI-RADS ≥ 4 and Bethesda ≥ 4 maximized specificity (96.2%) and PPV (98.4%) with a high Youden J (0.552), supporting a rule-in strategy in category IV of Bethesda. Size alone was a weak discriminator (AUC 0.66); within Bethesda III–IV nodules, malignancy did not differ significantly by the 16 mm threshold (p = 1.00). ROC using continuous tumor size yielded AUC = 0.66; the ROC-derived optimal cut-off was 16 mm. Applying this split produced sensitivity 0.80 and specificity 0.50. Conclusions: Integrating ACR TI-RADS with Bethesda cytology significantly improves specificity and PPV for indeterminate thyroid nodules, supporting a morphology-driven approach over traditional size-based thresholds. Incorporation of combined sonographic–cytologic criteria into management algorithms may reduce unnecessary interventions and optimize patient care. Full article

Background: Thyroid tuberculosis abscesses (TTA) are rare manifestations of extrapulmonary tuberculosis, with the available literature consisting almost exclusively of individual case reports and small observational series. This systematic review aimed to evaluate current management strategies and associated clinical outcomes for TTA. Methods: Reports describing confirmed TTA, specified treatment regimens and clinical outcomes were systematically identified and synthesised from PubMed, Embase, Web of Science and Google Scholar from the period 1990 to 2025. Studies with suspected but unconfirmed cases were excluded. Risk of bias was assessed using the Joanna Briggs Institute tool. A total of 22 studies comprising 33 patients were included. Results: Significant diagnostic delays were seen. When diagnosis was established, standard four-drug anti-tubercular therapy (ATT) for at least 6 months emerged as the predominant first-line treatment. Surgical or percutaneous drainage procedures were typically reserved for large abscesses, treatment failure, acute suppurative presentations or suspected malignancy. Across published cases, lesion resolution and preservation of euthyroid function were reported in 92% of patients. However, the absence of comparative studies and the reliance on highly selected case material limit definitive conclusions and raise concerns about publication bias. Conclusions: TTA is a rare entity, with established treatment success with ATT, with surgery reserved for selected cases. Higher-quality comparative data are required to inform optimal management strategies. Full article

Background and aim: Recent preclinical studies have confirmed that inhibiting the MAP kinase pathway can induce the re-differentiation of radioiodine (RAI)-refractory (RAIR) follicular cell thyroid cancers (TCs). The aim of this trial is to investigate whether the combination of kinase inhibitors (KIs) with myo-inositol (MI) can induce or potentiate the re-uptake of RAI in cancer cells. Overview and methods: This is an open label, non-pharmacological, multicenter, randomized pilot study. Patients will be divided into two groups: (1) a control group in which patients are treated with KIs (subgroup a: trametinib plus dabrafenib; subgroup b: lenvatinib); (2) a group in which patients (divided into the two subgroups) are treated with the same KIs in addition to MI. After 30 days of MI treatment, all patients, treated with levothyroxine (L-T4) at a semi-suppressive dosage as per clinical practice, will be stimulated with recombinant human TSH (rhTSH) (days 31 and 32). On day 35, the patients will be subjected to whole-body scintigraphy, with hybrid imaging where possible (SPECT/CT), after the administration of diagnostic activity (185–222 MBq of 123-I in accordance with the SNMMI/EANM guidelines. Blood samples will be collected before starting MI therapy (day 0); after 30 days of MI therapy; and then on days 31, 32, 33, 34, and 35 after MI therapy. Quality of life (QoL) will be assessed at the beginning of the MI treatment and at the end of its administration. The primary endpoint is the restoration of 123-I uptake in RAIR-TC patients already on KI therapy alone and on KI therapy plus MI. The restoration of 123-I uptake in target lesions will be evaluated. Conclusions: MI may have a synergistic effect at the cellular level, and the possible increase in the re-differentiation of RAIR-TC in patients treated with KIs plus MI may have great clinical relevance. The re-uptake of RAI will be evaluated as the primary endpoint, and Tg values and QoL will be evaluated as the secondary endpoints. The main limitation of this study is that we do not investigate any clinical effects. We will have to postpone the clinical analysis to a later date after the administration of RAI for therapeutic purposes. Full article

Differentiated thyroid carcinoma (DTC) is the most common malignant endocrine tumor, with a generally favorable prognosis. Imaging, including iodine radioactive isotope scintigraphy (IRIS), is crucial for diagnosis and follow-up. While ¹³¹I has long been used for both therapeutic and diagnostic purposes, ¹²³I is reserved for diagnostic imaging due to its shorter half-life and γ emissions. This review highlights the utility of ¹²³I scintigraphy, especially in pre-treatment assessment and dosimetry for DTC. It is particularly valuable before radioiodine (RAI) ablation, providing accurate imaging in patients with iodine-refractory (IR) or biochemically incomplete response (BIR) DTC. When compared to post-therapeutic ¹³¹I scans, ¹²³I scintigraphy appears to have a lower sensitivity for detecting metastatic lesions, particularly in lymph nodes and lungs. However, its diagnostic performance compared to low-dose diagnostic ¹³¹I is more variable, with some studies suggesting superiority due to the absence of stunning. Further research is needed to standardize its use and optimize its role in guiding DTC management. Full article

Background/Objectives: The diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) is a rare and aggressive subtype characterized by diffuse gland involvement and early cervical lymph node metastasis. Preoperative differentiation from classic papillary thyroid carcinoma and autoimmune thyroid disease remains challenging on B-mode ultrasound. This study aimed to describe the multiparametric ultrasound features of DSV-PTC in a single-center case series and highlight practical imaging insights. Methods: We retrospectively reviewed seven consecutive patients with histologically confirmed DSV-PTC evaluated at a single center between 2013 and 2025. All patients underwent standardized B-mode ultrasound, color Doppler, and two-dimensional shear-wave elastography prior to surgery. Clinical, autoimmune, cytological, surgical, pathological, and follow-up data were analyzed descriptively. Results: The cohort included five females and two males (mean age 28 years). Autoimmune thyroid disease was present in three patients. High-risk ultrasound features were identified in all cases, with microcalcifications in six patients and a diffuse “snowstorm” appearance in five. Elastography demonstrated increased stiffness in six out of seven lesions (Emean 28–173 kPa; Emax 31–300 kPa). Cervical lymph node metastases were confirmed in all patients. In two cases, elastography aided identification of focal malignant involvement within diffusely altered thyroid parenchyma. All patients underwent total thyroidectomy with central neck dissection; lateral neck dissection and radioiodine therapy were performed selectively. No distant metastases were detected. Conclusions: In this case series, DSV-PTC showed a characteristic multiparametric ultrasound pattern combining high-risk B-mode features with frequently increased tissue stiffness. Elastography provided complementary information, particularly in the presence of autoimmune thyroid disease, by helping localize focal malignant involvement within diffusely altered parenchyma. Full article

Background: Molecular testing is recommended to refine risk stratification in indeterminate thyroid nodules (Bethesda III–IV), but data on dual-gene (BRAF and RAS) testing using fresh FNA washout specimens are limited. We aimed to evaluate the performance of BRAF and RAS mutation analysis from fresh thyroid FNA washout material, with a focus on indeterminate cytology. Methods: We retrospectively analyzed 1139 patients who underwent washout-based molecular testing between May 2022 and October 2024 at a tertiary endocrine center. Of these, 307 had available histopathologic results after surgery. Primary outcomes were sample adequacy, mutation spectrum, and diagnostic metrics (sensitivity, specificity, PPV, NPV, and accuracy). Analyses were repeated under two assumptions that classified borderline/low-risk neoplasms as benign vs. malignant, and within the Bethesda III–IV subset. Results: Adequate material for molecular analysis was obtained in 1037/1139 samples (90.9%). In the operated cohort (n = 307), malignant lesions comprised 31.9% and low-risk neoplasms 8.5%. When borderline lesions were considered benign, mutation positivity yielded a sensitivity of 48.0%, a specificity of 89.6%, a PPV of 75.9%, an NPV of 71.9%, and an accuracy of 72.9%. In Bethesda III–IV nodules (n = 153), sensitivity, specificity, and accuracy were 41.0%, 85.2%, and 66.0% (malignant assumption). Isolated BRAF positivity showed high specificity (~96.7%) with modest sensitivity. Conclusions: Our findings extend current diagnostic approaches by showing that dual-gene (BRAF and RAS) testing from fresh FNA washouts is technically feasible (≥90% adequacy) and provides high specificity with modest sensitivity for malignancy in indeterminate nodules. In settings lacking comprehensive commercial panels, this low-complexity approach offers a practical adjunct to cytology and imaging for preoperative decision-making. Full article

Thyroid nodule evaluation relies heavily on ultrasound imaging, yet it suffers from significant inter-operator variability. To address this, we present a preliminary validation of the Synergy-Net platform, an AI-driven Computer-Aided Diagnosis (CAD) system designed to standardize acquisition and improve diagnostic accuracy. The system integrates a U-Net architecture for anatomical segmentation and a ResNet-50 classifier for lesion characterization within a Human-in-the-Loop (HITL) workflow. The study enrolled 110 patients (71 benign, 39 malignant) undergoing surgery. Performance was evaluated against histopathological ground truth. The system achieved an Accuracy of 90.35% (95% CI: 88.2–92.5%), Sensitivity of 90.64% (95% CI: 87.9–93.4%), and an AUC of 0.90. Furthermore, the framework introduces a multimodal approach, performing late fusion of imaging features with genomic profiles (TruSight One panel). While current results validate the 2D diagnostic pipeline, the discussion outlines the transition to the ANTHEM framework, incorporating future 3D volumetric analysis and digital pathology integration. These findings suggest that AI-assisted standardization can significantly enhance diagnostic precision, though multi-center validation remains necessary. Full article

Background: Effective preoperative patient counseling is essential to shared decision-making. In thyroid surgery, patient communication can be complicated by the complex anatomy and variable surgical approaches, which may not be fully conveyed through conventional verbal explanations or schematic drawings. Virtual three-dimensional (3D) thyroid models may provide an intuitive tool to enhance patient comprehension. Methods: We conducted a randomized controlled trial at Peking Union Medical College Hospital with 94 newly-diagnosed thyroid cancer patients scheduled for thyroidectomy. Participants were assigned to either the control group (n = 47), which received preoperative drawing-based counseling, or the intervention group (n = 47), which utilized a virtual 3D model for communication. The Thyroid Navigator app, developed by Kuma Hospital, was used to provide dynamic 3D representation of the thyroid gland, surrounding structures, and potential surgical procedures. After standardized preoperative consultations, patients were surveyed to assess their understanding in pertinent anatomy and postoperative complications. Results: Patients in the 3D model group demonstrated similar correct response rates in lesion localization (p = 0.536) or parathyroid gland recognition (p = 0.071), but significantly higher accuracy in identifying the recurrent laryngeal nerve and the extent of lymph node dissection compared with the control group (p < 0.05). Moreover, comprehension of the causes of major postoperative complications—including hoarseness (recurrent laryngeal nerve injury, p = 0.004), hypocalcemia (parathyroid gland impairment, p = 0.015), and bleeding (inadequate hemostasis, p = 0.008)—was significantly improved in the 3D model group. Conclusions: Use of a virtual 3D thyroid model significantly improves patient comprehension of thyroid anatomy, surgical procedures, and potential complications, thereby enhancing clinician–patient communication. Virtual 3D models represent a practical and cost-effective supplement to conventional counseling in thyroid surgery, offering clear benefits in patient education and shared decision-making. Full article

Medical image segmentation acts as a foundational element of medical image analysis. Yet its accuracy is frequently limited by the scale fluctuations of anatomical targets and the intricate contextual traits inherent in medical images—including vaguely defined structural boundaries and irregular shape distributions. To tackle these constraints, we design a multi-scale feature attention network (MFA-Net), customized specifically for thyroid nodule, skin lesion, and breast lesion segmentation tasks. This network framework integrates three core components: a Bidirectional Feature Pyramid Network (Bi-FPN), a Slim-neck structure, and the Convolutional Block Attention Module (CBAM). CBAM steers the model to prioritize boundary regions while filtering out irrelevant information, which in turn enhances segmentation precision. Bi-FPN facilitates more robust fusion of multi-scale features via iterative integration of top-down and bottom-up feature maps, supported by lateral and vertical connection pathways. The Slim-neck design is constructed to simplify the network’s architecture while effectively merging multi-scale representations of both target and background areas, thus enhancing the model’s overall performance. Validation across four public datasets covering thyroid ultrasound (TNUI-2021, TN-SCUI 2020), dermoscopy (ISIC 2016), and breast ultrasound (BUSI) shows that our method outperforms state-of-the-art segmentation approaches, achieving Dice similarity coefficients of 0.955, 0.971, 0.976, and 0.846, respectively. Additionally, the model maintains a compact parameter count of just 3.05 million and delivers an extremely fast inference latency of 1.9 milliseconds—metrics that significantly outperform those of current leading segmentation techniques. In summary, the proposed framework demonstrates strong performance in thyroid, skin, and breast lesion segmentation, delivering an optimal trade-off between high accuracy and computational efficiency. Full article

Background and Clinical significance: Cowden syndrome is an autosomal dominant disorder caused by germline loss-of-function mutations in the PTEN tumor suppressor gene. It is characterized by multiple hamartomas and an increased lifetime risk of malignancies affecting the breast, thyroid, endometrium, and gastrointestinal (GI) tract. Pediatric presentations may include macrocephaly, scrotal tongue, and intellectual disability. Gastrointestinal involvement is frequent, with juvenile-like hamartomatous polyps occurring in at least half of patients and distributed throughout the GI tract, posing a risk for malignant transformation. Early diagnosis and surveillance are crucial for improving patient outcomes. Case Presentation: We report a case of a 10-year-old Caucasian female with Cowden syndrome, with a history of a malignant germ cell tumor of the ovary consisting of a yolk sac tumor and low-grade immature teratoma diagnosed at age six, and thyroidectomy at age nine. The patient has mild intellectual disability. Routine radiological surveillance revealed a right colon intraluminal mass, prompting referral for pediatric gastroenterology evaluation. Endoscopy identified multiple polyps throughout the colon, stomach, and small intestine. Polypectomy of larger lesions was performed, and histopathology confirmed juvenile-like hamartomatous polyps without dysplasia or malignancy. This case highlights the necessity of comprehensive gastrointestinal evaluation in pediatric Cowden syndrome patients. Endoscopic surveillance is essential for early detection and management of polyps. Conclusions: Given the multisystem involvement and elevated cancer risk associated with PTEN mutations, a multidisciplinary approach that includes genetic counseling, dermatologic evaluation, and ongoing oncologic monitoring is recommended. Increased awareness of gastrointestinal manifestations enables timely intervention and may reduce morbidity and mortality in this high-risk population. Full article

A radioiodine-refractory differentiated thyroid cancer patient with rising serum thyroglobulin (Tg) levels underwent ¹⁸F-FDG PET/CT scan, which showed a hypermetabolic region in the proximal segment of esophagus, leading to ambiguity in diagnosis. MRI was immediately added, and PET/MRI fusion image localized an air-containing lesion interlinked with esophagus with enhanced T2 hyperintense mucosal signal, indicating an inflammatory esophageal diverticulum, which was subsequently verified by endoscopy. This case highlights the added value of PET/MRI image fusion in cases with inconclusive ¹⁸F-FDG PET/CT findings, requiring no additional tests and utilizing existing software, thereby minimizing the need for invasive procedures. Full article

A 14-year-old spayed female Jindo dog presented with a firm, non-painful right-sided cervical mass. Computed tomography identified three distinct, separate masses thought to be arising from the right thyroid lobe; the largest measured 66.6 mm × 42.0 mm × 37.6 mm with an estimated volume of 56 cm³ and showed invasion into the right internal jugular vein. Multiple hepatic nodules were detected without evidence of pulmonary metastasis and regional lymph node involvement. Right thyroidectomy with resection of the invaded vein and partial liver lobectomy were performed. The histologic results confirmed all three masses as follicular-compact thyroid carcinomas, and the hepatic lesion as metastatic thyroid carcinoma. The dog recovered uneventfully, remained euthyroid, and showed no local recurrence over a 5-month follow-up. In human medicine, multifocality is common in papillary thyroid carcinoma and is associated with a high rate of recurrence. This report documents the first canine case of multifocal thyroid carcinoma, featuring macroscopic vascular invasion and an uncommon metastatic pattern in which the liver was affected in the absence of detectable pulmonary lesion. The presence of multifocal disease within a single canine thyroid lobe necessitates comprehensive cross-sectional imaging, meticulous surgical planning with vascular considerations, and long-term monitoring to optimize the prognosis of this carcinoma. Full article