Jie Wu

To compare the thyroid-specific quality of life (QoL) in patients with benign thyroid nodules (BTNs) who underwent thermal ablation (TA) versus thyroid lobectomy (TL). Patients with BTNs who underwent ultrasound-guided TA or TL were enrolled in the present study. The Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QoL) which focus on thyroid-specific symptoms that are also relevant to patients with BTNs was used to evaluate patients' thyroid-specific QoL. Propensity score matching (PSM) was performed to control for confounding variables. Group differences in the THYCA-QoL scores were analyzed using t- tests. After PSM, 82 patients were included in each group. The median follow-up time for questionnaire administration was 3 (3, 3) months in the TA group and 6 (4, 8) months in the TL group. Compared with TL, the TA group reported significantly lower scores in voice, concentration, scar, tingling hands/feet, and weight gain (all p < 0.05), suggesting better thyroid-specific QoL. However, the TA group had higher scores on the "less interest in sex" scale, indicating more sexual interest-related concerns. TA was associated with better thyroid-specific QoL than TL in several domains, though sexual interest-related concerns were slightly higher. These results suggest it may be a feasible alternative for patients with BTNs, with further studies needed to confirm long-term outcomes.

This study aimed to evaluate the efficacy and safety of US-guided thermal ablation (TA) for solitary papillary thyroid carcinoma (PTC) in elderly patients. This retrospective study included 91 elderly patients with solitary PTC who were treated with TA. The primary outcome was disease progression. The secondary outcomes included the volume change of ablated tumors, the volume reduction rate (VRR), the rate of complete disappearance, and complications. There were 73 T1a stage, 10 T1b stage and 8 T2 stage PTC patients older than 65 years old included in this study. During a median follow-up of 22.0 months, the overall disease progression rate was 2.2% (2/91). One patient developed a new tumor, and another developed lymph node metastasis (LNM). No patients were diagnosed with local recurrence, lymphatic/distant metastasis, or death due to PTC. At the longest follow-up, 72 months after TA, the median VRR was 100.0%, and 90.9% (10/11) of ablated tumors had been fully absorbed. Transient hoarseness occurred in two patients (2.2%). TA is an effective and safe option for elderly patients with solitary PTC, providing a minimally invasive alternative for those who refuse surgery or active surveillance.

This study aims to evaluate the feasibility, efficacy, and safety of microwave ablation (MWA) for cervical lymph node metastasis (CLNM) originating from papillary thyroid carcinoma (PTC) versus non-papillary thyroid carcinoma (non-PTC). In this retrospective study, 262 patients with CLNM treated by MWA between July 2016 and May 2024 were included. Comparative study based on propensity score matching (PSM) between the PTC and non-PTC groups was carried out. After PSM, 30 cases (median age, 54.5 years [IQR 48-65.3]; 26 women) in the PTC group and 10 cases (median age, 56.5 years [IQR 49.5-66]; 7 women) in the non-PTC group were followed for a median of 22.5 months [IQR 12-36] and 8 months [IQR 6-22.5] (p = 0.072), respectively. Statistical analysis revealed significant differences between the PTC and non-PTC groups in disease progression (13.3% vs. 50%, p = 0.029), distant metastasis (0% vs. 30%, p = 0.012), disease progression-free survival (68% vs. 45%, log-rank p = 0.003), and tumor disappearance progression-free survival (99.9% vs. 20%, log-rank p = 0.019). The only complication observed was transient hoarseness, with no significant difference in complication rates between the two groups (6.7% vs. 0%, p > 0.99). Significant reductions in MD and volume were observed between pre- and post-MWA at 1, 3, 6, 9, and 12 months (all p < 0.05). MWA is a safe and effective treatment option for patients with CLNM from PTC. However, for CLNM from non-PTC, more aggressive monitoring and additional therapies after MWA may be necessary.

Background: Thermal ablation (TA) is a minimally invasive alternative for patients with papillary thyroid carcinoma (PTC). However, sonographically occult lesions may lead to new tumor development during follow‐up monitoring. This study involved developing and validating a prediction model for identifying patients at high risk of new tumors after receiving TA. Methods: This study involved the retrospective analysis of the pathological results of patients who received total thyroidectomy between January and June 2023 to identify risk factors for occult lesions. A prediction model was developed on the basis of these risk factors, with patients stratified into risk groups. The model was externally validated in patients who received TA with more than 5 years of follow‐up monitoring. Results: The training cohort included 377 patients (median age 46 years, 76.1% female). Two independent risk factors for occult thyroid lesions were identified: tumor stage (T1a vs. T1b: OR 3.502, p < 0.001; T1a vs. T2: OR 4.124, p = 0.029) and tumor multifocality (OR 4.435, p < 0.001). Patients were stratified into low‐risk (< 0.09), medium‐risk (0.09–0.29), and high‐risk (> 0.29) groups. The prediction model demonstrated good discrimination, with an AUC of 0.717, which remained stable after internal validation (bias‐corrected AUC: 0.769). External validation of 290 patients receiving TA (median age 43 years, 72.8% female) with more than 5 years of follow‐up monitoring confirmed the effectiveness of the model in predicting new tumor development (AUC: 0.755). Conclusions: This risk‐stratified prediction model for occult lesions provides an evidence‐based tool for clinicians to estimate new tumor risk after receiving TA and to guide individualized follow‐up strategies.

The present study aimed to analyze the relationship between the incidence of complications and tumor size following thermal ablation of benign thyroid nodules (BTNs). In this retrospective study, 1198 patients who underwent thermal ablation for unifocal BTN were enrolled. Receiver Operating Characteristic analysis was performed to select the cutoff values of the maximum diameter (MD) for dividing patients into different groups or subgroups. Multivariable logistic regression was performed to identify the risk factors. Propensity score matching (PSM) was employed to control for confounding variables. The overall complication rate was 3.8% (45/1198). Major complications included hoarseness (2.4%), nodule rupture (0.3%) and delayed hemorrhage (0.1%), whereas minor complications were limited to intraoperative hemorrhage (0.9%). The difference in the overall complication rate between the smaller group (< 3.15 cm) and the larger group (> 3.15 cm) was significant (1.0% vs. 6.5%, p < 0.001). In the subgroup analysis, a significant difference was observed between the 3.15-4.15 cm and > 4.15 cm subgroups (4.2% vs. 8.7%, p = 0.023); however, no significant difference was identified between the < 2.35 and 2.35-3.15 cm subgroups (0.6% vs. 1.6%, p = 0.390). Multivariable logistic regression indicated that MD and the nodule component were associated with complications. After PSM, no significant difference in complication rates was observed between MWA and RFA in either the smaller group (p = 1.000) or the larger group (p = 0.186). The incidence of complications in thermal ablation is greater for larger thyroid nodules, particularly for predominantly solid nodules with MDs greater than 3.15 cm.

Thyroid nodule rupture (TNR) is a rare and severe complication after thermal ablation (TA), mostly from benign thyroid nodules (BTN). To summarize the incidence of TNR after TA and analyze the causes and prevention strategies. This retrospective study enrolled 3971 patients who underwent TA for BTN from January 2014 to March 2024. The incidence, causes, and risk factors of TNR were analyzed. Propensity score matching (PSM) controlled for confounding factors. Multivariate regression identified risk factors for TNR. ROC curves determined the optimal cutoff value for the maximum diameter (MD) for TNR. TNR occurred in 8 cases [0.2% (8/3971)]. The mean time from TA to TNR was 29.6 ± 13.0 days (range, 20-60 days). After PSM, MD was larger in the TNR group than in the non-TNR group [mean 4.1 ± 1.6 cm vs. mean 1.8 ± 1.2 cm; p < 0.001]. The optimal cutoff value of MD for TNR was 2.75 cm. After PSM, the incidence of pressure on the ablation zone was significantly higher in the TNR group than in the non-TNR group [100% (8/8) vs. 0 (0/32); p < 0.001], which has been suspected as a case of TNR. Antibiotic drugs, aspiration, or incision drainage could successfully manage all TNR cases. TNR could be encountered in case of pressure on the BTN after TA. Protecting the ablation site from pressure might be crucial in preventing TNR, especially within two months. TNR is more likely to occur if the MD of BTN exceeds 2.75 cm under pressure. Observation, antibiotics, and aspiration could successfully manage all TNR cases.

To evaluate the impact of thyroid-stimulating hormone (TSH) levels on tumor progression and survival in patients with uni- and multifocal T1N0M0 papillary thyroid cancer (PTC) treated with microwave ablation (MWA). This retrospective study analyzed the records of 525 patients with uni- and multifocal T1N0M0 PTC who underwent MWA from January 2015 to December 2022. Patients were stratified into uni-focal (U-PTC) and multifocal (M-PTC) groups and further categorized based on post-ablation TSH levels into low (≤1 mU/L), medium (1-2 mU/L), and high (>2 mU/L) subgroups. The tumor progression rates and progression-free survival were assessed. In U-PTC patients, lower TSH levels were significantly associated with higher tumor progression rates (10.1%) compared to those in the medium (2.9%) and high (2.1%) TSH groups (p = .009). Conversely, in M-PTC patients, tumor progression rates did not vary significantly across TSH levels. Progression-free survival rates in U-PTC patients were notably lower at the 5-year mark in the low TSH group (85.7%) compared to the medium TSH group (96.5%, p = .046). However, progression-free survival rates in M-PTC patients showed convergence across all TSH levels by the 5-year follow-up. Maintaining TSH levels within the normal range post-ablation may be appropriate for managing T1N0M0 PTC treated with MWA, but randomized controlled trials are needed to confirm optimal TSH targets and their impact on outcomes.

Human Papillomavirus (HPV) DNA screening was a crucial element in the fight against cervical cancer and had been adopted in many countries, including China. However, the onset of the COVID-19 pandemic in March 2020 disrupted this program significantly. The aim of this study is to investigate the prevalence and distribution of HPV genotypes among the population undergoing cervical cancer screening during the pandemic period. From January 2017 to December 2022, Peking Union Medical College Hospital gathered 45,496 cervical swabs from individuals undergoing cervical cancer screening. These samples were analyzed to detect fifteen high-risk HPV (HR-HPV) DNA types and a combination of two low-risk HPV (LR-HPV) types. The study revealed an overall infection rate of 11.24% (5,114/45,496), with 11.06% (5,032/45,496) of individuals infected with HR-HPV. The number of HPV screening patients and the infection rates of HPV, HR-HPV, LR-HPV, multiple genotype HPV (M-HPV), and single genotype HPV (S-HPV) during the pandemic were lower than those observed before the pandemic. Moreover, the age group with the highest percentage of infected individuals was under 45–49 years, with HPV52, HPV58, HPV16, and HPV51 being the most prevalent genotypes. Notably, HPV66 emerged as the fifth most commonly detected genotype during the pandemic. Additionally, among the eleven age groups examined, women under 25 exhibited the highest detection rate, with HPV52 and HPV16 infection rates exceeding those observed in the pre-pandemic period. The findings of this study offer significant insights for shaping HPV prevention strategies and enhancing cervical cancer screening initiatives in China following the epidemic.

Thermal ablation (TA) is a safe and effective treatment for benign thyroid nodules (BTNs). However, there has been no consensus on the optimal maximum diameter (MD) of BTNs for TA. This study aimed to identify the optimal MD of BTNs for TA based on complete disappearance rate after TA. This retrospective study included 639 BTNs treated with TA from June 2014 to January 2022. The complete disappearance rate of BTNs after TA was summarized, related influencing factors were explored, and the optimal MD of BTNs for TA was identified. At the final follow-up (median: 40 months, range: 24-95 months), the overall volume reduction rate was 95.4 ± 9.0%, and 50.5% of the BTNs (323/639) completely disappeared. The MD was significantly negatively correlated with complete disappearance (odds ratio 0.89, 95% confidence interval 0.87-0.92; p < 0.001). Calcification, comet-tail artifacts, multilocular cysts, and composition of BTNs, as well as diabetes were negatively correlated with complete disappearance. Restricted cubic spline indicated that an MD of 25.0 mm was the optimal threshold of BTNs for TA, which was confirmed by subgroup logistic regression analysis. Compared with BTNs with MD ≤ 25.0 mm, those with MD > 25.0 mm had a greater complication rate (6.5% vs. 2.4%, p = 0.012). The MD of BTNs was negatively correlated with complete disappearance after TA; an MD > 25.0 mm indicated a reduced likelihood of complete disappearance compared with an MD ≤ 25.0 mm. An MD of 25.0 mm is an appropriate threshold of BTNs for TA on the basis of complete disappearance rate.