Preoperative Visualized Ultrasound Assessment of the Recurrent Laryngeal Nerve in Thyroid Cancer Surgery: Reliability and Risk Features by Imaging

He, Yaqian; Li, Zhihui; Yang, Yujia; Lei, Jianyong; Peng, Yulan

doi:10.2147/cmar.s330114

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…Nevertheless, the liquid contrast of the barrier between the RLN and ZT during US-guided MWA procedure made it easier to identify the RLN. He et al reported that the RLN had a thickness of 1.8 to 2.5 mm and a breadth that varied from 2 to 2.7 mm [ 30 ]. In our study, we found that the RLN had a thickness of about 2.510 ± 0.349 mm and a width of about 2.768 ± 0.399 mm.…”

Section: Discussionmentioning

confidence: 99%

Protect the recurrent laryngeal nerves in US-guided microwave ablation of thyroid nodules at Zuckerkandl tubercle: a pilot study

Hu,

Wang,

et al. 2024

BMC Cancer

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Background To evaluate the safety and efficacy of US-guided microwave ablation in patients with thyroid nodules at Zuckerkandl tubercle. Methods 103 consecutive patients with thyroid nodules at Zuckerkandl tubercle (ZTTN) were enrolled in this study from November 2017 to August 2021. Prior to the surgery or US-guided microwave ablation (MWA), preoperative ultrasound visualization of the recurrent laryngeal nerve (RLN) and ZTTN was performed, the size and the position relationship between them were observed. Patients were followed up at 1, 3, 6, and 12 months after MWA and the volume reduction rates (VRR) of the thyroid nodules were analyzed. Results All patients successfully had the RLN and ZTTN detected using ultrasound before surgery or ablation with a detection rate of 100%. For the 103 patients, the majority of ZTTN grades were categorized as grade 2, with the distance from the farthest outside of ZTTN to the outer edge of thyroid ranging between 6.0 and 10.0 mm. The position relationship between ZTTN and RLN was predominantly type A in 98 cases, with type D observed in 5 cases. After MWA, the median nodule volume had significantly decreased from 4.61 (2.34, 8.70) ml to 0.42 (0.15, 1.41) ml and the VRR achieved 84.36 ± 13.87% at 12 months. No nodules regrew throughout the 12-month follow-up period. Of the 11 patients experienced hoarseness due to RLN entrapment before ablation, 7 recovered immediately after separation of the RLN and ZTTN during MWA, 2 recovered after one week, and the other 2 recovered after two months. Conclusions The RLN is closely related to ZTTN and mainly located at the back of ZTTN. The RLN can be separated from ZTTN by hydrodissection during MWA. US-guided MWA is a safe and effective treatment for ZTTN.

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Section: Discussionmentioning

confidence: 99%

Protect the recurrent laryngeal nerves in US-guided microwave ablation of thyroid nodules at Zuckerkandl tubercle: a pilot study

Hu,

Wang,

et al. 2024

BMC Cancer

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“…The tumor invasion outside the glands can be judged by both preoperative ultrasound and intraoperative macroscopic observation ( 28 ). Based on the preoperative blood phosphorus level, intraoperative frozen-section pathological examination is needed to further determine the pathological characteristics (e.g., the number of lesions on one side of the gland and the number of metastases in the lymph nodes).…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinicopathological features of papillary thyroid carcinoma in solid organ transplant recipients: a retrospective study

Hu¹,

Wu²,

Ju³

et al. 2022

Gland Surg

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Background: With the advances in organ transplantation technology and the increased number of organ recipients, more organ transplant recipients are living longer. However, many newly-onset thyroid cancer cases have been found among this population. The question remains in the uncertainty in whether the posttransplant thyroid cancer is more pathologically aggressive than the thyroid cancer in non-organ-transplant recipients. We compared the clinicopathological features of papillary thyroid carcinoma (PTC) between solid organ transplant recipients (SOTR) and the general population, in an attempt to improve the detection rate of post-transplant PTC in SOTR and overall survival prognosis of those patients Methods: The clinical data of 408 PTC patients in the First Affiliated Hospital of Zhejiang University School of Medicine from July 2013 to April 2019 were retrospectively analyzed. The clinicopathological features were compared between non-organ-transplant recipients with PTC (group A, n=380) and SOTR with newly-onset PTC (group B, n=31) using Chi-square test, Fisher's exact test, Student's t-test, and logistic regression.Results: There were significant differences between these two groups in central compartment lymph node metastasis (P=0.005), multifocality (P=0.003), and maximum tumor diameter (P=0.007). Compared with group A, group B had a higher rate of tumor multifocality, higher rate of lymph node metastasis, and smaller tumor size. In addition, PTC in group B was more aggressive in biological behaviors such as tumor multifocality and lymph node metastasis.Conclusions: Compared with the general population, PTC after SORT demonstrate a more malignant pathological feature. The examination rate of thyroid cancer in SORT should be increased to improve the overall prognosis after solid organ transplant.

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“…Thyroid lesion(s) and the RLN in each patient were analyzed by ultrasonography of the anterior cervical region as described ( 18 ), with the patient in the supine position and the neck at maximal extension ( Appendix 1 , Method 2). Longitudinal and transverse sections were captured with the thyroid lesions and RLN positioned in the middle of the images.…”

Section: Methodsmentioning

confidence: 99%

“…High-frequency ultrasonography is widely used to diagnose disorders involving peripheral nerves ( 13 - 17 ), and our previous study showed that preoperative ultrasound can be applied to visualize the RLN reliably ( 18 ). In our previous study, we injected the lymph nodes surrounding the RLN with carbon nanoparticles to confirm the same RLNs that had been identified by preoperative ultrasound during surgery.…”

Section: Introductionmentioning

confidence: 99%

“…In our previous study, we injected the lymph nodes surrounding the RLN with carbon nanoparticles to confirm the same RLNs that had been identified by preoperative ultrasound during surgery. In addition, the concordance of results between preoperative and intraoperative ultrasound parameters [intraclass correlation coefficients (ICC) =0.403] and the statistics for measurements taken independently by 2 sonographers (ICCs ranged from 0.495 to 0.824) showed good reliability ( Appendix 1 , Method 1) ( 18 ). Therefore, we wondered whether preoperative ultrasonography could reliably detect RLN invasion in patients with thyroid carcinoma.…”

Section: Introductionmentioning

confidence: 99%

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Predicting recurrent laryngeal nerve invasion by preoperative ultrasonography in patients with thyroid carcinoma

He,

Yang,

Wen

et al. 2023

Quant Imaging Med Surg

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Background For thyroid cancer staging, evaluation of extent of local invasion, including recurrent laryngeal nerve (RLN), may assist surgical decision-making. Methods This prospective study evaluated patients who underwent thyroidectomy at a single tertiary-level academic institution. Patients with complete clinical information and ultrasound imaging of thyroid carcinoma and RLN were enrolled. Those who had thyroidectomy before or did not fit the above conditions were excluded. Patients were assigned to either a development or validation cohort. Development of models was constructed in a primary cohort based on preoperative ultrasound features and clinicodemographic data from August 2020 to December 2021. Validation of the models was then performed on an independent cohort between January and March of 2022. Multivariate logistic regression and nomograms were mainly used for statistical analysis. Results Using data from 816 patients (80 RLN invasion), we built nomogram 1 based on age [95% confidence interval (CI): 1.315 to 145.933, P=0.029], body mass index (BMI; 95% CI: 1.228 to 10.874, P=0.020), tumor size (95% CI: 4.677 to 1,373.1, P=0.002), tumor adjacent to medial (95% CI: 1.816 to 26.713, P=0.005) and posterior thyroid capsules (95% CI: 5.567 to 756.583, P=0.001), and distance <1 mm between tumor and the RLN (95% CI: 10.389 to 826.746, P<0.001). Nomogram 2 was built based on tumor adjacent to the posterior thyroid capsule (95% CI: 2.922 to 53,074.51, P=0.017), distance <1 mm between tumor and the RLN (95% CI: 1.478 to 1,241.646, P=0.029), and loss of typical fascicular echotexture of the RLN along the long axis (95% CI: 35.11 to 53,272.81, P<0.001). In the validation cohort, nomogram 1 and 2 showed sensitivities of 94.74% and 57.89%, specificities of 74.12% and 95.29%, positive predictive values (PPV) of 45.00% and 73.26%, negative predictive values (NPV) of 98.43% and 91.03%, accuracies of 76.92% and 88.46%, and C-indices of 0.86 and 0.89. Conclusions Preoperative ultrasound is a feasible approach to evaluate RLN invasion in patients with thyroid carcinoma. Nomogram 1 may sensitively identify the risk of RLN invasion, and it may be checked using the more specific and accurate nomogram 2 to reduce false positives.

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Preoperative Visualized Ultrasound Assessment of the Recurrent Laryngeal Nerve in Thyroid Cancer Surgery: Reliability and Risk Features by Imaging

Cited by 9 publications

References 19 publications

Protect the recurrent laryngeal nerves in US-guided microwave ablation of thyroid nodules at Zuckerkandl tubercle: a pilot study

Protect the recurrent laryngeal nerves in US-guided microwave ablation of thyroid nodules at Zuckerkandl tubercle: a pilot study

Analysis of clinicopathological features of papillary thyroid carcinoma in solid organ transplant recipients: a retrospective study

Predicting recurrent laryngeal nerve invasion by preoperative ultrasonography in patients with thyroid carcinoma

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