The incidence of differentiated thyroid cancer has been increasing in the last decades all over the world. Such a steady growth cannot be entirely attributable to more intensive thyroid nodule screening and more sensitive diagnostic procedures. Several environmental factors have changed with sufficient rapidity in the same time frame and may represent credible candidates for this increase. They include modified iodine intake, lifestyle-associated risk factors, exposure to various toxic compounds, pollutants and xenobiotics, nutritional deficiencies, eating habits and comorbidities. Foremost, nutritional patterns have gained high interest as possible promoters and modifiable risk factors for thyroid cancer in recent years. The aim of this narrative review is to focus on the relationship between thyroid cancer and nutritional factors, dietary habits and obesity. Low iodine intake has been associated to increased risk of thyroid cancer, favoring the development of more aggressive histotypes. Moreover, correction of iodine deficiency can shift thyroid cancer subtypes toward less aggressive forms, without affecting the overall risk for cancer. Actually, evidence regarding the association between selenium and vitamin D deficiency and thyroid cancer is very limited, despite their well-known anti-cancer potentials, and the clinical usefulness of their supplementation is still uncertain in this setting. Albeit the relationship between single foods and thyroid cancer is difficult to examine, fish and iodine-rich foods, vegetables, and fruits might exert protective effects on thyroid cancer risk. Conversely, no clear association has been found for other foods to date. Lastly, a clear association between obesity and the risk of thyroid cancer, with more aggressive behavior, seems to emerge from most studies, likely involving variations in thyroid function and chronic inflammation mediated by cytokines, insulin, leptin and adiponectins. Although no definite association between dietary factors and thyroid cancer has been firmly established so far, some nutritional patterns, together with excessive weight, seem to play a relevant role in thyroid cancer carcinogenesis as well as in its severity and aggressiveness. These effects may play an additive role to the well-established one exerted by environmental carcinogens, such as pollutants and radiation exposure.

Nutritional status and follicular-derived thyroid cancer: An update

Purpose: This study aimed to establish and validate an ultrasound radiomics nomogram for the preoperative prediction of central lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). Patients and Methods: The prediction model was developed in 609 patients with clinicopathologically confirmed unifocal PTC who received ultrasonography between Jan 2018 and June 2018. Radiomic features were extracted after the ultrasonography of PTC. Lasso regression model was used for data dimensionality reduction, feature selection, and radiomics signature building. The predicting model was established based on the multivariable logistic regression analysis in which the radiomics signature, ultrasonography-reported LN status, and independent clinicopathologic risk factors were incorporated, and finally a radiomics nomogram was established. The performance of the nomogram was assessed with respect to the discrimination and consistence. An independent validation was performed in 326 consecutive patients from July 2018 to Sep 2018. Results: The radiomics signature consisted of 23 selected features and was significantly associated with LN status in both primary and validation cohorts. The independent predictors in the radiomics nomogram included the radiomics signature, age, TG level, TPOAB level, and ultrasonography-reported LN status. The model showed good discrimination and consistence in both cohorts: C-index of 0.816 (95% CI, 0.808-0.824) in the primary cohort and 0.858 (95% CI, 0.849-0.867) in the validation cohort. The area under receiver operating curve was 0.858. In the validation cohort, the accuracy, sensitivity, specificity and AUC of this model were 0.812, 0.816, 0.810, and 0.858 (95% CI, 0.785-0.930), respectively. Decision curve analysis indicated the radiomics nomogram was clinically useful. Conclusion: This study presents a convenient, clinically useful ultrasound radiomics nomogram that can be used for the pre-operative individualized prediction of central LN metastasis in patients with PTC.

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An Ultrasound Radiomics Nomogram for Preoperative Prediction of Central Neck Lymph Node Metastasis in Papillary Thyroid Carcinoma.

Purpose of review In this review, we evaluate recent findings related to the association between obesity and thyroid cancer. Recent findings During the last several decades, the prevalence of obesity and thyroid cancer have been increasing in parallel on a global scale. Current evidence suggests that the growing incidence of differentiated thyroid cancer (DTC) is pathogenically linked to the spread of obesity, but the biological mechanisms that may explain this connection have been only partially described. Furthermore, unlike other tumors, data on the impacts of obesity on the aggressiveness of DTC and response to treatment of DTC remain conflicting. Summary Emergent knowledge regarding the links between obesity and thyroid cancer suggests a relevant role for obesity as a risk factor for DTC, with no apparent impact on its aggressiveness.

Obesity as a risk factor for thyroid cancer.

BackgroundCentral compartment lymph node (CCLN) metastasis in papillary thyroid cancer (PTC) is associated with higher risk of loco-regional recurrence and distant metastasis. This study evaluated the prognostic implication of the number of metastatic CCLN in PTC.MethodsProspective data collection on 91 patients with PTC who underwent total thyroidectomy and CCLN dissection with or without lateral neck dissection between January 2005 and December 2010 was made. Number of positive CCLN was correlated with known prognostic factors (age, gender, tumour size, extrathyroidal extension and lateral node metastasis).ResultsPatients were divided into three groups according to the number of positive CCLN: group A = 0 (n = 35); B = 1–2 nodes (n = 32) and C = >3 nodes (n = 24). The risk of lateral compartment disease increased in parallel with the number of positive CCLN (31 vs. 50 vs. 75 % in groups A-B-C, respectively; p < 0.004). Gender/age/tumour size/extrathyroidal extension did not correlate with number of positive CCLN. The increasing number of positive CCLN did not influence post-ablation iodine uptake (1.25 vs. 1.14 vs. 2.63 %) and correlated with mean thyroglobulin values at 1-year post-ablation (12.3 vs. 42.3 vs. 91.48 μg/L)ConclusionsThe number of CCLN metastasis is a risk factor for lateral compartment disease with no correlation with other prognostic markers.

The number of positive lymph nodes in the central compartment has no prognostic impact in papillary thyroid cancer

To develop a nomogram based on postoperative clinical and ultrasound findings to quantify the probability of central compartment lymph node metastases (CLNM) A total of 952 patients with histologically confirmed papillary thyroid carcinoma (PTC) were included in this retrospective study and assigned to three groups based on sex and age The strongest predictors for CLNM were selected according to ultrasound imaging features, and an ultrasound (US) signature was constructed By incorporating clinical characteristics, a predictive model presented as a nomogram was developed, and its performance was assessed with respect to calibration, discrimination and clinical usefulness Predictors contained in the nomogram included US signature, US-reported LN status and age The US signature was constructed with tumour size and microcalcification The nomogram showed excellent calibration in the training dataset, with an AUC of 0826 (95% CI, 0765–0887) for male patients, 0818 (95% CI, 0746–0890) for young females and 0808 (95% CI, 0757–0859) for elder females For male and young female patients, application of the nomogram to the validation cohort revealed good discrimination, with AUCs of 0813 (95% CI, 0722–0904) and 0814 (95% CI, 0712–0915), respectively Conversely, for elderly female patients, the nomogram failed to show good performance with an AUC of 0742 (95% CI, 0661–0823) This ultrasound-based nomogram may serve as a useful clinical tool to provide valuable information for treatment decisions, especially for male and younger female patients • Age, gender, US-reported LN status and US signature were the strongest predictors of CLNM in PTC patients and informed the development of a predictive nomogram
 • Microcalcification was the strongest predictor in the US signature, as CLMN was identified in approximately 92% of patients characterised by diffuse microcalcification
 • Stratified by sex and age, this nomogram achieved good performance in predicting CLNM, especially in male and young female patients This prediction tool may be useful as an imaging marker for identifying CLNM preoperatively in PTC patients and as a guide for personalised treatment

Papillary thyroid carcinoma: an ultrasound-based nomogram improves the prediction of lymph node metastases in the central compartment

Central lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) is common. But the association between primary tumor characteristics and specific features of metastatic lymph nodes in PTC has not been fully identified. Determining risk factors for LNM may help surgeons determine rational extent of lymph node dissection. Data from 432 patients who underwent thyroidectomy with cervical lymph node dissection for PTC were retrospectively analyzed. The relationships between LNM to central compartment or lateral compartment and clinicopathologic factors were analyzed. Cox regression model was used to determine the risk factors for recurrence-free survival (RFS). Central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were found in 216 (50.0%) and 65 (15.0%) patients, respectively. In the multivariate analysis for CLNM, patients < 45 years of age (OR 2.037, 95% CI 1.388–2.988, P < 0.001), extrathyroidal invasion (OR: 2.144, 95% CI 0.824–5.457, P = 0.011), vascular invasion (OR 13.817, 95% CI 1.694–112.693, P = 0.014), LLNM (OR 2.851, 95% CI 1.196–6.797, P = 0.014) and TNM Stage III–IV (OR 465.307, 95% CI 113.903–1900.826, P < 0.001) were independent predictors for high prevalence of CLNM. In the multivariate analysis for LLNM, tumor size more than 1cm (OR 3.474, 95% CI 1.728–6.985, P < 0.001) and CLNM (OR 5.532, 95% CI 2.679–11.425, P < 0.001) were independent predictors for high prevalence of LLNM. Moreover, tumor with T3–T4 stage, extrathyroidal invasion and CLNM were the significant factors related to the RFS. For patients with pre-operative risk factors of LNM, an accurate preoperative evaluation of central compartment or lateral compartment is needed to find suspicious lymph nodes. And prophylactic lymph node dissection should be performed in patients with high risk of CLNM. Moreover, we suggest performing close follow-up for patients with high risk of RFS.

Predictive factors for central lymph node and lateral cervical lymph node metastases in papillary thyroid carcinoma

Comparison of Laparoscopic and Open Approach in Treating Gallbladder Cancer.

Background:Epidemiologic studies have demonstrated an increased risk for papillary thyroid carcinoma (PTC) with increasing body mass index (BMI). However, the relationships between excess weight an...

Influence of Body Mass Index on the Clinicopathologic Features of Papillary Thyroid Carcinoma.

Hepatic epithelioid angiomyolipoma (EAML) is an uncommon mesenchymal tumor with malignant potential, which is clinically susceptible to being misdiagnosed as hepatocellular carcinoma. Therefore, accurate diagnosis of hepatic EAML and treatment is necessary. We report two cases of hepatic EAML that were identified by abdominal computed tomography (CT). The first case presented in a 37-year-old woman and was an oval-shaped liver mass, measuring 4.5×4.2×4.9 cm. The second case presented in a 51-year-old woman and was a round-shaped mass measuring 4×3.5×3.7 cm. Both patients underwent laparoscopic resection. Microscopically, we detected epithelioid and spindle-shaped cells with adipocytes. After the analysis of biomarkers, we found that both cases were positive for HMB45 and Melan-A, which helped to confirm the diagnosis. Hepatic EAML is a rare clinical tumor, which has a high rate of misdiagnosis and the final diagnosis depends on histopathologic and immunohistochemical features. Laparoscopic resection remains the recommended choice for hepatic EAML. Partial hepatic EAML has a tendency become malignant and thus long-term follow-up is needed.

Xing-Hai Yang

Papers

Predictive factors for central lymph node and lateral cervical lymph node metastases in papillary thyroid carcinoma

Comparison of Laparoscopic and Open Approach in Treating Gallbladder Cancer.

Influence of Body Mass Index on the Clinicopathologic Features of Papillary Thyroid Carcinoma.

Hepatic epithelioid angiomyolipoma: a report of two cases and review of the literature.