Lung metastasis of thyroid cancer demonstrated as metastasized pulmonary nodules on CT scans. The segmentation of such metastasized nodules is a key issue for lung metastasis diagnosis and progress assessment of patients with thyroid cancer. In this paper, a segmentation model designed for segmenting metastatic pulmonary nodules in CT scans of patients with thyroid cancer. Our segmentation model fuses features from input patches of different sizes and from different decoding scales in terms of weight blocks. Two parallel ResUNet are utilized as input branches to incorporate two different sized input patches to make the inputs cover the whole nodule region without introducing excessively larger background noise. The weight blocks are used not only to highlight informative regions and most relative features but also to suppress non-informative noisy regions and irrelative features to the segmentation tasks. Evaluation results on the dataset for CT scans of patients with metastasis of thyroid cancer demonstrate that our model achieves 90.19% in DSC, 92.47% in PPV, 89.92% in Sensitivity and 87.03% in IoU. Evaluation results also show that our method can be well transferred to the LIDC-IDRI dataset for primary lung cancer and achieves 91.82% in DSC, 89.77% in PPV, 92.97% in Sensitivity and 87.70% in IoU, which outperforms most state-of-the-art methods.

目的 研究中、高危分化型甲状腺癌患者术后131 I治疗的动态疗效评估,并探讨影响疗效的有关因素.方法 回顾性收集就诊于苏州大学第一附属医院的318例DTC患者.按照治疗疗效评估体系对4种治疗疗效进行评估并分析.结果 中高危患者各疗效组间差异有统计学意义.ps-Tg≤3.53ng/mL,时间间隔≤233d及131 I治疗剂量<150mCi是中危患者ER独立预测因素.ps-Tg≥11.8ng/mL是中危患者SIR的独立预测因素.ps-Tg≤1.04ng/mL是高危患者ER的独立预测因素.ps-Tg≥7.58ng/mL、远处转移是高危患者SIR的独立预测因素.结论 ps-Tg≤3.53ng/mL、时间间隔≤233d的中危患者首次131 I治疗后的疗效较好;ps-Tg≥11.8ng/mL的中危患者首次131 I治疗后疗效较差.ps-Tg≤1.04ng/mL的高危患者首次131 I治疗后疗效较好;ps-Tg≥7.58ng/mL、远处转移的高危患者首次131 I治疗后疗效较差.

Background:Skip metastasis in papillary thyroid cancer (PTC), defined as lateral lymph node metastasis (LLNM) without the involvement of central lymph node metastasis (CLNM), is generally unpredictable. Our study aimed to develop a model to predict skip metastasis by using clinicopathological and ultrasound factors of PTC.Methods:We retrospectively reviewed the medical records of patients who underwent total thyroidectomy and central lymph node dissection (CLND) plus lateral lymph node dissection (LLND) between January 2019 and December 2021 at the First Affiliated Hospital of Soochow University. Furthermore, univariate and multivariate analyses assessed the clinical and ultrasound risk factors. Receiver operating characteristic (ROC) curves were used to find the optimal cut-off values for age and dominant nodule diameter. Multivariate logistic regression analysis results were used to construct a nomogram and were validated internally.Results:In all patients, the skip metastasis rate was 15.4% (41/267). Skip metastasis was more frequently found in patients with a tumour size ≤10 mm (OR 0.439; P = 0.033), upper tumour location (OR 3.050; P=0.006) and fewer CLNDs (OR 0.870; P = 0.005). After analysing the clinical and ultrasound characteristics of the tumour, five factors were ultimately associated with lateral lymph node skip metastasis and were used to construct the model. These factors were an age >40 years, tumour diameter <9.1 mm, upper tumour location, non-smooth margin and extrathyroidal extension. The internally evaluated calibration curves indicated an excellent correlation between the projected and actual skip metastasis probability. The nomogram performed well in discrimination, with a concordance index of 0.797 (95% CI, 0.726 to 0.867).Conclusions:This study screened for predictors of skip metastasis in PTC and established a nomogram that effectively predicted the risk of potential skip metastasis in patients preoperatively. The method can predict and distinguish skip metastases in PTC in a simple and inexpensive manner, and it may have future therapeutic utility.

Review question / Objective: The aim of this study was to evaluate whether RAI treatment can reduce the recurrence rate in LR and IR PTMC by means of a metaanalysis.

Background. The incidence of papillary thyroid microcarcinoma (PTMC) has significantly increased in recent years, and the decision to use radioactive iodine (RAI) ablation in low-risk (LR) and intermediate-risk (IR) patients is controversial. The aim of this study was to evaluate whether RAI ablation can reduce the recurrence rate in LR-IR PTMC patients. Methods. A comprehensive literature search of the PubMed, Embase, Cochrane Library, and Web of Science was conducted according to the PRISMA statement. Results. There were 8 studies in English that fit our search strategy, and a total of 2847 patients were evaluated. The results of the meta-analysis showed RAI ablation in LR-IR PTMC patients did not reduce cancer recurrence (risk radio (RR) 0.56, 95% CI 0.19-1.70, P=0.31). Nevertheless, we further performed data analysis and found that IR PTMC patients without RAI ablation had a higher rate of cancer recurrence than those who underwent RAI ablation (RR 0.23, 95% CI 0.11-0.49, P=0.0001). Furthermore, patients with risk factors for lymph node metastasis (RR 0.16, 95% CI 0.06-0.42, P=0.0002), microscopic extrathyroidal extension (RR 0.19, 95% CI 0.06-0.60, P=0.005), and multifocality (RR 0.13, 95% CI 0.04-0.45, P=0.001) in the absence of RAI ablation were more likely to have recurrence. Conclusions. Based on our current evidence, RAI ablation can reduce the cancer recurrence rate over 5 years in IR PTMC patients, especially when patients have some risk factors, such as lymph node metastasis, microscopic extrathyroidal extension, and multifocality.