With the advancement of thyroid tumor treatment concepts and the progress of standardized treatment processes nationwide, the 5-year survival rate of thyroid tumors in China has risen from 67.5% in 2003 to 84.3% in 2015. As China has been continuously enriching its treatment options for advanced thyroid cancer in recent years, gradually improving the standardized treatment system for early and intermediate thyroid cancer, enhancing multidisciplinary collaboration methods and concepts, and regularizing scientific statistics, the survival rate of thyroid tumors continues to improve. We still need to consider the future development direction and core driving force of China’s thyroid discipline, correctly view the “prosperous” stage of domestic thyroid discipline development, and actively review the future development direction of China’s thyroid discipline.
ObjectiveTo analyze the clinicopathologic features of thyroid tumors with RAS gene mutation.MethodThe clinicopathologic data of thyroid tumor patients who underwent surgical treatment or biopsy and were diagnosed pathologically at the Department of Pathology of the Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2021 to June 2023, were collected. ResultsA total of 798 patients with thyroid tumors who met the inclusion criteria were collected, including 747 cases of follicular epithelial tumors and 51 cases of medullary thyroid carcinoma (MTC). Among 798 patients, the RAS gene mutations were detected in 36 cases (4.5%), including 25 (69.4%) patients with NRAS mutations, 8 (22.2%) patients with HRAS mutations, 3 (8.3%) patients with KRAS mutations, and 4 (1.1%) patients accompanied with TERT promoter mutations. Among 36 patients with RAS mutant thyroid tumors, the male to female ratio was 7∶11, with a median age of 48.5 years, with an average tumor diameter of 2 cm. The mutation rate of RAS gene in different histological types of thyroid tumors, from high to low, was highest in the thyroid follicular carcinoma (FTC, 25.9%), followed by differentiated high grade thyroid carcinoma (20.0%), anaplastic thyroid carcinoma (20.0%), noninvasive follicular thyroid neoplasm with papillary like nuclear features (18.2%), follicular variant of papillary thyroid carcinoma (FVPTC, 16.0%), and well-differentiated thyroid tumour of uncertain malignant potential (WT-UMP, 12.8%), the mutation rates of RAS gene in the FTC, FVPTC, and WT-UMP were significantly higher than that of the classical papillary thyroid carcinoma (P<0.001 1), and the mutation rate of RAS gene was the lowest in the classical papillary thyroid carcinoma (1.5%). A total of 35 patients were effectively followed up with an average follow-up period of 21.4 months, 6 of whom had cervical lymph node metastasis, 4 patients developed distant metastasis, and 1 patient with anaplastic thyroid carcinoma died. ConclusionsRAS gene mutation can occur in thyroid follicular differentiated tumors and MTC. NRAS mutation is more common. The mutation rate is the highest in FTC, is the lowest in classical papillary thyroid carcinoma. Differential diagnosis combined with tissue morphology and other molecular changes can provide a reference for guiding treatment and evaluating prognosis.
ObjectiveTo understand the research status, advantages and disadvantages, indications and contraindications, as well as the current challenges and countermeasures, controversies, and future development of gasless trans-subclavian approach endoscopic thyroidectomy (GTAET). MethodThe relevant domestic and international literature on GTAET was reviewed. ResultsIn terms of oncological outcomes (such as the number of central lymph nodes dissected), GTAET is comparable to traditional open surgery. It demonstrates markedly higher postoperative cosmetic satisfaction and significantly lower incidences of anterior neck paresthesia and swallowing traction discomfort. Compared to other endoscopic approaches (such as the transaxillary approach), GTAET offers advantages including a shorter surgical path, less trauma during cavity creation, a better visual field for central lymph node dissection, and a shorter operative time. It also avoids CO2 insufflation-related risks such as subcutaneous emphysema and hypercapnia. The main limitations of this technique are its generally longer operative time compared to open surgery and the potential for increased postoperative drainage. Furthermore, it faces several technical challenges and application difficulties in clinical practice, including the optimization of specialized instruments, standardization of surgical procedures, and management of lateral neck lymph node dissection. ConclusionsGTAET is a safe and feasible minimally invasive surgical approach for thyroid disease. While ensuring thorough tumor eradication, it combines the advantages of a well-concealed incision, excellent preservation of anterior neck function, and the safety and convenience of gasless technique. It also has a relatively manageable learning curve, making it an excellent surgical option for patients with thyroid tumors who prioritize cosmetic outcomes and quality of life.