Publications by authors named "Linwah Yip"
Introduction: The outcomes of completion thyroidectomy are not well-documented. The study aim is to compare the risks of total thyroidectomy (TT), thyroid lobectomy (TL), and completion thyroidectomy (CT) using a large multi-institutional database.
Methods: All cases of thyroidectomy without lymphadenectomy were identified using the CESQIP national database (2013-2023).
The Landmark Series: Testing in Thyroid Nodule Fine Needle Aspiration Cytology.
Ann Surg Oncol
April 2025
There has been remarkable growth in our understanding of the biologic behavior and molecular signature of thyroid malignancies, which has led to the introduction, application, and evolution of molecular testing of thyroid nodule FNA cytology. Next-generation sequencing molecular testing is an important, well-validated diagnostic tool for management of cytologically indeterminate thyroid nodules. It reduces unnecessary thyroid surgery for benign disease, avoiding associated surgical risks for the patient and reducing healthcare expenses.
View Article and Find Full Text PDFIntroduction: The American Association of Endocrine Surgeons drafted Entrustable Professional Activities for Comprehensive Endocrine Surgery to assess trainees in core topics.
Methods: Fourteen Entrustable Professional Activities were defined. There were 10 "core" Entrustable Professional Activities, with 6 having 3 phases (pre-, intra-, and postoperative) and 4 having a single phase.
Reappraisal of BRAFK601E-positive thyroid tumors in the NIFTP era.
Endocr Relat Cancer
December 2024
BRAFK601E is an uncommon mutation typically found in encapsulated follicular-patterned thyroid tumors. Previous studies on BRAFK601E-positive thyroid tumors were conducted before the implementation of the non-invasive follicular neoplasm with papillary-like nuclear features (NIFTP) diagnosis. This study aimed to characterize BRAFK601E-positive tumors and evaluate changes in the diagnosis and management of these patients after the introduction of NIFTP.
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- The study evaluates how molecular testing can help determine the need for surgery in patients with differentiated thyroid carcinoma (DTC) sizes ranging from 1 to 4 cm and its association with disease recurrence.
- Among the analyzed patients, only 3.8% experienced recurrence, with no significant association found between recurrence and preoperative variables like tumor size, age, or sex.
- Molecular risk groups showed that intermediate risk tumors between 2.1-4 cm had a higher recurrence rate (11.3%) compared to smaller tumors (5.8%), indicating that size and molecular testing are important considerations for treatment decisions.
Article Synopsis
- Kürsteiner canals (KC) are embryological remnants linked to parathyroid and thymic development, with ongoing research aimed at understanding their role in various parathyroid lesions and cysts.
- A study evaluated 62 cystic and 22 non-cystic parathyroid lesions over a 12-year period, identifying distinct KC phenotypes in relation to the presence of parathyroid hormone (PTH).
- The findings reveal that KC commonly appear in parathyroids, particularly in non-PTH cysts, and suggest that these manifestations may originate from KC, while PTH-positive cysts are associated with different characteristics.
Introduction: Thyroid cytopathology cases with suspicious for malignancy (SFM) diagnosis often result in resection. However, molecular testing offers details that may provide additional insights. In this study, the molecular profiles of SFM cases from two institutions that routinely used ThyroSeq v3 (TSV3) were examined.
View Article and Find Full Text PDFThe Role of Molecular Markers in Thyroid Cancer Diagnostics and Treatment.
Surg Clin North Am
August 2024
Molecular testing for cytologically indeterminate thyroid nodules has demonstrated benefit by reducing the need for diagnostic thyroidectomies and reducing costs. Its use is currently recommended in practice guidelines from the American Thyroid Association and the American Association of Endocrine Surgeons when clinically appropriate. Moreover, there is growing evidence that molecular testing may provide prognostic information and can detect targetable genetic alterations which may expand treatment options for refractory advanced thyroid cancers.
View Article and Find Full Text PDFBackground: Normocalcemic hyperparathyroidism can occur, but surgery should not be considered until common etiologies for secondary hyperparathyroidism are comprehensively excluded. Calcium deficiency is an underrecognized cause of normocalcemic parathyroid hormone elevation, and we aim to determine if the implementation of a preoperative calcium challenge can be used to reduce unnecessary parathyroidectomy.
Methods: Consecutive patients referred for parathyroidectomy (1/21-6/22) with normocalcemia (serum calcium <10 mg/dL) and concurrently elevated parathyroid hormone levels were routinely treated with supplemental calcium and vitamin D3, and follow-up laboratory studies were assessed.
Background: Differences in presenting symptoms of primary hyperparathyroidism and outcomes of parathyroidectomy between sexes have been described, but whether these can be assessed by perioperative use of a validated tool, such as the Pasieka Parathyroidectomy Assessment Score, is unknown.
Method: All patients with primary hyperparathyroidism were asked to complete symptom assessment at the preoperative and postoperative visits. The assessment included a query for 13 Pasieka Parathyroidectomy Assessment Score parameters evaluated using a visual analog scale as described by Pasieka (summative score 0-1,300), and general quality of life and wellness.
Background: Renal hyperparathyroidism due to end-stage kidney disease is associated with considerable morbidity, and when refractory is treated with parathyroidectomy. Recurrent renal hyperparathyroidism is a major surgical complication, yet initial target parathyroid remnant size and outcomes, including rates of recurrence are not well elucidated.
Methods: This is a single-institution retrospective cohort study of patients who underwent initial subtotal parathyroidectomy for renal hyperparathyroidism on dialysis, from 1990-2022.
Article Synopsis
- The study investigates how molecular tests, like ThyroSeq v3, can help assess risks of malignancy in indeterminate thyroid cytopathology cases, providing a more accurate risk probability compared to traditional methods.
- Results showed that molecular-derived risk of malignancy (MDROM) rates for various cytopathologic diagnoses were generally within established reference ranges, but the positive call rates (PCR) varied more significantly among cytopathologists, particularly for atypia of undetermined significance (AUS).
- The findings suggest that MDROMs and PCRs can serve as valuable metrics for evaluating cytopathologists’ performance and improving overall quality in diagnosing thyroid conditions.
Article Synopsis
- A comprehensive genomic analysis was conducted on a large number of thyroid nodules (50,734 FNA samples) to identify molecular alterations and better understand their clinical significance, particularly in Bethesda categories III-VI.
- The results showed that a majority (65.3%) of the samples tested negative for significant alterations, while a smaller proportion (33.9%) tested positive, revealing different mutation patterns in BCIII-IV and BCV-VI nodules, with BCV-VI showing more aggressive genetic changes.
- The findings indicate that 68% of BCIII-IV nodules were negative, highlighting the potential to avoid unnecessary surgery, while BCV-VI nodules had more actionable mutations that could inform treatment decisions for patients.
Article Synopsis
- Molecular testing (MT) shows promise as a tool to assess the risk of recurrence in differentiated thyroid carcinoma before starting treatment, in addition to traditional preoperative factors.* -
- In a study of 945 patients, tumor size emerged as the primary predictor of recurrence, while incorporating MT results improved predictive accuracy in a subset of patients.* -
- The study found that recurrences were present across all risk categories defined by the American Thyroid Association (ATA) Risk Stratification System (RSS), highlighting the importance of tumor size and MT for predicting disease outcomes.*
Introduction: Indeterminate thyroid cytology diagnoses are associated with intermediate risks of malignancy. Application of molecular testing (MT) to indeterminate specimens provides additional diagnostic and prognostic information. While a positive or suspicious MT result may prompt surgery, a negative MT result is associated with a low probability of cancer or noninvasive follicular thyroid neoplasm with papillary-like nuclear features and approximates that of a benign cytology diagnosis.
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- Molecular testing enhances the diagnostic precision for thyroid cancer, prompting a need to explore its links to tumor characteristics and prognostic outcomes.
- In a study of 578 thyroid cancer patients who underwent genetic testing, cancers were classified into three risk groups: low (49.9%), intermediate (37.5%), and high (12.6%), with a 9.1% recurrence rate observed during a median follow-up of 19 months.
- Results indicated that higher-risk groups were associated with older age, more aggressive tumor features (like vascular invasion), and significantly greater recurrence likelihood compared to lower-risk groups.
Objective: To assess the validity of the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) for evaluating thyroid nodules in children.
Methods: Patients aged <19 years with thyroid nodule(s) evaluated by ultrasound (US) from 2007-2018 at a tertiary children's hospital were included. Two radiologists scored de-identified thyroid US images using ACR TI-RADS (from 1, "benign" to 5, "highly suspicious").
Background: The American College of Radiology Thyroid Imaging Reporting and Data System for ultrasound classification of malignancy risk was developed to better triage thyroid nodules for fine-needle aspiration biopsy. To examine further, we compared thyroid cytologic classification rates in nodules before and after institutional Thyroid Imaging Reporting and Data System implementation.
Methods: Cytology diagnoses by Bethesda criteria (categories I-VI) from January 2014 to October 2021 were retrieved; observed changes in yearly category frequency were analyzed by linear regression; and pooled cohorts of pre- (2014-2018) and post-Thyroid Imaging Reporting and Data System (2019-2021) cytology call rates were compared.
Article Synopsis
- Renal cell carcinoma (RCC) is the leading type of cancer that spreads to the thyroid, making diagnosis challenging due to similar cytological features in thyroid tumors.
- This study examined the effectiveness of molecular testing for detecting metastatic RCC in fine-needle aspiration (FNA) samples from the thyroid, focusing on VHL gene alterations that are uncommon in primary thyroid cancers.
- Results showed that 50% of samples had harmful VHL mutations, suggesting that incorporating molecular testing can enhance diagnosis and management of patients with indeterminate thyroid nodules potentially caused by metastatic RCC.
Importance: Adrenalectomy is the definitive treatment for multiple adrenal abnormalities. Advances in technology and genomics and an improved understanding of adrenal pathophysiology have altered operative techniques and indications.
Objective: To develop evidence-based recommendations to enhance the appropriate, safe, and effective approaches to adrenalectomy.
Background: Liver metastasis from duodenopancreatic neuroendocrine neoplasms (DP-NENs) is a major cause of mortality in multiple endocrine neoplasia type 1 (MEN1) patients, yet much of their natural history is unknown.
Methods: This longitudinal, retrospective cohort study analyzed all MEN1 patients with imageable functional (F) and nonfunctional (NF) DP-NENs (1990-2021) for liver metastasis-free survival (LMFS) and overall survival (OS).
Results: Of 138 patients, 85 (61.
Article Synopsis
- The study focuses on noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), which was redefined in 2016, and assesses patients diagnosed during surgery rather than retrospectively like previous studies.
- A total of 79 patients with a mean age of 51 years were included, the majority being women, and their NIFTP nodules averaged 2.4 cm in size, with many categorized as either TI-RADS 3 or 4 on ultrasound.
- Molecular testing revealed significant genetic alterations in 93.5% of the nodules, with common mutations and fusions identified, and patients were primarily treated via lobectomy or total thyroidectomy, with close follow-up planned for
Article Synopsis
- Molecular testing, specifically ThyroSeq v3 (TSv3), is utilized to evaluate cancer risk in thyroid nodules with Bethesda V (suspicious for malignancy) fine needle aspiration (FNA) samples, as previous data was limited for this category.
- In a study of 128 SFM samples, 78.1% were TSv3 positive with a high cancer prevalence of 82.8%, and the test yielded a sensitivity of 89.6% and specificity of 77.3%.
- Among patients with confirmed cancer, the study found varying levels of risk based on molecular risk groups (MRGs), with higher disease recurrence rates associated with MRG-High tumors during an average follow-up of
Article Synopsis
- EIF1AX gene mutations are found in both benign and malignant thyroid tumors, but their preoperative implications remain unclear, prompting this study to explore their characteristics and outcomes.
- In a study of 31 patients, the researchers found that 55% of mutations were in exon 2 and 48% had coexisting mutations, with a notably higher prevalence of cancer in nodules with multiple mutations.
- The findings indicate that isolated non-splice mutations are benign, while one-third of isolated splice mutations are cancerous, suggesting the need for tailored clinical management based on mutation type and co-occurrence.