RESUMEN
Background@#The true benefit of thyroid cancer screening is incompletely understood. This study investigated the impact of ultrasound screening on thyroid cancer outcomes through a comparison with symptomatic thyroid cancer using data from a nationwide cohort study in Korea. @*Methods@#Cox regression analysis was performed to assess the hazard ratios (HRs) for all-cause and thyroid cancer-specific mortality. Considering the possible bias arising from age, sex, year of thyroid cancer registration, and confounding factors for mortality (including smoking/drinking status, diabetes, and hypertension), all analyses were conducted with stabilized inverse probability of treatment weighting (IPTW) according to the route of detection. @*Results@#Of 5,796 patients with thyroid cancer, 4,145 were included and 1,651 were excluded due to insufficient data. In comparison with the screening group, the clinical suspicion group was associated with large tumors (17.2±14.6 mm vs. 10.4±7.9 mm), advanced T stage (3–4) (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09 to 1.41), extrathyroidal extension (OR, 1.16; 95% CI, 1.02 to 1.32), and advanced stage (III–IV) (OR, 1.16; 95% CI, 1.00 to 1.35). In IPTW-adjusted Cox regression analysis, the clinical suspicion group had significantly higher risks of all-cause mortality (HR, 1.43; 95% CI, 1.14 to 1.80) and thyroid cancer-specific mortality (HR, 3.07; 95% CI, 1.77 to 5.29). Mediation analysis showed that the presence of thyroid-specific symptoms was directly associated with a higher risk of cancer-specific mortality. Thyroid-specific symptoms also indirectly affected thyroid cancer-specific mortality, mediated by tumor size and advanced clinicopathologic status. @*Conclusion@#Our findings provide important evidence for the survival benefit of early detection of thyroid cancer compared to symptomatic thyroid cancer.
RESUMEN
A primary right atrial (RA) mass is not common; instead, most tumors in the right atrium originate from metastasis through the caval route. Here we describe a patient with a huge RA tumor that showed contiguous spread from the inferior vena cava. This 60-year-old patient, positive for hepatitis B surface antigen, visited the emergency department of our institution due to recently aggravated dyspnea. Transthoracic and transesophageal echocardiography clearly demonstrated a huge RA mass, 6.5x6.0 cm, causing flow disturbance. Cardiac magnetic resonance imaging and dynamic computed tomography of the liver showed multiple large hepatic masses that extended into the right atrium, with tumor thrombi in the inferior vena cava. Given the enhancement pattern in dynamic computed tomography of the liver, the hepatic mass was diagnosed as hepatocellular carcinoma. Due to the risk of spontaneous rupture of the mass, emergency transarterial chemoembolization was performed, without complications. Thereafter, thalidomide, which has been shown to have anti-angiogenic effects, was prescribed to the patient.