In recent years, the incidence of thyroid cancer has rapidly increased, whereas the mortality rate has not risen correspondingly. Therefore, scholars at home and abroad have proposed the view of overdiagnosis in thyroid cancer, sparking intense debates about the phenomenon of overdiagnosis and overtreatment. A historical review and discussion of the primary reasons for the increase in thyroid cancer incidence and the improvement in treatment outcomes are beneficial. It helps clarify that the real increase in thyroid cancer is primarily due to the higher incidence rate, rather than overdiagnosis. Additionally, it allows us to reevaluate which factors guarantee favorable efficacy in thyroid cancer.
近年来甲状腺癌的发病率快速增长，而甲状腺癌的死亡率没有同步增长，因此国内外学者提出甲状腺癌过度诊断的观点，围绕甲状腺癌过度诊疗现象的讨论也日渐激烈。回顾历史、探讨甲状腺癌发病率增长和疗效改善的主要原因，更有利于厘清甲状腺癌真实增长是甲状腺癌发病率增高的最主要原因，而不是过度诊断。同时，也能重新认识哪些因素是甲状腺癌良好疗效的保证。.

Lung cancer has had one of the highest incidences and mortality in the world over the last few decades, which has aided in the promotion and popularization of screening for lung ground-glass nodules (GGNs). People have great psychological anxiety about GGN because of the chance that it will develop into lung cancer, which makes clinical treatment of GGN a generally excessive phenomenon. Overdiagnosis in screening has recently been mentioned in the literature. An important research emphasis of screening is how to reduce the incidence of overdiagnosis and overtreatment. This paper discusses from different aspects how to characterize the occurrence of overdiagnosis and overtreatment, how to reduce overdiagnosis and overtreatment, and future screening, follow-up, and treatment approaches.

UNASSIGNED: Cervical intraepithelial neoplasia (CIN) is a collective term for pre-cancerous lesions associated with cervical invasive carcinoma. Treatment options depend on the development and progression of the disease. Especially for patients with CINII grade who are aged 25 years and older and have fertility requirements, it is a clinical challenge to determine whether to proceed with conservative or excisional treatment. Excisional treatment increases the risk of overtreatment outcomes, such as cervical insufficiency, preterm labor, miscarriage, and premature rupture of membranes, in young women with childbearing potential. P16 immunohistochemical staining has greatly improved the consistency of CINII patient\'s diagnosis. The aim of this study was to analyze the risk factors predicting pathological degradation after cervical excision in cervical intraepithelial neoplasia grade II P16-positive patients over 25 years old, and to provide information to help optimize clinical treatments patients with CINII disease.
UNASSIGNED: Single-factor and logistic regression models were used to analyze the risk factors for pathological downgrading in the CINII/P16-positive (+) group. The predicted probability of pathological downgrading in the CINII/P16(+) group of patients was calculated according to the logistic regression model to generate a new variable multi-indicator association for receiver operating characteristic (ROC) curve plotting to determine the predictive ability.
UNASSIGNED: A total of 248 women who met the inclusion and exclusion criteria were included. Statistical analysis showed that the CINII/P16(+) group had a higher pathological downgrading rate compared with the CINIII group after cold knife conization (CKC) (χ2=6.26, P=0.012). Univariate factors showed that the differences were statistically significant when comparing age, number of biopsy-involved quadrants, menopausal status, and involvement of glands, respectively (P<0.05). In contrast, the differences were not statistically significant when comparing cytological findings, type of transformation zone, high-risk human papilloma virus (HR-HPV) testing, abortion status, pregnancy frequency, time from diagnosis to CKC and Ki67 percentage between the two groups. Multifactorial logistic regression showed that the extent of biopsy CINII involvement [odds ratio (OR), 1.589], menopausal status (OR, 4.031), and glandular involvement (OR, 5.549) were all independent risk factors for pathological downgrading in the CINII/P16(+) patient group (P<0.05). The order of significance of the areas under the ROC curve (AUCs) was as follows: combined multiple indicators (AUC 0.716) > gland involvement (AUC 0.625) > biopsy CINII involvement extent (AUC 0.614) > menopausal status (AUC 0.565).
UNASSIGNED: A higher rate of pathological downgrading after CKC was found in CINII/P16-positive patients who were aged over 25 years. Overtreatment exists in patients with CINII/P16-positive diagnosis. Independent factors for pathological downgrading were identified by the factors including if the lesion involved the gland, the extent of CINII involvement on biopsy, and menopausal status.

The effect of attachment positions on anchorage has not been fully explored. The aim of the present study is to analyze the effect of overtreatment with different anchorage positions on maxillary anchorage enhancement with clear aligners in extraction cases.
Models of the maxilla and maxillary dentition were constructed and imported into SOLIDWORKS software to create periodontal ligament (PDL), clear aligners, and attachments. Attachment positions on second premolars included: without attachment (WOA), buccal attachment (BA), and bucco-palatal attachment (BPA). Overtreatment degrees were divided into five groups (0°, 1°, 2°, 3°, 4°) and added on the second premolars. The calculation and analysis of the displacement trends and stress were performed using ANSYS software.
Distal tipping and extrusion of the canines, and mesial tipping and intrusion of the posterior teeth occurred during retraction. A strong anchorage was achieved in cases of overtreatment of 2.8° with BA and 2.4° with BPA. Moreover, the BPA showed the best in achieving bodily control of the second premolars. When the overtreatment was performed, the canines and first molars also showed reduced tipping trends with second premolars attachments. And the stress on the PDL and the alveolar bone was significantly relieved and more evenly distributed in the BPA group.
Overtreatment is an effective means for anchorage enhancement. However, the biomechanical effect of overtreatment differs across attachment positions. The BPA design performs at its best for stronger overtreatment effects with fewer adverse effects.

Thyroid cancer incidence in France has increased rapidly in recent decades. Most of this increase has been attributed to overdiagnosis, the major consequence of which is overtreatment. We aimed to estimate the cost of thyroid cancer management in France and the corresponding cost proportion attributable to the treatment of overdiagnosed cases.
Multiple data sources were integrated: the mean cost per patient with thyroid cancer was estimated by using the Echantillon Généraliste des Bénéficiaires data set; thyroid cancer cases attributable to overdiagnosis were estimated for 21 departments using data from the French network of cancer registries and extrapolated to the whole country; medical records from 6 departments were used to refine the diagnosis and care pathway.
Between 2011 and 2015, 33 911 women and 10 846 men in France were estimated to be diagnosed of thyroid cancer, with mean cost per capita of €6248. Among those treated, 8114 to 14 925 women and 1465 to 3626 men were due to overdiagnosis. The total cost of thyroid cancer patient management was €203.5 million (€154.3 million for women and €49.3 million for men), of which between €59.9 million (or 29.4% of the total cost, lower bound) and €115.9 million (or 56.9% of the total cost, upper bound) attributable to treatment of overdiagnosed cases.
The management of thyroid cancer represents not only a relevant clinical and public health problem in France but also a potentially important economic burden. Overdiagnosis and corresponding associated treatments play an important role on the total costs of thyroid cancer management.

暂无摘要。

Objective: To evaluate the effect of ultrasound diagnosis of thyroid micro-malignant nodules and accumulate practical experience for the management of active surveillance for them, so as to avoid overtreatment. Methods: A total of 949 patients who were diagnosed with thyroid malignant nodules using ultrasonography, with the nodules being less than 1 cm in size and without regional lymph node metastasis or distant metastasis, were included. They were treated by the same surgeon of the Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences from February 2014 to December 2020. 112 patients chose immediate surgery. The rest patients were asked to accept ultrasound examination every 6 months to 1 year. Follow-up endpoints: tumor size growth of 3 mm, tumor volume increase greater than 50%, lymph node metastasis or distant metastasis. Results: The median follow-up time was 19 months. 713 patients underwent surveillance for more than 6 months. Of the 713 patients, 570 (79.9%) were women, with mean age at 43.5 years old. Tumor progression was observed in 47 (6.6%) patients with a cumulative incidence of 2.7% (1 year), 7.2% (2 years) and 9.5% (3 years). In multivariate analysis, patient age [HR=0.508, 95%CI: 0.275-0.939, P=0.031], lesion number [HR=2.945, 95%CI: 1.593-5.444, P=0.001] and tumor size [HR=2.245, 95%CI: 1.202-4.192, P=0.011] at the beginning of observation were independent risk factors for tumor progression in patients with minimal thyroid malignant nodules during follow-up. During a median (range) active surveillance of 19 (6-80) months, 74 patients chose surgery during the surveillance. Among the 186 patients who underwent surgery, only 3 patients were diagnosed with fibrotic nodules in pathology, while the rest were papillary thyroid carcinoma. The ultrasound accuracy reached 98.4%(183/186). Conclusions: Ultrasonography is an effective method of diagnosing malignant thyroid nodules. Thyroid micro-malignant nodules progress slowly. As a result, it is safe to observe them instead of taking immediate surgery. Patient age, lesion number and tumor size at the beginning of observation are independent risk factors for the tumor progression of malignant nodules.
目的： 评价对超声诊断的甲状腺微小恶性结节进行监测随访的效果，探讨甲状腺微小恶性结节避免过度治疗的管理策略。 方法： 收集2014年2月至2020年12月由中国医学科学院肿瘤医院同一位头颈外科医师接诊、同一位超声医师超声诊断为甲状腺微小恶性结节(肿瘤长径≤1.0 cm)、无区域淋巴结转移和远处转移的初诊患者949例，其中有112例患者选择立即手术治疗，其余患者接受以超声检查为主的监测随访。随访终点为肿瘤进展，包括较初诊时肿瘤长径增大≥3 mm或肿瘤体积增大≥50%、出现区域淋巴结转移或远处转移。 结果： 中位随访时间为19个月。在713例随访时间≥6个月的患者中，随访期间出现肿瘤进展47例(6.6%)，1、2、3年肿瘤进展累积发生率分别为2.7%、7.2%和9.5%，无1例患者出现远处转移。单因素Cox回归分析显示，患者的初诊年龄、病灶数量和肿瘤长径与甲状腺微小恶性结节患者随访期间肿瘤进展有关(均P<0.05)。多因素Cox回归分析显示，患者的初诊年龄(年龄>50岁：HR＝0.340，95%CI为0.133~0.866)、病灶数量(HR＝2.939，95%CI为1.590~5.431)和肿瘤长径(HR＝2.293，95%CI为1.226~4.289)是甲状腺微小恶性结节患者随访期间肿瘤进展的独立影响因素。随访期间74例患者选择手术治疗，与112例确诊后选择立即行手术治疗的患者合计，行手术治疗的患者共有186例，其中183例术后病理诊断为甲状腺乳头状癌，3例为纤维化结节。超声诊断甲状腺微小恶性结节的准确率达98.4%(183/186)。 结论： 超声是诊断甲状腺微小恶性结节的有效手段。甲状腺微小恶性结节进展缓慢，对其进行监测随访安全可行，有助于避免过度治疗。患者的初诊年龄、病灶数量和肿瘤长径是甲状腺微小恶性结节随访期间发生进展的独立影响因素。.

UNASSIGNED: Active surveillance (AS) has been considered the first-line management for patients with clinical low-risk papillary thyroid microcarcinoma (PTMC) who often have lymph node micrometastasis (m-LNM) when diagnosed. The \"low-risk\" and \"high prevalence of m-LNM\" paradox is a potential barrier to the acceptance of AS for thyroid cancer by both surgeons and patients.
UNASSIGNED: Patients diagnosed with PTMC who underwent thyroidectomy with at least one lymph node (LN) examined were identified from a tertiary center database (n = 5,399). A β-binomial distribution was used to estimate the probability of missing nodal disease as a function of the number of LNs examined. Overall survival (OS) probabilities of groups with adequate and inadequate numbers of LNs examined were estimated using the Kaplan-Meier method in the Surveillance, Epidemiology, and End Results (SEER) database (n = 15,340). A multivariable model with restricted cubic splines was also used to verify the association of OS with the number of LNs examined.
UNASSIGNED: The risk of residual m-LNM (missed nodal disease) ranged from 31.3% to 10.0% if the number of LNs examined ranged from 1 and 7 in patients with PTMC. With 7 LNs examined serving as the cutoff value, the intergroup comparison showed that residual positive LNs did not affect OS across all patients and patients aged ≥55 years (P = 0.72 and P = 0.112, respectively). After adjusting for patient and clinical characteristics, the multivariate model also showed a slight effect of the number of LNs examined on OS (P = 0.69).
UNASSIGNED: Even with the high prevalence, OS is not significantly compromised by persistent m-LNM in the body of patients with low-risk PTMC. These findings suggest that the concerns of LNM should not be viewed as an obstacle to developing AS for thyroid cancer. For patients with PTMC who undergo surgery, prophylactic central LN dissection does not provide a survival benefit.

UNASSIGNED: Empirical treatment was introduced when pathological or microbiological results of tuberculosis (TB) were not available. This report was designed to evaluate an algorithm based on empirical treatment in defining tuberculous pleural effusion (TPE) in high burden areas but short of diagnostic tools.
UNASSIGNED: In this retrospective study, a total of 924 eligible patients were enrolled and 203 (22.0%) were primarily diagnosed as TPE by our diagnostic algorithm based on effusion characteristics [adenosine deaminase (ADA) and exudate] and immunoassays [purified protein derivative (PPD), M. tuberculosis antibody (TB-Ab) and interferon-gamma release assay (IGRA)]. All diagnosed cases received World Health Organization (WHO) standard anti-TB treatment and 187 of them had at least one year of follow-up. The final diagnosis and prognosis of these patients were traced and recorded.
UNASSIGNED: A total of 177 (94.65%) cases benefited from standard treatment, 5 (2.67%) failed due to early termination or drug resistance, and 5 (2.67%) were finally confirmed as misdiagnosis. Regarding diagnostic efficacy, 72 (30.13%) patients received four TB tests, and the combination of the four tests could increase the diagnosis of TPE. Besides, receiving operating characteristics curve (ROC) analysis revealed that our algorithm was the best method to differentiate TPE from malignant pleural effusion (MPE) with higher sensitivity and specificity than other serum markers.
UNASSIGNED: This clinical diagnostic algorithm was an efficient and available method for the diagnosis of TPE. This diagnostic algorithm should be implemented in regions with high TB prevalence but short of diagnostic tools.

BACKGROUND: The objective of this study was to analyze the effects of aligner overtreatment on torque control and intrusion of incisors for anterior retraction with clear aligners.
METHODS: Models including a maxillary dentition without first premolars, maxilla, periodontal ligaments, attachments, and aligners were constructed and imported to finite-element software. Two groups of models were created: (1) without canine attachment and (2) with canine attachment. Overtreatment degrees (0°, 1°, 2°, 3°, 4°, and 5°) were applied for both groups.
RESULTS: Clear aligner therapy caused lingual tipping and extrusion of incisors, distal tipping and extrusion of canines, and mesial tipping and intrusion of posterior teeth, which was more significant with canine attachments except for second premolars. Aligner overtreatment produced palatal root torquing and intrusion of incisors, distal tipping of canines, and mesial tipping of second premolars, with more significant in the condition with canine attachments. With canine attachments, 1.2° overtreatment could cause bodily retraction of central incisors. Without overtreatment, stress was concentrated on apical and cervical area of both labial and lingual surfaces of periodontal ligaments. The stress value was higher with canine attachments. However, when overtreatment was added, the stress was distributed more evenly.
CONCLUSIONS: Clear aligner therapy produced lingual tipping and extrusion of incisors during anterior retraction. Overtreatment can achieve incisor intrusion and palatal root torquing, and the effect could be augmented by adding attachments on canines, which required more anchorage from posterior teeth. Appropriate overtreatment with placing attachments on canines should be designed to ensure bodily retraction and the least root resorption.