The authors have no acknowledgments.

This study protocol was approved by the Ethics Committee of Sichuan Cancer Hospital (Approval date: September 27, 2019). All the procedures involving human participants were performed in accordance with the ethical standards of the institutional and national research committees, as well as the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all the patients before surgery.
1. Inclusion and exclusion criteria
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The authors have nothing to disclose.

For recurrent and metastatic differentiated thyroid carcinoma (DTC), surgical treatment is still preferred17. The 5 year disease-specific survival rate of patients with DTC and R0 resection is 94.4%, which is significantly higher than that of patients with R1 resection (67.9 %)2. Achieving disease control in the neck is crucial for attaining a better quality of life and disease-specific survival for patients4. Medullary thyroid carcinoma is mainly tr...

Thyroid cancer is the seventh most common malignancy in China1, and surgery is the most important treatment method2,3. Complete resection of the tumor is strongly associated with high survival rates and a good quality of life in patients with locally advanced thyroid cancer3,4; however, this type of resection is challenging. The neck contains important organs and tissues, such as the trachea, esophagus, and common carotid artery. Resection for advanced thyroid cancer is even more risky and difficult considering the proximity of such tumors to important organs and large blood vessels in the neck and mediastinum5,6. Thus, adequate preoperative evaluation is necessary.
Currently, computed tomography (CT), magnetic resonance (MRI), and color Doppler ultrasonography, which are widely used in clinical settings, provide a two-dimensional (2D) view, which limits the evaluation of the tumor volume, boundaries, and relationships with important surrounding structures7,8. Substantial clinical experience and efficient trial and error are required before surgeons can translate 2D images into 3D space. Computer-aided 3D visualization can use 2D imaging to create a more intuitive 3D model that can be used for preoperative planning and treatment plan selection, thereby making doctor-patient communication more intuitive and reducing doctor-patient disagreements. Although the model provides 3D visualization, it is intangible. This 3D-guided preoperative evaluation and preparation can shorten the surgical time and reduce the surgical risks. The 3D approach has been widely used in hepatobiliary surgery, orthopedics, and oral and maxillofacial surgery9,10. In thyroid cancer, 3D visualization is currently used to assist in ultrasonic diagnosis and in the formulation of surgical plans11,12,13,14,15.
Therefore, we believe that 3D visualization can be conveniently applied to the diagnosis and treatment of locally advanced thyroid cancer. This visualization method includes CT acquisition, computer-aided 3D modeling, and preoperative evaluation using 3D models. The 3D models can be used to determine surgical difficulties, surgical risks, and the potential postoperative functional status. Surgeons can engage in detailed doctor-patient communication, surgical plan formulation, and the corresponding surgical preparation16. Furthermore, this method can provide an adequate preoperative assessment of patients, reduce the surgical risks, and improve patient satisfaction without increasing patient trauma.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Brilliance 256-layer spiral CT system</td>
			<td>Philips Healthcare, Andover, MA, USA</td>
			<td>N/A</td>
			<td>Used for plain and enhanced CT imaging</td>
		</tr>
		<tr>
			<td>3D-Matic digital medical software application</td>
			<td>Anhui King Star Digital S&#38;T Co. Ltd.</td>
			<td>N/A</td>
			<td>Used for computer-aided 3D visualization reconstruction</td>
		</tr>
	</tbody>
</table>

computer-aided three-dimensional visualization in the treatment of locally advanced thyroid cancer

The diagnosis and treatment of locally advanced thyroid carcinoma are challenging. The challenge lies in the evaluation of the tumor scope and the formulation of an individualized treatment plan. Three-dimensional (3D) visualization has a wide range of applications in the field of medicine, although there are limited applications in thyroid cancer. We previously applied 3D visualization for the diagnosis and treatment of thyroid cancer. Through data collection, 3D modeling, and preoperative evaluation, we can obtain 3D information regarding the tumor outline, determine the extent of tumor invasion, and conduct adequate preoperative preparation and surgical risk assessment. This study aimed to demonstrate the feasibility of 3D visualization in locally advanced thyroid cancer. Computer-aided 3D visualization can be an effective method for accurate preoperative evaluation, the development of surgical methods, shortening the surgical time, and reducing the surgical risks. Furthermore, it can contribute to medical education and doctor-patient communication. We believe that the application of 3D visualization technology can improve outcomes and quality of life in patients with locally advanced thyroid cancer.

From December 2017 to July 2021, 23 patients with locally advanced thyroid cancer underwent 3D modeling. Of these 23 patients, 4 were excluded from surgery owing to surgical risks, and the remaining 19 patients were treated with surgery following 3D modeling (Table 1). All 19 patients had locally advanced thyroid cancer, including 14 for whom this was the initial diagnosis, 16 who had varying degrees of dyspnea, and 18 who had large tumors in the neck (primary thyroid tumor or metastatic lymph node) that...

Watch this Scientific Journal Video about Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer at JoVE.com

Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer

In diagnosing and treating locally advanced thyroid cancer, the application of computer-aided three-dimensional reconstruction can provide additional information regarding the tumor scope and anatomic characteristics, thereby assisting in risk assessment and surgical planning.

The diagnosis and treatment of locally advanced thyroid carcinoma are challenging. The challenge lies in the evaluation of the tumor scope and the ...

The computer aided three dimensional reconstruction can provide information regarding the tumor scope and anatomy characteristics, thereby assisting in risk assessment and surgical plan. The computer aided three-dimensional reconstruction can provide information for diagnosing and treating local advanced thyroid cancer. To begin, obtain plain and enhanced CT images of the patients using a 256 layer spiral CT system.Obtain the scan data from the CT system in DICOM format. Then import the data into the 3D visualization software by clicking on the Open button. If the data contains image noise, process the data for Gaussian smoothing by first selecting the data with the right mouse button, and then clicking on the Gaussian smoothing button.Next, select the tab Different Models in the software according to the structure to be reconstructed, such as blood vessels or the skin. Set the color, maximum threshold and minimum threshold. Adjust the upper and lower thresholds based on the observed preview effect.Repeat the procedure to obtain the segmentation data of other structures such as the bones. Click on the calculation button to complete the preliminary 3D model reconstruction. Then use the smoothing algorithm button to optimize the segmented data and ensure that the reconstructed sawtooth edges match the real tissue.Then use the one click navigation button to locate the 2D and 3D images and determine whether the segmentation effect was accurate. Use the pen or brush tool to fix the incorrect layers. For preoperative evaluation, view the 3D model and evaluate the tumor volume and location.Using the magnification, rotation, tissue transparency and separation functions, evaluate the relationships between the tumor and the adjacent tissues using a combination of various structures. In the case of a 50 year old patient with thyroid carcinoma, initial evaluation using CT angiography suggested that a large number of vessels were involved in the tumor. Using CT data, the surgical team completed computer-aided 3D modeling of the tumor.Evaluation of the 3D model revealed the relationships between the tumor and the blood vessels, and further operative procedures were determined. It's important to check whether the three dimensional images is consistent with the CT images for successful reconstruction.

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420 Görüntüleme.  Affiliated Cancer Hospital of University of Electronic Science and Technology of China. Bilgisayar destekli üç boyutlu rekonstrüksiyon, tümör kapsamı ve anatomi özellikleri hakkında bilgi sağlayabilir, böylece risk değerlendirmesine ve cerrahi plana yardımcı olabilir. Bilgisayar destekli üç boyutlu rekonstrüksiyon, lokal ileri tiroid kanserinin teşhisi ve tedavisi için bilgi sağlayabilir. Başlamak için, 256 katmanlı spiral BT sistemi kullanarak hastaların düz ve geliştirilmiş BT görüntülerini elde edin.Tarama verilerini CT sisteminden DICOM fo...