SAT-827 - Finite Element Modeling in Endocrine Tumors (2020-2025): A Systematic Review of Biomechanical and Multiphysics Advances, Clinical Gaps, and Future Directions

Context: Endocrine tumors originate in sensitive anatomical regions, including the skull base, cervical compartment, and adrenal area, where minor variations in mechanical stress or temperature, measured in millimeters, can result in visual impairments, hormonal imbalances, or therapeutic risks. The Finite Element Method (FEM) offers a quantitative framework for analyzing these processes in complex geometries; however, its application in endocrine oncology remains fragmented and lacks a comprehensive synthesis.

Aim: This systematic review is the inaugural study to synthesize biomechanical and multiphysics advances in endocrine tumors using FEM, identifying clinical utility and translational gaps.

Method: We employed a PRISMA 2020-based search and screening protocol to analyze FEM studies from 2020 to 2025. Boolean combinations tailored for four databases yielded 477 records; following a dual-phase peer screening process, eight original studies met the inclusion criteria, spanning biomechanical, thermal, electromagnetic, and optothermal domains.

Results: In the pituitary region (n=1), mechanical models showed that optic chiasm compression induces greater deformation in crossing fibers, providing a mechanistic explanation of bitemporal hemianopsia. In the thyroid (n=6), structural FEM demonstrated that tracheal stiffness increases regional stress and correlates with the intra-thyroidal distribution of papillary microcarcinomas; notably, this biomechanical marker was validated against a large clinical cohort of 998 patients. Regarding thermal therapies, several thermal and electromagnetic simulations reported optimization of radiofrequency and microwave ablation parameters, while optothermal models showed that subcutaneous fat thickness is the principal determinant of surface thermal variation, limiting the diagnostic capacity of infrared thermography. In the adrenal gland (n=1), a coupled electromagnetic–thermal model forecasted microwave ablation zones with ex vivo validation. Across studies, validation strategies were heterogeneous, and overall methodological quality was predominantly moderate, with recurrent gaps in numerical transparency. No FEM evidence was identified for endocrine pancreatic or parathyroid tumors; exocrine pancreatic studies were addressed separately in an appendix.

Conclusion: This review provides the first integrated map of FEM applications in endocrine tumors. It shows that although current use is predominantly investigational, FEM holds meaningful clinical potential to anticipate neural deformation, tumor distribution, and thermal effects. Progress toward clinical integration will require rigorously validated, patient-specific, fully coupled Multiphysics models capable of supporting personalized therapeutic decisions and enabling digital twins in endocrine oncology.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*