Objective To summarize the significance of BRAFV600E mutation for the diagnosis, treatment, and prognosis of papillary thyroid cancer (PTC). Methods Related literatures which were published in recent years for exploring the relationship of BRAFV600E mutation and PTC were collected and reviewed. Results The BRAFV600E mutation was the most common mutant type in PTC, which played an important role in the oncogenesis and development of PTC. In addition, this type of mutation was closely associated with aggressive behavior and poor prognosis of PTC. The BRAFV600E testing in fine needle aspiration (FNA) samples of thyroid nodule not only facilitated to improve the diagnostic accuracy of PTC, but also helped ensure the recurrence risk classification, selection of surgical treatment, and follow-up planning. Conclusion BRAFV600E mutation was prevalent in PTC and had important significance both in diagnosis and prognostic evaluation of PTC.
ObjectiveTo introduce the advances of intraoperative neuromonitoring (IONM) during thyroid or parathyroid surgery. MethodsThe literatures about IONM during thyroid or parathyroid surgery in recent years at home and abroad were collected and reviewed. ResultsIONM is improved from invasive to noninvasive:endotracheal intubation with electrode on its surface. Standardized procedures of IONM is developed. Intermittent monitoring is replaced by continuous monitoring. The monitoring of external branch of superior laryngeal nerve is also a supplement to laryngeal recurrent nerve. With the aid of IONM, non-recurrent laryngeal nerve could be identified easily, also injury spot, and damage degree. We could speculate probable damage mechanisms and prevent irreversible nerve damage through IONM. ConclusionsIONM could be an effective technique to reduce the risk of recurrent laryngeal nerve injury during thyroid or parathyroid surgery, especially in complex surgery and reoperations, which could predict the postoperative function of laryngeal recurrent nerve, and help to avoid severe postoperative complications.
ObjectiveTo identify the risk factors of central lymph nodal (CLN) metastasis in papillary thyroid carcinoma (PTC) and indicate central neck dissection. MethodsFifty cases were analyzed retrospectively. The BRAFV600E gene mutation was analyzed by sequencing and expression of VEGF-C was analyzed by using immunohistochemically. The clinicopathologic and molecular marker factors relating to CLN metastasis were analyzed. ResultsThe BRAFV600E gene mutation was found in 30 of 50 (60.0%) patients of PTC. Univariate analysis showed that BRAFV600E gene mutation of PTC patients was significantly correlated with high expression of VEGF-C (87.5% vs. 34.6%,P=0.000), not with clinicopathologic factors. High expression of VEGF-C was significantly correlated with CLN metastasis in PTC (87.5% vs. 57.7%, P=0.019). Multivariate analysis showed that invasion of the surrounding tissues (P=0.009,OR=9.082,95% CI:1.748-47.185) and the high expression of VEGF-C (P=0.009,OR=9.082,95% CI:1.748-47.185) were independent risk factors for the presence of CLN metastases. Conclusions①The BRAFV600E gene mutation for PTC patients is significantly correlated with high expression of VEGF-C, not with CLN metastasis in PTC. ②High expression of VEGF-C is significantly correlated with CLN metastasis in PTC. ③Tumor extrathyroidal extension, especially invasion of the surrounding tissues is significantly correlated with CLN metastasis in PTC.
ObjectiveTo explore the clinical characteristics, diagnosis and treatment of ectopic thyroid gland (ETG) so as to reduce the misdiagnosis and improper treatment. MethodsAccording to the patients who were definitely diagnosed ETG by pathology from 2002 to 2010 in our hospital, their clinical and pathological data were retrospectively analyzed. ResultsThere were 14 patients, 4 cases of male and 10 cases of female. Five patients had clinical symptoms. Eight cases were diagnosed before operation and six cases were diagnosed by pathology after operation. There were 4 cases were malignancy and 10 were benign. Three cases of differentiated ectopic thyroid carcinoma patients and 1 normal position's thyroid had papillary carcinoma patient accepted TSH suppression treatment after operation, 4 benign patients and 1 ectopic thyroid medullary carcinoma patient accepted levothyroxine substitution treatment after operation, and the other 5 benign patients did not accept any treatment after operation. Nine patients who accepted follow-up in 1-10 years had orthobiosis, and the malignancy patients without recurrence and metastasis. ConclusionsETG usually reveal no any special clinical features. For any masses from root of tongue to mediastinum, especially cervical masses, should be carefully check whether there are thyroid in normal position, and to exclude ETG. The color Doppler ultrasound, thyroid radioactive scanning, thyroid function tests, computed tomography, and fine needle aspiration cytology are all important examination measures. Due to the ETG may occur the same lesions as the normal position's thyroid, so once it is be definitly diagnosed, the treatment should be based on patient's age, position, size, and type of ETG, and nature of the lesions to select follow-up observation, operative treatment, levothyroxine replacement or therapeutic inhibition of TSH, and 131I therapy.
ObjectiveTo summarize and analyze the relevant studies about the tumor suppressor phosphatase and tensin homolog deleted on chromosome ten (PTEN) and thyroid tumor then further elucidate?the possible mechanism of thyroid tumor formation and progression. Mothods Domestic and international literatures investigating the correlation between PTEN and thyroid tumor were retrieved and reviewed. ResultsThe abnormal expression of PTEN protein resulted by the mutation or methylation of PTEN gene may up-regulate the expression of its downstream effectors such as PI3K, mTOR, FAK, etc. This probably correlate with thyroid neoplasia and progression. Conciusions Abnormalites of PTEN and its downstream signal ways may correlate with the initiation and development of thyroid tumors. However, the specific mechanism still remains unclear and need more further researches
ObjectiveTo explore optimal current intensity for neural monitoring of vagus nerve and recurrent laryngeal nerve during the thyroid and parathyroid surgery, so that we can judge function, location, identify, and protect the nerve more effectively and more quickly. MethodA total of 100 patients who underwent thyroid or parathyroid operations by the same surgeon in West China Hospital, meanwhile accepted intraoperative neuromonitoring (IONM), and 186 nerves at risk were enrolled in this study. According to the standardized process of nerve monitoring, we stimulated the vagus nerve with the current strength of 1-5 mA, and respectively stimulated laryngeal recurrent nerve with 1-3 mA indirectly and directly, and recorded the amplitude of electromyographic signal, and changes of heart rate and blood pressure during the process. The purpose was seeking the optimum current strength for each stage of IONM. ResultsIn 186 vagus nerves being tested, when monitoring the vagus nerve outside the carotid sheath, 109 vagus nerves (58.6%) sent out signals and got stable electromyography and warning tone with 1 mA, 164 (88.2%) vagus nerves had signals with 2 mA, 177 (95.2%) vagus nerves had signals with 3 mA, 182 (97.8%) vagus nerves had signals with 5 mA. Before and after the vagus nerve stimulation, heart rate and blood pressure of patients had no significant change. When directly monitoring the vagus nerve with 1 mA, V1 signals had no response in 2 vagus nerves (1.1%), V2 signals had no response in 9 vagus nerves (4.8%). But if the current intensity of stimulation was 2 mA or 3 mA, all patients got stable electromyographic signals. When searching for the laryngeal recurrent nerve, 92 (49.5%) got signals with 1 mA, 171 (91.9%) got signals with 2 mA, 184 (98.9%) got signals with 3 mA. When identifying laryngeal recurrent nerve and others, if the intensity of current was more than 2 mA, the current might conduct around and produce illusion. However, if the intensity of stimulation current was 1 mA, there's no electromyographic signal when we put the probe onto the tissue close to the laryngeal recurrent nerve. During identification of branches of laryngeal recurrent nerve with current strength of 1 mA, each electromyographic signal could be obtained. The chief branch into the throat produced the highest amplitude. The esophagus and trachea branch emg amplitude value was similar, equalling to 1/3-1/4 of the amplitude value in chief branch. ConclusionsWe suggest using current intensity of 5 mA on the surface of the carotid sheath to monitor the vagus nerve indirectly and obtain V1 signal, as an alternative to opening the carotid sheath. If fail, dissecting the carotid sheath, and using current intensity of 3 mA to monitor the vagus nerve directly; 3 mA is the optimal current intensity to search for the laryngeal recurrent nerve, and 1 mA is the optimal current intensity to identify the laryngeal recurrent nerve and its branches of esophagus and trachea, blood vessels, and so on.
ObjectiveTo investigate the value of carbon nanoparticle adopted in reoperation for thyroid cancer recurrence. MethodsFrom July to November of 2015, patients diagnosed with thyroid cancer recurrence in department of Thyroid & Parathyroid surgery, West China Hospital, Sichuan University were enrolled in the research. All enrollment patients underwent carbon nanoparticles location guided by ultrasonography before reoperation. Relative data about surgery and location were analyzed retrospectively. ResultsTwenty-two patients were enrolled in the research. Mean operation time was (60.45±12.91) minutes. During surgery, a total of 405 (average 18.4) lymph nodes were harvested, and the staining rate was 71.9% (291/405). The pathological examination showed that there was a significant difference in the positive rate between carbon nanoparticles stained lymph nodes (45.0%, 131/291) and non-stained lymph nodes (5.3%, 6/114), P < 0.001. In addition, the positive rate in non-targeted stained lymph nodes was 30.2% (62/205). By contrast, it was 5.3% (6/114) in non-targeted non-stained lymph nodes. The difference showed significant significance (P < 0.001). ConclusionsAdoption of carbon nanoparticles in reoperation for thyroid cancer, which improves efficiency of dissection for the non-palpable lymph nodes metastasis, is worth generalizing in clinical practice.
Objective To report our experience in using The Bethesda System for Reporting Thyroid Cytopathology(TBSRTC), and to investigate the diagnostic value of the system based on the cytologic-histologic result. Methods Pathological data of 2 257 thyroid nodules classified by TBSRTC which were obtained from the Department of Pathology of West China Hospital between Jan.2010 to Dec.2012 were collected and analyzed, to investigate the diagnostic evaluation indicators, such as the sensitivity, specificity, and diagnostic accuracy of the system based on the cytologic-histologic result. Results Of the 2 257 thyroid nodules, 442 (19.6%) were diagnosed as categoryⅠ, 1 184(52.4%) were diagnosed as categoryⅡ, 216(9.6%) were diagnosed as categoryⅢ, 38(1.7%) were diagnosed as categoryⅣ, 172(7.6%) were diagnosed as categoryⅤ, 205(9.1%) were diagnosed as categoryⅥ. Using TBSRTC categoryⅡas the boundary point of diagnosing benign and malignant diseases, the sensitivity, specificity, and diagnostic accuracy were 93.7%(236/252), 86.6%(323/373), and 89.4%(559/625)respectively, while categoryⅢwas excluded from analysis. When including categoryⅢinto analysis, the sensitivity, specificity, and diagnostic accuracy were 94.3%(267/283), 74.9%(323/431), and 82.6%(590/714)respectively. Conclusion The validity of TBSRTC was high at our institution. TBSRTC has proven to be an accurate and reliable approach for the diagnosis of thyroid nodules.
ObjectiveTo investigate the clinical value of cervical vascular color Doppler ultrasound for dignosis of nonrecurrent laryngeal nerve before thyroid surgery. MethodsThere were 1931 cases of thyroid patients treated between January 2010 to Jule 2014, group these patients according to the results of preoperative chest radiograph examination, the chest radiograph shows abnormal vessels image were group A (45 cases), no abnormalities were group B (1886 cases). Before operaton, made patients of group A to have routine carotid duplex ultrasound to identify whether the right subclavian artery abnormalities. All patients were exposed to conventional methods of recurrent laryngeal nerve during surgery. ResultsThe 45 patients of group A, chest angiography showed 17 cases with right subclavian artery abnormalities, they were confirmed that all the 17 patients were nonrecurrent laryngeal nerve by surgery, no damage cases. The other 28 cases showed a normal right subclavian artery and no cases of nonrecurrent laryngeal nerve. The 1886 patients in group B, surgical exploration found four cases with nonrecurrent laryngeal nerve, injury in 1 case. The 21 patients whose nonrecurrent laryngeal nerve were on the right side, there were no left side with nonrecurrent laryngeal nerve and no co-exist cases of nonrecurrent and recurrent laryngeal nerve. The average exposure time of nonrecurrent laryngeal nerve in patients of group A (17 cases) was significantly shorter than that group B[(4.28±1.08) min vs. (15.50±2.08) min, t=-15.978, P=0.000]. ConclusionsThe cervical vascular color Doppler ultrasound examination before thyroid surgery can be adjuvant used, if there is the right subclavian artery abnormalities, it showes that there is the right side nonrecurrent laryngeal nerve. So as to effectively prevent the damage of nonrecurrent laryngeal nerve during thyroid surgery.
ObjectiveTo investigate diagnosis, gene detection, and treatment principle of medullary thyroid carcinoma.Method The relevant literatures and guidelines about diagnosis and treatment of medullary thyroid carcinoma were summarized and analyzed retrospectively. Resultsmedullary thyroid carcinoma was given priority to surgical treatment. hereditary medullary cancer could be prophylactic thyroidectomy by the RET gene test results. advanced progressive medullary thyroid carcinoma, could be treated by palliative surgery, external radiotherapy, or systemic treatment with the tyrosine kinase inhibitor. ConclusionsPrognosis of medullary thyroid carcinoma is worse, and occurrence of early metastasis is easy. so the first operation should be thoroughgoing. and the operation timing of prophylactic total thyroidectomy for hereditary medullary cancer could be determined by the results of RET gene detection to achieving early cure.