Objective To investigate the diagnostic significance of fine needle aspiration cytology (FNAC) combined with BRAFV600E gene detection in the diagnosis of cervical lymph node metastasis of thyroid cancer. Methods Atotal of 140 patients with suspected cervical lymph node metastasis of thyroid cancer were collected as the research objects, and all patients were given ultrasound-guided FNAC and detection of BRAFV600E gene. The significance of the diagnosis was analyzed according to the gold standard after pathological examination. Results All the 140 patients underwent surgical treatment. For FNAC, the sensitivity was 63.6% (84/132), the specificity was 100% (8/8), the accuracy was 65.7% (92/140), the positive predictive value was 100% (84/84), and the negative predictive value was 14.3% (8/56). For detection of BRAFV600E gene, the sensitivity was 84.8% (112/132), the specificity was 100% (8/8), the accuracy was 85.7% (120/140), the positive predictive value was 100% (112/112), and the negative predictive value was 28.5% (8/28). For FNAC combined with BRAFV600E gene detection, the sensitivity was 90.9% (120/132), the specificity was 100% (8/8), the accuracy was 91.4% (128/140), the positive predictive value was 100% (120/120), and the negative predictive value was 40.0% (8/20). The area under curve of receiver operating characteristic for FNAC, detection of BRAFV600E gene, and FNAC combined with BRAFV600E gene detection were 0.818, 0.924, and 0.955, respectively. Conclusion FNAC combine with BRAFV600E gene detection improves the accuracy of neck lymph node metastasis in patients with thyroid cancer, which is worthyof performed.
Objective To explore the potential indicators of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC) patients and to develop a nomogram model. Methods The clinicopathologic features of PTMC patients in the SEER database from 2004 to 2015 and PTMC patients who were admitted to the Center for Thyroid and Breast Surgery of Xuanwu Hospital from 2019 to 2020 were retrospectively analyzed. The records of SEER database were divided into training set and internal verification set according to 7∶3. The patients data of Xuanwu Hospital were used as the external verification set. Logistic regression and Lasso regression were used to analyze the potential indicators for cervical lymph node metastasis. A nomogram was developed and whose predictive value was verified in the internal and external validation sets. According to the preoperative ultrasound imaging characteristics, the risk scores for PTMC patients were further calculated. The consistency between the scores based on pathologic and ultrasound imaging characteristics was verified. Results The logistic regression analysis results illustrated that male, age<55 years old, tumor size, multifocality, and extrathyroidal extension were associated with cervical lymph node metastasis in PTMC patients (P<0.001). The C index of the nomogram was 0.722, and the calibration curve exhibited to be a fairly good consistency with the perfect prediction in any set. The ROC curve of risk score based on ultrasound characteristics for predicting lymph node metastasis in PTMC patients was 0.701 [95%CI was (0.637 4, 0.765 6)], which was consistent with the risk score based on pathological characteristics (Kappa value was 0.607, P<0.001). Conclusions The nomogram model for predicting the lymph node metastasis of PTMC patients shows a good predictive value, and the risk score based on the preoperative ultrasound imaging characteristics has good consistency with the risk score based on pathological characteristics.
Objective To investigate the efficacy of fine needle aspiration-thyroglobulin (FNA-Tg) with colloidal gold immunochromatographic assay (CGICA) on the assessment of lymph node metastasis during surgery in papillary thyroid carcinoma (PTC) patients. Methods Seventy-eight patients with PTC who underwent surgery in the Department of Thyroid Surgery of West China Hospital of Sichuan University from August to December 2019 were selected as the research objects, 289 neck lymph node specimens cleaned during the operation were prepared into eluent after lymph node FNA within 10 minutes in vitro, and then the FNA-Tg level was detected rapidly and quantitatively by CGICA. The specimen of washout fluid was labeled and sent to the laboratory for FNA-Tg detection by Roche electrochemiluminescence immunoassay. The lymph nodes in the whole group were divided into central region group and lateral cervical region group according to their location. According to the long diameter of lymph nodes, they were divided into <5 mm group, 5–10 mm group and >10 mm group. With postoperative pathological report as the gold standard, the receiver operating characteristic (ROC) curve of the whole group of data subjects was drawn, and the area under curve (AUC) was compared to calculate the best cut-off value of FNA-Tg in diagnosing PTC lymph node metastasis. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of FNA-Tg CGICA method and Roche method in the whole group and different subgroups were compared. The data of 55 lymph nodes detected by FNA-Tg CGICA method and rapid frozen pathology were collected, and the diagnostic efficacy indexes of CGICA method and rapid frozen pathology in the diagnosis of lymph node metastasis were compared. Results The ROC curves AUC of FNA-Tg detected by CGICA method and Roche method was 0.850 and 0.883, respectively, the difference was not statistically significant (Z=1.011, P>0.05). The sensitivity was 77.7% and 79.6% respectively (χ2=0.05, P>0.05), specificity was 84.9% and 93.5% respectively (χ2=7.50, P<0.05). Using McNemar test, there was no significant difference in the diagnostic results between the CGICA method and Roche method of FNA-Tg in the whole group (P>0.05). The diagnostic efficacy of FNA-Tg CGICA method was better in the lateral cervical region group than that in the central region group, and the diagnostic efficacy of the group with the long diameter of lymph nodes >10 mm was better than those of the groups with the long diameter of lymph nodes <5 mm and 5–10 mm. There was no significant difference in diagnostic results between FNA-Tg CGICA method and rapid frozen pathology (P>0.05). Conclusions The FNA-Tg CGICA method has high value in diagnosing PTC cervical lymph node metastasis, and has the characteristics of rapidity and convenience. The diagnostic efficiency is similar to that of Roche method.
Objective To summarize the research progress on diagnostic criteria of lymph node metastasis in medullary thyroid carcinoma (MTC), and the indication and scope of lateral cervical lymph node dissection (LCLND). Method By searching PubMed and CNKI databases, the related guidelines and literature about the diagnosis and treatment of lateral cervical lymph node metastasis in MTC in recent years were obtained and reviewed. Results The metastatic rate of lateral cervical lymph nodes in MTC patients was high. The indication of LCLND was both consensus and controversy. The LCLND of MTC was also controversial, and the focus of controversy mainly focused on the survival rate, recurrence rate, distant metastasis and postoperative complications of patients receiving prophylactic LCLND. Different imaging methods had their own advantages and disadvantages in diagnosing lymph node metastasis of MTC. Nuclear medicine was effective but expensive. Fine needle puncture was also an effective method for the diagnosis of lymph node metastasis of MTC. At present, calcitonin level, tumor size and lymph node metastasis were still important indicators for evaluating MTC for prophylactic LCLND, but the application of related indications had not been unified. Many scholars recommended comprehensive consideration of various indicators to evaluate whether MTC carried out preventive LCLND. Conclusions The LCLND of MTC needs to be further explored and standardized on the basis of the existing consensus. The focus of prophylactic LCLND should be to improve the survival rate of patients while reducing complications as much as possible.
ObjectiveTo explore the causes and surgical strategies of completion thyroidectomy for thyroid cancer. Method The clinical data of 35 patients with thyroid cancer who underwent completion thyroidectomy in Guizhou Provincial People’s Hospital from January 2020 to July 2022 were analyzed retrospectively. Results There were 23 females and 12 males, aged from 17 to 68 years (median 42 years). The nature of thyroid nodules in 22 patients was not determined at preoperative fine needle aspiration cytology or intraoperative frozen pathological examination, but the paraffin section examination after operation indicated thyroid cancer. Pathological examination after the first operation showed that 11 patients had a large number of lymph node metastasis in the central area (more than 5), and 2 patients were confirmed as medullary thyroid carcinoma. All the 35 patients underwent completion thyroidectomy at 5–93 days after the initial operation, among which 3 patients underwent resection of the affected side residual glandular lobe and isthmus ± ipsilateral CLN dissection, 18 patients underwent contralateral lobectomy and CLN cleaning, and 14 patients underwent contralateral lobectomy and lymph node dissection of the affected side cervical region (Ⅲ–Ⅳ region). The operative time was 45–135 min (median 105 min). Intraoperative blood loss was 10–50 mL (median 20 mL). One patient suffered from temporary recurrent laryngeal nerve injury after operation, and voice had returned to normal at 5 months after operation. Six patients showed temporary hypoparathyroidism, and serum parathyroid hormone returned to normal level in 1–3 months after symptomatic treatment. Nineteen patients were treated with iodine-131 after operation, and were followed-up for 1–16 months (median 12 months). No signs of tumor recurrence or metastasis were found. Conclusions Accurate preoperative and intraoperative evaluation of thyroid nodules and standardized surgery can reduce the incidence of completion thyroidectomy. For patients who really need completion thyroidectomy, adequate doctor-patient communication during the perioperative period, early response measures and appropriate completion thyroidectomy can reduce the probability of postoperative tumor recurrence and improve the survival of patients.
ObjectiveTo summarize the characteristics of cervical lymph node metastasis (LNM) in the papillary thyroid carcinoma (PTC) coexisting with Hashimoto thyroiditis (HT). MethodThe literatures related to cervical LNM of PTC coexisting with HT in recent years were collected and summarized. ResultsCompared with the PTC patients without HT, the more enlarged lymph nodes could be detected, and the cervival central LNM rate was lower, but there was still controversy about cervival lateral LNM in the patients with PTC coexisting with HT. The male, young, large tumor diameter, extraglandular invasion, multifocal cancer, BRAF gene mutation, and higher thyroid peroxidase antibody and thyroglobulin antibody levels, as well as the ultrasound features such as thyroid nodule aspect ratio >1, extremely low echo, calcification, and lymph node calcification, liquefaction, and disappearance of hilar lymph nodes could be used to evaluate the risk factors of cervical LNM for the patients with PTC coexisting with HT. ConclusionsFrom the results of this review, it is suggests that the rate of central LNM is lower in patients with PTC coexisting with HT, but the status of LNM in the cervical lateral region remains to be explored. The relevant risk factors in combination with ultrasonic characteristics could help evaluate cervical lymph node status, could provide basis for early detection of metastatic lymph nodes and the formulation of individualized surgical plans, and improve the prognosis of patients.