Objective To summarize the ultrasonographic and pathological features of benign thyroid nodules in thyroid imaging reporting and data system (TI-RADS) 4 class. Methods The preoperative ultrasonographic features and pathological features of 46 patients (52 nodules) with TI-RADS 4 class benign thyroid nodules who got treatment in Affiliated Hospital of Nanjing University of Traditional Chinese Medicine between June 2016 and June 2017 were retrospectively analyzed. Results Among the 52 thyroid nodules, 32 nodules (61.54%) were categorized as TI-RADS 4A, 12 nodules (23.08%) were categorized as TI-RADS 4B, and 8 nodules (15.38%) were categorized as TI-RADS 4C. On ultrasonographic images, the 52 thyroid nodules showed hypoechogenicity (90.38%), solid or predominantly solid (98.08%), nodules>1 cm in diameter (61.54%), defined margin (63.46%), microcalcification (50.00%), abundant or pointy blood flow (65.39%), morphological rule (90.38%), aspect ratio≤1 (92.31%), and no suspicious lymph nodes (86.54%). On histology, these thyroid nodules revealed nodular goiter with fibrosis or calcification (38.46%), nodular goiter with adenoma (30.77%), nodular goiter (9.61%), Hashimoto’s thyroiditis (17.31%), and thyroid follicular adenoma (3.85%). Conclusion Nodular goiter (thyroid nodules with fibrosis, calcification or adenomatoid hyperplasia), Hashimoto’s thyroiditis, and thyroid follicular adenoma will lead to malignant signs on ultrasonographic images, we should refer to other examination methods to make combinated evaluation.
ObjectiveTo investigate the guiding value of preoperative imaging and intraoperative rapid pathology in the diagnosis and treatment of pancreatic cystic neoplasm (PCN).MethodsThe clinical data of 205 patients with PCN diagnosed by pathology from July 14, 2003 to July 31, 2018 were analyzed retrospectively. The precise and fuzzy diagnostic rate and misdiagnosis rate of PCN by preoperative imaging and intraoperative rapid pathology were analyzed.ResultsThe most commonly used preoperative imaging methods were ultrasound and CT, in 146 cases (82.95%) and 141 cases (80.11%), respectively. There were 54 cases (30.68%) with MRI. Of them, 47 cases were examined by single examination, 129 cases received combined examination, of which 123 cases (95.35%) were examined by ultrasound combined with CT. The precise and fuzzy diagnostic rate of PCN by ultrasound, CT, and MRI were 81.51% (119/146), 81.56% (115/141), and 87.04% (47/54), respectively. Comparison of ultrasound with CT and MRI showed statistical significance (χ2=47.747, P<0.001; χ2=11.873, P=0.018), but no significant difference was observed between CT and MRI (χ2=5.012, P>0.05). In 27 cases of false diagnosis by ultrasound, no obvious abnormality was found in 14 cases (51.85%), followed by misdiagnosis as pancreatic pseudocyst (11 cases, 40.74%). Of the 26 cases misdiagnosed as pancreatic cancer by CT, 57.69% (15 cases) were misdiagnosed as pancreatic cancer; 7 cases were misdiagnosed by MRI, 42.86% (3 cases) of patients were misdiagnosed as pancreatic cancer and pancreatic pseudocyst. Thirty-one cases were misdiagnosed by intraoperative rapid pathology, and most of them misdiagnosed as pancreatic pseudocyst (10 cases, 32.26%). The next was SPN misdiagnosed as pancreatic neuroendocrine tumor (7 cases, 22.58%). The precise and fuzzy diagnostic rates of PCN were 81.58% (124/152), 86.84% (132/152), and 97.37% (148/152) in preoperative imaging, intraoperative rapid pathology, and preoperative imaging combined with intraoperative rapid pathology, while the misdiagnostic rates were 18.42% (28/152), 13.16% (20/152), and 2.63% (4/152), respectively.ConclusionsIn preoperative imaging and intraoperative rapid pathological examination, it is possible that ultrasound could not find PCN lesions. CT and MRI are most likely to be misdiagnosed as pancreatic cancer. Intraoperative rapid pathological examination misdiagnosed as pancreatic pseudocyst is most common. Perfect preoperative imaging and rapid intraoperative pathology can improve the correct diagnosis rate of PCN and avoid unreasonable surgical intervention measures.
ObjectiveTo investigate the role of intraoperative frozen section pathology in central lymph node metastasis of papillary thyroid microcarcinoma (PTMC), and to analyze the risk factors of central lymph node metastasis.MethodsClinical data of 481 patients diagnosed with PTMC from January 2015 to June 2019 in our hospital were included. The consistency of frozen pathological results of intraoperative prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes with postoperative paraffin pathological results, as well as the relationship between the numbers of intraoperative lymph nodes sent for examination and postoperative pathological results were analyzed. Then the Kappa value were calculated respectively. Furthermore, univariate and multivariate analysis were used to analyze the factors affecting central lymph node metastasis.ResultsCentral lymph node metastasis was found in 207 patients with PTMC (43.0%). Of the 207 patients, 192 patients were examined by frozen section, with 139 patients had positive results. The Kappa value of prelaryngeal lymph nodes, paratracheal lymph nodes, pretracheal lymph nodes, and central lymph nodes were 0.300, 0.643, 0.560, and 0.755, respectively (P<0.001). Simultaneous intraoperative examination of three anatomic lymph nodes in the central region has a high accuracy in evaluating whether there was lymph node metastasis. The consistency test between intraoperative frozen and postoperative paraffin pathological results showed that when the number of lymph nodes was less than 5, the Kappa value was 0.690 (P<0.001), and when more than or equal to 5, the Kappa value was 0.816 (P<0.001). The results of logistic regression showed that, maximum value of tumor diameter, tumor number, and thyroid capsule involvement were risk factors for central region lymph node metastasis in PTMC (P<0.05).ConclusionsCentral region lymph node metastasis in PTMC was common. Prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes should be selected for frozen pathological examination during the operation, which could effectively indicate whether the central lymph nodes were involved. And combined with the risk factors of lymph node metastasis, such as maximum value of tumor diameter, number of tumors, and thyroid capsule involvement, a more accurate individualized operation plan can be designed for patients.
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.