ObjectiveTo explore the value of fluorescence tracer technique in sentinel lymph node (SLN) orientation of cN0 papillary thyroid cancer. MethodsThe total clinical data of 40 cT1-3N0M0 thyroid cancer patients admitted from January 2015 to January 2016 in our hospital were collected, and the SLN with indocyanine green (ICG) as fluorescent trace agent were observed and detected, and the effect of ICG detecting SLN and the guide role of SLNB on the dissection of the central area of neck lymph nodes by intraoperative frozen biopsy pathology and postoperative paraffin pathology were analyzed. ResultsA total of 40 thyroid cancer patients were treated by SLNB and then conducted by the dissection of the central area of neck lymph nodes, and 37 cases detected SLN, so the detection rate was 92.5% (37/40). And a total of 98 SLNs were detected, 1-5 for each case, average of 2.65/case. Intraoperative frozen pathological detected 28 cases of patients with metastases in SLN, and 9 patients without metastasis, including 1 case with postoperative pathology detecting micrometastasis in SLN and other 8 cases without metastasis in the central area of neck lymph nodes. Three cases who were not detected the SLN showed no metastases in final postoperative paraffin pathology. The SLNB of ICG fluorescent tracer was with a sensitivity of 96.6% (28/29), false-negative rate of 3.45% (1/29). ConclusionThe fluorescent tracer technique can guide the dissection of the central of neck lymph node of cN0 thyroid cancer patients accurately with a high detection rate and advantages of high sensitivity in detecting the SLN of thyroid cancer.
ObjectiveTo analyze the relevant factors of levelⅡlymph node metastasis in papillary thyroid carci-noma. MethodsThe clinicopathologic data of 83 patients from November 2011 to March 2014 were analyzed retrospec-tively. All the primary tumors were papillary thyroid carcinoma located in unilateral lobe with ipsilateral lateral neck lymph node metastasis. The relationship of gender, age, microcarcinoma, superior pole involved by carcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis was analyzed. The calculated data were analyzed with Chi-Square test and there was significant difference when P < 0.05. ResultsThe rate of lymph node metastasis at levelⅡ, Ⅲ, Ⅳ, Ⅴ, Ⅵwas 51.8% (43/83), 78.3% (65/83), 71.7% (59/83), 4.8% (4/56), and 79.5% (66/83), respectively. There was no significant relationship of gender, age, microcarcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis (P > 0.05). The rate of lymph node metastasis at levelⅡwas significantly higher when superior pole involved by carcinoma (P < 0.05). ConclusionAmong the patients with papillary thyroid carcinoma, when superior pole involved by carcinoma the patient should be underwent selective neck dissection, the proper extent of dissection including levelⅡshould be performed.
Objective To investigate the expressions and clinical significance of Notch-2 protein and Numb protein in papillary thyroid carcinoma (PTC). Methods PTC tissues and its para-cancerous tissues of 50 patients with PTC who treated in The Affiliated Hospital of Inner Mongolia University for Nationalities from Mar. 2014 to Mar. 2017 were retrospectively collectied, to detect the expressions of Notch-2 protein and Numb protein by immunohistochenmical method. Results ① Expressions of Notch-2 protein and Numb protein in PTC tissues and para-cancerous tissues: the positive-expression rate of Notch-2 protein in PTC tissues was 82.00% (41/50), which was higher than that of para-cancerous tissues〔18.00% (9/50)〕, the difference was statistically significant (χ2=40.960, P<0.001). The positive-expression rate of Numb protein in PTC tissues was 66.00% (33/50), which was higher than that of para-cancerous tissues 〔0 (0/50) 〕, the difference was statistically significant (χ2=49.254, P<0.001). ② The relationship between expression of Notch-2 protein and expression of Numb protein in PTC tissues: there was a positive correlation between expressions of Notch-2 protein and Numb protein in PTC tissues (rs=0.323, P=0.022). ③ The relationship between expressions of Notch-2 protein and Numb protein in PTC tissues and clinicopathological features of the PTC patients: the expression of Notch-2 protein in PTC tissues was not significantly correlated with gender, age, tumor diameter, capsule infiltration, cervical lymph node metastasis, and TNM staging (P>0.05). The expression of Numb protein in PTC tissues was not significantly correlated with gender, age, tumor diameter, and capsule infiltration (P>0.05), but was significantly correlated with cervical lymph node metastasis and TNM staging (P<0.05), the positive rates of Numb protein in patients of staging Ⅲ+Ⅳ group and cervical lymph node metastasis group were lower than those of patients in staging Ⅰ+Ⅱ group and non-cervical lymph node metastasis group. Conclusion The positive-expression rate of Notch-2 protein and Numb protein in PTC tissues are higher than those of para-cancerous tissues, and there is a positive correlation between them in PTC tissues, suggesting that there may be a synergistic effect in the course of PTC progression.
Objective To analyze the clinical and pathological factors related to the metastasis of contralateral central lymph nodes (Cont-CLNs) in unilateral near isthmus papillary thyroid carcinoma (PTC), and to establish a prediction model of lymph node metastasis, so as to provide reference for the scope of lymph node dissection. Methods A total of 381 unilateral PTC patients from February 2012 to June 2022 were collected in our hospital, and according to the location of the cancer, they were divided into the isthmus group (n=152) and the unilateral glandular lobe group (n=229) , and the correlation analysis was performed on whether there was Cont-CLNs metastasis. One hundred and fifty-two patients in the unilateral isthmus PTC group were further divided into metastatic and non metastatic groups based on whether Cont-CLNs metastasis occurred. Univariate analysis was used to analyze the relationship between gender, age, distribution of glandular lobe, tumor size, tumor location, pathological subtype, capsule invasion, thyroid stimulating hormone (TSH) level, combine Hashimoto’s thyroiditis (HT), ipsilateral central lymph nodes（Ipsi-CLNs) metastasis and Cont-CLNs metastasis. According to the univariate analysis results of this study and the possible high-risk factors of contralateral central lymph node metastasis of unilateral thyroid papillary carcinoma in other literatures, they were included in logistic multivariate analysis to obtain independent risk factors and establish a prediction model. Results The incidence of Cont-CLNs metastasis in unilateral isthmus PTC patients was higher than that in nilateral glandular lobe group (24.3% vs. 14.4%, χ²=6.009, P=0.014). Univariate analysis showed that Cont-CLNs metastasis in patients with unilateral near isthmus PTC was correlated with age (P=0.02), tumor size (P＜0.01), capsule invasion (P＜0.01) and Ipsi-CLNs metastasis (P＜0.01), but not with gender, distribution of glandular lobe, tumor location, pathological subtype, TSH level and whether to merge HT (P＞0.05). Further logistic multivariate analysis suggested that capsule invasion and Ipsi-CLNs metastasis were independent risk factors for Cont-CLNs metastasis in patients with unilateral near isthmus PTC. Moreover, the above logistic multifactor prediction model is proved to be effective by the test of goodness of fit by Hosmer and Lemeshow. Conclusions Capsule invasion and Ipsi CLNs metastasis are high risk factors for Cont-CLNS metastasis in patients with unilateral near isthmus PTC. It is suggested that such patients should be cleaned up with prophylactic Cont-CLNs while cleaning up Ipsi-CLNs.
ObjectiveTo evaluate the value of preoperative risk assessment of papillary thyroid carcinoma with ultrasound for clinic diagnosis and treatment.MethodsThe data of 400 patients with papillary thyroid carcinoma received operative treatment in 2017 were retrospectively analyzed. Recorded and analyzed the ultrasonic risk assessment and postoperative grading of clinic risk assessment, to evaluate coherence and correlation between them.ResultsThere were 400 lesions with an average size of (12.8±8.5) mm. Among 400 lesions, diameter of 214 lesions less than 10 mm, diameter of 178 lesions were between 10 mm and 40 mm, and diameter of 8 lesions were larger than 40 mm. A total of 242 cases had lymph node metastasis and 309 cases had capsule invasion. Clinical and ultrasoud risk assessment was performed on 400 lesions. There were 224 lesions with low risk of clinical risk stratification vs. 111 lesions with low ultrasonic risk, 148 lesions with intermediate risk of clinical risk stratification vs. 270 lesions with intermediate ultrasonic risk, and 28 lesions with high risk of clinical risk stratification vs. 19 lesions with high ultrasonic risk. The consistency of postoperative recurrence risk stratification and preoperative ultrasound recurrence risk stratification was moderate (κ=0.414, P<0.01). In addition, the consistency between ultrasound examination and clinical lymph node metastasis was poor (κ=0.291, P<0.05), and the consistency of invasion of the capsule was moderate (κ=0.402, P<0.05).ConclusionPre- operative evaluation of recurrence risk grading before thyroid ultrasound, focusing on individualized preoperative assessment, the assessment is more detailed and detailed, and is helpful for follow-up treatment and early screening for recurrence risk.
ObjectiveTo summarize the prevention and treatment strategies and their effects on lymphatic leakage following transoral endoscopic thyroid cancer lateral neck lymph node dissection. MethodsA retrospective review was conducted, we collected clinical data from 47 patients with papillary thyroid carcinoma who underwent transoral endoscopic thyroidectomy and lateral neck lymph node dissection at our hospital from January 2021 to May 2023. A stepwise sequential treatment plan was adopted for patients with postoperative lymphatic leakage: low-fat, low-protein diet, continuous strong negative pressure suction, subcutaneous injection of Group A streptococcus in the surgical cavity, and ligation of the thoracic duct or lymphatic vessels through a small incision. The effectiveness of the sequential treatment plan was summarized. ResultsOut of the 47 patients, lymphatic leakage occurred in 5 cases postoperatively. Patient No.1 was cured of lymphatic leakage after sequential treatments including pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, subcutaneous injection of Group A streptococcus in the surgical cavity, and finally ligation of the thoracic duct or lymphatic vessels through a small incision. Patient No.20 was conservatively cured of lymphatic leakage with an initial surgical procedure involving pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, and subcutaneous injection of Group A streptococcus in the surgical cavity. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30 was the same as Patient No.1, Patient No.36 was the same as Patient No.20. Through the stepwise sequential treatment measures, all 5 patients successfully recovered from lymphatic leakage; the postoperative hospital stay ranged from 3 to 17 days, with an average of 8.6 days. ConclusionsThe stepwise sequential treatment plan used in this study can effectively prevent and treat lymphatic leakage after transoral endoscopic thyroid cancer lateral neck lymph node dissection. Given the small sample size of this study, we believe that it is necessary to conduct long-term studies to confirm the durability and stability of these measures.
ObjectiveTo investigate the expressions of Snail and N-cadherin protein in thyroid papillary carcinoma (PTC) tissues and cell lines, and then discuss the clinical value of Snail and N-cadherin expressions. MethodsImmunohis-tochemical SP technique was performed to detect the expressions of Snail and N-cadherin protein in 60 cases of PTC, and the relation between the expression of Snail or N-cadherin and clinicopathologic indicators was analyzed. Western blot was used to investigate the constitutive and inducible expressions of Snail and N-cadherin protein. Results①The positive rates of Snail and N-cadherin protein expressions were 85.0% (51/60) and 78.3% (47/60) respectively in the PTC tissues of 60 patients with PTC, which were significantly higher than those (0, 0, respectively) in the corresponding normal tissues adjacent to the cancer (P < 0.01).②The positive rates of Snail and N-cadherin protein expressions in the PTC with lymph node metastasis were significantly higher than those in the PTC without lymph node metastasis (P < 0.01), which were not related with the gender, age, tumor size of the patients (P > 0.01).③There was a positive correlation between Snail and N-cadherin protein positive expression (rs=0.721, P < 0.001).④The constitutive and inducible expressions of Snail and N-cadherin in the PTC tissues and cell lines further were identified by Western blot. ConclusionsSnail and N-cadherin could constitutively express in PTC, which might play important roles in the development and metastasis of PTC. Snail and N-cadherin might be used as effective indicators.
ObjectiveTo investigate the influencing factors of cervical lymph node metastasis of papillary thyroid carcinoma (PTC) and provide more accurate guidance for the cleaning strategy of PTC cervical lymph node.MethodsRetrospectively analyzed the case data of pathological diagnosis of PTC patients from June 2013 to June 2019 in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, and explored the influencing factors of lymph node metastasis in central region and lymph node metastasis in lateral cervical region.ResultsThe results of multivariate analysis showed that patients aged ≤55 years old, tumor diameter >1 cm, peripheral invasion, bilateral cancer, and multifocal cancer had a higher lymph node metastasis rate in the central region (P<0.05). When the number of risk factors mentioned above was 0, 1, 2, 3, 4, 5 and 6, the lymph node metastasis rate in the central region was respectively: 3.5% (4/113), 25.2% (72/286), 30.0% (70/233), 38.6% (76/197), 52.5% (53/101), 76.9% (20/26), and 100% (13/13). With the increase of the number of risk factors, the lymph node metastasis rate in central region increased (χ2=236.894, P<0.001). In the lymph node metastasis in lateral cervical region, multivariate analysis showed that patients with tumor diameter >1 cm, membranous invasion, and lymph node metastasis in the central region ≥2 had a higher lymph node metastasis rate (P<0.05), while lymph node metastasis in the lateral cervical region was not related to age, gender, peripheral invasion, and multifocal carcinoma (P>0.05). When the cumulative number of risk factors in patients was 0, 1, 2, 3, 4, 5, and 6, the lymph node metastasis rate in the lateral cervical region was respectively: 11.1% (1/9), 29.4% (5/17), 79.2% (19/24), 89.6% (43/48), 96.4% (27/28), 100% (21/21), and 100% (3/3). With the increase in the number of risk factors, lymph node metastasis in the lateral cervical region increased (χ2=101.094, P<0.001).ConclusionsThe cervical lymph node metastasis is positively correlated with the number of corresponding risk factors. With the increase of risk factors, cervical lymph node metastasis rate also increases. The number of risk factors provides a simple and intuitive indicator for cervical lymph node metastasis, which is more conducive to the formulation of individualized and accurate surgical program.
ObjectiveTo investigate the relationship between family history of malignant tumor (FHOMT) and clinicopathological features of patients with sporadic papillary thyroid carcinoma (PTC), and to provide basis for individualized diagnosis and treatment.MethodsPatients admitted to the department of breast and thyroid surgery in Renmin Hospital of Wuhan University from January 1, 2017 to September 30, 2019 for thyroid surgery for the first time and pathologically diagnosed as PTC were collected. According to the presence or absence of FHOMT, tumor type and family member type, their clinicopathological features were compared.ResultsIn 2 123 patients, there were 1 932 patients without FHOMT and 191 patients with FHOMT. The most common FHOMT was the family history of lung cancer (1.80%). Compared with PTC patients without FHOMT, PTC patients with FHOMT had a later onset age (P=0.000), a lower proportion of central lymph node metastasis (P=0.004), and a lower ratio of capsule invasion (P=0.021). PTC patients with respiratory-related FHOMT had a later onset age (P=0.000). PTC patients with male first-degree relatives had a later onset age (P=0.000). And PTC patients whose first-degree relatives were female had a lower proportion of central lymph node metastasis (P=0.007).ConclusionThere are differences in onset age, central lymph node metastasis and capsule invasion between PTC patients with and without FHOMT.
Objective The aim of this study is to review the association between long non-coding RNA (lncRNA) and papillary thyroid carcinoma (PTC). Method The relevant literatures about lncRNA associated with PTC were retrospectively analyzed and summarized. Results The expression levels of noncoding RNA associated with MAP kinase pathway and growth arrest (NAMA), PTC susceptibility candidate 3 (PTCSC3), BRAF activated non-coding RNA (BANCR), maternally expressed gene 3 (MEG3), NONHSAT037832, and GAS8-AS1 in PTC tissues were significantly lower than those in non-thyroid carcinoma tissues. The expression levels of ENST00000537266, ENST00000426615, XLOC051122, XLOC006074, HOX transcript antisense RNA (HOTAIR), antisense noncoding RNA in the INK4 locus (ANRIL), and metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in PTC tissues were upregulated in PTC tissues, comparing with the non-thyroid carcinoma tissues. These lncRNAs were possibly involved in cell proliferation, migration, and apoptosis of PTC. Conclusion LncRNAs may provide new insights into the molecular mechanism and gene-targeted therapy of PTC and become new molecular marker for the diagnosis of PTC.