Efficacy and safety of vandetanib on advanced medullary thyroid carcinoma: single center result from a phase Ⅲ study / 中华耳鼻咽喉头颈外科杂志

Objective@#There is no effective therapy for patients with advanced medullary thyroid carcinoma (MTC). Vandetanib,a novel multitargeted receptor tyrosine kinase inhibitor, has previously shown antitumor activity in phase Ⅱ studies of patients with advanced MTC. This study was to evaluate the efficacy and the safety of vandetanib on advanced MTC.@*Methods@#This study was an open, international multi-center phase Ⅲ clinical trial and the study number was NCT01298323. The single-center study was a sub-group analysis of the international study, which was conducted on 9 pathologically confirmed advanced MTC patients by Cancer Hospital Chinese Academy of Medical Sciences between March 2012 and October 2017. Vandetanib (300 mg) was orally administered daily till death or withdrawal. The efficacy was evaluated according to RECIST criteria and the adverse events were evaluated according to NCI criteria.@*Results@#The objective response rate was 3/9,and the disease control rate was 4/9. The median progression-free survival was 44 months. All patients who had the elevated levels of calcitonin (CTN) and carcino-embryonic antigen (CEA) before treatment began to show the decreases in the level of CTN and CEA after 3 months and later showed again the increases in the levels of both tumor markers with tumor progression. By ROC curve analysis, CTN was of statistically significance(P<0.05, 95%CI 0.558-0.834), but CEA was not(P>0.05). Adverse events were generally mild (grade 1 or 2),including hypertension (9 cases),skin rash (9 cases), and diarrhea (6 cases). Two patients developed grade 3 elevation of serum glutamate pyruvate transaminase and one patient developed grade 3 elevation of drug-related bowel disease. No grade 4 drug-related adverse event occurred.@*Conclusions@#Vandetanib is effective and well tolerated for patients with locally advanced or metastatic MTC who have no chance for surgery. This indicates the increase of CTN is clinically relevant to disease progression, but the number of patients are extremely low, and, therefore further research is needed. Long-term use of vandetanib may cause resistance.

Comparison of antibiotics and saline irrigation with tube drainage in the treatment of postoperative abdominal and pelvic infectious effusion / 中华肿瘤杂志

Objective@#To compare the efficiency of saline irrigation, antibiotics irrigation and high-concentration antibiotics perfusion with tube drainage in the treatment of infectious effusion.@*Methods@#Clinical and sonographic features of abdominal and pelvic infectious effusion of 64 patients with malignant tumor collected from September 2013 to September 2017 were retrospectively analyzed. The changes of effusion size and temperature, catheterization time were evaluated in saline irrigation group and antibiotics irrigation group. The catheterization time was compared between antibiotics irrigation group and high-concentration antibiotics perfusion group.@*Results@#The effective rates of the saline irrigation group and the antibiotics irrigation group were 68.6% and 86.8%, respectively, and the times of catheterization were 11.9±8.4 days and 7.8±4.8 days, respectively, with significantly statistical difference (both P<0.05). However, the effective rates of the antibiotics irrigation group and the high concentration antibiotic perfusion group were 86.8% and 100.0%, respectively (P=0.067), while the times of catheterization were 7.8±4.8 days and 3.6±3.1 days, respectively (P<0.001).@*Conclusion@#The antibiotic irrigation with tube drainage, especially the high concentration perfusion is more effective than saline in the treatment of abdominal and pelvic infection effusion.

The value of ultrasound classification in BI-RADS category 4 of breast complex cystic masses / 中华肿瘤杂志

Objective@#To analyze the feature of breast complex cystic masses and to classify it at ultrasonography (US), which applied to the Breast Imaging Reporting and Data System (BI-RADS) categories 4a to 4c with pathological results as the golden standards.@*Methods@#The ultrasonographic data and clinical features of 78 patients with complex cystic masses confirmed by pathology in Cancer Hospital from July 2014 to June 2017 were retrospectively reviewed. The complex cystic breast masses were divided into four classes on the basis of their US features: type 1 [thick wall and (or) thick septa (> 0.5 mm)], type 2 (one or more intra-cystic masses), type 3 (mixed cystic and solid components with cystic components more than 50%) and type 4 (mixed cystic and solid components with solid components more than 50%). Positive values (PPVs) were calculated for each type. Multiple linear regression analysis was used to analyze the ultrasonographic features of the masses (lesion size, margins, blood flow resistance index, calcification, and axillary lymph nodes, etc.) with malignant correlation.@*Results@#There were 81 lesions in 78 patients. Among the 81 masses based on US appearance, 14 (17.3%) were classified as type Ⅰ, 18 (22.2%) as type Ⅱ, 18 (22.2%) as type Ⅲ, and 31 (38.3%) as type Ⅳ. The positive predictive values of the malignant lesions of type Ⅰ, type Ⅱ, Ⅲ and Ⅳ were 7.1%, 16.7%, 61.1% and 48.3%, respectively (P=0.040). In all the 81 masses, 14 were BI-RADS categories 4a, 18 were BI-RADS categories 4b and 49 were BI-RADS categories 4c. Masses with maximum diameter equal to or larger than 2.0 cm, unclear margins, RI≥0.7 and presence of abnormal axillary nodes assessment had a high probability of malignancy (P=0.030, 0.038, <0.001 and 0.025, respectively).@*Conclusion@#Ultrasound typing is helpful for differentiating benign and malignant breast complex cysts and classifying BI-AIDS 4a to 4c, thus providing clearer treatment for clinical practice.

Dye-tattooing under ultrasound guidance in preoperative localization of neck recurrences from thyroid cancer / 中华肿瘤杂志

Objective@#To evaluate the efficacy and safety of the application of dye-tattooing under ultrasound guidance in preoperative localization of neck recurrences from thyroid cancer.@*Methods@#Between October 2014 to September 2016, 25 patients with 34 lesions were enrolled. There were 22 cases of papillary thyroid carcinoma and three cases of medullary thyroid carcinoma, all of which could not be detected by computed tomography. Surgeons located the recurrent lesions using dye-tattooing under ultrasound guidance along with radiologist three days before the operation.@*Results@#All lesions were successfully located (100%), 32 of which were located directly and two of which were located indirectly. Postoperative pathological examination confirmed 25 metastases of papillary thyroid carcinoma, two metastases of medullary thyroid carcinoma, and seven cases of false positives. The accuracy of ultrasound diagnosis was 79.4%. After 15 months of follow-up, neither tumor residual nor recurrences was detected according to imaging tests.@*Conclusions@#Dye-tattooing under ultrasound guidance represents a reliable and safe method for localization of neck recurrences from thyroid cancer. The cooperation between experienced surgeons and radiologists will be crucial to successful location.

Advances in research on ultrasound-guided percutaneous ethanol injection for treatment of benign cystic thyroid nodules / 中国癌症杂志

Because of development and popularization of the ultrasound techniques, the detection rate of nodal thyroid has increased. Surgery is the long-established therapeutic option. However, due to the surgical trauma, compli-cations and the effect on quality of life, various minimally invasive treatments have been proposed and widely used. A large number of foreign studies have shown that ultrasound-guided percutaneous ethanol injection is a more commonly used minimally invasive way to treat benign pure cystic and predominantly cystic thyroid nodules. This article provides an up-to-date review of the overseas studies and summarized on percutaneous ethanol injection for the treatment of benign cystic thyroid nodules.

Study on the Mechanism of Butylphthalide Delaying Renal Fibrosis of Mice Model with Unilateral Ureteral Obstruction / 实用医学杂志

Objective To study on the possible mechanism of butylphthalide delaying renal fibrosis of mice with obstructive nephropathy. Methods Totally 72 male CD-1 mice of clean grade were selected and randomly assigned into 4 groups: sham operation group (Sham), model group (UUO), control group (ACEI) and treatment group (NBP). The mice in the control group (ACEI) and the treatment group (NBP) were given benazepril and butylphthalide by gavage, and the mice in sham operation group (Sham) and model group (UUO) were given normal saline by gavage. Six mice were sacrificed at the third, 7th, 14th day, respectively. The obstructive renal tissue was selected for immunohistochemical staining and western blot. Results (1)With the longer time of ureteral obstruction, the expression of Nrf-2 was gradually strengthened in time-dependent manner;(2)Compared with the model group, the levels of Nrf-2 and γ-GCS in butylphthalide group were significantly increased, and the expression of type Ⅰ collagen was decreased significantly (P < 0.05). The expression of Nrf-2 and γ-GCS in each time points was stronger than that in the benazepril group (P < 0.05). Correlation analysis showed that: there was a positive correlation between Nrf-2 and γ-GCS (r = 0.930) and a negative correlation between Nrf-2 and the expression level of type Ⅰ collagen(r = -0.859). Conclusion Butylphthalide can relieve renal interstitial injury caused by oxidative stress and delay the progress of renal interstitial fibrosis by activation of Nrf-2 pathway and up-regulated expression ofγ-GCS.

Performance of ultrasonography for the preoperative staging of papillary thyroid carcinoma / 中华医学超声杂志（电子版）

Objective To evaluate the performance of ultrasonography (US) for the preoperative staging of papillary thyroid carcinoma (PTC). Methods One hundred and twenty-one patients with cytologically proven PTC were prospectively collected. Patients were recruited at the Chinese Academy of Medical Sciences Cancer Hospital from January 2014 to November 2014. Preoperative US was performed for the evaluation of primary tumor size, extrathyroidal extension and neck lymph node metastasis according to the 6th UICC TNM staging system. Results The sensitivity, specificity, positive predictive value (PPV) and negative predicative value (NPV) of US in predicting extrathyroidal extension were 89.6%(60/67), 72.2%(39/54), 80.0%(60/75), 84.8%(39/46), respectively. The accuracies of preoperative US for T1, T2, T3, T4 stage were 75.0%(36/48), 100%(1/1), 81.9%(59/72), 0, respectively. The sensitivity, specificity, PPV, and NPV of US in predicting neck lymph node metastasis were 47.5%(29/61), 90.0%(54/60), 82.9%(29/35), 62.8%(54/86), respectively. Conclusion Ultrasonography is a feasible tool for preoperative staging of PTC and is helpful for accurate prediction of extrathyroidal tumor extension and lateral neck lymph node metastasis.

Evaluation of the efficacy and the limitation of ultrasound-guided core-needle biopsy, core-needle aspiration and fine-needle aspiration in micro-nodules of thyroid / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and the limitation of ultrasound-guided core-needle biopsy, ultrasound-guided core-needle aspiration and ultrasound-guided fine-needle aspiration in micro-nodules of thyroid.</p><p><b>METHODS</b>A retrospective was performed in 92 patients with suspectable malignent micro-nodules in thyroid. Of them, 52 patients underwent US-CNB and US-FNA and 40 patients underwent US-CNA and US-FNA. The diagnoses for the micro-nodules were identified by histopathlogical examination after surgery.</p><p><b>RESULT</b>Among 52 cases with both US-CNB and US-FNA, 41 got nondiagnostic US-CNB and 11 cases successfully got the correct diagnoses of US-CNB; 6 cases got the incorrect diagnosis of US-FNA and 46 cases got the correct diagnosis of US-FNA. Of 40 cases with US-CNA and US-FNA, unsatisfactory specimen of US-CNA occurred in 14 cases and satisfactory specimen of US-CNA were got in 26 cases; unsatisfactory specimen of US-FNA occurred in 4 cases and satisfactory specimen of US-FNA. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US-FNA in 92 cases for the diagnosis of malignancy were 93.4%, 86.7%, 97.3%, 72.2% and 92.3%, respectively.</p><p><b>CONCLUSIONS</b>US-FNA is the most valuable method for the diagnosis of suspectable malignent micro-nodules in thyroid before operation.</p>

Ultrasonic manifestations of large adrenal cortical adenoma / 中华医学超声杂志（电子版）

Objective To analyze the sonographic ifndings of large adrenal cortical adenoma. Methods The sonographic characteristics of thirteen cases of large adrenal cortical adenoma (diameter≥4.0 cm) which were diagnosed by surgery from January 2006 to August 2012 were retrospectively reviewed. Results In all cases, the adenomas had distinct margins. The mean size of lesions was (5.5±1.6) cm, ranging from 4.0 cm to 8.8 cm. On echotexture, three lesions were homogeneous and the remaining ten lesions were heterogeneous. In addition, seven contained hypoechoic nodules and hyperechoic septum, three had anechoic area, three had extremely hyperechoic area with acoustic shadow, and two had patchy hyperechoic area. On Doppler, most lesions had no lfow signal. Conclusions Large adrenal adenomas have complete capsule and heterogeneous internal echoes with septum, calciifcation, necrosis and hemorrhages. These characteristics are less frequently seen incommon adrenal adenoma, therefore may be helpful in recognition of large adrenal adenoma in clinical practice.

Sentinel lymph node biopsy guided neck dissection in patients with papillary thyroid carcinoma / 中华普通外科杂志

ObjectiveTo evaluate combined radioisotope and methylene blue dye method for identifying sentinel lymph node (SLN) for modified radical neck dissection of papillary thyroid carcinoma (PTC). MethodFifty-one consecutive PTC patients without clinical evidence of locoregional lymph node involvement were enrolled in the study between August 2007 and September 2010.5 h ( rangel.5 - 8 h) before the surgery,one single intratumoral injection of 74 MBq in a volume of 0.4 ml 99mTc -Dextran was administered under ultrasound guidance and 1％ methylene blue dye was injected into the parenchyma surrounding the primary tumor intraoperatively.Preoperative lymphoscintigraphy,intra-operative hand-held gamma probe detecting and blue dyed lymph node were used to identify the SLN.All SLNs were sent for frozen-section and the specimens of routine selective neck dissection were stained with haematoxylin and eosin (H&E). ResultsSLNs were identified in 48 of 51 cases (94.1％ ) with combination method.SLN identification rate were 66.7％by methylene blue dye method and 90.2％by radioisotope method respectively.Final pathologic examination revealed that 30 cases ( 58.8％ ),including 3 cases who had negative SLNs,had lateral neck occult lymph node metastasis.The rate of occult lymph node metastasis in level Ⅱ,level Ⅲ,level Ⅳ and level Ⅴ were 17.6％,52.9％,29.4％ and 0％.Thus,the sensitivity,specificity,accuracy, and positive and negative predictive values of SLN biopsy were 90％, 100％,94.1％,100％ and 87.5％,respectively. ConclusionsSLNB is feasible and safe,the findings correlate with lateral lymph node status.Therefore,SLN biopsy is a good method for estimating the status of lateral lymph node in patients with clinical negative lymph node papillary thyroid carcinoma.

Sonographic diagnosis of carotid body tumor / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyse the features of gray scale and colour Doppler sonography for carotid body tumor, to improve the sonographic diagnostic accuracy.</p><p><b>METHODS</b>A retrospective review was performed of sonographic material of 18 carotid body tumors by gray scale sonography and 11 by colour Doppler sonography, with comparison with other diseases which are frequently misdiagnosed as carotid tumor.</p><p><b>RESULTS</b>Well-defined, even weakly hypoechoic masses were noted on gray scale ultrasonogram at the carotid bifurcation, commonly broadening the carotid bifurcation and often encasing the common, external and internal carotid arteries. Disorderly non-echoic channel- like structures in the tumor were sometimes observed. Colour Doppler sonography showed abundant flow in the tumor. The non-echoic channel- like structures were vascularities. Seventeen masses diagnosed by ultrasound were proved to be carotid body tumors. The other was confirmed as a neurogenic tumor, giving an accuracy rate of 94.4% for sonographic diagnosis.</p><p><b>CONCLUSION</b>Sonographic examination of the carotid body tumor is highly accurate. It is safe and reliable.</p>

Diagnostic significance of ultrasonography and CT for large upper abdominal mass / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To assess the effect of ultrasonography and computerized tomography (CT) in the diagnosis of large upper abdominal mass.</p><p><b>METHODS</b>Data from 43 cases that were clinically and pathologically confirmed were retrospectively analyzed and the effect of their preoperative ultrasonography and CT was compared.</p><p><b>RESULTS</b>Four of 10 (40 percent) cases of liver mass were diagnosed correctly using ultrasonic device, nineteen of 25 (76 percent) cases of adrenal gland mass and 2 of 4 cases of kidney mass. Two of 10 (20 percent) cases of liver mass were correctly diagnosed by CT, and so were 6 of 22 (27.2 percent) cases of adrenal gland mass. In 4 patients with spleen mass, neither ultrasonography nor CT diagnosis was correct.</p><p><b>CONCLUSION</b>Because upper abdomen organs are closely connected with each other, correct imaging localization of a large mass in this region is not easy. In this study, we compared the accuracy of ultrasonography and CT in diagnosing large upper abdominal masses, and found that ultrasonography works better for adrenal rather than liver or kidney. Neither ultrasonography or CT could accurately diagnose a large mass in the spleen.</p>