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Objective:To study the diagnostic value of the artificial intelligence (AI) diagnostic system, ACR TI-RADS classification and AI+ ACR TI-RADS combined diagnostic performance in benign and malignant thyroid nodules and its guiding significance for surgical treatment.Methods:From Nov. 1, 2021, to Feb. 26, 2022, 349 patients with 605 thyroid nodules who received surgical treatment in Department of Thyroid (Hernia) Surgery, Department of General Surgery, the First Medical Center of the PLA General Hospital, were selected. There were 95 males and 254 females, male: female=1:2.67, aged 16-78 years, and the nodule diameter was 0.2-5.6 cm. SPSS 26.0 and R studio software were used for data processing. AI diagnostic system, ACR TI-RADS grading and AI+ ACR TI-RADS combined diagnostic efficacy were statistically analyzed, respectively. ROC curve analysis was performed in parallel.Results:The AUC value of AI+ ACR TI-RADS combined diagnosis was 0.900, greater than 0.857 of AI diagnostic system and 0.788 of ACR TI-RADS, and the difference was statistically significant ( Z= 7.631, both P<0.001) . The sensitivity of the combined diagnosis was 95.32%, the specificity was 84.61%, the accuracy was 92.56%, the positive predictive value was 94.69%, the negative predictive value was 86.27%, the missed diagnosis rate was 4.68%, and the misdiagnosis rate was 15.38%, which were better than the other two diagnostic methods. With an excellent coincidence rate with postoperative pathological results ( Kappa=0.804, P<0.001) . The accuracy of combined diagnosis in identifying the maximum diameter of different tumors was 89.58% for d≤0.5 cm, 96.09% for 0.5<d≤1.0 cm, 95.45% for 1.0<d≤2.0 cm, 87.88% for 2.0<d≤4.0 cm, and 85.71% for d>4.0 cm, better than the other two diagnostic methods. Conclusions:The combined application of AI+ACR TI-RADS has a certain primary screening value in evaluating thyroid nodule properties. The combined diagnosis of the two can more effectively determine the benign and malignant thyroid nodules.
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Objective:To investigate the infiltration of immune cells and prognosis in papillary thyroid carcinoma (PTC) with cervical lymph nodes metastases.Methods:The RNA-seq data and clinicopathological data of PTC patients were downloaded from the Cancer Genome Atlas (TCGA) database. There were 85 patients in the PTC with cervical lymph nodes metastases group and 23 patients in the control group, according to the inclusion and exclusion criteria. CIBERSORT deconvolution algorithm was used to calculate the infiltration ratio of 22 kinds of immune cells in PTC with cervical lymph nodes metastases. Different immune infiltrating cells were compared between PTC with cervical lymph nodes metastases and normal thyroid. The correlation between clinical characteristics (age, gender, extra-thyroid invasion and TNM stage) and infiltration of immune cells were evaluated, then different immune cells related to the prognosis of PTC with cervical lymph nodes metastases patients were screened by Kaplan-Meier analysis.Results:The B cells naive, B cells memory, T cells CD8, macrophages M1, mast cells activated and eosinophils were down-regulated in tumor tissue compared with normal. Macrophages M0, macrophages M2, dendritic cells resting, dendritic cells activated and mast cells resting were higher in tumor tissue compared with that of normal. Macrophages M0, macrophages M2 and dendritic cells resting were positively correlated with extra-thyroid invasion and TNM stage, and patients with a high proportion of those immune cells had a shorter progression-free survival (PFS) . The B cells naive and T cells CD8 were negatively correlated with extra-thyroid invasion and TNM stage, and patients with a high proportion of those immune cells had a longer progression-free survival (PFS) .Conclusions:The pattern of immune cell infiltration of PTC with cervical lymph nodes metastases has specificity, and it was related to clinical characteristics and prognosis. This study provides theoretical evidences and new insights for the role of immune cell microenvironment in PTC lymph node metastasis.
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Objective:To investigate the epidemiological and clinicopathological characteristics of thyroid cancer.Methods:Data of 13 673 thyroid cancer patients admitted to the First Medical Center of PLA General Hospital from Jan. 2014 to Dec. 2019 were retrospectively analyzed. According to the admission criteria, 9 662 patients were screened out, including 2 768 males and 6 894 females, with an average age of 43.98±11.28 years. According to the year of diagnosis and treatment, the incidence of thyroid cancer, the changing trend of age of new cases, the average length of hospitalization, the pathological classification of the tumor, the size of the primary tumor, multifocal tumor, and the rate of lymph node metastasis were statistically analyzed. The surgical methods were summarized and discussed.Results:① Characteristics of population economics: the ratio of males to females were 1.00:2.49, the number of cases increased year by year, and the rate of increase of female was higher than that of male. The average age of onset of the patients was (43.98±11.28) years old, and the incidence rate of the young population increased by 6.0%, showing a younger trend. The mean length of hospital stay was (7.21±2.85) d, and the length of hospital stay decreased. ② Clinicopathological features: There were 9 513 cases of papillary thyroid carcinoma (PTC) (98.46%) , 45 cases of follicular thyroid carcinoma (FTC) (0.47%) , 58 cases of medullary carcinoma (MTC) (0.60%) and 18 cases of poorly differentiated thyroid carcinoma (PDTC) (0.19%) . There were 2 cases (0.02%) of undifferentiated thyroid carcinoma (ATC) and 26 cases (0.26%) of a particular type. The tumor size was (1.10±0.85) cm, among which the microcarcinoma (D ≤1 cm) accounted for 64.5% and showed an increasing trend year by year, with the fastest growth rate. There were 3 809 cases of multifocal carcinoma (39.4%) , and the proportion of multifocal carcinoma increased year by year in recent 3 years. The central region and lateral region lymph node metastasis rates were 33.0% and 13.0%, respectively. Correlation analysis showed that the differences were statistically significant except for pathological types ( P<0.05) . ③ Surgical methods: in the first 3 years, 2 224 patients (84.2%) underwent normative primary resection, which increased to 94.9% in the last 3 years. In the first 3 years, 2 033 patients (77.0%) underwent central lymph node dissection, which increased to 91.8% in the last 3 years. In the first 3 years, 188 cases (50.5%) underwent normative lateral cervical dissection, which increased to 71.6% in the last 3 years. Conclusions:The incidence of thyroid cancer is increasing year by year, showing a younger trend; Papillary carcinoma accounts for 98.5% of thyroid cancer. The proportion of microcarcinoma and multifocal carcinoma is increasing. The rate of lymph node metastasis in the central region and lateral region is increasing; surgery is gradually standardized, and it is necessary to standardize the diagnosis and treatment of thyroid cancer and postoperative follow-up.
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Objective To explore the value of monitoring techniques of the external branch of superior laryngeal nerve (EBSLN) in thyroid surgery and to study its protective effects on vocal function after thyroid surgery.Methods We retrospectively analyzed the clinical data of 139 patients who underwent primary surgery of papillary thyroid cancer with neurological monitoring from Jun.2017 to Mar.2018 in the General Surgery Department of PLA General Hospital.The tumors of 31 cases were located in the upper pole of the gland and elsewhere in 108 cases.The patients' vocal function was assessed at one week and one month after surgery.The rate of EBSLN identified visually and by the intraoperative nerve monitoring (IONM) were counted.EBSLN recognition efficiency and prevalence of EBSLN damage during the operation of tumor in upper pole of thyroid and in other location were compared.Results In the 139 patients,there were 218 upper poles(218 EBSLN) treated intraoperatively,of which 145 were recognized visually (126(57.8％) confirmed by IONM,and 203(93.1％) were identified by IONM,OR=8.27(x2=59.345,P=0.00).The percentage of EBLSN located in the upper pole accurately identified by the naked eye was 20/46(43.5％) while by IONM was 43/46(93.4％).The percentage of EBSLN at the other position accurately identified visually was 106/172(61.6％),and by IONM was 160/172(93.0％).The number of visually identified cases in different locations showed significantly differences according to the chi-square test (x2=4.901,P=0.027),and no significant difference by IONM identification according to chi-square test (x2=0.012,P=0.914).Five patients had a low voice at one week postoperatively and low voice and vocalization change were not observed after one month.Conclusions IONM can effectively increase the proportion of intraoperative EBSLN identification to ensure the safety of surgery.The difficulty of visual identification of EBSLN during the surgery of tumor in upper pole is greater than that in other locations.IONM can provide more evidences for nerve protection and reduce the risk of injury.
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Objective To investigate the clinical effects of different surgical methods for primary hyperthyroidism complicated with thyroid cancer.Methods The clinical data of patients with primary thyroid hyperthyroidism complicated with thyroid cancer who visited our hospital from Jan.2011 to Dec.2017 were collected,including preoperative preparation,operation mode and so on,to explore the clinical effect of different surgical methods.Results Thirty patients with single nodules preoperatively,no suspected lymph node metastasis and no intraoperative involvement of glandular extravasation were performed Ipsilateral thyroid + isthmectomy and contralateral thyroidectomy.Less than 1g of thyroid tissue was retained at the throat of the contralateral gland (less than 1 cm x 1 cm x 1 cm volume of glandular tissue).Double-sided total thyroidectomy was performed on 19 patients with preoperative ultrasound suspects cancer and multiple nodules,bilateral cancers,suspected lymph node metastases,and extraeapsular invasion.All patients who were followed did not show recurrence or metastasis of hyperthyroidism or thyroid cancer.Conclusions The treatment of hyperthyroidism combined with thyroid gland should be based on the principle of thyroid cancer cure and relapse prevention of hyperthyroidism and according to the tumor size,location,pathological type and risk of relapse stratified development of personalized surgery program.Conventional central lymph node dissection is necessary for patients with primary hyperthyroidism complicated with thyroid cancer,especially for those with young age,large tumor diameter,and invasion of the capsule and the surrounding tissue.
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Objective To investigate the efficacy and safety of indocyanine green fluorescence imaging in the lymph node dissection of radical thyroidectomy.Methods Radical thyroidectomy was performed using indocyanine green fluorescence imaging technology for two patients at the Department of General Surgery of Chinese People's Liberation Army (PLA) General Hospital in July 2018.Indocyanine green was injected into the thyroid glands after bilateral thyroid glands were exposed during operation.Bilateral total thyroidectomy plus central lymph node dissection was performed in case 1,and bilateral total thyroidectomy plus central area and left lateral area(area Ⅱ a,Ⅲ,Ⅳ) lymph node dissection was performed in case 2.Both operations were performed under the guidance of real-time fluorescence imaging system.The total number of lymph nodes detected,the number of small lymph nodes (diameter less than 3 mm),the level of parathyroid hormone(PTH),the incidence of complications such as hypocalcemia,hoarseness and short-term recurrence were observed.Results After excitation by the near-infrared light of the fluorescence detector probe,the display showed that the parathyroid gland and surrounding tissues were not visualized,and the thyroid glands and lymph nodes were brightly illuminated.The number of lymph nodes dissected in the central region of the two patients was 20 (13 with diameter less than 3 mm) and 10(6 with diameter less than 3 mm),respectively.For case 2,13 lymph nodes were dissected in the left lateral area (area Ⅱ a,Ⅲ,Ⅳ),and 8 lymph nodes with diameter less than 3 mm were dissected.There were no complications such as hypocalcemia and hoarseness after operation.The levels of parathyroid hormone and serum calcium were normal on the first day and 3 months after operation.There was no recurrence or metastasis of the tumors by ultrasonography 3 months after operation.Conclusion Indocyanine green fluorescence real-time imaging technology can help to identify lymph nodes specifically during radical thyroidectomy,and can achieve real-time dynamic imaging,which can make lymph node dissection more thorough and can be used as a new method for lymph node tracing in thyroid cancer surgery.
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Laryngeal nerves injury,including recurrent laryngeal nerve (RLN) and superior laryngeal nerve,is one of the most terrible complications of thyroid surgery.External branch of superior laryngeal nerve (EBSLN) is adjacent to the upper pole of thyroid gland,which make it vulnerable to be injured during the ligation of the superior thyroid vessels.As a result,patients would have phonating dysfunction,especially the changes in the voice quality alongside the alterations in the high pitched sound production ability.Intraoperative neural monitoring technique applying neural electrophysiology method to detect and protect the nerve and assess its function during the operation decreases the occurrence of EBSLN injury and improves the living quality.This article is going to make a review of the progress of the application.
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<p><b>OBJECTIVE</b>To analyze the efficacy and safety of laparoscopic adjustable gastric placation (LAGBP), a new procedure for surgical treatment of obesity.</p><p><b>METHODS</b>Clinical and 1-year follow-up data of 10 patients who underwent LAGBP in our department between September and November 2011 were analyzed retrospectively.</p><p><b>RESULTS</b>The mean operative time was (93.0±13.4) min, while the mean intraoperative blood loss was (15.5±4.7) ml. The mean excessive body weight loss rate(%EWL) at 3, 6, 9 and 12 months after the operation was 25.1%, 40.6%, 45.3% and 50.8% respectively. There were no severe post operative complications.</p><p><b>CONCLUSIONS</b>LAGBP is associated with high safety and good short-term efficacy.</p>