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OBJECTIVE@#To assess the safety and efficacy of"leverage pry-off method"for preventing thermal injury during microwave ablation of benign thyroid nodules.@*METHODS@#From July, 2017 to September, 2019, a total of 348 patients with benign thyroid nodules underwent ultrasound-guided microwave ablation. For protecting from thermal injury during the ablation, "hydrodissection technique" was used in 174 of the patients (admitted from July, 2017 to August, 2018) and "leverage pry-off method" in the other 174 patients (admitted from September, 2018 to September, 2019). All the patients were followed up for 1 to 12 months after the operation for observation of severe complications and nodular residues.@*RESULTS@#Ultrasound-guided microwave ablation was completed in all the 348 patients. The most common severe complication associated with the ablation was voice change, occurring in 3 cases (1.7%) in "hydrodissection technique" group and in 4 (2.3%) in the "leverage pry-off method" group, showing no significant difference between the two groups (P>0.05). During the follow-up, no significant difference was found in the rate of nodular residues between the "hydrodissection technique" group and "hydrodissection technique" group (9.8% vs 10.9% (P>0.05).@*CONCLUSIONS@#The "leverage pry-off method" is simple and effective for preventing thermal injury during microwave ablation of benign thyroid nodules.
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Humans , Microwaves/therapeutic use , Thyroid Nodule/surgery , Burns , Hospitalization , Radiofrequency AblationABSTRACT
Objective:To analyze the correlation between serum claudin-1(Cla-1) level and the risk of papillary thyroid carcinoma(PTC) in patients with thyroid nodules.Methods:The clinical data of 345 patients with thyroid nodules were retrospectively analyzed. According to the pathological results, they were divided into PTC group and benign thyroid nodule(BTN) group. The difference of serum Cla-1 level between 2 groups and its correlation with the risk of PTC were analyzed.Results:In groups of PTC( n=225) and BTN( n=120), the median value of serum Cla-1 level was 14.03(10.30, 20.40) ng/mL. The differences in the median value[17.90(14.00, 22.93)ng/mL vs 9.40(8.15, 11.20) ng/mL] of serum Cla-1 level in the PTC and BTN were statistically significant by Wilcoxon signed-rank test. The prevalence of PTC in thyroid nodules increased gradually with increasing of serum Cla-1 level. Receiver operated characteristic curve analysis showed that the best diagnostic cut-off value of the PTC was 13.02 ng/ml of which the sensitivity was 81.8%, the specificity was 89.2%, and the area under curve(AUC) was the largest(AUC=0.944, P<0.01, 95% CI 0.922-0.965). Logistic regression analysis showed that elevated serum Cla-1 level increased the risk of PTC, and it was statistically significant( OR=4.334, 95% CI 1.662-11.303, P=0.003). There was a significant correlation among the serum Cla-1 level and gender, age, location of involvement, number and diameter of cancer nodules, extracapsular invasion of thyroid, lymph node metastasis, tumor stage and combined with Hashimoto′s thyroiditis( P<0.01). Conclusion:The serum level of Cla-1 may be one of risk factors to predict PTC, and it is related to the total amount of PTC tumor cells in vivo, but it was not related to the aggressive behavior of tumor.
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Objective:To observe the clinical efficacy of Pingxiao capsules in the treatment of benign thyroid nodules. Methods:Totally 240 patients with benign thyroid nodules were randomly divided into the treatment group and the control group with 120 ones in each. The control group received levothyroxine at low dose, the treatment group received Pingxiao capsules, and the treatment course was 3 months. The type B ultrasonic inspection and lab inspection ( for thyroid hormones and blood lipid) were carried out, the cura-tive effect was compared and the adverse reactions were recorded as well. Results:Three patients in the treatment group and five ones in the control group were lost during the follow-up. After the treatment, the max diameter of thyroid nodule and the thyroid volume de-creased in both groups (P<0. 05), and those in the treatment group were smaller than those in the control group (P<0. 05). The levels of TSH and TC in the control group decreased after the treatment, which were significantly lower than those in the treatment group (P<0. 05). The total effective rate in the treatment group was higher than that in the control group, and the incidence of ad-verse reactions was lower than that in the control group, and both had significant differences between the groups (P<0. 05). Conclu-sion:Pingxiao capsules are effective and safe in the treatment of benign thyroid nodules.
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Objective To explore the effects and complication treatments of microwave ablation(MWA) for benign thyroid nodules.Methods The clinical data of 74 patients with benign thyroid nodules treated with MWA in our department from June 2014 to May 2015 were collected and studied retrospectively.Furthermore,the effects and complication treatments were analyzed and calculated.Results A total of 93 nodules were treated with MWA,of which 46 were the main nodules,cystic 47;7 nodules' ablation were not complete,the complete ablation rate was 92.47％.The postoperative reduction of volume in cystic nodules were significantly higher than solid nodules,and the number of solid nodules decreased more rapidly postoperation.The untreated cystic nodules developed a certain degree of growth after 6 months of surgery.After treatment,the TSH of solid nodules were obviously higher,the FT3 and FT4 were much lower than those before treatment and cystic nodules(P ＜ 0.05).A total of 17 cases of complications occurred in the positive symptomatic treatment,all cases were cured within a few days,there was no serious complications.Conclusion Microwave ablation has a high ablation rate in the treatment of thyroid benign nodules,the ablation effects are different between solid and cystic nodules;early and targeted measures can effectively prevent and deal with surgical complication.
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Objective To analyze the clinicopathological characteristics of patients with benign thyroid nodules(BTN) and thyroid carcinoma(TC),and explore the clinical value of fine-needle aspiration biopsy (FNAB)in diagnosis of TC.Methods A retrospective analysis was conducted on the data of 2918 cases with thyroid carcinoma,who underwent surgery in the People's Hospital of Wuhan University between January 2011 and February 2015.Results Patients aged younger than 45 years old accounted for 26.23％ and 51.26％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant (P ＜ 0.05).Male patients accounted for 16.82％ and 20.15％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant (P ＜ 0.05).Patients with family history of thyroid related diseases accounted for 2.93％ and 3.70％ in BTN group and CT group,respectively,and there was no statistically significant difference between the two groups (P ＞ 0.05).Patients with solitary lesion accounted for 40.42％ and 47.95％ in BTN group and CT group,respectively,and the difference between the two groups were statistically significant(P ＜ 0.05).Af ter the application of FNAB,the percentage of the patients diagnosed with TC was increased by 4.83％ (P ＜ 0.05),and the diameter of nodular was increased by 4 cm (P ＜ 0.01).Conclusion Patients with TC have a characteristic of earlier onset age,higher proportion of male patients and lower incidence of multifocality compared with patients with BTN.There was no statistically significant difference between the TC group with family history of thyroid related diseases and the BTN group.The application of FNAB avoids of unnecessary surgeries on some BTN patients with small pathological diameter of nodule,it is important for preoperative diagnosis of thyroid nodules.
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Objective To investigate the expression of heparanase (Hpa) in serum and tissue of patients with papillary thyroid carcinoma (PTC) and its clinical significance.Methods Immunohistochemical method (SP) and enzyme linked immunosorbent assay (ELISA) were used to detect the expression of Hpa protein in serum and tissues of 38 cases of PTC,37 cases of patients with benign thyroid nodules,and 30 normal controls.Results Expression of Hpa in PTC was higher than that of benign thyroid nodules (P＜0.01).Expression of Hpa in lymph node metastasis group was higher than that in group without lymph node metastasis (P＜0.05).Compared with the normal control group,the content of serum Hpa in patients with benign thyroid nodules had no significant difference (P＞0.05).Hpa content in serum of patients with PTC was higher than that of benign thyroid nodules group and the normal control group (P＜0.01).There was no statistically significant difference of the level of serum Hpa between groups with and without lymph node metastasis.Conclusions Detecting tissue and preoperative serum Hpa concentration is valuable for diagnosis of PTC.Hpa detection in tissues can be used to determine whether there was lymph node metastasis in PTC patients,while Hpa detection in preoperative serum can not judge whether there is lymph node metastasis.
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Objective To compare serum protein fingerprint among Uygur patients with thyroid cancer and benign thyroid nodules, and Han patients with thyroid cancer, and to screen ethnic-specific protein markers of thyroid cancer. Methods Using the technology of two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), the protein expression profiles of Uygur and Han patients with thyroid cancer and Uygur patients with thyroid nodules were established and compared by image analysis software between two groups. Liquid chromatography-mass spectrometry/mass spectrometry coupling techniques ( LC-MS/MS) were used to identify differential protein. The protein′s name, cellular localization and functional classification were searched in Swissport database. Results There are 11 differentially expressed proteins by comparison of sera in Uygur patients with benign thyroid nodules and thyroid cancer, in which complement C3 and C4b levels were down-regulated in the serums of Uygur patients with benign thyroid nodules, and 9 proteins such as heme-binding proteins etc were up-regulated. There are 7 differentially expressed proteins by comparison of serums in Uygur and Han patients with thyroid cancer, in which transferrin level was up-regulated in the serum of Uygur patients with thyroid cancer, and 6 proteins such as cytokeratin-1 etc were down-regulated in serum of Uygur patients with thyroid cancer. Conclusion Combined screening of multiple labelled proteins including heme-binding protein,α2-macroglobulin, and transferrin protein etc may provide the basis for the diagnosis of thyroid cancer in Uygurs and Hans.
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Objective To study the relationship between heparanase( Hpa) , urokinase type plasminogen activator( uPA) expression and lymph node metastasis in thyroid carcinoma.Methods Immunohistochemieal SP method was used to analyze the expression of Hpa and uPA in 113 cases of thyroid carcinoma and 134 cases of be-nign thyroid nodules.The expression of Hpa and uPA in thyroid carcinoma and its clinical significance were ana-lyzed.Results The positive expression rate of Hpa and uPA in thyroid carcinoma and benign nodular thyroid tis-sue were 82.30%,16.42%and 89.38%, 11.19%.The positive expression rate of Hpa and uPA in carcinoma tissues with lymph metastasis and without metastasis were 93.94%,100% and 65.96%,74.47%.Expression of Hpa and uPA in thyroid carcinoma group was significantly higher than that of benign thyroid nodules group( P<0.001) .The rate of positive expression in lymph metastatic tissues were significantly higher than those in tissue without metastasis( P<0.001) .Hpa and uPA expression in thyroid carcinoma tissues was positively correlated( r=0.437, P=0.021).Conclusion The expression of Hpa and uPA is closely related with the occurrence and metastasis of thyroid carcinoma.