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Objective:To investigate the value of the decrease rate of parathyroid hormone (PTH) in predicting permanent hypoparathyroidism (PHP) in one month after operation of papillary thyroid carcinoma (PTC) .Methods:The clinical data of 322 patients with PTC who underwent at least total thyroidectomy and unilateral central lymph node dissection in the Thyroid Surgery Center of West China Hospital of Sichuan University from Jan. 2013 to Jun. 2018 were retrospectively analyzed. There were 257 women and 65 men. According to the time when PTH returned to normal, they were divided into 307 cases in the temporary hypoparathyroidism (THP) group and 15 cases in the PHP group. The decrease rate of PTH and the incidence of hypoparathyroidism in one month after operation were counted, the clinical characteristics and operation information were observed, and the risk factors of PHP were analyzed. SPSS 23.0 statistical software was used for data processing. χ 2 test and t test were used for comparison between THP and PHP. The related factors were analyzed by multivariate logistic regression. Results:307 cases of THP and 15 cases of PHP were included. Multivariate logistic analysis showed that age ≥ 55 years old ( OR, 35.193; 95% CI, 2.936 - 421.870; P=0.005) and PTH before operation closer to normal lower limit ( OR, 2.349; 95% CI, 1.161 - 4.755; P = 0.018) were independent risk factors for PHP. Patients with PHP had a higher rate of PTH decline in 1 month after operation ( OR, 373.439; 95% CI, 26.568 - 5248.983; P=0.000) . The ROC curve showed that the sensitivity and specificity of predicting PHP were 86.7% and 94.8% respectively. Conclusions:The age of patients with PTC ≥ 55 years old and PTH before operation closer to normal lower limit are independent risk factors for the occurrence of PHP. The decline rate of PTH in one month after operation which more than 73.2% can predict PHP.
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Objective:To investigate the effect of endoscopic thyroidectomy through breast milk approach in patients with papillary thyroid carcinoma and its influence on Wnt and integrin signaling pathways.Methods:A total of 136 patients diagnosed with papillary thyroid carcinoma in our hospital from Jul. 2018 to Mar. 2020 were selected and were hospitalized for surgical treatment. According to different surgical procedures, they were divided into a study group (68 cases) and a control group (68 cases) . The control group was treated with open thyroidectomy and the study group was treated with thoracoscopic thyroidectomy. The two groups were compared in terms of immune function [CD4+, CD8+ and CD4+/CD8+], and pain index [PGE2, IL-6, Cor and VAS score]. RT-PCR method was used to detect WNT1, β-catenin, GSK3β and integrin Signal pathway before and after surgery.Results:Three days after operation, compared with the control group, the study group had significantly higher CD4+ and CD4+/CD8+ levels [ (27.62±2.52) vs (24.63±2.67) , (0.66±0.18) vs (0.52±0.13) ], while the CD8+ level was significantly lower [ (41.62±3.54) vs (45.62±3.63) ] ( P<0.001) ; PGE2, IL-6, Cor, VAS of the study group were significantly lower than the control group [ (48.54±9.86) vs (57.21±8.12) , (5.13±0.71) vs (6.99±0.95) , (511.23±67.52) vs (633.12±71.47) , (1.26±0.56) vs (3.99±2.06) ] ( P<0.001) ; WNT1, β-catenin, GSK3β, integrin β1, FAK, Ras, and MAPK mRNA expression levels in the study group were significantly lower than those of the control group[ (1.79±0.15) vs (2.85±0.25) , (1.94±0.15) vs (2.64±0.24) , (2.13±0.19) vs (2.97±0.28) , (1.95±0.17) vs (2.58± 0.23) , (2.15±0.16) vs (2.87±0.22) , (1.95±0.18) vs (2.91±0.27) , (1.89±0.12) vs (2.87±0.31) ] ( P<0.001) . Conclusion:Endoscopic thyroidectomy through thoracolumbar approach can effectively reduce postoperative pain in patients with papillary thyroid cancer, have a smaller impact on immune function, and block the expression of Wnt and integrin signaling pathways to reduce tumor metastasis risk.
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Objective: Thyroglobulin antibodies (TgAb) are detected in thyroid cancer patients up to 25%. We investigated the prognostic value of TgAb positivity in patients with papillary thyroid carcinoma (PTC) after initial therapy. Patients and Methods: A database of 109 consecutive patients who underwent total thyroidectomy and therapeutic lateral neck dissection followed by remnant ablation for PTC between January 1989 and December 2014 was reviewed We recorded the patients' all serum Tg and TgAb levels over time to establish changing trends. Patients were classified as either positive or negative according to serum TgAb levels. The recurrence or persistence rates in both groups were compared. Results: Of the 109 patients enrolled 14 patients had TgAb positivity. Thirty-two (29.3%) showed disease recurrence or persistent disease during 101 months of follow-up. Twenty-seven of 95 patients (28.4%) with negative TgAb had persistent or recurrent disease, whereas 5 of 14 patients (35.7%) with positive TgAb had persistence or recurrence (P = 0.57). No significant difference in disease-free survival (115.3 ± 10.8 vs. 224.1 ± 16.6 months, P = 0.78) and overall survival (P = 0.59) was observed between TgAb positive and TgAb negative patients. Conclusions: TgAb status is not useful as a prognostic and predictive factor for clinical outcomes in patients with PTC in our experience
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Objective: To investigate the effects of lysine acetyltransferase (Kat5) on the proliferation and apoptosis of thyroid papillary carcinoma cells. Methods: RT-PCR and Western blotting methods were used to determine the expression levels of Kat5 mRNA and protein in the thyroid papillary carcinoma BHP10-3. TPC-1 . K1 cells and thyroid epithelial Nthy-ori3-l cells. The thyroid papillary carcinoma TPC-1 cells were divided into blank control group, negative control group and silencing Kat5 group (si-Kat5 group). The cells in blank control group were not transfected. the cells in negative control group were transfected with negative control siRNA. and the cells in si-Kat5 group were transfected with Kat5 siRNA. The expression levels of Kat5 mRNA and protein in the thyroid papillary carcinoma TPC-1 cells in various groups were detected by RT-PCR and Western blotting methods. The proliferation activities of the TPC-1 cells in various groups were measured by CCK-8 method, the colony formation assay was used to measure the clone formation rates of the TPC-1 cells in various groups, the apoptotic rates of the TPC-1 cells in various groups were detected by flow cytometry, and the expression levels of cyclin-dependent kinase 2 (CDK2). P21, P53. cleaved caspase-3. P13K, phosphorylated P13K (p-P13K), AKT, and phosphorylated AKT (p-AKT) protein in the TPC-1 cells in various groups were detected by Western blotting method. Results: The expression levels of Kat5 mRNA and protein in the thyroid papillary carcinoma BHP10-3. TPC-1 and K1 cells were higher than those in thyroid epithelial Nthy-ori3-l cells (P<0. 05). The differences in the Kat5 mRNA and protein expression levels, the proliferation activities, the clone formation rates, the apoptotic rates and the expression levels of CDK2. P21. P53. cleaved caspase-3. P13K. p-P13K . AKT and p-AKT proteins in the TPCM cells between various groups were statistically significant (P<0.05). Compared with blank control group and negative control group, the expression levels of Kat5 mRNA and protein in the TPC-1 cells in si-Kat5 group were decreased ( P
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Background: The aim of this study is to determine the prognostic factors which affect both disease-free survival (DFS) and overall survival (OS) in thyroid papillary carcinoma with clinical lateral lymph node metastasis. Methods: One hundred and three papillary thyroid carcinomas diagnosed in adult patients received therapeutic lateral neck dissection between December 1989 and June 2010 were analyzed retrospectively. All of the patients were classified as American Thyroid Association (ATA) intermediate risk category. Age, gender, tumor stage and size, multicentricity and bilaterality, vascular invasion and extrathyroidal invasion, ipsilateral/contralateral lymph node involvement, lymph node ratio, extranodal tumor extension, and development of recurrence were the factors which might affect disease-free and OS. Univariate and multivariate analyses were performed. ROC analysis was used to find the cutoff value for lymph node ratio. Results: One hundred and three patients were followed median 101 months. Locoregional or systemic recurrence developed in 20 patients (19.4%) while 7 patients (6.8%) had persistent disease. In multivariate analysis, lymph node ratio (P = 0.003, relative risk [RR] 5.4, 95% confident interval [CI] 1.7–16.5) and contralateral lymph node involvement (P = 0.02, RR 4.9, 95% CI 1.3–18.5) were the independent factors affecting DFS where contralateral lymph node involvement (P = 0.009, RR 44.4, 95% CI 2.5–765.2) was the only factor which affected OS. Conclusions: Lymph node ratio and contralateral metastasis affect DFS while contralateral metastases only affect OS in patients with N1b thyroid papillary carcinoma
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Objective To evaluate the value and short-term efficacy of Miccoli for cervical lymph node dissection in patients with thyroid papillary carcinoma.Methods From Mar.2017 to Jan.2018,15 patients with thyroid papillary carcinoma received cervical lymph node dissection in Department of Thyroid and Breast Surgery of Nanjing Chinese Traditional Medicine Hospital,and they were divided into open surgery group (8 cases) and Miccoli surgery group (7 cases).The operation time,incision length,intraoperative blood loss,total number of dissection lymph nodes,incidence of postoperative complications and length of hospital stay between the two groups were analyzed.These groups were followed up for 6 months after surgery,in terms of neck comfort,incidence of enlarged lymph nodes in the cervical region and blood thyroglobulin level.Results There was no obvious difference between the two groups in intraoperative blood loss(P=0.651),total number of dissection lymph nodes(P=0.887),the incidence of postoperative complications(P=0.52),incidence of intumescent lymph node(P=1.000) and blood thyroglobulin level(P=0.826) after 6 months.The operation time of Miccoli group was longer than that of the open group(P=0.001),but the incision length(P=0.001),length of hospital stay(P=0.001)and postoperative neck comfort(P=0.001)were superior to those of the open surgery group.Conclusion Miccoli operation can be used to perform cervical lymph node dissection for PTC patients,which can achieve the curative effect of open surgery,without increasing the risk of postoperative complications,and the postoperative neck comfort was better.
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Objective To explore the correlation of of lymph node metastasis rate ( LR) with postoperative recurrence and prognosis in patients with thyroid papillary carcinoma (PTC). Methods From January 2010 to June 2013,the clinical data of sixty-two patients with PTC in Baoshan Branch,Shanghai First People′s Hospital were retrospectively analyzed. According to the LR, patients were divided into low LR (＜25%) group(38 cases),high LR(≥25%) group (24 cases). The clinical pathological characteristics, postoperative recurrence and 5-year survival rate of the two groups was compared,and the influence factors of prognosis were analyzed. Results There was significant difference in LR among patients with different ages,numbers of lesions,lesion diameters,TNM stages and numbers of lymph node metastasis (P＜0. 05);compared with high LR group,the recurrence in low LR group was obviously reduced(15. 8% vs. 41. 7%), and 5-year survival rate was significantly increased ( 92. 1% vs. 63. 0%) ( P＜0. 05) . LR and TNM stage were the independent risk factors of prognosis in PTC patients,and age was independent protection factor (HR＝1. 587,1. 714,0. 617,P＜0. 05). Conclusion LR can be used as one of postoperative recurrence and prognosis evaluation indicators of PTC.
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Objective To investigate the expression of LncRNA TCONS_00003757 in papillary thyroid carcinoma ( PTC) , and to explore the effect of LncRNA TCONS_00003757 on the proliferation, migration, and invasion in TPC-1 cells. Methods Sixty cases of papillary thyroid carcinoma specimens and paired normal tissues were collected after surgery from October 2017 to March 2018 in the Tangshan Workers Hospital. Real-time PCR analysis was used to examine the expression level of LncRNA TCONS_00003757 in PTC tissues, and the association of LncRNA TCONS_00003757 expression levels with the clinicopathological data of patients was analyzed. The effects of LncRNA TCONS_00003757 and ST3GAL5 silencing on the proliferation, migration, and invasion in TPC-1 cells were assessed by MTT, scratch test, and transwell assay. Protein expression of ST3GAL5 was detected by Western blot after LncRNA TCONS_00003757 silencing. Results LncRNA TCONS_00003757 expression was increased in PTC tissues compared with that in normal tissues ( P<0. 05 ) , which was correlated with capsule invasion and lymph node metastasis( P<0.05) . LncRNA TCONS_00003757 expression in TPC-1 cells was higher than that in normal thyroid follicular epithelial Nthy-ori 3-1 cells(P<0.05). LncRNA TCONS_00003757 and ST3GAL5 silencing inhibited the proliferation, migration, and invasion of thyroid cancer TPC-1 cells, and ST3GAL5 expression was decreased after LncRNA TCONS_00003757 silencing (P<0.05). Conclusion LncRNA TCONS_00003757 expression in PTC is significantly increased and correlated with its occurrence and development. Silencing LncRNA TCONS_00003757 may inhibit the proliferation, migration, and invasion of thyroid papillary cancer cells via decreasing ST3GAL5 expression.
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Objective To compare the sonographic features as well as clinical histopathological features of follicular variant papillary thyroid carcinoma(FVPTC) and conventional papillary thyroid carcinoma (CPTC) in pediatric patients.Methods From Jan.2006 to Dec.2017,26 FVPTC patients and 82 CPTC patients were enrolled in this study.The clinical histopathological findings and the sonographic features were compared between the two groups.FVPTCs and CPTCs were divided into PTC-like and follicular neoplasm(FN)-like based on sonographic characteristics.Results The mean nodule size of FVPTCs was larger than that of conventional PTCs.Extrathyroid invasion and cervical lymph node metastasis did not have significant difference between CPTC and FVPTC patients(53.8％ vs 62.2％ and 76.9％ vs 82.9％,respectively).Multiple nodules(P=0.000)and distant pulmonary metastases(P=0.024) were more frequent in CPTCs than in FVPTCs(P＜0.05).The rate of an ill-defined margin (P=0.000) and calcification (P=0.003)in terms of sonographic features were lower in FVPTCs than conventional PTCs(P＜0.05).A Ⅴ+Ⅵ diagnosis of PTC on FNAC of FVPTCs was less common than that of conventional PTCs (P=0.014).Multifocality(P=0.000),extrathyroidal invasion (P=0.000),and lymph node metastasis (P=0.000) were significantly different between PTC-like FVPTCs and FN-like FVPTCs.Conclusion FVPTC in children and adolescents shows a relatively larger size,more benign sonographic features,and a lower diagnostic rate of PTC by FNAC compared with conventional PTCs in pediatric patients.
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OBJECTIVE: This study aims to investigate differences in the metabolomic profiles of patients who received different surgeries for papillary thyroid carcinoma (PTC). METHODS: Two surgical methods, i.e., unilateral and total thyroidectomy, were employed according to different disease conditions. Sera from patients who were treated with levothyroxine sodium tablets before and after surgery was analyzed with a Bruker 500 Hz nuclear magnetic resonance (NMR) spectrometer. Data were analyzed via principal component analysis (PCA) and partial least squares discriminate analysis (PLS-DA) with SIMCA-P+ 11.0 software, and metabolites were obtained and compared. The first and second principal components were selected from PCA, PLS-DA, and orthogonal partial least squares discriminate analysis (OPLS-DA). A p-value less than 0.05 was considered statistically significant. RESULTS: There were significant differences in serum metabolomics before and after surgery. Compared with unilateral thyroidectomy, total thyroidectomy reversed some highly increased metabolite levels (e.g., taurine and betaine). More significant variations in abnormal metabolites were noted after total thyroidectomy than after unilateral thyroidectomy (e.g., alanine, choline, hippurate, and formic acid). CONCLUSIONS: The choice of surgical method for PTC patients should be based not only on the tumor condition but also on the potential consequences of metabolic variations. Total thyroidectomy reversed some increased metabolite levels but led to accumulation of some other metabolites due to the loss of thyroid function; thus, metabolic disturbances caused by thyroid hormone deficiency should be prevented in advance.
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Humans , Male , Female , Adult , Thyroidectomy/methods , Thyroid Neoplasms/surgery , Metabolomics/methods , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/metabolism , Thyroid Neoplasms/diagnostic imaging , Magnetic Resonance Spectroscopy , Principal Component Analysis , Thyroid Cancer, Papillary/metabolism , Thyroid Cancer, Papillary/diagnostic imagingABSTRACT
Objective To investigate the composition and pathological subtypes of thyroid cancer in patients with thyroid nodule surgery in Guiyang in recent 8 years, and to analyze their influencing factors. Methods A retrospective pathological analysis of 4 262 thyroid surgery cases in Affiliated Hospital of Guizhou Medical University during the 2009-2016 to investigate the proportion of thyroid cancer and pathological subtype. The iodine content of salt was reduced at the end of 2012 in Guiyang. 2009-2012 as the pre down-regulation group(n＝1 572), 2013-2016 as the after down-regulation group ( n＝2 690), then comparative analysis before and after the adjustment of the iodine content of salt composition of thyroid cancer and changes of pathological subtype was performed. Results From 2009 to 2016, the proportion of thyroid cancer were 17.08%, 17.52%,15.65%, 18.58%, 19.80%, 29.35%, 35.34%, and 48.33%, increased year by year (P＜0.05). Thyroid microcarcinoma were 2.14%, 4.74%, 3.40%, 3.65%, 3.80%, 7.03%, 9.10%, and 25.95%(P＜0.05). The constituent ratio of thyroid cancer after adjustment of salt iodine content was higher than before. Papillary thyroid carcinoma is the main pathological subtype before and after adjustment of salt iodine content. The proportion of female patients was higher than that of males. The age of patients with thyroid cancer after adjustmen was higher than before ( P＜0. 05). Conclusions In the past 8 years, the constituent ratio of thyroid cancer and thyroid microcarcinoma in Guiyang increased year by year. The reason may be related to the increase of radiation in the environment, the improvement of medical level and the higher detection rate of thyroid microcarcinoma. The relationship between iodine nutrition and thyroid cancer needs to be further studied.[Key words] Thyroid cancer; Thyroid microcarcinoma; Thyroid papillary carcinoma; Pathological type;Iodized salt; Iodine nutrition
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Objective To determine the diagnostic value of plain CT in tuberous goiter and thyroid papillary carcinoma.Methods The CT images including 63 lesions from 58 patients with thyroid papillary carcinoma and 103 lesions from 86 patients with tuberous goiter proven by pathology were reviewed retrospectively.The analyses were mainly focus on the internal density,the presence of calcification, andthe relation of the lesion with the normal thyroid and adjacent tissue.Results There were statistically significant differences in the internal density,the morphology of calcification and the relation of the lesion with normal thyroid and adjacent tissue between the papillary carcinoma and tuberous goiter lesions.The common CT appearances of papillary carcinoma included uniform density,crab pattern change,micro calcifications and unclear boundaries of the lesion.Focal necrosis and cystic changes were also occasionally found in papillary carcinoma and usually occured at the peripheral area.Tuberous goiters usually manifested as mixed density with macro or eggshell calcifications as well as clear boundaries both with normal thyroid tissue and adjacent tissue.Conclusion The plain CT helps for the preliminary distinction of tuberous goiter and thyroid papillary carcinoma.
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Objective To study the inhibitory effect of ursolic acid on the proliferation of human papillary thyroid carcinoma cell line TPC-1 in vitro. Method TPC-1 cells were treated with different concentrations of ursolic acid (control group:0μM, experimental group:3μM , 6μM, 12μM);MTT assay was used to observe the effect of the growth of TPC-1 cells on different concentrations of ursolic acid at the same time;Apoptosis and cell cycle distribution of TPC-1 cells were treated with ursolic acid by flow cytometry;The expression of Bcl-2, Bax and Caspase-9 mRNA in TPC-1 cells were treated with ursolic acid by QRT-PCR;The expression of Bcl-2, Bax and Caspase-9 protein in TPC-1 cells were treated with ursolic acid by Western blot. Results MTT assay showed that ursolic acid inhibited the proliferation of TPC-1 cells in a concentration and time-dependent manner, and the IC50 at 24 h, 48 h and 72 h was 14.21 μM, 10.56 μM, 10.39 μM; Flow cytometry showed that ursolic acid inhibited the apoptosis of TPC-1 cells in a concentration-dependent manner, and the growth of TPC-1 cells was arrested in S phase;QRT-PCR showed that Bcl-2, Bax and Caspase-9 mRNA were expressed in the control and experimental groups, ursolic acid inhibited the expression of Bcl-2 mRNA in a concentration-dependent manner and up-regulated the expression of Bax and Caspase-9 mRNA;Western blot results showed that Bcl-2, Bax and Caspase-9 were expressed in the control and experimental groups, ursolic acid inhibited the expression of Bcl-2 protein in a concentration-dependent manner and up-regulated the expression of Bax protein and Caspase-9 protein. Conclusion Ursolic acid can significantly inhibit the proliferation and induce apoptosis of human papillary thyroid TPC-1 cells, providing some ideas for the treatment of thyroid cancer.
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Objective To investigate the effect of miR-181b on the proliferation and apoptosis of thyroid papillary carcinoma cells by down-regulating CYLD protein and its mechanism. Methods qPCR was used to detect the expression and difference of miR-181b in papilla-ry thyroid carcinoma and normal thyroid tissue. Western blotting was used to detect the regulation between miR-181b and CYLD protein. Clone formation assay was used to detect the proliferation of thyroid cancer cells after inhibition of miR-181b. Flow cytometry was used to detect the apoptosis of thyroid carcinoma cells after inhibition of miR-181b. Results Compared with normal thyroid tissue,the expression of miR-181b in papillary thyroid carcinoma was up-regulated,the difference was statistically significant(P<0. 05). The expression level of miR-181b in FTC-133 cell line was relatively high. Western blotting confirmed that miR-181b could directly regulate the expression of CYLD protein. Inhi-bition of miR-181b expression can inhibit the proliferation of thyroid cancer cells,and to some extent promote its apoptosis behavior. Conclu-sion miR-181b can regulate the expression of CLYD and affect the proliferation and apoptosis of thyroid cancer cells.
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Objective At present,the detection rate of cervical metastatic lymph nodes in patients with papillary thyroid carcinoma (PTC) is relatively low by imaging technology.The article aimed to demonstrate the ultrasonographic features of PTC in predicting cervical lymph nodes metastasis(CLNM).Methods A retrospective analysis was done on 169 PTC patients proved by surgery and pathology who underwent cervical lymph node dissection in the Department of Ultrasonography in Nanjing General Hospital of Nanjing Military Command from January 2016 to March 2017.The patients were divided into CLNM group(n=83) and non-CLNM group (n =86).Analysis was made on the related risk factors of PTC CLNM.Results Multivariate logistic regression analysis showed that age(OR=0.211,95％CI:0.078～0.571,P=0.002),nodule size (OR=3.116,95％CI:1.498～6.482,P=0.002) and shape (OR=3.000,95％CI:1.301～6.913,P=0.010) were risk factors for CLNM in PTC(P＜0.05).The sensitivity rates of patient's age,nodule shape,module size,and microcalcification for predicting CLNM in PTC patients were 91％、79％、61％、75％ respectively.Conclusion For PTC patients less than 30 years old,ultrasonographic features with maximal diameter of nodule ＞ 1 cm,irregular shape,and microcalcification have a certain predictive value on CLNM and can be used as the basis for the selection of intraoperative cervical lymph node dissection.
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Objective The objective of this study was to evaluate the correlation between maximum standard uptake values( SUVmax ) of 18 F-FDG PET/CT and BRAF mutation in patients with papillary thyroid car-cinoma(PTC).Methods Atotalof51patients(meanageof49.3±12.9years)whounderwent18F-FDGPET/CT imaging and biopsy before thyroidectomy were retrospectively analyzed. Based on the pathological results, there were 48 patients with PTC and 3 patients with follicular thyroid carcinoma(FTC). The SUVmax of thyroid nodule was measured by semi-quantitative analysis. The correlation between clinical data( gender,age,tumor size and thyroglobulin concentration) and SUVmax was also analyzed. The difference of SUVmax between the two groups was analyzed by comparing the BRAF V600E mutation group and the non-mutation group. Results In patients with PTC,27 patients had BRAF V600E mutations and 11 patients had no tumor mutation. The SUVmax of BRAF V600E mutation group was significantly higher than that in the non-mutated group(5. 5 ± 3. 9 vs. 2. 2 ± 1. 2,P=0. 002). The SUVmax of patients with tumor diameter≥1 cm was significantly higher than that in patients with tumor <1 cm(P<0. 05). The SUVmax of patients with elevated thyroglobulin concentration was higher than that in normal patients(P<0. 05). No BRAF V600E mutation was observed in the FTC group. Conclusion The BRAF V600E mutant gene has a high SUVmax value in patients with PTC. There were significant difference in SUVmax among different tumor size and serum thyroglobulin concentration.
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To develop a simple and easy promotion risk score to identify individuals with undiagnosed papillary thyroid carcinoma (PTC), and further to compare the diagnostic efficiency of PTC risk sore with fine needle aspiration cytodiagnosis (FNAC). in order to optimize the screening process of PTC. A sample of 1003 individuals aged 11-82 years underwent a surgical treatment of thyroid nodule participated in the study. The risk score was developed by stepwise backward multiple logistic regression. And using the receiver operating characteristic (ROC) curve to evaluate the diagnostic efficacy, the best diagnostic cut-off point and the risk stratification of malignant. Compare the sensitivity, specificity, accuracy, and area under curve ( AUC) of PTC risk score, FNAC and their combined diagnosis to judge their diagnostic efficiency. The risk score included age, TSH, nodule morphology and boundary by palpation, nodule characteristics, shape, boundary, calcification and blood flow signal by ultrasound. Its AUC= 0. 815, 6 point was the best cutoff point to differentiate benign from malignant thyroid nodules, and risk stratification of thyroid carcinoma were divided into four levels: very high risk group (score ≥ 9 points), high risk group ( score were 5-8 points), moderate risk group ( score were 3 ~ 4 points), low risk group ( score ≤ 2 points). The sensitivity, specificity, and accuracy of FNAC were 86. 3% , 90. 0% , and 87. 0% respectively, AUC=0. 891, while the sensitivity, specificity, and accuracy of PTC risk rating scale were 83. 8% , 70. 0% , and 81. 0%respectively, AUC = 0. 822. The sensitivity, specificity, and accuracy of their combined diagnosis were 97. 5% , 85. 0% , and 95. 0% , AUC=0. 965. This risk score can be used as a screening method before FNAC. If combined with FNAC, it may improve the diagnostic efficacy of PTC, and thereby possibly minimizing the unnecessary invasive examination and surgical treatment for patients with thyroid nodules and reducing personal costs.
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To develop a simple and easy promotion risk score to identify individuals with undiagnosed papillary thyroid carcinoma (PTC), and further to compare the diagnostic efficiency of PTC risk sore with fine needle aspiration cytodiagnosis (FNAC). in order to optimize the screening process of PTC. A sample of 1003 individuals aged 11-82 years underwent a surgical treatment of thyroid nodule participated in the study. The risk score was developed by stepwise backward multiple logistic regression. And using the receiver operating characteristic (ROC) curve to evaluate the diagnostic efficacy, the best diagnostic cut-off point and the risk stratification of malignant. Compare the sensitivity, specificity, accuracy, and area under curve ( AUC) of PTC risk score, FNAC and their combined diagnosis to judge their diagnostic efficiency. The risk score included age, TSH, nodule morphology and boundary by palpation, nodule characteristics, shape, boundary, calcification and blood flow signal by ultrasound. Its AUC= 0. 815, 6 point was the best cutoff point to differentiate benign from malignant thyroid nodules, and risk stratification of thyroid carcinoma were divided into four levels: very high risk group (score ≥ 9 points), high risk group ( score were 5-8 points), moderate risk group ( score were 3 ~ 4 points), low risk group ( score ≤ 2 points). The sensitivity, specificity, and accuracy of FNAC were 86. 3% , 90. 0% , and 87. 0% respectively, AUC=0. 891, while the sensitivity, specificity, and accuracy of PTC risk rating scale were 83. 8% , 70. 0% , and 81. 0%respectively, AUC = 0. 822. The sensitivity, specificity, and accuracy of their combined diagnosis were 97. 5% , 85. 0% , and 95. 0% , AUC=0. 965. This risk score can be used as a screening method before FNAC. If combined with FNAC, it may improve the diagnostic efficacy of PTC, and thereby possibly minimizing the unnecessary invasive examination and surgical treatment for patients with thyroid nodules and reducing personal costs.
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Objective To explore the diagnostic value of CEUS for thyroid TI-RADS 3,4 nodules.Methods The CEUS performence of 95 patients with thyroid TI-RADS 3,4 nodules (all were confirmed by surgery pathology) diagosed by conventional ultrasound were reviewed retrospectively,and the value of CEUS in the revision and differential diagnosis of thyroid TI-RADS 3,4 nodules were analyzed.Results Compared with pathological pattern,conventional ultrasound TI-RADS classifications in assessing the property of thyroid nodule had no statistical differences (χ2 =3.56,P =0.06).For thyroid TI-RADS 3,4 nodules,compared with conventional ultrasound TI-RADS classifications,the diagnosis accuracy of CEUS score and revised CEUS TI-RADS classifications showed significant differeces respectively (P=0.03,＜0.01) for thyroid papillary carcinoma greater than 1 cm.But no statistical difference were found respectively (P=0.25,1.00) for thyroid papillary carcinoma smaller than 1 cm.According to the ROC curve analysis,the area under the curve of traditional ultrasound TI-RADS classifications,CEUS score and revised CEUS TI-RADS classifications were 0.64,0.75,0.81 respectively,cut-off value was TI-RADS 4a,1 score,TI-RADS 4a respectively,the sensitivity and specificity of evaluating benign and malignant nodules was 45.3％ and 80.0％,69.3％ and 65.0％,82.7％ and 60.0％,respectively.The area under the ROC curve were statistical difference between CEUS score,revised CEUS TI-RADS classifications and conventional ultrasound TI-RADS classifications (both P＜0.05),while CEUS score and revised CEUS TI-RADS classifications without statistical difference.Conclusion CEUS had the revised and improved identification value for thyroid TI-RADS 3,4 nodules.
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Objective@#To understand the clinical manifestation, imaging characteristics and outcomes of pulmonary malignant tumors in children.@*Method@#We retrospectively collected information about seven cases of pulmonary malignant tumors in children in our hospital from Jan 2010 to Dec 2016. The information included clinical manifestation, imaging characteristics, pathologic results, and treatment.@*Result@#(1) All the seven patients firstly visited pediatric internal medicine departments. Symptoms included cough (n=6), dyspnea (n=4), fever (n=2), anorexia (n=2), chest tightness (n=1), chest pain (n=1), lameness (n=1), abdominal distension and constipation (n=1). We did not find hemoptysis, wheezing or weight loss in those patients. Physical examinations revealed unilateral reduced breath sounds (n=5), moist rales and wheezes (n=1), and normal (n=1). Extrapulmonary signs included abdominal distension (n=2), left hip tenderness (n=1), and mass in left scrotum. We did not identify clubbing finger, anemic appearance, lymph node enlargement, or hepatosplenomegaly etc. (2) Laboratory examination results: complete blood count showed white blood cells in normal range except one case (17.44×109/L). Neutrophil percentage ranged from 0.348 to 0.767. C reactive protein ranged between<1 and 162 mg/L. Hemoglobin was normal. Three out of four cases had abnormal blood tumor markers.(3) Imaging results showed multiple nodes (n=3), multiple cystic lesions in lungs (n=2) (both with pleuropulmonary blastoma), endobronchial soft tissue mass (n=1), pulmonary round-shaped mass (n=1), and mediastinal mass (n=1). Imaging results also found atelectasis (n=3), pneumonia (n=2), pneumothorax (n=2), longitudinal diaphragmatic hernia (n=2), pleural effusion (n=1), subcutaneous emphysema (n=1). (4) All the patients underwent tumor puncture biopsy or tumor resection. Pathology revealed the final diagnosis of pleuropulmonary blastoma (n=3), endodermal sinus tumors (n=2), squamous cell carcinoma of lung (n=1), and thyroid papillary carcinoma (n=1). All of them were malignant tumors. We followed up them. Two patients died (both with pleuropulmonary blastoma) after their parents refused any medical help. Two cases were lost to follow-up. Three patients survived (followed up for 19 months, 11 months and tow months, respectively). One case with thyroid papillary carcinoma pulmonary metastasis underwent right thyroid cancer radical plus left thyroid lobe resection plus modified selective central lymph node dissection, then iodine 131 treatment. One case with endodermal sinus tumor pulmonary metastasis underwent three times of chemotherapies, resection of left retroperitoneal tumor and left testicular tumor, and six additional chemotherapies. Another one case of endodermal sinus tumor pulmonary metastasis underwent three times of chemotherapies and was discharged.@*Conclusion@#Pulmonary malignant tumors are rare diseases in children. Clinical signs are often non-specific. For those with chest CT showing multiple cystic lesions, endobronchial soft tissue mass or multiple nodes, but no significant infection manifestation or no response to anti-infection therapy, pulmonary malignant tumors should be considered. Biopsy may be needed to confirm the final diagnosis.