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Introducción. La incidencia del carcinoma de tiroides ha aumentado a nivel mundial, probablemente relacionado con el sobre diagnóstico de nódulos tiroideos asintomáticos. La alta sobrevida del carcinoma diferenciado de tiroides ha permitido posibilidades de manejo quirúrgico menos radicales, o inclusive, la vigilancia activa de tumores seleccionados. Existen reportes de características clínico-patológicas del carcinoma de tiroides de nuestro país distintas a las reportadas en la literatura internacional. Métodos. Estudio observacional descriptivo de una cohorte retrospectiva de pacientes con carcinoma de tiroides atendidos en un hospital universitario entre 2015 y 2020. Resultados. Se identificaron 634 pacientes, el 83,4 % de sexo femenino. La tiroidectomía total con vaciamiento central fue el procedimiento más realizado (86,7 %). De 613 carcinomas diferenciados de tiroides, el 94,2 % corresponden al tipo papilar, seguido por el carcinoma de células de Hürtle (1,6 %); el 26,2 % presentaron subtipos histológicos agresivos y el 28,4 % compromiso tumoral bilateral. En los vaciamientos centrales se encontró 58,7 % de enfermedad metastásica; que fue de 49 % en los pacientes con microcarcinomas papilares (19 %). De las 68 lesiones del nervio laríngeo recurrente, 47 % fueron por secciones oncológicas. Discusión. En nuestra serie, la proporción de pacientes con carcinoma papilar de tiroides y de sus variantes histológicas agresivas, así como el compromiso tumoral bilateral es mayor a lo reportado en la literatura científica. Conclusión. El comportamiento biológico del carcinoma de tiroides es variable y puede tener características diferentes entre regiones; el manejo en nuestro medio debería considerar las características propias de nuestra población.
Introduction. The incidence of thyroid carcinoma has increased worldwide, probably related to the overdiagnosis of asymptomatic thyroid nodules. The high survival of differentiated thyroid carcinoma has allowed less radical surgical resection or even active surveillance for selected tumors. There are reports of clinicopathological features of thyroid carcinoma in our country that are different from those reported in the international literature. Methods. Retrospective observational study of a cohort of patients with thyroid carcinoma treated at a university hospital between 2015 and 2020. Results. 634 patients were identified; 83.4% were female. Total thyroidectomy with central dissection was the most performed procedure (86.7%). Of the 613 differentiated thyroid carcinomas, 94.2% were papillary type, followed by Hürtle cell carcinoma with 1.6%; 26.2% presented aggressive histological subtypes and 28.4% had bilateral tumor involvement. Metastatic disease was found in 58.7% of the central dissections performed, which was 49% in patients with papillary microcarcinomas (19%). Of the 68 recurrent laryngeal nerve injuries, 47% were due to oncological involvement. Discussion. In our series, the rate of patients with papillary thyroid carcinoma and its aggressive histological subtypes as well as bilateral tumor involvement is higher than that reported in the scientific literature. Conclusion: The biological behavior of thyroid carcinoma is variable and may have different characteristics between regions; the management in our country should consider our population's characteristics.
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Humans , Thyroid Neoplasms , Thyroid Cancer, Papillary , Postoperative Complications , Prognosis , Thyroid Gland , ThyroidectomyABSTRACT
Background: The measurement of plasma thyroglobulin (Tg) is widely used in the monitoring of differentiated thyroid cancer (CDT). In recent years, its value as a prognostic marker prior to ablation with radioiodine has increased, demonstrating its high negative predictive value. Recent studies indicate that a wide variety of factors could potentially influence pre-ablative Tg values, including residual tumor burden and stimulation modality. Aim: To relate the value of pre-ablative Tg with the amount of preoperative disease burden, lymph node metastases, treatment, and presence of residual disease. Material and Methods: Retrospective observational study of 70 patients with CDT treated between 2012 and 2018. The amount of disease burden was defined as the sum of largest diameter of individual tumors in each patient, and as the individually largest tumor per patient and number of metastatic lymph nodes. Results: A smaller tumor size and absence of remnant tissue was associated with lower Tg values, although the association was not always significant. Furthermore, no significant difference was found between Tg levels measured within or more than 14 days after the surgical procedure. Thus, an early measurement of pTg after surgery would allow an initial therapeutic decision making. Conclusions: A statistical association between pre-ablative Tg levels and the amount of preoperative tumor tissue burden was found in some subgroups of patients.
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ABSTRACT Objective: Cytological analysis and Bethesda classification of thyroid nodules is the standard method of diagnosing differentiated thyroid carcinoma (DTC). However, even for nodules with a non-malignant cytological diagnosis, there is a not insignificant risk of cancer. There are doubts whether this lack of certainty would influence patient prognosis. Our aim was to compare patients with DTC, classified according to the preoperative cytological diagnosis, regarding their evolution. Subjects and methods: A retrospective study was carried out with 108 DTC patients submitted to total thyroidectomy (TT) between 2009 and 2015, divided into three groups according to preoperative cytological diagnosis (Bethesda classification): classes I/II, III/IV, and V/VI. Groups were compared for evolution considering response to treatment at last evaluation as well as time disease free. Statistical analysis used ANOVA, chi squared, and Kaplan-Meier curves with p<0.05 considered significant. Results: Groups differed for time between nodule puncture and TT [in months; V/VI (2.35 ± 2.48) < III/IV (7.32 ± 6.34) < I/II (13.36 ± 8.9); p < 0.0001]. There was no significant difference between groups for evolution at final evaluation (disease free status; classes I/II: 71.4%; classes III/IV: 60%; classes V/VI: 66.6%; p = 0.7433), as well as time disease free (in months; classes I/II: 34.57 ± 25.82; classes III/IV: 38.04 ± 26.66; classes V/VI: 30.84 ± 26.34; p = 0.3841). Conclusions: DTC patients classified according to preoperative cytological diagnosis did not differ for evolution. Although patients with non-malignant cytological diagnoses were submitted to TT later, this did not affect the evolution of the cases.
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Abstract Objective To investigate Incidental Thyroid Carcinoma (ITC) by comparing the results of Fine Needle Aspiration Biopsy (FNAB) cytology and the postoperative pathological findings. Methods Data of 1479 patients who underwent total thyroidectomy were retrieved. Three hundred eighty-six patients were excluded due to insufficient data. Each surgical specimen studied received two histopathological diagnoses: the local diagnosis ‒ for the same area in which the FNAB was performed; and the final diagnosis, which includes a study of the entire surgical specimen. Results A thousand and ninety-three patients were investigated. FNAB result was malignant in 187 patients, benign in 204, suspicious or indeterminate in 668 cases, and inconclusive in 34 cases. The prevalence of ITC was 15.1%. Most of the ITC in this series was less than 0.5 cm. The incidence of ITC was higher in Bethesda III (17.5% ITC) and IV (19% ITC) than in Bethesda II cases (1.5% false negatives and 9% ITC). Conclusion Although the incidence of false-negative results in Bethesda II nodules is only 1.5%, 9% of these patients had ITC in the thyroid parenchyma outside the nodule that underwent preoperative FNAB. The incidence of ITC in the same scenario was even higher in Bethesda III (17.5%) and Bethesda IV cases (19%). Ultrasonography-guided FNAB is an excellent method for the assessment of thyroid nodules. However, biopsy sites should be carefully selected. Despite the high incidence of incidentalomas, total thyroidectomy should not always be the treatment of choice due to its rare but potentially serious complications. The findings of the present study can assist future clinical decisions towards active surveillance strategies for the management of papillary thyroid carcinoma.
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Resumo O carcinoma anaplásico da tireoide corresponde ao câncer de menor incidência e de pior prognóstico. Neste relato, descrevemos o caso de uma paciente de 64 anos submetida a tireoidectomia total associada a esvaziamento cervical nível VI devido a carcinoma papilífero de tireoide. No seguimento, apresentou sinais de recidiva regional e foi submetida a esvaziamento cervical ampliado e esofagectomia cervical. No intraoperatório, observou-se ausência de plano de clivagem entre o tumor e a artéria carótida comum (ACC) e procedeu-se com implante de shunt carotídeo, resseção em bloco incluindo segmento da ACC e do esôfago acometidos e ponte vascular com interposição da veia safena magna. Foi evidenciado carcinoma anaplásico em revisão de lâmina do exame anatomopatológico. A paciente foi submetida ao tratamento adjuvante e não apresenta sinais de recidiva locorregional. Diante da possibilidade de proceder uma cirurgia curativa com ressecção em bloco, o cirurgião vascular deve estar apto para as opções cirúrgicas.
Abstract Of all thyroid cancers, anaplastic thyroid carcinoma (ATC) has the lowest incidence and worst prognosis. In this report, we describe a 64-year-old female patient who underwent total thyroidectomy and level VI neck dissection for papillary thyroid carcinoma. During follow-up, she showed signs of regional recurrence and underwent extended neck dissection and cervical esophagectomy. Intraoperatively, there was no cleavage plane between the tumor and the common carotid artery (CCA), so a carotid shunt was implanted and en bloc resection, including the affected CCA and esophagus segments was performed followed by vascular bypass with interposition of a great saphenous vein graft. A pathology review found evidence of anaplastic carcinoma. The patient underwent adjuvant treatment and has no signs of locoregional recurrence. Presented with the possibility of carrying out curative surgery with en bloc resection, the vascular surgeon must be prepared for the surgical options.
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Introducción: en el campo de la salud, cada decisión representa datos, y las técnicas de minería de datos han empezado a ser una metodología prometedora para el análisis de esta información, especialmente en el diseño de los modelos predictivos. Métodos: estudio observacional analítico de pacientes mayores de 15 años, con reporte de punción de aspiración con aguja fina con estudio Bethesda IV, sometidos a manejo quirúrgico en el Hospital de San José de Bogotá. Los datos recogidos de los pacientes se incluyeron en tres grupos: la información sociodemográfica y clínica, los hallazgos en la citología y los reportes de la ecografía. Se realizó el análisis mediante Naive-Bayes, árbol de decisión y redes neuronales. Se usó la herramienta Weka versión 3.8.2. Resultados: de los 427 pacientes, 195 tuvieron resultados de patología de carcinoma de tiroides (45,6 %). Se evidenciaron mejores resultados usando la validación cruzada (10 fold) comparado con partición (66 %), la técnica de Bayes tuvo mejores resultados de clasificación correcta (91,1 %), comparado con la técnica de árbol (87,8 %) y la red neuronal (88,2 %). Conclusiones: el uso de la técnica de Naive Bayes muestra una importante exactitud para determinar la predicción de riesgo de malignidad en los pacientes con estudio citológico Bethesda IV, lo cual permitiría orientar de forma adecuada el manejo quirúrgico de los pacientes
Introduction: In the health field, each decision represents data, and data mining techniques have begun to be a promising methodology for the analysis of this information, especially in the design of predictive models. Methods: Analytical observational study; patients older than 15 years with a report of Bethesda IV after a fine needle aspiration biopsy that undergoing surgical management at the Hospital de San José in Bogotá. The data collected from those patients were included in three groups: sociodemographic-clinical information, cytology findings, and ultrasound reports. Analysis was performed using three technics: Naive Bayes, decision trees, and neural networks. Weka tool version 3.8.2 was used. Results: 195 patients out of 427, had a thyroid carcinoma pathology (45.6%). Better results were evidenced using cross-validation (10 fold) compared with a partition (66%), the Bayes technique had better results of correct classification (91.1%), than the tree technique (87.8%) and neural network (88.2%). Conclusions: The use of the Naive Bayes technique shows an important accuracy to determine the prediction of risk of malignancy in patients with a Bethesda IV cytological study, which would allow an adequate guide to the surgical management of patients.
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Humans , Data MiningABSTRACT
Objective:To investigate endoscopic thyroidectomy in the treatment of thyroid cancer and its effects on patient's quality of life.Methods:A total of 98 patients with thyroid cancer who received treatment in Zhoushan Hospital from March 2019 to March 2021 were included in this study. They were randomly divided into observation and control groups, with 49 patients in each group. Patients in the observation group underwent endoscopic thyroidectomy, and those in the control group underwent traditional surgery. Perioperative indicators and postoperative complications were compared between the two groups. Stress response measured before and 2 months after surgery and quality of life before and 3 months after surgery were compared between the two groups.Results:Operative time in the observation group was significantly longer than that in the control group [(89.82 ± 18.49)] minutes vs. (63.24 ± 17.28) minutes, t = 7.35, P < 0.05]. Intraoperative blood loss and postoperative drainage in the observation group were (10.32 ± 2.28) mL and (29.25 ± 3.17) mL, which were significantly lower than (15.42 ± 3.56) mL and (40.52 ± 4.95) mL in the control group ( t = 8.44, 13.42, both P < 0.05). There was no significant difference in length of hospital stay between the two groups ( P > 0.05). The incidence of postoperative complications in the observation group was significantly lower than that in the control group [4.08% (2/49) vs. 18.37% (9/49), χ2 = 5.01, P < 0.05]. At 2 days after surgery, white blood cell count, fasting plasma glucose, C-reactive protein in the observation group were (5.62 ± 0.41) × 10 9/L, (4.77 ± 0.38) mmol/L, and (13.25 ± 2.79) mg/L, which were significantly lower than (8.71 ± 0.98) × 10 9/L, (5.75 ± 0.45) mmol/L, (20.84 ± 3.86) mg/L in the control group ( t = 20.36, 11.64, 11.26, all P < 0.05). At 3 months after surgery, Karnofsky performance scale score in the observation group was significantly higher than that in the control group [(87.64 ± 4.35) points vs. (81.29 ± 4.02) points, t = 7.58, P < 0.05). Conclusion:Endoscopic thyroidectomy is highly effective on thyroid cancer, has few postoperative complications, produces little effect on stress response, and can improve the quality of life of patients.
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Objective:To investigate the effects of transaxillary endoscopic and traditional open radical thyroidectomy on the levels of inflammatory factors in patients with thyroid cancer.Methods:The clinical data of 102 thyroid cancer patients underwent radical thyroidectomy from October 2019 to October 2021 in Xinjiang Medical University Hospital of Chinese Medicine were retrospectively analyzed. Among them, 50 cases underwent transaxillary approach endoscopic radical thyroidectomy (study group), and 52 cases underwent open radical thyroidectomy (control group). The operation related indexes were compared between two groups, including operation time, intraoperative blood loss, postoperative drainage, lymph node clearance and hospital stay; the pain scores 1, 3 and 7 d after operation were recorded; the levels of interleukin-6 (IL-6), interleukin-10 (IL-10), galectin-3 (Gal-3) and tumor necrosis factor-α (TNF-α) before operation and 1 d after operation were measured by enzyme-linked immunosorbent assay; the postoperative complications were recorded, including hoarseness, limb numbness, cough after drinking water and hypocalcemia; and the cosmetic satisfaction was followed up 3 months after discharge, and the recurrence was observed by CT 6 months after discharge.Results:The operation time in study group was significantly longer than that in control group: (88.69 ± 15.16) min vs. (61.47 ± 15.48) min, while the intraoperative blood loss, postoperative drainage and hospital stay were significantly lower in control group: (51.21 ± 10.06) ml vs. (85.46 ± 11.37) ml, (98.29 ± 30.61) ml vs. (117.47 ± 30.25) ml and (5.35 ± 0.54) d vs. (7.72 ± 0.61) d, and there were statistical differences ( P<0.01); there was no statistical difference in lymph node clearance between two groups ( P>0.05). The pain score 1 and 3 d after operation in study group was significantly lower than that in control group: (5.13 ± 1.07) scores vs. (7.87 ± 1.46) scores and (4.22 ± 1.35) scores vs. (6.42 ± 1.28) scores, and there were statistical differences ( P<0.05); there was no statistical difference in pain score 7 d after operation between two groups ( P>0.05). There were no statistical differences in IL-6, IL-10, TNF-α and Gal-3 between two groups ( P>0.05); the IL-6, IL-10, TNF-α and Gal-3 1 d after operation in study group were significantly lower than those in control group: (26.27 ± 3.14) ng/L vs. (29.22 ± 4.52) ng/L, (7.54 ± 2.31) ng/L vs. (10.92 ± 2.54) ng/L, (14.98 ± 3.76) μg/L vs. (23.65 ± 2.46) μg/L and (3.54 ± 0.48) μg/L vs. (4.48 ± 0.63) μg/L, and there were statistical differences ( P<0.01). There was no statistical difference in the incidence of total complications between two groups ( χ2 = 1.73, P>0.05). The total satisfaction rate in study group was significantly higher than that in control group: 94.0% (47/50) vs. 78.8% (41/52), and there was statistical difference ( χ2 = 4.94, P<0.05). The patients were followed up for 6 months after discharge, and there was no recurrence. Conclusions:The transaxillary approach endoscopic radical thyroidectomy can reduce intraoperative blood loss, length of stay, postoperative drainage, postoperative pain, and to some extent inhibit inflammatory response. It can improve the postoperative cosmetic satisfaction, reduce the incidence of postoperative complications, and does not increase the recurrence rate
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Objective:To investigate the clinical value of imaging features of primary lesions combined with venous phase CT value in predicting central group lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC) .Methods:Clinical data of 170 PTC patients who underwent central group LN dissection in the First People's Hospital of Handan City of Hebei Province from January 2017 to June 2020 were retrospectively analyzed. All patients were divided into different groups according to whether central group LN metastasis or not, and there were 89 patients with central group LN metastasis and 81 patients without central group LN metastasis. The CT value and imaging features of primary lesions in different periods were analyzed, and the imaging features of primary lesions combined with venous phase CT values to predict the central group LN metastasis were evaluated by the receiver operating characteristic (ROC) curve.Results:There were no statistically significant differences in CT value in plain scan phase and CT value, net increased CT value, standardized CT value in arterial phase between patients with and without central group LN metastasis (all P>0.05) . The CT value, net increased CT value and standardized CT value in venous phase of patients with central group LN metastasis were (113.84±22.95) HU, (59.05±12.10) HU and 0.72±0.14 respectively, which were significantly higher than those of patients without central group LN metastasis [ (103.99±17.67) HU, (51.29±14.45) HU and 0.59±0.10] ( t=3.26, P<0.001; t=3.81, P<0.001; t=3.67, P<0.001) . ROC curve analysis showed that the area under the curve for diagnosing central group LN metastasis of PTC patients was 0.75, 0.70 and 0.76 when the cut-off values of CT value, net increased CT value and standardized CT value in venous phase were 115.78 HU, 62.37 HU and 0.75 respectively. There were statistically significant differences in the diameter of primary focus and the contact area of thyroid capsule between patients with and without central group LN metastasis ( Z=-2.34, P=0.019; Z=-2.08, P=0.037) . There were no statistically significant differences between calcification and primary lesion location (both P>0.05) . Lesion diameter >2 cm (87.73%) and capsule contact range ≥1/2 (92.17%) had the highest specificity in predicting central group LN metastasis. The imaging features of primary lesion combined with standardized CT value in venous phase was in good agreement with histopathological diagnosis results in predicting central group LN metastasis (Kappa=0.475) , and the sensitivity and specificity were 73.12% and 82.75% respectively. Conclusion:The imaging features of the primary lesion combined with CT value in venous phase have a good clinical value in predicting central group LN metastasis in PTC patients. Patients with primary lesion diameter >2 cm, capsule contact range ≥1/2 and the standardized CT value in venous phase >0.75 are more likely to have central group LN metastasis.
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Objective:To investigate the correlation between preoperative thyroid function and central lymph node metastasis in cN0 unilateral papillary thyroid microcarcinoma (PTMC).Methods:The clinical data of 208 patients with cN0 unilateral PTMC admitted to the First Affiliated Hospital of Anhui University of Science and Technology from July 2020 to December 2021 were retrospectively analyzed. The patients were divided into a metastasis group( n=64) and a non-metastasis group( n=144) according to whether there was central lymph node metastasis in postoperative pathology. The preoperative serum free three iodine thyroid gland (FT3), free thyroid hormone (FT4), thyroid stimulating hormone (TSH), anti thyroid peroxidase antibody (TPOAb) , anti thyroid globulin antibody (TGAb), paraffin pathological results and general data were compared between the two groups of patients. Statistical analysis was performed using SPSS 19.0 software. The measurement data of normal distribution were expressed by Mean±SD , and comparison between groups was performed by t test. Non-normal distribution measurement data were expressed as [ M( Q1, Q3)], and comparison between groups was performed by Mann-Whitney U test. Enumeration data were represented by n(%), and comparison between groups was performed by chi-square. Multivariate analysis was conducted by binary logistic multivariate regression analysis. Results:In 208 PTMC patients with cN0, the rate of central lymph node metastasis was 30.77% (64/208). The misexcision rate of parathyroid gland was 28.13% (18/64) in the metastatic group, 25.69% (37/144) in the non-metastatic group, and the overall misexcision rate was 26.44%. There were no significant differences in age, tumor subtypes, combined hashimoto′s thyroiditis, multiple lesions, FT3, FT4, TGAb and TPOAb between the metastatic group and the non-metastatic group ( P>0.05). The proportion of male patients in the metastatic group was higher than that in the non-metastatic group (32.81% vs 19.44%, χ2=4.38, P=0.036), the tumor diameter in the metastatic group was larger than that in the non-metastatic group [(0.63±0.23)cm vs (0.49±0.22)cm, χ2=3.99, P<0.001], and the preoperative TSH in the metastatic group was higher than that in the non-metastatic group[2.87(1.92, 4.95) vs 2.04(1.56, 2.84), Z=2.48, P=0.024], and differences between the two groups was statistically significant ( P<0.05). Multivariate logistic regression analysis showed that male, tumor diameter and preoperative TSH were independent risk factors for lymph node metastasis in central region ( P<0.05). Conclusions:The central lymph node metastasis rate of cN0 unilateral PTMC is high. Male, patients with large tumor diameter and high preoperative TSH should be alert to occult lymph node metastasis, and the protection of parathyroid glands should be strengthened during central lymph node dissection.
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Objective:To analyze the characteristics and influencing factors of the patients with cervical lymph node skip metastasis of papillary thyroid carcinoma (PTC), as to guide the precise treatment of lateral area.Methods:The clinicopathological data of 237 patients with PTC initially diagnosed and treated in Xuanwu Hospital Capital Medical University from Feb 2014 to Mar 2022 were analyzed retrospectively. Among them, there were 217 positive in the central area, and 20 negative, with skip rate 8.4%. The age, sex, pathological type, glandular lobe involvement, tumor size, number of tumor lesions, primary lesion location, and capsule invasion were statistically compared. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was conducted using the t test. The measurement data of non normal distribution are expressed by M( Q1, Q3), and the Mann Whitney U test is used for comparison between groups. Comparison between groups of count data was conducted using the chi-square test, correction chi-square or Fisher exact probability. Results:Multivariate analysis showed that age ≥ 55 years old( OR: 6.032, 95% CI: 1.692-21.504, P=0.006), female( OR: 23.459, 95% CI: 2.181-252.341, P=0.009), tumor ≤5 mm( OR: 79.453, 95% CI: 7.570-833.891, P<0.001)and located in the upper lobe( OR: 3.446, 95% CI: 1.325-8.962, P=0.011) were independent risk factors for skip metastasis. The patients with skip metastasis had a smaller total number of cervical lymph node metastases( Z=-2.81, P=0.005), smaller total number of neck dissection lymph nodes( Z=-6.62, P<0.001) and less lymph nodes metastases in level Ⅳ( Z=-2.54, P=0.011) than patients with non-skip metastasis. Conclusions:Skip metastasis often occurred with age ≥55 years, female, tumor size less than 5mm and located in the upper lobe. For these patients, careful evaluation for the lateral area is required.
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The incidence of thyroid cancer continues to increase, among which differentiated thyroid cancer occupies the main position. Development of molecular biology has facilitated early diagnosis and precise treatment of thyroid carcinoma, and hopefully provided potential options for certain subtypes with poor prognosis, such as radioactive iodine-refractory differentiated thyroid carcinoma. This review summarizes the gene variants of high frequency and the mechanism of such gene variants, application of molecular biological detection in clinical diagnosis, as well as the correlation of specific gene variants with clinicopathological characteristics and prognosis for differentiated thyroid carcinoma.
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Thyroid cancer is the most common malignant tumor of the endocrine system, and the incidence is increasing year by year, which seriously threatens people's health. Autophagy is a programmed mode of death that can be used as a potential target for anti-tumor therapy and plays an important regulatory role. Leucine-rich repeat kinase 2 (LRRK2) is a protein kinase encoded by PARK8 gene. The recent studies have confirmed that autophagy is closely related to thyroid cancer. This paper analyzes the possible regulatory mechanism of LRRK2 affecting thyroid cancer through autophagy, providing new ideas for basic research and clinical diagnosis and treatment of thyroid cancer.
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Objective:To summarize the prognosis of medullary thyroid carcinoma (MTC) patients with biochemical recurrence (the increase of postoperative calcitonin and no abnormal imaging) and to investigate the optimal cut-off value of calcitonin for postoperative structural recurrence (with imaging abnormality).Methods:Literature retrieval was conducted for PubMed, CNKI, EMbase, Web of Science, Cochrane and other databases, and literatures related to the increase of calcitonin after MTC surgery were included. Review Manager 5.4 software was used for Meta-analysis of the recurrence and death. SPSS 23.0 software was used and receiving operating characteristic (ROC) curve was used to analyze the rising folds of postoperative calcitonin level in comparison with the maximum value of experiment detection, and to predict the outcome of biochemical recurrence transforming to structural recurrence, and then the optimal cut-off value could be worked out.Results:A total of 7 studies including 1 005 MTC patients (276 cases of biochemical recurrence and 542 cases of biochemical cure). Meta-analysis showed that structural recurrence rate in postoperative biochemical recurrence group [40.6% (112/276) vs. 2.2% (12/542); OR = 27.99, 95% CI 14.57-53.78, P < 0.001] and mortality [10.0% (19/190) vs. 0.96% (3/312); OR = 7.26, 95% CI 2.42-21.84, P < 0.001] were higher than those in the biochemical cure group (normal postoperative calcitonin level and no disease state). The data of 89 MTC patients with biochemical recurrence were collected in another 4 studies. ROC curve analysis showed that area under the curve of the rising folds of postoperative calcitonin level in predicting structural recurrence was 0.825; according to the cut-off value at all sections, the optimal cut-off value of the increased postoperative calcitonin was 50 times, the sensitivity was 66. 7%, the specificity was 88.6%. Conclusions:MTC patients with postoperative biochemical recurrence have higher structural recurrence rate and mortality compared with patients with normal postoperative calcitonin. The postoperative elevation of calcitonin more than 50 times the maximum value of the laboratory detection can be taken as the critical diagnostic value, when more than 50 times is prone to structural recurrence.
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Objective:To systematically evaluate the diagnostic value of fine-needle aspiration washout fluid for measuring thyroglobulin (FNA-Tg) and fine-needle aspiration cytology (FNAC) in cervical lymph node metastasis of papillary thyroid carcinoma.Methods:Chinese Journal Full-Text Database, Wanfang Database, VIP Chinese Science and Technology Journal Database and other databases from January 2016 to December 2020 were retrieved. And then diagnostic trials from the databases regarding the comparison of FNA-Tg and FNAC in the diagnosis of papillary thyroid carcinoma with neck lymph node metastasis based on the histopathological diagnosis as the gold standard were included. The literatures were screened out according to the diagnostic test inclusion criteria recommended by the Cochrane Collaboration Screening and Diagnostic Test Methods Group; and then the quality of the included literatures was evaluated and feature information was extracted. Review Manager 5.0 and MetaDiSc software were used to conduct Meta analysis, and a summary receiver operating characteristic (SROC) curve of FNAC and FNA-Tg in the diagnosis of lymph node metastasis was drawn to calculate the area under the curve and to judge the diagnostic efficacy.Results:A total of 19 articles and 2 792 cervical lymph nodes were finally included. The sensitivity of FNAC and FNA-Tg in the diagnosis of cervical lymph node metastasis in papillary thyroid carcinoma was 0.80 (95% CI 0.78-0.81) and 0.92 (95% CI 0.91-0.93), respectively; the specificity was 0.93 (95% CI 0.92-0.95) and 0.91(95% CI 0.89-0.93); the diagnostic odds ratio was 51.55 (95% CI 38.61-68.81) and 110.03 (95% CI 82.18-147.32), respectively; the areas under the SROC curve was 0.900 and 0.968, respectively. Conclusions:The accuracy of FNA-Tg in the diagnosis of cervical lymph node metastasis of papillary thyroid carcinoma is higher than that of FNAC. FNA-Tg can be used as an important diagnosis supplement to FNAC and it can be widely used in clinical practice.
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Objective:To investigate the predictive effect of intraoperative selective lymph node frozen pathological examination on central lymph node metastasis in thyroid papillary carcinoma (PTC).Methods:A total of 721 PTC patients who underwent primary radical thyroidectomy and central lymph node dissection in Xuanwu Hospital of Capital Medical University from January 2015 to June 2019 were selected. All patients underwent intraoperative selective lymph node frozen pathological examination. According to the paraffin section pathological diagnosis results, there were 449 cases of thyroid micropapillary carcinoma (PTMC) and 272 cases of non-PTMC. The association of the frozen pathological examination results of intraoperative prelaryngeal lymph nodes, anterior tracheal lymph nodes and paratracheal lymph nodes with the pathological results of postoperative central lymph nodes was analyzed in all patients and those with central lymph node positive confirmed by postoperative pathological examination in different groups stratified by tumor long diameter, including 192 cases in PTMC group, 142 cases in long diameter >1 cm and <2 cm group and 55 cases in long diameter ≥2 cm group; postoperative paraffin pathological results were treated as the gold standard. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis were calculated.Results:There were 42.8% (192/449) and 72.4% (197/272) of PTMC patients and non-PTMC patients with central lymph node metastasis, respectively. Among 192 PTMC patients with central lymph node metastasis, the sensitivity of prelaryngeal lymph nodes, paratracheal lymph nodes and anterior tracheal lymph nodes was 28.1% (47/167), 61.4% (70/114) and 53.8% (91/169), respectively based on the intraoperative frozen pathological diagnosis. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis was 72.4% (139/192) and 27.6% (53/192), respectively. Among 197 non-PTMC patients with central lymph node metastasis, the sensitivity of prelaryngeal lymph nodes, paratracheal lymph nodes and anterior tracheal lymph nodes was 49.7% (82/165), 51.6% (96/186) and 64.7% (112/173), respectively based on the intraoperative frozen pathological results. The sensitivity and false negative rate of intraoperative frozen pathological examination in the diagnosis of central lymph node metastasis was 84.8% (167/197) and 15.2% (30/197), respectively. The sensitivity of intraoperative lymph node frozen pathological results in the diagnosis of central lymph node metastasis for patients with thyroid capsule involvement in PTMC group, long diameter > 1 cm and < 2 cm group and long diameter ≥ 2 cm group was 81.7% (116/142), 81.7% (103/126) and 92.2% (47/51), respectively.Conclusions:Cervical central lymph node metastasis of PTC is common. Intraoperative frozen pathological examination of prelaryngeal lymph nodes, anterior tracheal lymph nodes and paratracheal lymph nodes can effectively predict whether the central lymph nodes are involved, and this hint is more obvious when the tumor long diameter is more than 2 cm and the thyroid capsule is involved.
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Objective:To investigate the clinical characteristics of primary thyroid lymphoma (PTL) and the differences in clinical manifestations and survival between the two main pathological subtypes of PTL.Methods:The clinical data of 52 patients with PTL diagnosed in Shanxi Province Cancer Hospital from January 2011 to January 2022 were retrospectively analyzed. The clinical characteristics and survival between the two main pathological subtypes [diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue lymphoma (MALT)] were compared.Results:Among 52 PTL patients, there were 12 males and 40 females, with a median age of 65 years old (34-83 years old). All patients presented with anterior cervical mass at the time of visit. MALT was diagnosed in 12 cases (23.1%). DLBCL was diagnosed in 37 cases (71.2%), of which 5 cases were double/triple expression lymphoma. B-cell lymphoma (unclassified) was diagnosed in 2 cases (3.8%). Follicular lymphoma (FL) was diagnosed in 1 case (1.9%). There was statistical difference in the proportion of patients with cervical lymph node enlargement between MALT and DLBCL patients [66.7% (8/12) vs. 94.6% (35/37), χ2 = 4.23, P < 0.05]. The 3-year OS rates of MALT and DLBCL patients were 90.9% and 73.9%, and the difference in OS between the two groups of patients was statistically significant ( χ2 = 5.11, P = 0.024). Conclusions:Pathological subtypes of PTL are related to the prognosis of patients.
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Objective:To analyze the alternative splicing (AS) events of patients with thyroid carcinoma (THYC) and explore the correlation between AS events and the prognosis of THYC.Methods:The clinical data and the Percent Splice In (PSI) value of AS events of THYC were downloaded from The Cancer Gene Atlas (TCGA) database and the TCGA SpliceSeq database respectively. The occurrence of seven kinds of AS events including AA, AD, AF, AP, ME, ES and RI in THYC was investigated and the matrix of AS events and survival data was constructed. Univariate Cox regression analysis was used to screen AS events related to prognosis of THYC. To avoid over-fitting, the least absolute shrinkage and selection operator (LASSO) regression analysis was performed. Then Multivariate Cox regression analysis was used to construct prognosis model. Kaplan-Meier curve and receiver operating characteristic (ROC) curve were performed to evaluate the prognosis ability of the risk model. We also used Pearson correlation analysis to select splicing factors (SF) which were correlated with survival associated AS events. Above SF genes were enrolled to gene ontology (GO) enrichment and KEGG pathway analysis.Results:A total of 10 447 genes and 45 150 AS events in 507 THYC patients were found in the present study. Among them, ES was the main type (38.84%) and ME was the type with the least frequency (0.51%). Totally 1 842 AS events associated with prognosis of THYC patients were identified. Three AS events including USHBP1-48249-AA、CACNB1-40626-AT and BEX5-89679-AP were selected to construct the prognosis model. The risk score of 0.807 was indicated as the best cut-off value of prognosis model. The patients were divided into high-risk group (240 cases) and low-risk group (241 cases) based on the risk score. The results demonstrated that the risk model could be used as a valuable prognostic factor for THYC ( P<0.001, AUC=0.929). The SF-AS network was constructed and several SF genes, including CDK12, RBM25, DDX39B, SRRM2 and DDX46 were identified as hub genes. Conclusions:The risk model based on 3-AS events was valuable prognosis predictor of THYC. The SF-AS network provided new insight for the exploration of tumorigenesis and development of THYC.
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Objective:To investigate the clinicopathological features and prognosis of medullary thyroid carcinoma (MTC) co-existent with Hashimoto's thyroiditis (HT).Methods:Seven cases of MTC co-existent with HT were collected from Fujian Cancer Hospital between Jan 2007 and May 2021. Its clinicopathological features were analyzed.Results:All patients were adult female with a median age of 49 years, and 6 of them were unilateral MTC. The tumor diameter ranged from 0.4 to 7.0 cm. The thyroid tissue surrounding the tumor showed HT. The follow-up time was 16 to 152 months, with a median time of 61 months, 5 patients (tumor diameter <1 cm) were biochemically cured, 1 patient (tumor diameter >1 cm) was anatomically cured. The another patient died due to tumor progression 30 months after surgery, the tumor cells in which were highly atypia and more mitoses (5~8/10HPF) necrosis and vascular invasion were also observed.Conclusion:MTC with HT are mostly sporadic cases, and most of them have a fair prognosis.
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Objective:To study the risk factors of postoperative permanent hypoparathyroidism after total thyroidectomy.Methods:In this retrospective study ,the receiver operating characteristic (ROC) curve of postoperative 24 h parathyroid hormone(PTH) values was used to predict the risk of permanent hypoparathyroidism.The clinical and pathological features that related to postoperative permanent hypoparathyroidism were studied by χ2 test and multivariate Logistic regression analysis. Results:Eight hundred and eighty-nine patients were enrolled, the incidence of postoperative transient and permanent hypoparathyroidism was 33.3% and 4.0%, respectively. When 24 h PTH levels less than or equal to 5.84 pg/ml were used as cut off value, the sensitivity of the prediction of permanent hypoparathyroidism was 100%, the specificity was 72%, and the positive predictive value was 22.5%. The presence of parathyroid gland in the pathologic specimen, parathyroid autotransplantation and PTH≤5.84 pg/ml at 24 h after operation were statistically significant risk factor for permanent hypoparathyroidism in multivariate analysis( χ2=10.900, P=0.001; χ2=4.415, P=0.044; χ2=13.576, P=0.000). Group analysis found that the lower 24 h PTH the higher incidence of permanent hypoparathyroidism. Conclusions:For patients undergoing total thyroidectomy, when parathyroid gland is involved and/or the PTH value is low at 24 h after surgery, the occurrence of permanent hypoparathyroidism is high.