RESUMEN
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.
RESUMEN
Aiming at the problem of timeliness of CBCT reconstruction, a CBCT fast short scan reconstruction method is proposed. At the same time, the image reconstruction process in which a new attenuation compensation algorithm is applied to improve image quality. When performing FDK three-dimensional reconstruction of a single-frame acquisition image, the Parker-weighted image is calculated in real time, and a new attenuation compensation algorithm is applied in the back projection process to complete the short scan Parker-weighted reconstruction. This method simulates the CBCT synchronous acquisition and reconstruction process by establishing collection and reconstruction threads. Under the premise of satisfying the reconstruction quality, the reconstruction can be completed within 1 to 2 seconds after the patient collection is completed, which achieves the purpose of real-time.
Asunto(s)
Humanos , Algoritmos , Tomografía Computarizada de Haz Cónico , Procesamiento de Imagen Asistido por Computador , Tomografía Computarizada de Haz Cónico EspiralRESUMEN
Objective:To investigate the patterns of lateral and central neck lymph node metastasis in N1b papillary thyroid carcinoma (PTC) patients.Methods:From Jun 2018 to Sep 2020, 96 consecutive treatment-naive unilateral N1b PTC patients were included. After total thyroidectomy, bilateral central neck and unilateral lateral neck dissection (including the level Ⅱa, Ⅱb, Ⅲ, Ⅳ and Ⅴb) metastasis in different levels and pathological status of lymph nodes were analyzed.Results:The lymph node metastasis rates were 85% in ipsilateral paratracheal region, 82% in level Ⅲ, 77% in level Ⅳ, 55% in pre-tracheal region, 47% in contralateral paratracheal region, 40% in level Ⅱa, 34% in pre-laryngeal region, 6% in level Ⅱb, 6% in intermuscular region, 4% in level Ⅴb. Tumor size >1cm and pre-tracheal lymph nodes netastasis were associated with contralateral paratracheal metastasis ( OR=3.282 and 3.064, P<0.05); Metastasis to Ⅵa was associated with metastasis to Ⅵb ( OR=3.364, P<0.05). Conclusion:Level Ⅱa-Ⅳ of lateral neck and all subgroups of central neck lymph nodes tend to be involved in PTC with lateral neck metastasis. Lateral neck including level Ⅱa-Ⅳ and the whole central neck including right Ⅵb lymph nodes dissection is recommended for N1b PTC patients.
RESUMEN
Objective@#To observe the expression and clinical significance of galectin-1 in Chinese laryngeal squamous cell carcinoma patients.@*Methods@#Immunohistochemical technique was used to test the galecin-1 protein expression in the 50 laryngeal squamous cell carcinoma patients and Western blot method was used to test the galecin-1 protein expression in the 3 of the patients. SAS 9.4 software was used to analyze the relationship between the galectin-1 protein and the clinical degrees, pathological grades and lymph node metastasis in all the cases.@*Results@#In the 50 laryngeal squamous cell carcinoma patients, the positive rate of galectin-1 protein was 74% (37/50). The expression of galectin-1 protein was correlated with the severity of clinical staging, pathological differentiation and lymph node metastasis.@*Conclusions@#High expression of galectin protein related with the occurrence and development of head and neck squamous cell carcinomas.
RESUMEN
This article focuses on the controversial issues in the diagnosis and treatment of thyroid cancer. Several commonly used molecular tests, especially gene mutation and fusion detection, in the preoperative diagnosis of thyroid nodules and the prognosis evaluation of thyroid cancer are introduced. For the thyroid nodules with uncertain indeterminate cytology, different molecular screening methods have their own advantages and disadvantages. Among them, DNA detection, especially multi-gene molecular testing based on next-generation sequencing has better sensitivity and specificity. Besides being used in diagnosis, it can also detect gene mutations related to tumor prognosis, such as BRAFV600E mutation and TERT promoter mutation, which is increasingly widespread and accepted.
RESUMEN
Objective@#To investigate the diagnostic performance of fine-needle aspiration (FNA) cytology for the detection of lateral lymph node metastases in patients with papillary thyroid carcinoma (PTC).@*Methods@#A total of 109 lateral lymph nodes with suspicious metastases from 85 patients were retrospectively subjected to FNAC, fine-needle aspiration thyroglobulin measurement (FNATg), and FNATg/SerumTg measurement. Lymph node pathological results after surgery were taken as the gold standard. Using Mann-Whitney U test, Pearson linear model and ROC curve were used for data analysis.@*Results@#The sensitivity, specificity and accuracy of FNATg for the diagnosis of lateral neck lymph node metastasis were respectively 93.7%, 90.0% and 93.3% and those of FNATg/SerumTg were respectively 89.9%, 90.0% and 93.2% respectively, the threshold values for FNATg and FNATg/SerumTg were 0.925 ng/ml and 1.007, respectively. The sensitivity, specificity and accuracy of FNATg combined with FNAC were respectively 91.0%,93.5% and 94.4%. The existence of thyroid tissue and the expression of serum Tg did not affect the expression of lymph node FNATg. The FNATg cutoff value of 0.925 ng/ml showed the best diagnostic performance in patients with a thyroid gland, while the FNATg/SerumTg cutoff ratio of 14.95 showed the best diagnostic performance in patients without a thyroid gland. The serum TgAb significantly interfered with the expression of FNATg in the lateral neck metastatic lymph nodes (P=0.049).@*Conclusions@#FNATg alone or the combination of FNATg with FNAC are highly reliable in the diagnosis of lateral neck lymph node metastases in patients with PTC. The expression of TgAb may interfere with the accuracy of the diagnostic performance of FNATg.
RESUMEN
Objective@#To study the diagnostic value of a multi-gene molecular testing in cytologically indeterminate thyroid nodules.@*Methods@#From February 2018 to September 2018, patients with thyroid nodules who underwent fine needle aspiration(FNA) at Peking University Cancer Hospital were enrolled. Three hundred and sixty patients were included, consisting of 86 men and 274 women, with a mean age of 45.8 years (between 13 and 89 years old). Among 391 nodules, 141 were cytologically inderminate and 75 were resected. FNA samples underwent prospective testing using a next-generation sequencing (NGS) assay, which included 16 genes for point mutations and 26 types of gene fusions. The testing results of indeterminate nodules were compared with surgical outcomes, to determine the diagnostic performance. The results were compared with the BRAF V600E single gene mutation analysis by χ2 test.@*Results@#The multi-gene testing showed a sensitivity of 73.2%, specificity of 96.8%, positive predictive value of 96.8%, and negative predictive value of 73.2%. The diagnostic accuracy of multi-gene testing was significantly higher than the BRAF V600E mutation test (83.3% vs 73.6%, χ2=31.588, P<0.01).@*Conclusion@#Multi-gene testing in FNA samples is an effective method to diagnose cytologically indeterminate thyroid nodules, which has a higher accuracy than BRAF V600E mutation detection.
RESUMEN
Objective@#To analyze the infection of human papillomavirus and expression of p53 in patients with hypopharynx squamous cell carcinoma.@*Methods@#The pathological samples of 15 clinically diagnosed hypopharynx cancer patients were collected. Lunimex and PCR techniques were used to detect the human papillomavirus (HPV) gene and immunohistochemical method was used to analyze the HPV protein expression in the samples. PCR and direct sequencing were used to screen the mutations in p53 gene and immunohistochemistry was used to evaluate the expressing profiles of p53 proteins.@*Results@#In the 15 cases, 6 were positive for HPV16/18 gene and 2 cases were positive for HPV16/18 E6 protein expression. The total positive rate was about 46.7% (7/15). In addition, 9 of 15 (60.0%) cases had sequencing-confirmed p53 mutations and p53 immunohistochemistry (IHC) confirmed 9 (60.0%) cases had positive staining.@*Conclusions@#The high HPV infection rate and p53 expression in hypopharynx squamous cell carcinoma patients in the study lays a foundation for further elucidating the pathogenesis of this kind of cancer.
RESUMEN
Objective To explore the feasibility for the tissue dispersion quantitative analysis software of ultrasonic strain elastography in diagnosing benign or malignant of thyroid lesions.Methods Eighty-two patients with 98 lesions were examined by ultrasonic strain elastography.There were 11 parameters of elastography imaging obtained by the tissue dispersion quantitative analysis software,including average relative strain value(MEAN),standard deviation of relative strain value(SD),area ratio of low-strain region (AREA％),complexity(COMP),kurtosis(KURT),skewness (SKEW),contrast (CONT),entropy(ENT),inverse different moment (IDM),angular second moment (ASM),correlation (CORR).The receiver operating characteristic (ROC) curve was constructed if there were statistically significant differences between benign and malignant lesions,and the areas under the ROC curve were got.Results All parameters except CORR had statistically significant between the groups of benign and malignant thyroid lesions (P ＜0.05).The AREA％ and IDM were the best valuable parameters,the areas under the curve(AUC) of which were 0.965 and 0.908,respectively.Their cut-off point were 81.96％ and 0.42,the sensitivity and specificitywere 98.4％ and 89.2％,91.8％ and 86.5％,respectively.Conclusions The tissue dispersion quantitative analysis software is helpful in the evaluation of benign ormalignant of thyroid lesions,parameters of AREA％ and IDM has the highest relationship with pathology and good diagnostic value.
RESUMEN
Objective To evaluate the salvage surgery for papillary thyroid cancer patients with residual neck metastatic lymph nodes after thyroidectomy.Methods Clinical data of 97 patients undergoing salvage neck dissection between September 2007 to June 2010 were analyzed retrospectively.Results Among 97 patients,residual metastatic lymph nodes were found in 80 patients in lateroposterial neck,overall residual rate was 82.47％.Residual rate was 85.71％ in 56 patients who underwent initial lateroposterial neck dissection in other hospitals:100％ in 8 patients who underwent berry-picking; 93.33％ in 30 patients who underwent partial dissection; 66.67％ in 18 patients who underwent whole neck dissection.Residual rate was 78.05％ in 41 patients who did not undergo initial lateroposterial neck dissection.The number of dissected lymph nodes was 15-45,with an average of 23 nodes removed and 8.21 metastatic lymph nodes per case.Residual metastatic lymph nodes were found in 67 patients in central neck,overall residual rate was 82.47％,residual rate was 53.85％ in 13 patients who underwent initial central neck dissection,and 71.42％ in 84 patients who did not undergo initial central neck dissection.Conclusions Correct imaging diagnosis decreases cervical residual metastatic lymph nodes in patients with papillary thyroid cancer.Successful salvage operation lies in choosing correct mode of neck dissection and carrying out sufficient dissection.