Ultrasonic classification and evolution of thyroid shrinking nodules / 中华超声影像学杂志

Objective:To investigate the ultrasonographic features and evolution of thyroid shrinking nodules in order to improve the differential diagnosis and management strategy and avoid unnecessary biopsy.Methods:A total of 245 patients with old bleeding of benign thyroid nodules diagnosed via fine needle aspiration cytology (FNAC) from May 2015 to July 2020 in the southern part of the Shanghai General Hospital Affiliated to the Medical College of Shanghai Jiaotong University, including 263 nodules. The sonographic parameters such as size, shape, aspect ratio, echo, edge, boundary, periphery, halo, calcification, posterior echo enhancement and posterior acoustic attenuation of nodules were analyzed retrospectively, and the ultrasonic appearances of nodules were classified; 41 nodules from 40 patients, who did ultrasound examinations more than twice and had both complete ultrasonographic data, were compared and then classified in order to explore the evolution rules of the nodules.Results:Two hundred and sixty-three thyroid shrinking nodules in 245 cases were classified into 4 types: "cystic wall shrinkage sign" type(71.48%, 188/263), "carcinoma-like" type (22.05%, 58/263), "inflammation-like" type(3.04%, 8/263) and "undefined atypical solid nodules" type(3.42%, 9/263). Of the 41 consecutive follow-up nodules, 37 cases showed obvious cystic wall shrinkage sign, and 7 of them developed into "carcinoma-like" type and 6 cases into "inflammation-like" type.Conclusions:The ultrasonographic appearance of thyroid shrinking nodules is a dynamic process, which can be divided into 4 types: "cystic wall shrinkage sign" , "carcinoma-like" , "inflammation-like" and "undefined atypical solid nodules" types. The "cystic wall shrinkage sign" type is typical and common. The "cystic wall shrinkage sign" type can develope into the "carcinoma-like" type or the "inflammation-like" type.

The clinical study of character types of sentinel lymph nodes in patients with breast cancer in lymphatic contrast enhanced ultrasound / 中华超声影像学杂志

Objective To evaluate the diagnostic efficiency in differential diagnosis for breast sentinel lymph nodes,and to analyze the imaging characteristics of involved breast sentinel lymph node in lymphatic contrast enhanced ultrasound.Methods Sixty-one patients suspected with breast cancer from May 2017 to March 2019 in Shanghai General Hospital,Shanghai Jiao Tong University were included in the study.Ultrasound contrast agent was injected subcutaneously,and axillary lymph nodes were displayed under contrast enhanced ultrasound mode.The longitudinal diameter (anteroposterior diameter),transverse diameter,longitudinal/transverse ratio and the distance from skin surface were measured.Five types were concluded according to the imaging characteristics in lymphatic contrast enhanced ultrasound:type Ⅰ,uniform enhancement;type Ⅱ,ring-shape enhancement;type Ⅲ,ununiform enhancement;type Ⅳ,regional filling defect;type Ⅴ,total filling defect.Sentinel lymph nodes were guided by wire guides and verified in pathology after excision in the operation.Results The detection rate of sentinel lymph nodes was 95.08％ (58/61).Seventy-seven lymph nodes,including 21 involved nodes and 56 uninvolved nodes were detected by lymphatic contrast enhanced ultrasound in 58 patients.The longitudinal diameters and transverse diameters of involved lymph nodes were larger than those of uninvolved ones (P =0.001,0.003).When type Ⅳ(regional filling defect) and type Ⅴ (total filling defect) were classified as involved,the sensitivity,specificity,positive-predictive value,negative-predictive value,accuracy and the area under ROC curve of predicting sentinel lymph node metastases were 85.71 ％,96.43 ％,90.00 ％,94.70 ％,93.51 ％ and 0.911,respectively.Conclusions Lymphatic contrast enhanced ultrasound reaches a high diagnostic efficiency in qualitative analysis of breast sentinel lymph nodes.Regional filling defect and total filling defect are the imaging characteristics of involved sentinel lymph nodes in lymphatic contrast enhanced ultrasound.

The clinical study of character types of sentinel lymph nodes in patients with breast cancer in lymphatic contrast enhanced ultrasound / 中华超声影像学杂志

Objective@#To evaluate the diagnostic efficiency in differential diagnosis for breast sentinel lymph nodes, and to analyze the imaging characteristics of involved breast sentinel lymph node in lymphatic contrast enhanced ultrasound.@*Methods@#Sixty-one patients suspected with breast cancer from May 2017 to March 2019 in Shanghai General Hospital, Shanghai Jiao Tong University were included in the study. Ultrasound contrast agent was injected subcutaneously, and axillary lymph nodes were displayed under contrast enhanced ultrasound mode. The longitudinal diameter (anteroposterior diameter), transverse diameter, longitudinal/transverse ratio and the distance from skin surface were measured. Five types were concluded according to the imaging characteristics in lymphatic contrast enhanced ultrasound: typeⅠ, uniform enhancement; type Ⅱ, ring-shape enhancement; type Ⅲ, ununiform enhancement; type Ⅳ, regional filling defect; type Ⅴ, total filling defect. Sentinel lymph nodes were guided by wire guides and verified in pathology after excision in the operation.@*Results@#The detection rate of sentinel lymph nodes was 95.08% (58/61). Seventy-seven lymph nodes, including 21 involved nodes and 56 uninvolved nodes were detected by lymphatic contrast enhanced ultrasound in 58 patients. The longitudinal diameters and transverse diameters of involved lymph nodes were larger than those of uninvolved ones (P=0.001, 0.003). When type Ⅳ(regional filling defect) and type Ⅴ(total filling defect) were classified as involved, the sensitivity, specificity, positive-predictive value, negative-predictive value, accuracy and the area under ROC curve of predicting sentinel lymph node metastases were 85.71%, 96.43%, 90.00%, 94.70%, 93.51% and 0.911, respectively.@*Conclusions@#Lymphatic contrast enhanced ultrasound reaches a high diagnostic efficiency in qualitative analysis of breast sentinel lymph nodes. Regional filling defect and total filling defect are the imaging characteristics of involved sentinel lymph nodes in lymphatic contrast enhanced ultrasound.

Investigation on peripheral blood TSHR mRNA for differentiation of benign and malignant thyroid nodules / 中华内分泌代谢杂志

Objective To assess the value of peripheral blood thyroid stimulating hormone receptor(TSHR) mRNA determination in differential diagnosis of benign and malignant thyroid nodules.Methods Fine needle aspiration cytology (FNAC) and (or) postoperative histopathology as the gold standard were carried out,the expression of circulating TSHR mRNA was determined by RT-PCR in 33 patients with benign thyroid nodules,39 patients with thyroid cancer,and 20 normal controls.Results TSHR mRNA signals were not detected in normal controls,the positive rate of TSHR mRNA was higher in the group with malignant nodules than the group of benign nodules (91.2％ vs 48.5％,P＜0.01).TSHR mRNA level in the preoperative malignant group was significantly higher than that in the normal,benign,and postoperative cancer groups (all P ＜ 0.01).Using peripheral blood TSHR mRNA for differentiating benign or malignant of thyroid nodule had a sensitivity,specificity,and accuracy of 91.2％,51.5％ and 71.6％,respectively.The sensitivities of TSHR mRNA,FNAC,and these two methods combined in detecting malignant nodules were 91.3％,86.9％,and 100.0％ respectively,while diagnostic accuracies were respectively 84.0％,80.0％,and 92.0％.TSHR mRNA expression showed no significant relationship with sex,age,size,and number of nodule in these patients (all P ＞ 0.05),but it did exhibit significant difference between benign and malignant nodules(P＜0.01).Conclusion The peripheral blood TSHR mRNA could be used as a molecular marker for thyroid cancer,and it would help enhance the preoperative differentiation of benign and malignant thyroid nodules.

Clinicopathological significance of expression of HIF-1α and P-gp in pancreatic carcinoma / 中华肝胆外科杂志

Objective To investigate the expression of HIF-1α and P-gp protein in pancreatic carcinoma and determine their clinicopathological significance and the correlation between the expression of HIF-1α, P-gp and the clinical prognosis. Method In samples from 74 cases of pancreatic carcinoma and 10 healthy individuals, the expression of HIF-1α and P-gp were detected by immunohistochemical method. Results The positive expression rate of HIF-1α and P-gp was 75.7% and 86.5%,respectively, which were remarkably higher than that in normal pancreatic tissue (P＜0.05). There was a positive correlation between the expression of HIF-1α and that of P-gp. The aberrant expression of HIF-1α and P-gp was associated with lymph node metastasis but not the location, size, clinical stages and nerve invasion of the tumor. Patients with high intensity of HIF-1α and P-gp expression showed a significantly lower median survival time than those with low intensity expression.Conclusions The expression of HIF-1α and P-gp is up-regulated in pancreatic carcinoma and there is a positive correlation between them. The expression of HIF-1α and P-gp might be related to the lymph node metastasis and poor prognosis.

Expression and clinical significance of Akt and phosphoryled Akt1 in pancreatic carcinoma / 中华胰腺病杂志

Objective To investigate the expression of Akt and phosphoryled Akt (p-Akt1) protein in pancreatic carcinoma and to determine the clinical significance. Methods In 74 cases of pancreatic carcinoma and 10 cases of normal pancreatic tissue samples, the expression of Akt and p-Akt1 were detected by immunohistochemical method, and the its relationship with clinicopathologic characteristics and prognosis were analyzed. Results The positive expression rate of Akt and p-Akt1 in pancreatic carcinoma were 87.8% and 83.8% respectively, while there was no expression of Akt and p-Akt1 in normal pancreatic tissue, and the difference was statistically significant (p < 0.05). There was a positive correlation between the expression of Akt and p-Akt1 in pancreatic carcinoma (r =0.274, P =0. 018). The expression of Akt and p-Akt1 was not significantly associated with the age, sex, location, size, pathology stages, lymph nodes metastasis, clinical stages and nerve invasion of the tumor (P >0.05). But the higher expression of p-Akt1 was associated with T stages and TNM staging (p =0. 002). Patients with high intensity of Akt and p-Akt1 expression showed a significantly longer median survival time [(16.0 ± 5.7) month and (23.0 ± 5.5) month, respectively]than those with low intensity expression [(9.3 ± 0.2) month and (11.1 ± 1.8) month (P = 0. 007 and P = 0.004) respectively]. Conclusions p-Akt1 expression is a significant positive prognostic factor for pancreaticcarcinoma and detection of p-Akt1 expression may be of clinical value.