Background: Thyroid cancer is a rare disease yet the most common endocrine malignancy in pediatrics. Unlike adult patients, children with thyroid nodules typically don’t complain of pain, soreness, or difficulty swal...Background: Thyroid cancer is a rare disease yet the most common endocrine malignancy in pediatrics. Unlike adult patients, children with thyroid nodules typically don’t complain of pain, soreness, or difficulty swallowing. Additionally, using the recommended therapy for adults to treat paediatrics is not appropriate. There is an unmet need for updated unique guidelines for the management of papillary thyroid carcinoma (PTC) in paediatrics and adolescents. Case Report: A 12-year-old girl had an atypical presentation of metastatic PTC in lymph nodes. She was treated initially with hemi-thyroidectomy, followed by total thyroidectomy. A multidisciplinary team followed her up till successful results were found. Conclusion: Due to the difference in pathophysiology between thyroid tumors in children and adults, a unique approach to PTC management is to be implemented. Further trials are required for a better understanding of risk factors, the likelihood of recurrence, and the long-term side effects of the chosen management plan.展开更多
BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants hav...BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants have been reported,but PTC with nodular fasciitis-like stroma(NFS)is a rare pathological variant and has been infrequently reported in the relevant literature.This condition involves abundant reactive stromal components rich in spindle cells,which may account for 60%-80%of the tumor along with a typical papillary carcinoma.CASE SUMMARY A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck,the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery.Thyroid function test results were normal.Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone.Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm×4.0 cm with a hypoechoic complex nodule,decreased vascularity and speckles of microcalcification.The patient underwent left thyroidectomy with central compartment lymph node dissection.Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC.The patient was asymptomatic at the 3-mo follow-up.CONCLUSION PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.展开更多
Introduction: The impact of pregnancy on the prognosis of papillary thyroid carcinoma (PTC) has been debated for several decades;however, no definitive conclusions have been reached. The main objective of this study i...Introduction: The impact of pregnancy on the prognosis of papillary thyroid carcinoma (PTC) has been debated for several decades;however, no definitive conclusions have been reached. The main objective of this study is to demonstrate the short-term influence of pregnancy on the evolution and prognosis of PTC. Materials and Methods: A prospective descriptive and analytical study was conducted in the Endocrinology and Diabetology Department at the Hassan II University Hospital in Fez, including patients followed for papillary thyroid carcinoma presenting with a pregnancy during the year 2019 and 2020. The follow-up of these patients was continued until 1 year postpartum. We studied the clinical, paraclinical and therapeutic factors that could influence the prognosis of the disease. Results: We included 26 patients. Our study showed a significant correlation between recurrence and the presence of unfavorable histological signs (p = 0.02) as well as the initial Tg level (0.01). However, pregnancy was not an influencing factor (p = 0.41). Conclusion: Pregnancy does not seem to be a factor aggravating the prognosis of differentiated thyroid cancers.展开更多
The purpose of this study was to assess the differences in clinical and sonographic features of papillary thyroid carcinoma(PTC) between cervical lymph node metastatic(CLNM) and nonmetastatic groups.Clinical data of P...The purpose of this study was to assess the differences in clinical and sonographic features of papillary thyroid carcinoma(PTC) between cervical lymph node metastatic(CLNM) and nonmetastatic groups.Clinical data of PTC patients(414 patients with 624 malignant nodules) who underwent a preoperative ultrasonography and surgery between June 2010 and March 2015 at Renmin Hospital of Wuhan University were retrospectively analyzed.Clinical factors,preoperative ultrasound features and the final pathological findings were obtained.The differences in the sonographic features of PTC between the CLNM group and the non-CLNM group were analyzed.There were 187 CLNM and 227 non-CLNM patients.The median age at the diagnosis of this cohort was 45.4 years old(ranging from 18 to 77 years).Ultrasonographic parameters that were significantly associated with CLNM [OR=2.569(1.502,4.393),P<0.001)] were as follows:the mulifocality of the nodules,size over 2 cm,the presence of microcalcifications,the distance ratio(DR) pattern showing the contact of the nodules with the thyroid capsule,and the extracapsular spread of the nodules.No significant differences in age,gender,thyroid stimulating hormone(TSH) levels and other ultrasonography parameters were found between the CLNM and the non-CLNM groups.Therefore,our results suggest that a larger size,microcalcifications,mulifocality,and the DR pattern showing the contact of the nodules with the thyroid capsule and extracapsular spread are significantly more indicative of CLNM in PTC.展开更多
In recent decades,while the incidence of thyroid cancer has increased exponentially around the world,mortality has remained stable.The vast majority of this increase is attributable to the identification of intrathyro...In recent decades,while the incidence of thyroid cancer has increased exponentially around the world,mortality has remained stable.The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas,which exhibit slow growth rates with indolent courses.A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis,as the majority of these tumors would not likely result in death if left untreated.Although surgical resection was the classical standard therapy for papillary microcarcinomas,active surveillance(AS)has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery.Despite the encouraging results of AS,its implementation in clinical practice is strongly influenced by psychosocial factors.The aim of this review is to describe the epidemiology,clinical evolution,prognostic factors,and mortality of papillary thyroid microcarcinomas.We also summarize the AS strategy according to published evidence,characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics,as well as analyze the current limitations for AS implementation.展开更多
BACKGROUND Fine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules.It includes two primary methods:Fine-needle capillary biopsy(FNCB)and fine-needle aspiration biopsy.Needle tra...BACKGROUND Fine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules.It includes two primary methods:Fine-needle capillary biopsy(FNCB)and fine-needle aspiration biopsy.Needle tract seeding(NTS)is a rare complication of thyroid fine-needle biopsy mainly caused by fine-needle aspiration biopsy rather than FNCB.Here,we present an extremely rare case of a papillary thyroid carcinoma(PTC)patient with FNCB-derived NTS.CASE SUMMARY We report a 32-year-old woman with PTC who showed subcutaneous NTS 1 year after FNCB and thyroidectomy.NTS was diagnosed based on clinical manifestations,biochemistry indices,and imaging(computed tomography and ultrasound).Pathological identification of PTC metastases consistent with the puncture path is the gold standard for diagnosis.Surgical resection was the main method used to treat the disease.After surgery,thyroid function tests and ultrasound scans were performed every 3-6 mo.To date,no evidence of tumor recurrence has been observed.CONCLUSION FNCB is a safe procedure as NTS is rare,and can be easily removed surgically with no recurrence.Accordingly,NTS should not limit the usefulness of FNCB.展开更多
BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgic...BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgical prophylactic lymph node dissection(LND) for clinical surgeons.AIM To investigate the relationship between subgroups of central LNM and lateral LNM in unilateral clinically node-negative PTC(cN0-PTC).METHODS Data were collected for 1089 PTC patients who underwent surgical treatment at the Department of Endocrine and Breast Surgery of the First Hospital of Chongqing Medical University from January 2016 to December 2017. A total of 388 unilateral cN0-PTC patients met the inclusion criteria and were enrolled in this study. The clinical and pathological data for these 388 patients who underwent total thyroidectomy + central LND + lateral LND were retrospectively analyzed. The relationship between the central LNM and lateral LNM subgroups was investigated.RESULTS The coincidence rate of cN0-PTC was only 30.0%.Optimal scaling regression analysis showed that sex(57.1% vs 42.9%, P = 0.026), primary tumor size(68.8% vs 31.2%, P = 0.008), tumor location(59.7% vs 40.3%, P = 0.007), extrathyroid extension(ETE)(50.6% vs 49.9%, P = 0.046), and prelaryngeal LNM(57.1% vs 42.9%, P = 0.004) were significantly associated with ipsilateral level-II LNM. Their importance levels were 0.122, 0.213, 0.172, 0.110, and 0.227, respectively. Primary tumor size(74.6% vs 30.2%, P = 0.016), pretracheal LNM(67.5% vs 32.5%, P < 0.001), and paratracheal LNM(71.4% vs 28.6%, P < 0.001) were significantly associated with ipsilateral level-Ⅲ LNM. Their importance levels were 0.120, 0.408, and 0.351, respectively. Primary tumor size(72.1% vs 27.9%, P = 0.003), ETE(70.4% vs 29.6%, P = 0.016), pretracheal LNM(68.3% vs 31.7%, P=0.001), and paratracheal LNM(80.8% vs 19.2%, P < 0.001) were significantly associated with ipsilateral level-IV LNM. Their importance levels were 0.164, 0.146, 0.216, and 0.472, respectively.CONCLUSION The LNM pathway of thyroid cancer has a certain regularity. For unilateral cN0-PTC patients with a tumor diameter > 2 cm and pretracheal or ipsilateral paratracheal LNM, LND at ipsilateral level Ⅲ and level IV must be considered. When there is a tumor in the upper third of the thyroid with prelaryngeal LNM, LND at level II, level Ⅲ and level IV must be considered.展开更多
BACKGROUND Papillary thyroid cancer(PTC)is the most common malignant tumor of the thyroid.However,the coexistence of PTC and sarcoma in one patient is rare.In this article,we report the case of a patient who presented...BACKGROUND Papillary thyroid cancer(PTC)is the most common malignant tumor of the thyroid.However,the coexistence of PTC and sarcoma in one patient is rare.In this article,we report the case of a patient who presented with both PTC and undifferentiated pleomorphic sarcoma(UPS),which has not been previously reported in the online Medline database(PubMed).CASE SUMMARY A 71-year-old man was admitted to our hospital for a mass on the right side of his neck for one month,which rapidly enlarged within 2 wk with distending pain.The patient was diagnosed with a thyroid malignancy by fine-needle aspiration and underwent total thyroidectomy and bilateral central lymph node dissection.Histology and immunohistochemistry revealed features of both PTC and UPS.The thyroid cancer 8 gene detection kit results showed BRAF and telomerase reverse transcriptase mutations.The disease progressed rapidly,and the patient died four months after surgery from extensive lung metastasis.CONCLUSION Our report highlights the patient’s pathological characteristics and related genetic mutations.Due to the rapid development and poor prognosis of cooccurring PTC and sarcoma,it is important for clinical physicians and pathologists to raise awareness of this type of tumor.展开更多
BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-yea...BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy.She was diagnosed with parathyroidoma,papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically.Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy.The healthy infant was delivered at the 40th week of pregnancy.The mother had no evidence of recurrence over three years of follow-up.CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.展开更多
BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,efcient and safe technology for PTC.In this article,we report one ...BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,efcient and safe technology for PTC.In this article,we report one case of a residual tumor and central lymph node metastasis(CLNM)after TA for PTC.CASE SUMMARY A 63-year-old female underwent bilateral ultrasound(US)-guided radiofrequency ablation for PTC.Three months later,she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography.The subsequent fine-needle aspiration(FNA)biopsies were negative.Due to her strong personal preference,she underwent total thyroidectomy and central lymph node dissection.Local tissue adhesion and a difficult dissection were noted during the operation.The pathology of the frozen sections during the operation was still negative.The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.CONCLUSION TA may lead to a residual tumor in patients with PTC.Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor.TA should be carefully considered in PTC treatment.展开更多
BACKGROUND This is the first documentation of a spontaneous and nonspecific chemical reaction of an iodinated contrast media with ammonium persulfate used in As3+-Ce4+catalytic spectrophotometry for urine iodine conce...BACKGROUND This is the first documentation of a spontaneous and nonspecific chemical reaction of an iodinated contrast media with ammonium persulfate used in As3+-Ce4+catalytic spectrophotometry for urine iodine concentration(UIC)detection.CASE SUMMARY We herein report an incidental case who had a dual source computed tomography examination for papillary thyroid carcinoma diagnosis.Serial spot urine specimens were collected during her hospitalization and were measured by As3+-Ce4+catalytic spectrophotometry on a Beckman Coulter AU5800.The reacted solutions were“brownish”,and the results showed extremely high iodine concentrations despite serial dilutions.The patient claimed no dietary habit of iodized salt or iodine-containing medical history,which strongly pointed to iodinated contrast media(ICM)via intravenous injection.Even with 0.01%ICM,its interruption is still profound on the desired urine iodine reaction with ammonium persulfate,leading to inaccurate UIC and possibly inappropriate treatment.CONCLUSION The following laboratory suggestions should be considered:(1)As3+-Ce4+catalytic spectrophotometry is only suitable for UIC measurement after confirmed ICM renal clearance;(2)A mass spectrometry-based method can be applied as an alternative during the ICM clearance period;and(3)The UIC baseline can be confirmed after ICM injection by consecutive detection for at least 2 mo.展开更多
Thyroid cancer is the most common endocrine system tumor.Ultrasound guided fine needle puncture(FNA)can identify benign and malignant thyroid nodules.However,due to the limitation of cytological detection,some thyroid...Thyroid cancer is the most common endocrine system tumor.Ultrasound guided fine needle puncture(FNA)can identify benign and malignant thyroid nodules.However,due to the limitation of cytological detection,some thyroid nodules are difficult to distinguish benign and malignant.BRAF gene mutation is a common human oncogenic mutation and the highest mutation frequency in papillary thyroid carcinoma.The combination of FNA and BRAF gene detection can significantly improve the diagnostic rate of benign and malignant thyroid nodules and make up for the deficiency of single diagnosis of cytology.Moreover,while the incidence of thyroid cancer is growing rapidly worldwide,its mortality remains stable.The problem of overdiagnosis and overtreatment of thyroid cancer is becoming more and more obvious.However,due to the limitations of current studies on BRAF genes,its prognostic value for papillary thyroid carcinoma remains controversial.Therefore,in order to reduce the adverse effects of overdiagnosis and treatment,the relationship between gene and tumor biological behavior needs further study in the future.展开更多
Objective To investigate the risk factors for cervical lymph node metastasis of clinically lymph node-negative(cN0)papillary thyroid carcinoma(PTC).Methods Patients and Methods:The clinicopathologic data of patients w...Objective To investigate the risk factors for cervical lymph node metastasis of clinically lymph node-negative(cN0)papillary thyroid carcinoma(PTC).Methods Patients and Methods:The clinicopathologic data of patients with cN0 PTC who underwent at least one lobectomy plus central lymph node dissection at Xuzhou Central Hospital from January 2018 to December 2020 were retrospectively collected and the risk factors of lymph node metastasis analyzed.Univariate and multivariate analyses were performed to detect the risk factors for cervical lymph node metastasis.Results A total of 312 patients with cN0 PTC were enrolled in this study.The postoperative pathology results showed that 134 patients(42.9%)had central lymph node metastasis,of whom 24(17.9%)had lateral lymph node metastasis(LLNM).The univariate analysis results showed that male gender,age<45 years,tumor diameter≥10 mm,bilateral cancer,capsule invasion,and multiple foci were associated with cervical lymph node metastasis of cN0 PTC(P<0.05).Further logistic regression analysis results showed that these factors,except age,were independent risk factors for cervical lymph node metastasis of cN0 PTC(P<0.05).The results also showed that the risk of LLNM increased with an increase in the number of positive central lymph nodes in patients with cN0 PTC(P<0.05).Conclusion Cervical lymph node metastasis of cN0 PTC is related to many factors,and a high number of positive central lymph nodes indicates a high risk of LLNM.Patients with risk factors should undergo preventive central lymph node dissection at the first surgery,and in patients with a high number of positive central lymph nodes,lateral lymph node dissection should be discreetly performed.展开更多
Objective:To explore the diagnostic value of serum TSH,ultrasound,and enhanced CT in papillary thyroid carcinoma with lymph node metastasis.Methods:168 patients who underwent thyroidectomy in Shaanxi Provincial People...Objective:To explore the diagnostic value of serum TSH,ultrasound,and enhanced CT in papillary thyroid carcinoma with lymph node metastasis.Methods:168 patients who underwent thyroidectomy in Shaanxi Provincial People’s Hospital from January 2020 to December 2021 were selected as the research subjects.Based on the pathological nature(benign or malignant),they were divided into two groups,with 86 patients in the control group and 82 patients in the study group.Based on whether the pathology was accompanied with lymph node metastasis,the PTC group was divided into a lymph node metastasis group and a non-lymph node metastasis group,with 51 and 31 patients in the respective groups.Retrospective analysis was conducted to observe and analyze the pathological results of the thyroid nodules’thyroid ultrasound results,neck enhanced CT results,and thyroid function test serology results.Results:Compared with the PTC group,there were significant differences in TR classification,ultrasonic lymph nodes,and enhanced CT lymph nodes,but no significant differences in the course of disease,nodule distribution,and the number of nodules between the benign nodule group and PTC group;in the comparison of lymph node metastasis using ultrasound and enhanced CT,the number of patients with ultrasound lymph nodes without abnormal metastasis in the non-metastasis group was 28,while that of the metastasis group was 21;the number of patients with abnormal metastasis in the non-metastasis group was 3,while that of the metastasis group was 30.The number of patients with a single node without metastasis and metastasis was 14 and 8,respectively,whereas the number of patients with multiple nodes without metastasis and metastasis was 17 and 43,respectively.There were statistically significant differences in the number of ultrasound lymph nodes and nodules,but no statistically significant differences in TR classification,enhanced CT lymph nodes,nodules distribution,and disease course.Conclusion:Serum TSH can be used to identify the nature(benign and malignant)of thyroid nodules,and enhanced CT is better than ultrasound when evaluating complex lesions.It can be used as a supplement to ultrasound based on clinical context.展开更多
Objective: The purpose of this study was to investigate the effect of Hashimoto’s thyroiditis on efficacy of <sup>131</sup>I ablation in intermediate- and high-risk of thyroid papillary carcinoma patients...Objective: The purpose of this study was to investigate the effect of Hashimoto’s thyroiditis on efficacy of <sup>131</sup>I ablation in intermediate- and high-risk of thyroid papillary carcinoma patients. The findings will help to develop a personalized treatment plan for patients with thyroid papillary carcinoma complicated with Hashimoto’s thyroiditis. Material and Methods: From January 2016 to December 2020, patients who were diagnosed with intermediate- and high-risk PTC with lymph node metastasis were analyzed retrospectively, excluding patients with incomplete clinical data, distant metastasis, positive TGAb, TSH Results: A total of 525 patients (166 males and 359 females) were included in the study, including 368 patients in ER group (70.1%) and 157 patients in NER group (29.9%). Eleven factors including combining Hashimoto’s thyroiditis, pre-ablative Tg levels, sex, tumor diameter, extraglandular invasion, multifocal, bilateral lesions, central lymph node metastasis, lateral lymph node metastasis, lymph node metastasis rate, thyroglobulin were statistically different between ER group and NER group with significance at P Conclusion: Hashimoto’s thyroiditis, Ps-Tg level and lateral lymph node metastasis are potential predictors for short-term efficacy of <sup>131</sup>I treatment in intermediate- and high-risk thyroid papillary carcinoma. Hashimoto’s thyroiditis, high Ps-Tg level and increased number of lateral lymph node metastasis reduce the efficacy of <sup>131</sup>I therapy in patients with intermediate and high risk thyroid papillary carcinoma.展开更多
Background:Accumulating evidence has revealed that circulating microRNAs(miRNAs)can serve as non-invasive biomarkers for cancer diagnosis.This study aimed to identify differentially expressed miRNAs in serum which mig...Background:Accumulating evidence has revealed that circulating microRNAs(miRNAs)can serve as non-invasive biomarkers for cancer diagnosis.This study aimed to identify differentially expressed miRNAs in serum which might become potential biomarkers for non-invasive diagnosis of papillary thyroid carcinoma(PTC).Methods:The experiment was carried out between 2015 and 2017.In the screening stage,the Exiqon miRNA quantitative real-time polymerase chain reaction(qPCR)panel was applied to select candidate miRNAs.In the following training,testing,and external validation stages,the serum samples of 100 patients and 96 healthy controls(HCs)were analyzed to compare the expression levels of the identified miRNAs.The areas under the receiver operating characteristic curves(AUCs)were calculated to assess the diagnostic value of the identified signature.Results:Three miRNAs(miR-25-3p,miR-296-5p,and miR-92a-3p)in serum were consistently up-regulated in PTC patients compared with HCs.A three-miRNA panel was constructed by logistic regression analysis and showed better diagnostic performance than a single miRNA for PTC detection.The AUCs of the panel were 0.727,0.771,and 0.862 for the training,testing,and external validation stage,respectively.Meanwhile,the panel showed stable capability in differentiating PTC patients from patients with benign goiters,with an AUC as high as 0.969.For further exploration,the three identified miRNAs were analyzed in tissue samples(23 PTC vs.23 HCs)and serum-derived exosomes samples(24 PTC vs.24 HCs),and the altered expression in the tumor also indicated their close relationship with PTC disease.Conclusion:We identify a three-miRNA panel in serum which might serve as a promising biomarker for PTC diagnosis.展开更多
Active surveillance(AS)can be considered as a treatment strategy for low risk papillary thyroid microcarcinoma(PTMC),with the absence of clinically apparent lymph nodes,extrathyroidal extensions,and distant metastasis...Active surveillance(AS)can be considered as a treatment strategy for low risk papillary thyroid microcarcinoma(PTMC),with the absence of clinically apparent lymph nodes,extrathyroidal extensions,and distant metastasis.After reviewing the reports on AS of low risk PTMCs worldwide,we introduced AS,and discussed the selection criteria for active surveillance candidates based on different guidelines and the follow-up schedules.Moreover,the requirement of cytological diagnosis,progression evaluation methods,necessity of thyrotropin suppression,and medical costs were issues that both clinicians and patients considered.The usefulness of AS for low risk PTMC patients depended on accurate and confidential evaluation of patient risk.Clinicians may adopt measures like dynamic monitoring,risk stratification,and making personal follow-up schedules to minimize these potential risks.By appropriately selecting PTMC patients,AS can be an effective alternative treatment to immediate surgery.展开更多
Due to exponential increases in incidences,low risk papillary thyroid microcarcinoma(PTMC)has become a clinical and social issue in recent years.An active surveillance(AS)management approach is an alternative to immed...Due to exponential increases in incidences,low risk papillary thyroid microcarcinoma(PTMC)has become a clinical and social issue in recent years.An active surveillance(AS)management approach is an alternative to immediate surgery for patients with low risk PTMC.With decreased doubts about the safety and validity due to evidence from a large number of studies,the AS approach has become increasingly popular worldwide.However,Chinese thyroid surgeons still lag behind other countries in their knowledge of clinical practices and research related to AS.To promote the implementation of AS in China,thyroid surgeons should understand the implications,advantages,and disadvantages of management approaches for AS,and should also consider the willingness of Chinese patients,the impact on the medical billing system,and the enthusiasm of doctors.Thus,a management approach for AS based on the Chinese population should be developed to reduce the risk of disease progression and enhance patient adherence.Herein,we summarize the recent research achievements and deficiencies in AS approaches,and describe the initial experiences regarding AS in the Chinese population,in order to assist Chinese thyroid surgeons in preparing for AS management in the era of PTMC precision medicine.展开更多
Objective: To investigate the risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC).Methods: A retrospective analysis of 209 patients with PTC who underwent primary surgery at the ...Objective: To investigate the risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC).Methods: A retrospective analysis of 209 patients with PTC who underwent primary surgery at the Beijing Friendship Hospital affiliated with Capital Medical University from November 2014 to November 2018 was performed. The patients were divided into the LLNM group and the non-LLNM group. The clinical and pathological characteristics of the patients were analysed. The risk factors for LLNM were analysed by univariate and multivariate analyses.Results: The incidence of LLNM was 13.4% in PTC patients. Univariate analysis showed that the maximum diameter of the primary tumour > 2 cm (P < 0.001), bilateral primary tumour (P= 0.020), extrathyroidal extension (ETE) (P < 0.001), central lymph node metastasis (CLNM) (P < 0.001), and CLNM number ≥ 5 (P < 0.001) were significantly associated with LLNM. Multivariate logistic regression analysis showed that the maximum diameter of the primary tumour > 2 cm, ETE, and CLNM were independent risk factors for LLNM (OR values were 3.880, 5.202, and 4.474, respectively). There were 6 patients with skip lateral cervical lymph node metastasis, accounting for 21% of all LLNM patients.Conclusion: This study revealed several independent risk factors for predicting LLNM in PTC patients, such as the maximum diameter of the primary tumour > 2 cm, ETE and CLNM. Lateral neck dissection may be recommended in PTC patients with those risk factors. Paying attention to the occurrence of skip lateral cervical lymph node metastasis during the clinical diagnosis and treatment processes is necessary.展开更多
Objective: To clarify the inhibitory mechanism of Haizao Yuhu Decoction on BRAFV600E mutation-driven papillary thyroid carcinoma cells. Methods: Prepare seaweed Yuhu Decoction medicated serum, select human normal thyr...Objective: To clarify the inhibitory mechanism of Haizao Yuhu Decoction on BRAFV600E mutation-driven papillary thyroid carcinoma cells. Methods: Prepare seaweed Yuhu Decoction medicated serum, select human normal thyroid cells Nthy-ori3-1 as the normal control group, and PLX4032 as the positive control drug. The experiment was divided into normal control group, model control group, PLX4032 group, Haizao Yuhu Decoction group (referred to as HYD group), Haizao Yuhu Decoction group + PLX4032 (referred to as HYD+PLX4032 group), and high iodine water group, at 8h and 24h respectively. At 72h, the cell proliferation of each group was detected by MTT method;at 24h, the expression of ERK and p-ERK protein in each group was detected by Western blot. Results: The longer the time, the more obvious the inhibitory effect of Haizao Yuhu Decoction-containing serum on the proliferation activity of BCPAP cells: Compared with the normal control group, the BCPAP cell proliferation activity of the model control group was significantly enhanced at 24h and 72h (P <0.05);At 24h, the PLX4032 group, HYD group, and HYD+PLX4032 group all showed a tendency to inhibit the proliferation of BCPAP cells, but there was no statistical difference;at 72h, compared with the model control group, the PLX4032 group The cell proliferation activity of the HYD group and HYD+PLX4032 group was significantly inhibited (P <0.05), and there was no difference between the high iodine water group and the model control group (P>0.05). In inhibiting the proliferation of BCPAP cells, the medicated serum of Shanghai Zaoyuhu Decoction has a synergistic effect with PLX4032 (F=10.87, P=0.005). Western blot results showed that there was no difference in the expression of ERK1/2 protein between the groups, but there were significant differences in the expression of p-ERK1/2 protein between the groups: Compared with the normal control group, the expression of p-ERK1/2 protein in the model group increased significantly (P < 0.05);Compared with the model control group, the expression of p-ERK1/2 protein in the PLX4032 group, the HYD group, and the HYD+PLX4032 group decreased significantly (P <0.05), and there was no difference between the high iodine water group and the model control group (P> 0.05). Conclusion: The medicated serum of Haizao Yuhu Decoction has an inhibitory effect on the proliferation of BCPAP cells, and its mechanism may be inhibiting the proliferation of BCPAP cells by inhibiting ERK1/2 protein phosphorylation, a protein post-translational modification process;the medicated serum of Haizao Yuhu Decoction may have Help enhance the effect of PLX4032 curative effect.展开更多
文摘Background: Thyroid cancer is a rare disease yet the most common endocrine malignancy in pediatrics. Unlike adult patients, children with thyroid nodules typically don’t complain of pain, soreness, or difficulty swallowing. Additionally, using the recommended therapy for adults to treat paediatrics is not appropriate. There is an unmet need for updated unique guidelines for the management of papillary thyroid carcinoma (PTC) in paediatrics and adolescents. Case Report: A 12-year-old girl had an atypical presentation of metastatic PTC in lymph nodes. She was treated initially with hemi-thyroidectomy, followed by total thyroidectomy. A multidisciplinary team followed her up till successful results were found. Conclusion: Due to the difference in pathophysiology between thyroid tumors in children and adults, a unique approach to PTC management is to be implemented. Further trials are required for a better understanding of risk factors, the likelihood of recurrence, and the long-term side effects of the chosen management plan.
文摘BACKGROUND Papillary thyroid carcinoma(PTC)is regarded as a fairly common endocrine malignancy,which can be divided into different multiple variants due to wide morphologic differences.The majority of PTC variants have been reported,but PTC with nodular fasciitis-like stroma(NFS)is a rare pathological variant and has been infrequently reported in the relevant literature.This condition involves abundant reactive stromal components rich in spindle cells,which may account for 60%-80%of the tumor along with a typical papillary carcinoma.CASE SUMMARY A 44-year-old man presented with a 4-mo history of a palpable mass over the anterior aspect of the left neck,the tumor demonstrated gradual enlargement but was painless during the 4 mo prior to discovery.Thyroid function test results were normal.Physical examination showed an enormous and firm nodular mass in the left lobe of the thyroid gland extending to the level of the hyoid bone.Ultrasonography of the neck revealed a well-defined heterogeneous lesion measuring around 5.0 cm×4.0 cm with a hypoechoic complex nodule,decreased vascularity and speckles of microcalcification.The patient underwent left thyroidectomy with central compartment lymph node dissection.Final histopathological examination confirmed the diagnosis of PTC with extensive fibromatosis-like stroma combined with typical PTC.The patient was asymptomatic at the 3-mo follow-up.CONCLUSION PTC-NFS is a rare pathological variant and its diagnosis and prognosis may be similar to typical papillary carcinoma.
文摘Introduction: The impact of pregnancy on the prognosis of papillary thyroid carcinoma (PTC) has been debated for several decades;however, no definitive conclusions have been reached. The main objective of this study is to demonstrate the short-term influence of pregnancy on the evolution and prognosis of PTC. Materials and Methods: A prospective descriptive and analytical study was conducted in the Endocrinology and Diabetology Department at the Hassan II University Hospital in Fez, including patients followed for papillary thyroid carcinoma presenting with a pregnancy during the year 2019 and 2020. The follow-up of these patients was continued until 1 year postpartum. We studied the clinical, paraclinical and therapeutic factors that could influence the prognosis of the disease. Results: We included 26 patients. Our study showed a significant correlation between recurrence and the presence of unfavorable histological signs (p = 0.02) as well as the initial Tg level (0.01). However, pregnancy was not an influencing factor (p = 0.41). Conclusion: Pregnancy does not seem to be a factor aggravating the prognosis of differentiated thyroid cancers.
基金supported by the National Natural Science Foundation of China(No.81471781,No.81502665 and No.81302314/H1622)the Fundamental Research Funds of Health and Family Planning Commission of Hubei Province(No.JS-20110118)the Fundamental Research Funds for the Central Universities of China(No.2042014kf0189)
文摘The purpose of this study was to assess the differences in clinical and sonographic features of papillary thyroid carcinoma(PTC) between cervical lymph node metastatic(CLNM) and nonmetastatic groups.Clinical data of PTC patients(414 patients with 624 malignant nodules) who underwent a preoperative ultrasonography and surgery between June 2010 and March 2015 at Renmin Hospital of Wuhan University were retrospectively analyzed.Clinical factors,preoperative ultrasound features and the final pathological findings were obtained.The differences in the sonographic features of PTC between the CLNM group and the non-CLNM group were analyzed.There were 187 CLNM and 227 non-CLNM patients.The median age at the diagnosis of this cohort was 45.4 years old(ranging from 18 to 77 years).Ultrasonographic parameters that were significantly associated with CLNM [OR=2.569(1.502,4.393),P<0.001)] were as follows:the mulifocality of the nodules,size over 2 cm,the presence of microcalcifications,the distance ratio(DR) pattern showing the contact of the nodules with the thyroid capsule,and the extracapsular spread of the nodules.No significant differences in age,gender,thyroid stimulating hormone(TSH) levels and other ultrasonography parameters were found between the CLNM and the non-CLNM groups.Therefore,our results suggest that a larger size,microcalcifications,mulifocality,and the DR pattern showing the contact of the nodules with the thyroid capsule and extracapsular spread are significantly more indicative of CLNM in PTC.
文摘In recent decades,while the incidence of thyroid cancer has increased exponentially around the world,mortality has remained stable.The vast majority of this increase is attributable to the identification of intrathyroidal papillary microcarcinomas,which exhibit slow growth rates with indolent courses.A diagnosis of thyroid cancer based upon the presence of these small tumors could be considered as an overdiagnosis,as the majority of these tumors would not likely result in death if left untreated.Although surgical resection was the classical standard therapy for papillary microcarcinomas,active surveillance(AS)has emerged over the last three decades as an alternative approach that is aimed to recognize a minority group of patients who will clinically progress and would likely benefit from rescue surgery.Despite the encouraging results of AS,its implementation in clinical practice is strongly influenced by psychosocial factors.The aim of this review is to describe the epidemiology,clinical evolution,prognostic factors,and mortality of papillary thyroid microcarcinomas.We also summarize the AS strategy according to published evidence,characterize the criteria for selecting patients for AS according to risk factors and environmental characteristics,as well as analyze the current limitations for AS implementation.
文摘BACKGROUND Fine-needle biopsy is an accurate and cost-efficient tool for the assessment of thyroid nodules.It includes two primary methods:Fine-needle capillary biopsy(FNCB)and fine-needle aspiration biopsy.Needle tract seeding(NTS)is a rare complication of thyroid fine-needle biopsy mainly caused by fine-needle aspiration biopsy rather than FNCB.Here,we present an extremely rare case of a papillary thyroid carcinoma(PTC)patient with FNCB-derived NTS.CASE SUMMARY We report a 32-year-old woman with PTC who showed subcutaneous NTS 1 year after FNCB and thyroidectomy.NTS was diagnosed based on clinical manifestations,biochemistry indices,and imaging(computed tomography and ultrasound).Pathological identification of PTC metastases consistent with the puncture path is the gold standard for diagnosis.Surgical resection was the main method used to treat the disease.After surgery,thyroid function tests and ultrasound scans were performed every 3-6 mo.To date,no evidence of tumor recurrence has been observed.CONCLUSION FNCB is a safe procedure as NTS is rare,and can be easily removed surgically with no recurrence.Accordingly,NTS should not limit the usefulness of FNCB.
文摘BACKGROUND Lymph node metastasis(LNM) of papillary thyroid carcinoma(PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgical prophylactic lymph node dissection(LND) for clinical surgeons.AIM To investigate the relationship between subgroups of central LNM and lateral LNM in unilateral clinically node-negative PTC(cN0-PTC).METHODS Data were collected for 1089 PTC patients who underwent surgical treatment at the Department of Endocrine and Breast Surgery of the First Hospital of Chongqing Medical University from January 2016 to December 2017. A total of 388 unilateral cN0-PTC patients met the inclusion criteria and were enrolled in this study. The clinical and pathological data for these 388 patients who underwent total thyroidectomy + central LND + lateral LND were retrospectively analyzed. The relationship between the central LNM and lateral LNM subgroups was investigated.RESULTS The coincidence rate of cN0-PTC was only 30.0%.Optimal scaling regression analysis showed that sex(57.1% vs 42.9%, P = 0.026), primary tumor size(68.8% vs 31.2%, P = 0.008), tumor location(59.7% vs 40.3%, P = 0.007), extrathyroid extension(ETE)(50.6% vs 49.9%, P = 0.046), and prelaryngeal LNM(57.1% vs 42.9%, P = 0.004) were significantly associated with ipsilateral level-II LNM. Their importance levels were 0.122, 0.213, 0.172, 0.110, and 0.227, respectively. Primary tumor size(74.6% vs 30.2%, P = 0.016), pretracheal LNM(67.5% vs 32.5%, P < 0.001), and paratracheal LNM(71.4% vs 28.6%, P < 0.001) were significantly associated with ipsilateral level-Ⅲ LNM. Their importance levels were 0.120, 0.408, and 0.351, respectively. Primary tumor size(72.1% vs 27.9%, P = 0.003), ETE(70.4% vs 29.6%, P = 0.016), pretracheal LNM(68.3% vs 31.7%, P=0.001), and paratracheal LNM(80.8% vs 19.2%, P < 0.001) were significantly associated with ipsilateral level-IV LNM. Their importance levels were 0.164, 0.146, 0.216, and 0.472, respectively.CONCLUSION The LNM pathway of thyroid cancer has a certain regularity. For unilateral cN0-PTC patients with a tumor diameter > 2 cm and pretracheal or ipsilateral paratracheal LNM, LND at ipsilateral level Ⅲ and level IV must be considered. When there is a tumor in the upper third of the thyroid with prelaryngeal LNM, LND at level II, level Ⅲ and level IV must be considered.
文摘BACKGROUND Papillary thyroid cancer(PTC)is the most common malignant tumor of the thyroid.However,the coexistence of PTC and sarcoma in one patient is rare.In this article,we report the case of a patient who presented with both PTC and undifferentiated pleomorphic sarcoma(UPS),which has not been previously reported in the online Medline database(PubMed).CASE SUMMARY A 71-year-old man was admitted to our hospital for a mass on the right side of his neck for one month,which rapidly enlarged within 2 wk with distending pain.The patient was diagnosed with a thyroid malignancy by fine-needle aspiration and underwent total thyroidectomy and bilateral central lymph node dissection.Histology and immunohistochemistry revealed features of both PTC and UPS.The thyroid cancer 8 gene detection kit results showed BRAF and telomerase reverse transcriptase mutations.The disease progressed rapidly,and the patient died four months after surgery from extensive lung metastasis.CONCLUSION Our report highlights the patient’s pathological characteristics and related genetic mutations.Due to the rapid development and poor prognosis of cooccurring PTC and sarcoma,it is important for clinical physicians and pathologists to raise awareness of this type of tumor.
文摘BACKGROUND There is a common pathologic relationship between parathyroid adenoma and thyroid cancer,but this relationship is infrequent in pregnant patients with primary hyperparathyroidism(PHPT).CASE SUMMARY A 27-year-old gravida 1 woman was transferred to our hospital at 16 wk of pregnancy.She was diagnosed with parathyroidoma,papillary carcinoma of the thyroid and thyroid adenoma and was managed surgically.Both the mother and the newborn were stable after a right inferior parathyroidectomy and total thyroidectomy.The healthy infant was delivered at the 40th week of pregnancy.The mother had no evidence of recurrence over three years of follow-up.CONCLUSION Awareness of concomitant PHPT and thyroid diseases may help in managing patients with a history of hypercalcemia.
基金the Shanghai Municipal Administrator of Traditional Chinese Medicine,No.2018ZY03005.
文摘BACKGROUND Debate exists regarding the use of thermal ablation(TA)to treat papillary thyroid carcinoma(PTC).Some studies have recommended TA as a new,efcient and safe technology for PTC.In this article,we report one case of a residual tumor and central lymph node metastasis(CLNM)after TA for PTC.CASE SUMMARY A 63-year-old female underwent bilateral ultrasound(US)-guided radiofrequency ablation for PTC.Three months later,she was diagnosed as thyroid cancer with suspected CLNM by US and contrast-enhanced computed tomography.The subsequent fine-needle aspiration(FNA)biopsies were negative.Due to her strong personal preference,she underwent total thyroidectomy and central lymph node dissection.Local tissue adhesion and a difficult dissection were noted during the operation.The pathology of the frozen sections during the operation was still negative.The final pathology results of paraffin-embedded sections revealed residual tumor cells at the edge of the PTC and CLNM.CONCLUSION TA may lead to a residual tumor in patients with PTC.Follow-up using US and FNA biopsy may not be adequate to evaluate the residual tumor.TA should be carefully considered in PTC treatment.
基金Supported by the“The Six Top Talent Project”of Jiangsu Province,No.WSW-004the Key Laboratory for Laboratory Medicine of Jiangsu Province of China,No.ZDXKB2016005。
文摘BACKGROUND This is the first documentation of a spontaneous and nonspecific chemical reaction of an iodinated contrast media with ammonium persulfate used in As3+-Ce4+catalytic spectrophotometry for urine iodine concentration(UIC)detection.CASE SUMMARY We herein report an incidental case who had a dual source computed tomography examination for papillary thyroid carcinoma diagnosis.Serial spot urine specimens were collected during her hospitalization and were measured by As3+-Ce4+catalytic spectrophotometry on a Beckman Coulter AU5800.The reacted solutions were“brownish”,and the results showed extremely high iodine concentrations despite serial dilutions.The patient claimed no dietary habit of iodized salt or iodine-containing medical history,which strongly pointed to iodinated contrast media(ICM)via intravenous injection.Even with 0.01%ICM,its interruption is still profound on the desired urine iodine reaction with ammonium persulfate,leading to inaccurate UIC and possibly inappropriate treatment.CONCLUSION The following laboratory suggestions should be considered:(1)As3+-Ce4+catalytic spectrophotometry is only suitable for UIC measurement after confirmed ICM renal clearance;(2)A mass spectrometry-based method can be applied as an alternative during the ICM clearance period;and(3)The UIC baseline can be confirmed after ICM injection by consecutive detection for at least 2 mo.
基金It was supported by Lanzhou Science and Technology Plan Project(2018-3-58)。
文摘Thyroid cancer is the most common endocrine system tumor.Ultrasound guided fine needle puncture(FNA)can identify benign and malignant thyroid nodules.However,due to the limitation of cytological detection,some thyroid nodules are difficult to distinguish benign and malignant.BRAF gene mutation is a common human oncogenic mutation and the highest mutation frequency in papillary thyroid carcinoma.The combination of FNA and BRAF gene detection can significantly improve the diagnostic rate of benign and malignant thyroid nodules and make up for the deficiency of single diagnosis of cytology.Moreover,while the incidence of thyroid cancer is growing rapidly worldwide,its mortality remains stable.The problem of overdiagnosis and overtreatment of thyroid cancer is becoming more and more obvious.However,due to the limitations of current studies on BRAF genes,its prognostic value for papillary thyroid carcinoma remains controversial.Therefore,in order to reduce the adverse effects of overdiagnosis and treatment,the relationship between gene and tumor biological behavior needs further study in the future.
文摘Objective To investigate the risk factors for cervical lymph node metastasis of clinically lymph node-negative(cN0)papillary thyroid carcinoma(PTC).Methods Patients and Methods:The clinicopathologic data of patients with cN0 PTC who underwent at least one lobectomy plus central lymph node dissection at Xuzhou Central Hospital from January 2018 to December 2020 were retrospectively collected and the risk factors of lymph node metastasis analyzed.Univariate and multivariate analyses were performed to detect the risk factors for cervical lymph node metastasis.Results A total of 312 patients with cN0 PTC were enrolled in this study.The postoperative pathology results showed that 134 patients(42.9%)had central lymph node metastasis,of whom 24(17.9%)had lateral lymph node metastasis(LLNM).The univariate analysis results showed that male gender,age<45 years,tumor diameter≥10 mm,bilateral cancer,capsule invasion,and multiple foci were associated with cervical lymph node metastasis of cN0 PTC(P<0.05).Further logistic regression analysis results showed that these factors,except age,were independent risk factors for cervical lymph node metastasis of cN0 PTC(P<0.05).The results also showed that the risk of LLNM increased with an increase in the number of positive central lymph nodes in patients with cN0 PTC(P<0.05).Conclusion Cervical lymph node metastasis of cN0 PTC is related to many factors,and a high number of positive central lymph nodes indicates a high risk of LLNM.Patients with risk factors should undergo preventive central lymph node dissection at the first surgery,and in patients with a high number of positive central lymph nodes,lateral lymph node dissection should be discreetly performed.
文摘Objective:To explore the diagnostic value of serum TSH,ultrasound,and enhanced CT in papillary thyroid carcinoma with lymph node metastasis.Methods:168 patients who underwent thyroidectomy in Shaanxi Provincial People’s Hospital from January 2020 to December 2021 were selected as the research subjects.Based on the pathological nature(benign or malignant),they were divided into two groups,with 86 patients in the control group and 82 patients in the study group.Based on whether the pathology was accompanied with lymph node metastasis,the PTC group was divided into a lymph node metastasis group and a non-lymph node metastasis group,with 51 and 31 patients in the respective groups.Retrospective analysis was conducted to observe and analyze the pathological results of the thyroid nodules’thyroid ultrasound results,neck enhanced CT results,and thyroid function test serology results.Results:Compared with the PTC group,there were significant differences in TR classification,ultrasonic lymph nodes,and enhanced CT lymph nodes,but no significant differences in the course of disease,nodule distribution,and the number of nodules between the benign nodule group and PTC group;in the comparison of lymph node metastasis using ultrasound and enhanced CT,the number of patients with ultrasound lymph nodes without abnormal metastasis in the non-metastasis group was 28,while that of the metastasis group was 21;the number of patients with abnormal metastasis in the non-metastasis group was 3,while that of the metastasis group was 30.The number of patients with a single node without metastasis and metastasis was 14 and 8,respectively,whereas the number of patients with multiple nodes without metastasis and metastasis was 17 and 43,respectively.There were statistically significant differences in the number of ultrasound lymph nodes and nodules,but no statistically significant differences in TR classification,enhanced CT lymph nodes,nodules distribution,and disease course.Conclusion:Serum TSH can be used to identify the nature(benign and malignant)of thyroid nodules,and enhanced CT is better than ultrasound when evaluating complex lesions.It can be used as a supplement to ultrasound based on clinical context.
文摘Objective: The purpose of this study was to investigate the effect of Hashimoto’s thyroiditis on efficacy of <sup>131</sup>I ablation in intermediate- and high-risk of thyroid papillary carcinoma patients. The findings will help to develop a personalized treatment plan for patients with thyroid papillary carcinoma complicated with Hashimoto’s thyroiditis. Material and Methods: From January 2016 to December 2020, patients who were diagnosed with intermediate- and high-risk PTC with lymph node metastasis were analyzed retrospectively, excluding patients with incomplete clinical data, distant metastasis, positive TGAb, TSH Results: A total of 525 patients (166 males and 359 females) were included in the study, including 368 patients in ER group (70.1%) and 157 patients in NER group (29.9%). Eleven factors including combining Hashimoto’s thyroiditis, pre-ablative Tg levels, sex, tumor diameter, extraglandular invasion, multifocal, bilateral lesions, central lymph node metastasis, lateral lymph node metastasis, lymph node metastasis rate, thyroglobulin were statistically different between ER group and NER group with significance at P Conclusion: Hashimoto’s thyroiditis, Ps-Tg level and lateral lymph node metastasis are potential predictors for short-term efficacy of <sup>131</sup>I treatment in intermediate- and high-risk thyroid papillary carcinoma. Hashimoto’s thyroiditis, high Ps-Tg level and increased number of lateral lymph node metastasis reduce the efficacy of <sup>131</sup>I therapy in patients with intermediate and high risk thyroid papillary carcinoma.
基金grants from the National Natural Science Foundation of China (No. 81672400, and No. 81702364)the Natural Science Foundation of Jiangsu Provincial Department of Education (No. BK20171085)。
文摘Background:Accumulating evidence has revealed that circulating microRNAs(miRNAs)can serve as non-invasive biomarkers for cancer diagnosis.This study aimed to identify differentially expressed miRNAs in serum which might become potential biomarkers for non-invasive diagnosis of papillary thyroid carcinoma(PTC).Methods:The experiment was carried out between 2015 and 2017.In the screening stage,the Exiqon miRNA quantitative real-time polymerase chain reaction(qPCR)panel was applied to select candidate miRNAs.In the following training,testing,and external validation stages,the serum samples of 100 patients and 96 healthy controls(HCs)were analyzed to compare the expression levels of the identified miRNAs.The areas under the receiver operating characteristic curves(AUCs)were calculated to assess the diagnostic value of the identified signature.Results:Three miRNAs(miR-25-3p,miR-296-5p,and miR-92a-3p)in serum were consistently up-regulated in PTC patients compared with HCs.A three-miRNA panel was constructed by logistic regression analysis and showed better diagnostic performance than a single miRNA for PTC detection.The AUCs of the panel were 0.727,0.771,and 0.862 for the training,testing,and external validation stage,respectively.Meanwhile,the panel showed stable capability in differentiating PTC patients from patients with benign goiters,with an AUC as high as 0.969.For further exploration,the three identified miRNAs were analyzed in tissue samples(23 PTC vs.23 HCs)and serum-derived exosomes samples(24 PTC vs.24 HCs),and the altered expression in the tumor also indicated their close relationship with PTC disease.Conclusion:We identify a three-miRNA panel in serum which might serve as a promising biomarker for PTC diagnosis.
基金This study was supported by grants from the National Natural Science Foundation of China(Grant No.81602926)the Tianjin Key Research and Development Program Science and Technology Support Key Projects(Grant No.17YFZCSY00690)the Shanghai Health and Family Planning Commission Intelligent Medical Research Project(Grant No.2018ZHYL0202).
文摘Active surveillance(AS)can be considered as a treatment strategy for low risk papillary thyroid microcarcinoma(PTMC),with the absence of clinically apparent lymph nodes,extrathyroidal extensions,and distant metastasis.After reviewing the reports on AS of low risk PTMCs worldwide,we introduced AS,and discussed the selection criteria for active surveillance candidates based on different guidelines and the follow-up schedules.Moreover,the requirement of cytological diagnosis,progression evaluation methods,necessity of thyrotropin suppression,and medical costs were issues that both clinicians and patients considered.The usefulness of AS for low risk PTMC patients depended on accurate and confidential evaluation of patient risk.Clinicians may adopt measures like dynamic monitoring,risk stratification,and making personal follow-up schedules to minimize these potential risks.By appropriately selecting PTMC patients,AS can be an effective alternative treatment to immediate surgery.
基金The work was supported by grants from the National Natural Science Foundation of China(Grant No.81760142)the Construction Project of Clinical Research Centre of General Surgical Disease in Yunnan Province(Grant No.2X2019-03-03)the“Ten Thousand People Plan”of Yunnan ProvinceMedical Experts Project(Grant No.RLCRC20210412).
文摘Due to exponential increases in incidences,low risk papillary thyroid microcarcinoma(PTMC)has become a clinical and social issue in recent years.An active surveillance(AS)management approach is an alternative to immediate surgery for patients with low risk PTMC.With decreased doubts about the safety and validity due to evidence from a large number of studies,the AS approach has become increasingly popular worldwide.However,Chinese thyroid surgeons still lag behind other countries in their knowledge of clinical practices and research related to AS.To promote the implementation of AS in China,thyroid surgeons should understand the implications,advantages,and disadvantages of management approaches for AS,and should also consider the willingness of Chinese patients,the impact on the medical billing system,and the enthusiasm of doctors.Thus,a management approach for AS based on the Chinese population should be developed to reduce the risk of disease progression and enhance patient adherence.Herein,we summarize the recent research achievements and deficiencies in AS approaches,and describe the initial experiences regarding AS in the Chinese population,in order to assist Chinese thyroid surgeons in preparing for AS management in the era of PTMC precision medicine.
文摘Objective: To investigate the risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC).Methods: A retrospective analysis of 209 patients with PTC who underwent primary surgery at the Beijing Friendship Hospital affiliated with Capital Medical University from November 2014 to November 2018 was performed. The patients were divided into the LLNM group and the non-LLNM group. The clinical and pathological characteristics of the patients were analysed. The risk factors for LLNM were analysed by univariate and multivariate analyses.Results: The incidence of LLNM was 13.4% in PTC patients. Univariate analysis showed that the maximum diameter of the primary tumour > 2 cm (P < 0.001), bilateral primary tumour (P= 0.020), extrathyroidal extension (ETE) (P < 0.001), central lymph node metastasis (CLNM) (P < 0.001), and CLNM number ≥ 5 (P < 0.001) were significantly associated with LLNM. Multivariate logistic regression analysis showed that the maximum diameter of the primary tumour > 2 cm, ETE, and CLNM were independent risk factors for LLNM (OR values were 3.880, 5.202, and 4.474, respectively). There were 6 patients with skip lateral cervical lymph node metastasis, accounting for 21% of all LLNM patients.Conclusion: This study revealed several independent risk factors for predicting LLNM in PTC patients, such as the maximum diameter of the primary tumour > 2 cm, ETE and CLNM. Lateral neck dissection may be recommended in PTC patients with those risk factors. Paying attention to the occurrence of skip lateral cervical lymph node metastasis during the clinical diagnosis and treatment processes is necessary.
基金Fund Project:General Program of Natural Science Foundation of Liaoning Province(No.2015020390)General Program of National Natural Science Foundation of China(No.81874441)。
文摘Objective: To clarify the inhibitory mechanism of Haizao Yuhu Decoction on BRAFV600E mutation-driven papillary thyroid carcinoma cells. Methods: Prepare seaweed Yuhu Decoction medicated serum, select human normal thyroid cells Nthy-ori3-1 as the normal control group, and PLX4032 as the positive control drug. The experiment was divided into normal control group, model control group, PLX4032 group, Haizao Yuhu Decoction group (referred to as HYD group), Haizao Yuhu Decoction group + PLX4032 (referred to as HYD+PLX4032 group), and high iodine water group, at 8h and 24h respectively. At 72h, the cell proliferation of each group was detected by MTT method;at 24h, the expression of ERK and p-ERK protein in each group was detected by Western blot. Results: The longer the time, the more obvious the inhibitory effect of Haizao Yuhu Decoction-containing serum on the proliferation activity of BCPAP cells: Compared with the normal control group, the BCPAP cell proliferation activity of the model control group was significantly enhanced at 24h and 72h (P <0.05);At 24h, the PLX4032 group, HYD group, and HYD+PLX4032 group all showed a tendency to inhibit the proliferation of BCPAP cells, but there was no statistical difference;at 72h, compared with the model control group, the PLX4032 group The cell proliferation activity of the HYD group and HYD+PLX4032 group was significantly inhibited (P <0.05), and there was no difference between the high iodine water group and the model control group (P>0.05). In inhibiting the proliferation of BCPAP cells, the medicated serum of Shanghai Zaoyuhu Decoction has a synergistic effect with PLX4032 (F=10.87, P=0.005). Western blot results showed that there was no difference in the expression of ERK1/2 protein between the groups, but there were significant differences in the expression of p-ERK1/2 protein between the groups: Compared with the normal control group, the expression of p-ERK1/2 protein in the model group increased significantly (P < 0.05);Compared with the model control group, the expression of p-ERK1/2 protein in the PLX4032 group, the HYD group, and the HYD+PLX4032 group decreased significantly (P <0.05), and there was no difference between the high iodine water group and the model control group (P> 0.05). Conclusion: The medicated serum of Haizao Yuhu Decoction has an inhibitory effect on the proliferation of BCPAP cells, and its mechanism may be inhibiting the proliferation of BCPAP cells by inhibiting ERK1/2 protein phosphorylation, a protein post-translational modification process;the medicated serum of Haizao Yuhu Decoction may have Help enhance the effect of PLX4032 curative effect.
