Papillary thyroid microcarcinoma(PTMC)measures 1 cm or less in its longest dimension.The incidence of PTMC is increasing worldwide.Surgery is the primary treatment;however,prophylactic central lymph node dissection is...Papillary thyroid microcarcinoma(PTMC)measures 1 cm or less in its longest dimension.The incidence of PTMC is increasing worldwide.Surgery is the primary treatment;however,prophylactic central lymph node dissection is controversial,and discrepancies between different guidelines have been noted.Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis,while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients.To selectively perform prophylactic lymph node dissections in high-risk patients,it is important to identify predictive factors for lymph node metastases in patients with PTMC.Several studies have reported on this,but their conclusions are not entirely consistent.Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases,and the most commonly reported factors include age,gender,tumor size and location,multifocality,bilaterality,extrathyroidal extension,and abnormal lymph node found using ultrasound.Here,we provide an overview of previous studies along with a favorable opinion on or against these factors,with the aim of increasing the understanding of this topic among the medical community.In addition,current opinions about prophylactic central lymph node dissection are reviewed and discussed.展开更多
Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-r...Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,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: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determ...Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determine the number of the lymph nodes in the CLND and the relationship to presence of chronic lymphocytic thyroiditis (CLT) and thymic tissue (TT). Methods: Total thyroidectomy and CLND materials from 153 patients with PTC were included in this study. Two histopathologic features (presence of CLT and TT) were evaluated for their value in adequacy of CLND. Results: Histopathologic examination revealed CLT and TT in CLND materials in 70 (46%) and 63 (41%) patients, respectively. Total number of lymph nodes in CLND materials was significantly higher in CLT (+) and TT (+) groups (p Conclusions: Our study demonstrates that presence of CLT in thyroid gland has been associated with higher number of central lymph nodes mainly due to increased number of benign hyperplastic lymph nodes. It may be possible to conclude that upper limit of lymph nodes for satisfactory CLND would be higher to correctly evaluate central lymph node status in existing staging systems if specimens have CLT. Results of this study also show that the presence of TT in surgical materials may represent the adequacy of CLND.展开更多
AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retr...AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.展开更多
Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver...Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced com- puted tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.展开更多
目的:以单中心资料为研究对象,建立包含超声声像图特征的甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)患者中央区淋巴结转移(central lymph node metastasis,CLNM)预测模型,以辅助临床进行术前评估、针对患者选择个体化的...目的:以单中心资料为研究对象,建立包含超声声像图特征的甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)患者中央区淋巴结转移(central lymph node metastasis,CLNM)预测模型,以辅助临床进行术前评估、针对患者选择个体化的治疗方案。方法:研究共纳入912例经术后病理学检查证实的PTC患者,收集一般情况、实验室指标和超声声像图,将其随机分为训练组(n=727)和验证组(n=185)。在训练组中研究CLNM的相关因素,采用logistic回归分析法建立预测模型,绘制列线图预测CLNM的风险,在验证组中对其效能进行验证,并利用临床决策曲线对其临床应用进行评价。结果:本研究建立了包含性别、年龄、病灶总直径(total tumor diameter,TTD)、促甲状腺激素(thyroid stimulating hormone,TSH)、钙化、病灶与甲状腺包膜的关系和桥本甲状腺炎的预测模型,在验证组和训练组中得到的曲线下面积(area under curve,AUC)分别为0.746和0.826。与术前超声相比,预测模型提高了诊断的灵敏度,并且通过临床决策曲线体现了其临床收益。结论:利用logistic回归建立的列线图预测模型,在预测PTC患者CLNM中体现出了较好的效能,能够补充超声诊断的不足。展开更多
基金Fundamental Research Funds for the Central Universities of China,No.3332019022.
文摘Papillary thyroid microcarcinoma(PTMC)measures 1 cm or less in its longest dimension.The incidence of PTMC is increasing worldwide.Surgery is the primary treatment;however,prophylactic central lymph node dissection is controversial,and discrepancies between different guidelines have been noted.Routine prophylactic central lymph node dissection may result in hypoparathyroidism and recurrent laryngeal nerve injury in some patients without lymph node metastasis,while simple thyroidectomy may leave metastatic lymph nodes in high-risk patients.To selectively perform prophylactic lymph node dissections in high-risk patients,it is important to identify predictive factors for lymph node metastases in patients with PTMC.Several studies have reported on this,but their conclusions are not entirely consistent.Several clinicopathologic characteristics have been identified as risk factors for central lymph node metastases,and the most commonly reported factors include age,gender,tumor size and location,multifocality,bilaterality,extrathyroidal extension,and abnormal lymph node found using ultrasound.Here,we provide an overview of previous studies along with a favorable opinion on or against these factors,with the aim of increasing the understanding of this topic among the medical community.In addition,current opinions about prophylactic central lymph node dissection are reviewed and discussed.
文摘Lung cancer is the most common cancer worldwide. In the United States, it causes more cancer-related deaths than the next four causes （breast cancer, prostate cancer, colon cancer, and pancreatic cancer） of cancer-related mortality combined （1）. About 30% of people have already progressed to stage III lung cancer and 40% to stage IV at the time they are diagnosed （2）. Although chest X-ray and sputum cytology, when applied in health check-ups, can identify some relatively small tumors, they are not able to lower the overall mortality （3）. More recently,
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.
文摘Background: Central lymph node dissection (CLND) for papillary thyroid carcinoma (PTC) allows correct pathologic staging of lymph nodes and planning of postoperative management. The purpose of this study was to determine the number of the lymph nodes in the CLND and the relationship to presence of chronic lymphocytic thyroiditis (CLT) and thymic tissue (TT). Methods: Total thyroidectomy and CLND materials from 153 patients with PTC were included in this study. Two histopathologic features (presence of CLT and TT) were evaluated for their value in adequacy of CLND. Results: Histopathologic examination revealed CLT and TT in CLND materials in 70 (46%) and 63 (41%) patients, respectively. Total number of lymph nodes in CLND materials was significantly higher in CLT (+) and TT (+) groups (p Conclusions: Our study demonstrates that presence of CLT in thyroid gland has been associated with higher number of central lymph nodes mainly due to increased number of benign hyperplastic lymph nodes. It may be possible to conclude that upper limit of lymph nodes for satisfactory CLND would be higher to correctly evaluate central lymph node status in existing staging systems if specimens have CLT. Results of this study also show that the presence of TT in surgical materials may represent the adequacy of CLND.
文摘AIM: To analyze the predictive factors for lymph node metastasis (LNM) in early gastric cancer (EGC). METHODS: Data from patients surgically treated for gastric cancers between January 1994 and December 2007 were retrospectively collected. Clinicopathological factors were analyzed to identify predictive factors for LNM. RESULTS: Of the 2936 patients who underwent gas-trectomy and lymph node dissection, 556 were diag-nosed with EGC and included in this study. Among these, 4.1% of patients had mucosal tumors (T1a) with LNM while 24.3% of patients had submucosal tumorswith LNM. Univariate analysis found that female gen-der, tumors ≥ 2 cm, tumor invasion to the submucosa, vascular and lymphatic involvement were significantly associated with a higher rate of LNM. On multivariate analysis, tumor size, lymphatic involvement, and tumor with submucosal invasion were associated with LNM. CONCLUSION: Tumor with submucosal invasion, size ≥ 2 cm, and presence of lymphatic involvement are predictive factors for LNM in EGC.
文摘Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon. We describe the surgical resection of a solitary para-aortic LN metastasis from HCC. A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor. He had already undergone radiofrequency ablation, transcatheter arterial chemoembolization, and percutaneous ethanol injection therapy for HCC. Despite treatment, viable regions remained in segments 4 and 8. We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver. Six months later, serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased. Enhanced com- puted tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta. Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value. There was no evidence of recurrence in other regions. Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract. Para-aortic LN metastasis from HCC was thus diagnosed. We performed lymphadenectomy. Histopathological examination revealed that the tumor was largely necrotic, with poorly differentiated HCC on its surface, which confirmed the suspected diagnosis. After 6 mo tumor marker levels were normal, with no evidence of recurrence. Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.
文摘目的:以单中心资料为研究对象,建立包含超声声像图特征的甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)患者中央区淋巴结转移(central lymph node metastasis,CLNM)预测模型,以辅助临床进行术前评估、针对患者选择个体化的治疗方案。方法:研究共纳入912例经术后病理学检查证实的PTC患者,收集一般情况、实验室指标和超声声像图,将其随机分为训练组(n=727)和验证组(n=185)。在训练组中研究CLNM的相关因素,采用logistic回归分析法建立预测模型,绘制列线图预测CLNM的风险,在验证组中对其效能进行验证,并利用临床决策曲线对其临床应用进行评价。结果:本研究建立了包含性别、年龄、病灶总直径(total tumor diameter,TTD)、促甲状腺激素(thyroid stimulating hormone,TSH)、钙化、病灶与甲状腺包膜的关系和桥本甲状腺炎的预测模型,在验证组和训练组中得到的曲线下面积(area under curve,AUC)分别为0.746和0.826。与术前超声相比,预测模型提高了诊断的灵敏度,并且通过临床决策曲线体现了其临床收益。结论:利用logistic回归建立的列线图预测模型,在预测PTC患者CLNM中体现出了较好的效能,能够补充超声诊断的不足。
