超声及血清CK-19、Galectin-3、miRNA-363联合诊断PTMC颈部淋巴结转移的临床价值

目的 研究超声及血清细胞角蛋白19(CK-19)、半乳糖凝集素3(Galectin-3)及微小核糖核酸-363(miRNA-363)联合诊断甲状腺微小乳头状癌(PTMC)颈部淋巴结转移(CLNM)的临床价值。方法 回顾性选取2021年7月至2023年6月在天津市环湖医院诊断的PTMC患者92例纳入研究组,选择同期本院收治的结节性微小甲状腺肿患者92例纳入对照组。观察两组病灶情况及超声特点;比较两组血清CK-19、Galectin-3、miRNA-363水平,研究组是否发生CLNM患者病灶超声特点及血清CK-19、Galectin-3、miRNA-363水平。分析PTMC~CLNM超声特点与血清CK-19、Galectin-3、miRNA-363水平的相关性。结果 研究组多枚病灶、病灶>0.5 mm、病灶纵横比≥1、病灶形态不规则、病灶边缘模糊、病灶微钙化、病灶低回声、淋巴结肿大占比分别为70.65%、71.74%、82.61%、61.96%、72.83%、80.43%、84.78%、70.65%,均大于对照组(31.52%、52.17%、27.17%、25.00%、19.57%、15.22%、66.30%、22.83%),差异均有统计学意义(P<0.05)。研究组血清CK-19、Galectin-3水平分别为(30.45±3.31)、(4.68±0.48)μg/L,均高于对照组[(7.05±0.73)、(1.72±0.19)μg/L],血清miRNA-363水平为(2.89±0.30) fmol/L,低于对照组[(4.30±0.46) fmol/L],差异均有统计学意义(P<0.05)。研究组发生CLNM患者多枚病灶、病灶形态不规则、病灶边缘模糊、病灶微钙化、淋巴结肿大占比分别为90.91%、86.36%、95.45%、100.00%、90.91%,均大于未发生CLNM患者(64.29%、54.29%、0、25.00%、64.29%),差异均有统计学意义(P<0.05)。研究组发生CLNM患者血清CK-19、Galectin-3水平(41.20±4.42)、(5.94±0.62)μg/L,均高于未发生CLNM患者[(24.36±2.71)、(3.25±0.34)μg/L],血清miRNA-363水平为(2.14±0.23) fmol/L,低于未发生CLNM患者[(3.46±0.36) fmol/L],差异均有统计学意义(P<0.05)。经Pearson相关分析,CLNM患者多枚病灶、病灶形态不规则、病灶边缘模糊、淋巴结肿大及血清CK-19、Galectin-3、miRNA-363水平均与CLNM呈正相关(P<0.05)。结论 超声及血清CK-19、Galectin-3、miRNA-363联合诊断PTMC~CLNM具有较高的临床价值。

Comparative study on operative trauma between microwave ablation and surgical treatment for papillary thyroid microcarcinoma

AIM To compare the effect and postoperative trauma of ultrasound-guided percutaneous microwave ablation and surgical resection in the treatment of papillary thyroid microcarcinoma(PTMC).METHODS Eighty-seven patients with PTMC treated at Fudan University affiliated Shanghai Fifth People's Hospital were enrolled as subjects. The patients were divided into a microwave ablation group(41 cases) and a surgical group(46 cases). The operative time, intraoperative blood loss, length of hospital stay, serum C-reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor-α(TNF-α), thyroid-related hormonal changes, and complications 7 d and 30 d after surgery were observed. RESULTS The operative time, intraoperative blood loss, and length of hospital stay in the surgical group were significantly higher than those in the microwave ablation group(P < 0.05). The levels of CRP, IL-6, and TNF-α in the surgical group were significantly higher than those in the microwave ablation group(P < 0.05). The free triiodothyronine(FT3) and free thyroxin(FT4) levels in the surgical group were significantly lower than those in the microwave ablation group(P < 0.05). However,the postoperative thyroid stimulating hormone(TSH)level was significantly higher than that in the microwave ablation group(P < 0.05). There were significant interactions between the FT3, FT4, and TSH 7 d and 30 d after operation and the treatment methods(P < 0.05).There was no significant difference in the complications between the two groups(P > 0.05). CONCLUSION Microwave ablation for papillary microcarcinoma of the thyroid gland has less trauma to the body, quicker recovery, and no scars. It can effectively shorten the length of hospital stay and improve the quality of life of patients.

Predictive factors for central lymph node metastases in papillary thyroid microcarcinoma

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.

BRAF^(V600E) Mutation and Its Association with Clinicopathological Features of Papillary Thyroid Microcarcinoma: A Meta-Analysis

Summary： Recent studies have demonstrated that the BRAFv600E mutation is associated with aggres- sive clinicopathological features of papillary thyroid carcinoma （PTC）. However, the BRAF mutation as a prognostic biomarker in papillary thyroid microcarcinoma （PTMC） is unclear. A systematic search of the electronic databases, including Medline, Scopus, CNKI and the Cochrane Library was performed up to July 1, 2014. Outcomes of interest included age, gender, concomitant hashimoto thyroiditis or nodular goiter, tumor size, pathological stage, tall cell variant of PTMC （TCVPTMC）, multifocality, extrathyroidal extension （ETE） and lymph node metastasis （LNM）. A total of 19 studies published from 2008 to 2014 comprising 2253 patients fulfilled the inclusion criteria and were in- cluded in the meta-analysis, and 1143 （50.7%） of these patients were BRAF mutation positive. BRAF mutation was associated with larger tumor size （OR： 1.64; 95% CI： 1.16-2.32）, multifocality （OR： 1.58; 95% CI： 1.25-2.00）, ETE （OR： 2.59; 95% CI： 2.03-3.29）, LNM （OR： 1.73; 95% CI： 1.14-2.62）, advanced stage （OR： 2.03; 95% CI： 1.14-3.64） and TCVPTMC （OR： 5.07; 95% CI： 1.49-17.27; P=0.009）. Additionally, the BRAF mutation was found to be not associated with age, gender, con- comitant hashimoto thyroiditis or nodular goiter （P〉0.05 for all）. This meta-analysis revealed that in patients with PTMC, BRAF mutation is associated with tumor size, multifocality, ETE, LNM, ad- vanced stage and TCVPTMC, and it may be used as a predictive factor for prognosis of PTMC.

Active surveillance as a management strategy for papillary thyroid microcarcinoma

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.

The active surveillance management approach for patients with low risk papillary thyroid microcarcinomas: is China ready?

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.

2016 Chinese expert consensus and guidelines for the diagnosis and treatment of papillary thyroid microcarcinoma

The incidence of papillary thyroid carcinoma(PTC)has exponentially increased in recent years.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of the reported cases of PTC.The debates and crucial issues in PTMC management have received researchers'attention.To further improve the clinical management of PTMC in China,

Thermal ablation for papillary thyroid microcarcinoma: Some clarity amid controversies

The increasing incidence of papillary thyroid microcarcinoma(PTMC)has become a global challenge.Because of its indolent nature,active surveillance(AS)has been proposed as a treatment option in selected PTMC patients to prevent surgery-related complications.However,only a few patients with PTMC receive the AS approach because of the serious psychological burden following the“cancer”diagnosis and the uncertainty of the timing for metastatic dissemination.Ultrasound(US)-guided thermal ablation can bridge the gap in the treatment options of PTMC patients who wish for a minimally invasive management approach.However,it has acquired only marginal attention from the thyroid guideline societies because of concerns regarding incomplete elimination.The recently published guidelines from the European Thyroid Association-Cardiovascular and Interventional Radiological Society of Europe and the American Head Neck Society Endocrine Section-initiated global consensus provide the most definitive evidence and essential foundational experience to address the long-term controversy over USguided thermal ablation for low-risk PTMC patient management and facilitate the responsible global dissemination of minimally invasive strategies.

Hepatopulmonary metastases from papillary thyroid microcarcinoma:A case report

BACKGROUND Papillary thyroid carcinoma(PTC)is the most common endocrine malignancy.Papillary thyroid microcarcinoma(PTMC)accounts for the majority of PTC cases.However,concurrent pulmonary and hepatic metastases of PTMC are rarely seen.Here,we present a patient with coexisting liver and lung metastases from PTMC.CASE SUMMARY We describe a 26-year-old woman with PTMC with multiple concurrent metastases.After 3 d of unexplained fever,she was admitted to our hospital.Her thyroid functional tests were abnormal.Her positron emission tomography(PET)/magnetic resonance imaging(MRI)examination showed increased fluorodeoxyglucose(FDG)metabolism and space-occupying lesions in the left lobe of the thyroid.Additionally,PET/MRI images revealed multiple nodules in the lung and liver with increased FDG metabolism.Chest computer tomography(CT)showed multiple pulmonary metastases.Abdominal ultrasound and liver MRI showed multiple space-occupying lesions in the liver.The patient underwent total thyroidectomy and central lymph node dissection.Postoperative pathological analysis showed a papillary microcarcinoma multiplex in the left lobe of the thyroid.A diagnosis of hepatopulmonary metastases from papillary thyroid microcarcinoma was made.The patient was given iodine-131 treatment one year after the surgery.She recovered well after the operation,and the incision healed well.After discharge,she was treated with oral levothyroxine sodium tablets,and symptomatic and supportive treatments were also given to promote radioactive excretion and prevent bone marrow suppression by iodine-131 treatment.CONCLUSION Since patients with thyroid cancer concurrent with hepatopulmonary metastases have rarely been reported,our case will highlight the clinical and pathological profiles of these patients.

Clinical significance of BRAF^(V600E) and TERT promoter mutation in papillary thyroid microcarcinoma

Objective The objective of this study was to analyze the correlation between BRAF^(V600E) and TERT promoter mutations and papillary thyroid microcarcinoma (PTMC) risk factors, and their importance in the risk assessment of papillary thyroid microcarcinoma.Methods This study retrospectively analyzed 107 cases of PTMC, which were diagnosed after the surgery in the department of head and neck surgery in Gansu Province Tumor Hospital from October 2014to June 2016. The mutations of BRAFV^(600E) and TERT promoter were detected by PCR direct sequencing.We analyzed the data usingχ~2 test and binary Logistic regression analysis.Results Among 107 patients with PTMC, the BRAFV^(600E) and TERT promoter mutation rates were 68.2%and 11.2%, respectively. Single factor analysis showed that there was a significant difference between the presence of membrane invasion, lymph node metastasis, and BRAFV^(600E) mutations (P<0.01). The age,gender, thyroid capsular invasion, poor pathologic subtype, and lymph node metastasis of patients, was significantly associated with the TERT promoter mutation (P<0.05) and the coexistence of the BRAF^(V600E)and TERT promotor mutations; although, there was a difference between the association of these factors with the TERT promoter mutation and the association of these factors with the coexistence of the BRAF^(V600E)and TERT promotor mutations. The multifactorial analysis showed that the factors closely related to the BRAFV^(600E) mutation included capsular invasion (P=0.012) and lymph node metastasis (P=0.000). The following factors were closely associated with the TERT promoter mutant:male (P=0.004), aged <45 years(P=0.026), capsular invasion (P=0.004), pathological subtype (P=0.030), and lymph node metastasis (P=0.043). The following factors were closely related to the simultaneous mutation of BRAFV^(600E) and TERT:male (P=0.022), capsular invasion (P=0.023), poor pathological subtype (P=0.041), and lymph node metastasis (P=0.030).Conclusion The risk of recurrence increases significantly when mutations in BRAFV^(600E) and TERT promoters occur simultaneously in PTMC and may have adverse outcomes. Combined detection of BRAFV^(600E) and TERT promoter mutations is of great value in risk assessment of PTMC.

Active surveillance in low risk papillary thyroid carcinoma

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.

Current Understanding of Papillary Thyroid Carcinoma

The term thyroid neoplasm incorporates tumors that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic thyroid carcinoma (ATC). PTC tends to have an indolent clinical course with low morbidity and mortality. However, this entity has a broad range of biological and clinical behavior that can result in disease recurrence and death, depending on patient and tumor characteristics and the initial treatment approach. PTC is the most common form of well-differentiated thyroid cancer (WDTC) and based on the most recent statistics, accounts for approximately 89.4% of all thyroid malignancies. PTC appears as an irregular solid or cystic nodule in normal thyroid parenchyma. PTC has the propensity for lymphatic invasion, but it is less likely to have hematogenous spread. Around 11% of patients with PTC present with distant metastases outside the neck and mediastinum. This manuscript with review the current understanding of the epidemiology, pathology, molecular characteristics, prognostic factors, and dynamic risk stratification of PTC centered on an evidence-based and personalized approach.

基于1190例PTMC的中央区淋巴结转移的危险因素分析

目的:分析经手术切除并行中央区淋巴结清扫的1190例甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)患者的超声影像特征和临床特征数据,探讨中央区淋巴结转移和PTMC超声特征参数及临床特征参数之间的相关性。方法:选取2018年1月—2020年12月因PTMC在北京大学深圳医院住院并行外科手术的患者共1190例,回顾性分析术前甲状腺彩超等资料,以手术病理结果为金标准,分析PTMC的超声特征以及临床参数和中央区淋巴结转移之间的关系。结果:年龄、男性、多灶、肿瘤突破包膜、点状钙化、未合并结节性甲状腺肿均是PTMC部中央区淋巴结转移的独立危险因素,建立危险因素的Logistic回归模型,据此模型,计算出四个危险因素的回归系数差异、该模型的似然比检验结果差异均有统计学意义,分析ROC曲线得出,以0.312为模型最佳诊断截断值时,曲线下面积为0.709,模型诊断效能最高,敏感度、特异度和约登指数分别为0.625、0.687、0.312。结论:年龄、男性、多灶、肿瘤突破包膜、有点状钙化、未合并结节性甲状腺肿均是PTMC颈部中央区淋巴结转移的独立危险因素,通过该模型可有效预测PTMC颈部中央区淋巴结转移风险。

超声弹性成像技术联合血清TSH检测对PTMC的诊断价值

目的 研究超声弹性成像技术联合血清促甲状腺激素(TSH)检测对甲状腺微小乳头状癌(PTMC)的诊断价值。方法 选取2020年3月至2021年2月普宁市人民医院收治的50例行手术治疗的甲状腺微小结节患者作为观察组,另选取50例同期健康体检者作为对照组。两组受检者均行超声弹性成像技术检查,同时采用化学发光法(CL)检测血清TSH水平,以术后病理诊断作为金标准,采用受检者工作特征曲线(ROC)确定TSH水平最佳截点,分析超声弹性成像技术联合血清TSH诊断PTMC的敏感度、特异度,并比较所有受检者的血清TSH水平、良性和恶性结节的弹性成像评分。结果 观察组患者经术后病理检查共检出137个结节,其中良性结节80个,恶性结节57个,超声弹性成像技术检出111个结节,其中65个良性结节,46个恶性结节,检出率为81.02%,与病理结果具有较高一致性。良性结节的超声弹性成像评分为(1.47±0.11)分,明显低于恶性结节的(3.19±0.26)分,差异有统计学意义(P<0.05);观察组中恶性结节患者的血清TSH水平为(2.91±0.24) mIU/L,良性结节患者为(2.28±0.33) mIU/L,明显高于对照组的(1.83±0.35) mIU/L,且与良性结节患者比较,恶性结节患者水平明显更高,差异均有统计学意义(P<0.05);经ROC分析结果显示,血清TSH联合超声弹性成像检测诊断PTMC的TSH最佳截点水平为2.16 mIU/L,其曲线下面积、检测敏感度、特异度以及约登指数均明显高于单独检测,差异均有统计学意义(P<0.05)。结论 超声弹性成像技术联合血清TSH检测诊断PTMC有较高临床价值,且联合诊断的价值更高,可将其作为诊断PTMC的重要指标和技术。

CircRNA_000121在伴有颈部淋巴结转移的甲状腺微小乳头状癌中的表达

目的 研究伴有颈部淋巴结转移的甲状腺微小乳头状癌(Papillary thyroid microcarcinoma, PTMC)中circRNA_000121表达情况。方法 以2022年1-4月在新疆医科大学第一附属医院血管甲状腺外科住院的60例患者作为研究对象。其中,PTMC伴有颈部淋巴结转移(中央区)[PTMC(L)组]患者30例,PTMC不伴有淋巴结转移(PTMC组)患者30例。收集所有患者术前外周血标本、术中甲状腺癌组织及一般资料。通过qRT-PCR检测2组患者血液和组织标本circRNA_000121、miR-146b-3p和MMP2的表达量。采用受试者工作特征曲线(ROC)分析circRNA_000121对甲状腺微小乳头状癌是否伴有颈部淋巴结转移的诊断价值。采用二分类Logistic回归分析circRNA-000121与miR-146b-3p、miR-146b-3p与MMP2在PTMC外周血标本、组织标本中的表达水平与淋巴结转移的相关性。结果 qRT-PCR结果显示,与PTMC组患者比较,PTMC(L)组患者的外周血和组织标本中circRNA_000121、MMP2呈高表达,miRNA-146b-3p呈低表达,差异有统计学意义(P均<0.05)。经ROC分析结果显示,外周血曲线下面积(AUC)为0.964,置信区间(95%CI)0.915~1.000,灵敏度0.933,特异度1.000;组织标本AUC为0.943,置信区间(95%CI)0.874~1.000,灵敏度0.900,特异度0.967。二分类Logistic回归分析结果显示,circRNA_000121、miRNA-146b-3p、MMP2在外周血和癌组织中的表达均与淋巴结转移相关,差异有统计学意义(P<0.05)。结论 CircRNA_000121在PTMC(L)患者甲状腺癌组织标本中呈高表达,与外周血表达一致,circRNA_000121在PTMC发生淋巴结转移预测方面有一定作用,其有望成为PTMC发生颈部淋巴结转移的生物学标记物。

基于超声造影特征构建列线图预测甲状腺微小乳头状癌颈淋巴结转移风险

目的通过分析甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)患者临床资料、结节超声和超声造影(contrast-enhanced ultrasound,CEUS)特征建立预测颈淋巴结转移(lymph node metastasis,LNM)风险的列线图模型,为合理规范的临床决策提供依据。方法回顾性分析2020年12月1日至2021年12月31日在新疆医科大学第一附属医院行甲状腺手术治疗的PTMC患者404个结节临床资料,应用随机函数按照7∶3分为建模组(n=282)与验证组(n=122)。应用Logistic回归分析筛选PTMC颈淋巴结转移的独立相关因素,构建列线图,以曲线下面积(area under curve,AUC)评估模型诊断效能,应用验证组数据进行外部验证。结果构建模型显示结节边缘、声晕、多灶性、包膜下生长或侵犯包膜、消退模式是颈淋巴结转移的危险因素(P<0.05);建模组AUC为0.747(0.690~0.804),最佳cut-off值为0.430,灵敏度0.65,特异度0.73;验证组AUC为0.778(0.697~0.860),最佳cut-off值为0.419,灵敏度0.64,特异度0.81。结论本研究构建的列线图可个体化预测PTMC颈淋巴结转移的风险,超声和超声造影特征有助于指导高风险人群的临床决策。

单发甲状腺微小乳头状癌颈部淋巴结转移的危险因素分析

目的:探讨影响单发甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素。方法:回顾性分析经手术和病理证实的单发PTMC病人癌结节的超声特征和颈部淋巴结转移的关系,并分析PTMC颈部淋巴结转移的危险因素。结果:119例PTMC病人中,无颈部淋巴结转移者86例(72.3%),颈部淋巴结转移者33例(27.7%)。观察组男性比例高于对照组(P<0.05),年龄明显低于对照组(P<0.01)。PTMC结节的超声特征中,2组癌结节最大径、血流丰富、突破包膜差异均有统计学意义(P<0.01)。logistic回归分析显示,年龄、癌结节最大径、突破包膜是PTMC颈部淋巴结转移的危险因素(P<0.01)。ROC曲线分析显示,年龄预测PTMC颈部淋巴结转移的诊断截点为43.5岁,AUC为0.769(95%CI:0.669~0.869),敏感度为66.7%,特异度为80.2%;癌结节最大径预测PTMC颈部淋巴结转移的诊断截点为6.5 mm,AUC为0.801(95%CI:0.719~0.882),敏感度为81.8%,特异度为66.3%。结论:PTMC病人的年龄、部分超声特征和颈部淋巴结转移存在一定相关性,对PTMC的临床治疗有一定参考作用。

男性甲状腺微小乳头状癌临床特点及中央区淋巴结转移危险因素分析

目的分析男性甲状腺微小乳头状癌的临床特点,并探讨其发生中央区淋巴结转移的危险因素。方法回顾分析2018年1月—2022年12月我科收治的首次手术治疗的甲状腺微小乳头状癌患者共743例,男性152例作为研究组,女性591例作为对照组,比较2组患者的临床病理资料,并使用单因素和多因素统计学方法分析男性甲状腺微小乳头状癌患者中央区淋巴结转移的危险因素。结果2组患者年龄、肿瘤最大径、肿瘤多灶性、肿瘤分布及颈侧区淋巴结转移差异均无统计学意义(P值均>0.05),2组患者肿瘤包膜侵犯、合并桥本甲状腺炎及中央区淋巴结转移情况差异均具有统计学意义(P值均<0.01)。单因素分析显示肿瘤最大径>5 mm、多灶、双侧分布、有包膜侵犯为男性甲状腺微小乳头状癌患者中央区淋巴结转移的危险因素,二元logistic多因素回归分析显示肿瘤最大径>5 mm、包膜侵犯为男性甲状腺微小乳头状癌患者发生中央区淋巴结转移的独立危险因素。结论相对于女性甲状腺微小乳头状癌患者,男性甲状腺微小乳头状癌患者更易出现包膜侵犯,中央区淋巴结转移率更高。临床对于肿瘤最大径>5 mm、有包膜侵犯的男性甲状腺微小乳头状癌患者要尤为重视中央区淋巴结的清扫。

单侧多灶性甲状腺微小乳头状癌颈部淋巴结转移预测因素的临床分析

目的 探讨单侧多灶性甲状腺微小乳头状癌颈部淋巴结转移的预测因素。方法 回顾性分析2010年1月至2020年1月哈尔滨医科大学附属二院收治的458例单侧多灶性甲状腺微小乳头状癌的临床数据。通过单因素和多因素logistic回归分析颈部中央区和颈侧区淋巴结转移的危险因素。结果 单因素分析表明,颈部中央区淋巴结转移情况在肿瘤直径和、腺体外侵袭和桥本氏甲状腺炎方面比较,差异均具有统计学意义(均P<0.05)。颈侧区淋巴结转移情况在肿瘤最大直径、肿瘤直径和以及中央区淋巴结转移方面比较,差异均具有统计学意义(均P<0.01)。多因素分析表明,桥本氏甲状腺炎是中央区淋巴结转移的独立危险因素(P<0.01);肿瘤直径和以及中央区淋巴结转移是颈侧区淋巴结转移的独立危险因素(均P<0.01)。结论单侧多灶性甲状腺微小乳头状癌中,桥本氏甲状腺炎是中央区淋巴结转移的独立危险因素,肿瘤直径和以及中央区淋巴结转移是颈侧区淋巴结转移的独立危险因素。

微小甲状腺乳头状癌组织中Ⅲ类β-微管蛋白表达与临床病理特征的关系

目的探究微小甲状腺乳头状癌组织中Ⅲ类β-微管蛋白(TUBB3)表达与临床病理特征的关系。方法收集2016年8月—2018年12月本院手术治疗留取的100例微小甲状腺乳头状癌组织及100例结节性甲状腺肿组织标本,采用免疫组化法检测TUBB3、E-钙黏蛋白(ECAD)和波形蛋白(VIMENTIN)表达情况,分析TUBB3与ECAD、VIMETIN表达及甲状腺微小乳头状癌(PTMC)临床病理特征的关系。结果微小甲状腺乳头状癌组织中TUBB3、VIMENTIN阳性表达率明显高于结节性甲状腺肿组织,ECAD阳性表达率明显低于结节性甲状腺肿组织(P<0.05);Pearson相关性分析显示,微小甲状腺乳头状癌组织中TUBB3表达与ECAD呈负相关,与VIMENTIN呈正相关(P<0.001);存在淋巴结转移、神经侵犯、脉管侵犯、被膜侵犯及肿瘤出芽率高患者TUBB3表达阳性率高于无淋巴结转移、神经侵犯、脉管侵犯、被膜侵犯及肿瘤出芽率低者(P<0.05);经术后3年随访,TUBB3阳性表达患者无疾病生存率低于TUBB3阴性表达者(P<0.05);多因素Cox比例风险回归分析结果显示,存在被膜侵犯、高肿瘤出芽率和TUBB3阳性表达是PTMC患者预后的独立危险因素(P<0.05)。结论TUBB3在微小甲状腺乳头状癌组织中表达升高,可能作用于上皮-间质转化过程促进肿瘤转移复发,影响预后。