目的探讨甲状腺BethesdaⅢ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法收集356例BethesdaⅢ结节患者,对其诊断原因,ROM及亚分类进行总结分析。结果在97例手术切除标本中,72例恶性...目的探讨甲状腺BethesdaⅢ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法收集356例BethesdaⅢ结节患者,对其诊断原因,ROM及亚分类进行总结分析。结果在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),BethesdaⅢ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。BethesdaⅢ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P<0.05)。结论BethesdaⅢ类的诊断具有一定的主观性和经验性,而对BethesdaⅢ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。展开更多
目的分析细针穿刺细胞学检查(FNAC)BethesdaⅢ类甲状腺结节结合组织Galectin-3分子表达和超声造影(CEUS)在鉴别良恶性中的应用价值。方法选择行FNAC检查诊断为BethesdaⅢ类甲状腺结节患者110例(140个结节),其中男性52例,女性58例;年龄25...目的分析细针穿刺细胞学检查(FNAC)BethesdaⅢ类甲状腺结节结合组织Galectin-3分子表达和超声造影(CEUS)在鉴别良恶性中的应用价值。方法选择行FNAC检查诊断为BethesdaⅢ类甲状腺结节患者110例(140个结节),其中男性52例,女性58例;年龄25~64岁,平均年龄45.5岁。所有组织分别进行Galectin-3分子免疫组织化学染色和CEUS两项检查,诊断结节的良恶性,比较良性组和恶性组常规超声甲状腺影像报告与数据系统(TI-RADS)分级、Galectin-3表达阳性率、CEUS增强模式及CEUS定量参数。采用受试者工作特性(ROC)曲线评估鉴别恶性结节的准确度。结果经细胞病理学确诊良性组患者80例,良性结节100个;恶性组患者30例,恶性结节40个。恶性组与良性组患者性别、年龄、TI-RADS分级、结节直径比较差异无统计学意义(P>0.05)。恶性组结节Galectin-3表达阳性率显著高于良性组(60.0%vs 30.0%),CEUS增强模式以早期低增强为主,CEUS定量评估软件测量结节峰值强度(PI)值低于良性组(5.32±1.46 vs 6.79±1.88)(χ^(2)=10.853、25.239,t=4.968,P<0.05)。以Galectin-3表达阳性联合CEUS检查作为评估BethesdaⅢ类甲状腺结节良恶性的主要依据,手术病理诊断结果为金标准,得出诊断恶性结节的准确度61.82%(34/55),灵敏度85.00%(34/40),特异度79.00%(79/100),阳性预测值61.82%(34/55)和阴性预测值92.94%(79/85)。采用ROC曲线进一步验证联合Galectin-3表达阳性和CEUS检查诊断BethesdaⅢ类甲状腺结节良恶性,结果准确度为82.5%,灵敏度80.9%,特异度75.6%。结论CEUS定量检查联合结节Galectin-3分子表达能够为FNAC诊断BethesdaⅢ类甲状腺结节的良恶性质提供更加丰富的生物学信息,CEUS增强模式以早期低增强为主,Galectin-3阳性表达有助于结节恶性的判断。展开更多
AIM To assess the long-term prognostic value of vascular endothelial growth factor receptor 1(VEGFR1)and classⅢβ-tubulin(TUBB3)mRNA expression in nonmetastatic rectal cancer.METHODS A total of 75 consecutive patient...AIM To assess the long-term prognostic value of vascular endothelial growth factor receptor 1(VEGFR1)and classⅢβ-tubulin(TUBB3)mRNA expression in nonmetastatic rectal cancer.METHODS A total of 75 consecutive patients with non-metastatic rectal cancer from March 2004 to November 2008 were analyzed retrospectively at our institute.The mRNA expressions of VEGFR1 and TUBB3 were detected by multiplex branched DNA liquid-chip technology.The Cutoff Finder application was applied to determine cutoff point of mRNA expression.SPSS software version 22.0was used for analysis.RESULTS The median follow-up was 102.7 mo(range,6-153.6).Theχ~2 and Fisher’s exact tests showed that VEGFR1expression was related to lymph node metastasis(P=0.013),while no relationships between TUBB3 and clinicopathological features were observed.Univariate analysis showed that T stage,lymph node metastasis,tumor differentiation,VEGFR1 and TUBB3 mRNA expression were correlated to overall survival(OS)(P=0.048,P=0.003,P=0.052,P=0.003 and P=0.015,respectively).Also,lymph node metastasis and VEGFR1expression independently influenced OS by multivariate analysis(P=0.027 and P=0.033).VEGFR1 expression was positively correlated with TUBB3(P=0.024).The patients with low expression of both TUBB3 and VEGFR1 presented a better OS(P=0.003).In addition,the receiver operating characteristic analysis suggested that the combination of lymph node metastasis and VEGFR1 had a more favorable prognostic value(P<0.001).CONCLUSION VEGFR1 expression and lymph node metastasis independently and jointly affect survival.Moreover,low expression of VEGFR1 and TUBB3 presented a better OS in patients with non-metastatic rectal cancer,which might serve as a potential prognostic factor.展开更多
文摘目的探讨甲状腺BethesdaⅢ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法收集356例BethesdaⅢ结节患者,对其诊断原因,ROM及亚分类进行总结分析。结果在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),BethesdaⅢ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。BethesdaⅢ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P<0.05)。结论BethesdaⅢ类的诊断具有一定的主观性和经验性,而对BethesdaⅢ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。
文摘目的分析细针穿刺细胞学检查(FNAC)BethesdaⅢ类甲状腺结节结合组织Galectin-3分子表达和超声造影(CEUS)在鉴别良恶性中的应用价值。方法选择行FNAC检查诊断为BethesdaⅢ类甲状腺结节患者110例(140个结节),其中男性52例,女性58例;年龄25~64岁,平均年龄45.5岁。所有组织分别进行Galectin-3分子免疫组织化学染色和CEUS两项检查,诊断结节的良恶性,比较良性组和恶性组常规超声甲状腺影像报告与数据系统(TI-RADS)分级、Galectin-3表达阳性率、CEUS增强模式及CEUS定量参数。采用受试者工作特性(ROC)曲线评估鉴别恶性结节的准确度。结果经细胞病理学确诊良性组患者80例,良性结节100个;恶性组患者30例,恶性结节40个。恶性组与良性组患者性别、年龄、TI-RADS分级、结节直径比较差异无统计学意义(P>0.05)。恶性组结节Galectin-3表达阳性率显著高于良性组(60.0%vs 30.0%),CEUS增强模式以早期低增强为主,CEUS定量评估软件测量结节峰值强度(PI)值低于良性组(5.32±1.46 vs 6.79±1.88)(χ^(2)=10.853、25.239,t=4.968,P<0.05)。以Galectin-3表达阳性联合CEUS检查作为评估BethesdaⅢ类甲状腺结节良恶性的主要依据,手术病理诊断结果为金标准,得出诊断恶性结节的准确度61.82%(34/55),灵敏度85.00%(34/40),特异度79.00%(79/100),阳性预测值61.82%(34/55)和阴性预测值92.94%(79/85)。采用ROC曲线进一步验证联合Galectin-3表达阳性和CEUS检查诊断BethesdaⅢ类甲状腺结节良恶性,结果准确度为82.5%,灵敏度80.9%,特异度75.6%。结论CEUS定量检查联合结节Galectin-3分子表达能够为FNAC诊断BethesdaⅢ类甲状腺结节的良恶性质提供更加丰富的生物学信息,CEUS增强模式以早期低增强为主,Galectin-3阳性表达有助于结节恶性的判断。
基金Supported by Fujian Province Natural Science Foundation,Nos.2016J01437,2017J01260 and 2018J01266the Fujian Medical Innovation Project,No.2015-CX-8+1 种基金the Peking University Cancer Hospital and Institute,Key Laboratory of Carcinogenesis and Translational Research,Ministry of Education/Beijing(2017 Open Project-9)Joint Funds for the innovation of science and Technology,Fujian Province,No.2017Y9074
文摘AIM To assess the long-term prognostic value of vascular endothelial growth factor receptor 1(VEGFR1)and classⅢβ-tubulin(TUBB3)mRNA expression in nonmetastatic rectal cancer.METHODS A total of 75 consecutive patients with non-metastatic rectal cancer from March 2004 to November 2008 were analyzed retrospectively at our institute.The mRNA expressions of VEGFR1 and TUBB3 were detected by multiplex branched DNA liquid-chip technology.The Cutoff Finder application was applied to determine cutoff point of mRNA expression.SPSS software version 22.0was used for analysis.RESULTS The median follow-up was 102.7 mo(range,6-153.6).Theχ~2 and Fisher’s exact tests showed that VEGFR1expression was related to lymph node metastasis(P=0.013),while no relationships between TUBB3 and clinicopathological features were observed.Univariate analysis showed that T stage,lymph node metastasis,tumor differentiation,VEGFR1 and TUBB3 mRNA expression were correlated to overall survival(OS)(P=0.048,P=0.003,P=0.052,P=0.003 and P=0.015,respectively).Also,lymph node metastasis and VEGFR1expression independently influenced OS by multivariate analysis(P=0.027 and P=0.033).VEGFR1 expression was positively correlated with TUBB3(P=0.024).The patients with low expression of both TUBB3 and VEGFR1 presented a better OS(P=0.003).In addition,the receiver operating characteristic analysis suggested that the combination of lymph node metastasis and VEGFR1 had a more favorable prognostic value(P<0.001).CONCLUSION VEGFR1 expression and lymph node metastasis independently and jointly affect survival.Moreover,low expression of VEGFR1 and TUBB3 presented a better OS in patients with non-metastatic rectal cancer,which might serve as a potential prognostic factor.
