Expressions and clinical significances of mannose-binding lectin(MBL) and MBL-associated serine protease 2(MASP-2) in patients with thyroid neoplasm

Objective： The aim of the study was to detect the levels of mannose-binding lectin （MBL）, MBL-associated serine protease 2 （MASP-2） and explore the clinical significances of them in patients with primary thyroid neoplasms. Methods： By using ELISA method, we detected the serum levels of MBL and MASP-2 in 26 patients with papillary thyroid carcinoma （PTC）, 30 patients with thyroid adenoma （TA） and 26 healthy people, respectively. Results： Serum MBL level was （565.23 ± 76.70） μg/L in PTCs higher than （324.267 ±24.74） μg/L in TAs, and （152.69± 16.95） IJg/L in healthy of controlling group. There was statistical significance between PTC and TA （P 〈 0.05）, however there was no difference between TA and healthy （P 〉 0.05）. Serum MASP-2 level was （726.153± 78.88） pg/L in PTCs higher than （379.266 ± 30.26） μg/L in TAs, and （203.846 ± 29.09） μg/L in healthy. Serum MASP-2 level was higher in PTCs than TAs, and the difference had statistical significance （P 〈 0.01）. But no difference was observed between in TAs and healthy. Conclusion： These findings might reflect inflammatory processes induced by defense mechanisms, in response to the development of the turnout. MBL may also be involved in the elimination of possible tumourigenic pathogens.

Stem cell biology in thyroid cancer: Insights for novel therapies

Currently, thyroid cancer is one of the most common endocrine cancer in the United States. A recent involvement of sub-population of stem cells, cancer stem cells, has been proposed in different histological types of thyroid cancer. Because of their ability of self-renewal and differentiation into various specialized cells in the body, these putative cells drive tumor genesis, metastatic activity and are responsible to provide chemo- and radioresistant nature to the cancer cells in the thyroid gland. Our Review was conducted from previously published literature to provide latest apprises to investigate the role of embryonic, somatic and cancer stem cells, and discusses the hypothesis of epithelial-mesenchymal transition. Different methods for their identification and isolation through stemness markers using various in vivo and in vitro methods such as flow cytometry, thyrosphere formation assay, aldehyde dehydrogenase activity and ATP-binding cassette sub-family G member 2 efflux-pump mediated Hoechst 33342 dye exclusion have been discussed. The review also outlines various setbacks that still remain to target these tumor initiating cells. Future perspectives of therapeutic strategies and their potential to treat advanced stages of thyroid cancer are also disclosed in this review.

Serial stimulated thyroglobulin measurements are more specific for detecting distant metastatic differentiated thyroid cancer before radioiodine therapy

Objective: Preablative stimulated thyroglobulin (ps-Tg) has the potential to be used in identifying distant metastatic differentiated thyroid carcinoma (DM-DTC), but its single level can be affected by remnant thyroid tissue and thyrotropin (TSH). The objective of this retrospective study was to evaluate the value of serial ps-Tg measurements in identifying DM-DTC specifically. Methods: A total of 317 DTC patients with serial measurements of ps-Tg, TSH and anti-Tg antibody were divided into M1 (n=72) and M0 (n=245) according to the presence of distant metastasis (DM) or not. The initial psTg measurement, with a corresponding TSH exceeding 30 mu IU/mL, was marked as Tg1, and ps-Tg measured right before radioactive iodine (RAI) therapy was defined as Tg2, with a median interval of 8 days. Delta Tg denotes Tg2-Tg1, and Delta TSH denotes TSH2-TSH1. Tg1, Tg2, Delta Tg, and Delta Tg/Delta TSH were tested for efficacy in identifying DM-DTC using receiver operating characteristic (ROC) curve analysis, and further compared with chest computed tomography (CT) and posttreatment whole-body RAI scan (RxWBS). Results: Compared with single ps-Tg measurement (Tg1 or Tg2), both Delta Tg and Delta Tg/Delta TSH were more narrowly distributed around zero in the M0 group, which made their distribution in the M1 group more distinguished in a relatively dispersed way. Delta Tg/Delta TSH manifested a higher accuracy (88.64%) and specificity (90.20%) in identifying DM-DTC than Tg1 or Tg2 measurements, with a much higher specificity than chest CT (90.20% vs. 66.00%) and a much higher sensitivity than RxWBS (83.33% vs. 61.11%). Conclusions: Serial ps-Tg measurements even over as short an interval as 8 days hold incremental value in identifying DM-DTC. Delta Tg/Delta TSH is a specific early biochemical marker for DM-DTC.

Extrapleural solitary fibrous tumor of the thyroid gland: A case report and review of literature

BACKGROUND Solitary fibrous tumor(SFT)is an uncommon mesenchymal neoplasm that arises from the pleura.A few SFTs have also been described in extrapleural sites.However,SFT of the thyroid gland is rare.Here,we report a case of extrapleural SFT on the thyroid gland,in addition to a literature review.CASE SUMMARY A 59-year-old man visited our hospital in July 2017 complaining of a large mass in his neck.His thyroid function test results,including antibody levels,were within the normal limits.Ultrasonography showed a 4.7 cm×4.0 cm×3.2 cm solitary mass of intermediate suspicion in the left thyroid lobe.A fine-needle aspiration biopsy was subsequently performed.The pathologist reported a benign follicular lesion.However,the size of this nodule increased to 5.5 cm×5.0 cm×3.4 cm by April 2018.After a multidisciplinary discussion,a left lobectomy was performed in May 2018.The specimen showed a well-demarcated,partly encapsulated,soft nodule of whitish and tan/brown color on the cut surface.Light microscopy revealed high cellularity with moderate cytologic atypia.The mitotic count was 5/10 high-power fields.There was no tumor necrosis or lymphovascular invasion.The tumor was CD34-positive and signal transducer and activator of transcription 6-positive.Neither thyroid transcription factor-1 nor cytokeratin expression was detected.The Ki-67 showed intermediate proliferative activity.The final diagnosis was extrapleural SFT of the thyroid gland with a clear resection margin.The patient was discharged without complication three days after the surgery.CONCLUSION In the literature,extrapleural SFT of the thyroid gland has been reported to behave indolently with the capacity for recurrence and rare metastasis,although surgical resection is the treatment of choice.Understanding this disease entity is important for accurate diagnosis and proper management.

RAS AND p53 EXPRESSION IN HUMAN THYROID CARCINOMA

Objective: To investigate the possible interaction between the ras and p53 genes over-expression in thyroid carcinoma, and whether there is a correlation between the ras and p53 over-expression and clinicopathological criteria. Methods: Eighty patients with thyroid lesions were examined for expression of ras and p53 genes by the labeled streptavidin biotin peroxidase (LSAB) method. Of these patients, 54 were diagnosed (average age: 39.9±15.9 years) with malignant lesions. Of those included in the study, 31 has papillary carcinoma, 13 had follicular carcinoma, 7 had medullary carcinoma, 3 had undifferentiated carcinoma and 19 were stratified to stage I, 28 to stage II, 2 to stage III and 5 to stage IV according to TNM staging system. Twenty-six benign nodular thyroid disorders were studied as control. Results: Positive immunostain results for ras and p53 genes were statistically significant between thyroid carcinomas and benign disorders (90.7% vs 23%, 55.5% vs 30.7%,P<0.05). Both p53 and ras overexpressions coexisted in 30 thyroid carcinomas, and of these, 3 died and 5 had recurrences within 4 years. Conclusions: Activation of ras gene and inactivation of p53 gene were cooperatively associated in thyroid tumorigenesis. The concurrent overexpressions of ras and p53 could result in a poor prognosis.

Middle thyroid vein tumor thrombus in metastatic papillary thyroid microcarcinoma:A case report and review of literature

BACKGROUND Although papillary thyroid microcarcinoma(PTMC)is not considered a threatening tumor,in some cases,it can be aggressive.Metastatic thrombosis of papillary thyroid carcinoma,follicular thyroid carcinoma,Hürthle cell carcinoma,poorly differentiated thyroid carcinoma and anaplastic thyroid carcinoma have been reported in the literature,but there have been no reports about PTMC.CASE SUMMARY A 45-year-old woman presented with a thyroid mass and thrombosis in a middle thyroid vein during a physical examination.She had no symptoms,and the physical examination showed no positive signs.Subsequent ultrasonographyguided fine-needle aspiration biopsy results indicated an atypical lesion of ambiguous significance,with some actively growing cells(TBSRTCⅢ)and the BRAFV600E mutation not present.This patient underwent left thyroidectomy,isthmus lobectomy,prophylactic central lymph node dissection and thromboembolectomy.Postoperative pathology showed papillary microcarcinoma of the left thyroid,and the thrombus in the middle thyroid vein was a tumor thrombus.CONCLUSION Middle thyroid vein tumor thrombus is an extremely rare condition in PTMC,but it does exist.Lobectomy and thromboembolectomy may be an option for patients with thrombi in the middle vein of the thyroid,and we strongly suggest close follow-up of these patients.

血清降钙素在甲状腺髓样癌的诊断、术前评估及术后随访中的临床价值

目的探讨血清降钙素(calcitonin,Ctn)对甲状腺髓样癌(medullary thyroid carcinoma,MTC)的诊断效能,术前Ctn与临床病理特征相关性及随访中影响MTC疾病进展的危险因素。方法系统性回顾2011年11月~2022年11月南京中医药大学附属中西医结合医院收治的50例甲状腺结节患者临床资料,ROC曲线计算Ctn、癌胚抗原(carcinoembryonic antigen,CEA)水平对MTC的诊断效能,单因素、多因素分析MTC中央区淋巴结转移的危险因素,绘制无疾病进展生存曲线预测危险因素。结果ROC曲线结果显示诊断MTC的术前Ctn截断值为23.81 pg/ml,CEA截断值为3.035 ng/ml。MTC患者的患病年龄、肿瘤直径、术前血清Ctn和CEA水平均高于非MTC患者。Ctn≥289.62 pg/ml是MTC患者中央区淋巴结转移的独立危险因素。生存曲线结果显示侵犯包膜、中央区淋巴结转移、T2级以上是预测疾病进展的危险因素(P<0.05),疾病发生进展的MTC患者术前Ctn较高。结论血清Ctn在MTC鉴别诊断、术前评估以及术后随访均有重要临床价值。

超声人工智能辅助诊断系统用于甲状腺髓样癌

目的 以甲状腺乳头状癌(PTC)为对照,对比超声甲状腺人工智能(AI)辅助诊断系统(AI辅助诊断系统)与不同年资超声医师诊断甲状腺髓样癌(MTC)的效果。方法 纳入经病理证实的63枚MTC、70枚PTC和62枚良性结节。以AI辅助诊断系统分析并识别结节,将恶性概率值≥0.40者诊断为恶性结节;由高、中及初级职称医师各1名利用我国甲状腺影像报告和数据系统(C-TIRADS)对甲状腺结节进行分类;对比两种方法诊断MTC及PTC的效能。结果 AI辅助诊断系统诊断MTC和PTC的敏感度、特异度、阳性预测值、阴性预测值、准确率及曲线下面积(AUC)均低于3名医师;高、中级职称医师与AI辅助诊断系统诊断MTC和PTC的AUC差异均有统计学意义(P均<0.01),初级职称医师与AI辅助诊断系统AUC差异均无统计学意义(P均>0.05)。AI辅助诊断系统诊断MTC的敏感度、特异度、阳性预测值、阴性预测值、准确率及AUC均低于其诊断PTC,但AUC差异无统计学意义(P>0.05)。结论 超声甲状腺AI辅助诊断系统诊断MTC效能较高。

The clinical management of Level VI lymph node and neck lymph node micrometastases in follicular thyroid carcinoma

Objective： We evaluated the relationship between the clinical management of level Ⅵ lymph node and neck lymph node micrometastases in follicular thyroid carcinoma. Methods： 326 negative neck lymph nodes of 68 cases with follicular thyroid carcinoma on routine pathology were examined by keratin-19 monoclonal antibody and S-P JmmunohJsto- chemistry to confirm lymph node micrometastasis. Follow-up pathological and clinical documents were compared. Results： Forty-six neck lymph nodes showed positive micrometastasis among 326 negative neck lymph nodes including 4 lymph nodes in Level Ⅱ （4/42）, 5 lymph nodes in Level Ⅲ （5/34）, 5 lymph nodes in Level Ⅳ （5/49）, 1 lymph node in Leve Ⅳ （1/17） and 31 lymph nodes in Level Ⅳ （31/184）. Six in 14 cases with positive micrometastasis showed distant metastasis or local recurrence, but only 3 in 54 cases with negative micrometastasis indicated distant metastasis or local recurrence （P 〈 0.01）. Conclusion： The research showed that Level VI neck lymph node micrometastasis is possibly occur and closely related with local recurrence and metastasis in follicular carcinoma of thyroid.

^(131)I treatment for brain metastases from differentiated thyroid carcinoma

To assess the clinical value of treatment with 131I for brain metastases from differentiated thyroid cancer (DTC), we have observed 8 cases of brain metastases from DTC who received follow-up after 131I therapy (2male, 6 female, aged 12～65 years). The results of 131I therapy were evaluated with clinical presentation, imaging scan and survival analysis. The main results are as follows. (1) All cases had been survival for 2～35 years in follow-up. (2)A space-occupying lesion in right cerebellum was reduced after taking 20.65 GBq and disappeared after 23.61 GBq,demonstrated by computed tomography. (3) The sequences and doses of 131I therapy were clearly decreased for the cases with total thyroidectomy in comparison with those with semithyroidectomy (p＜0.01). (4) The brain metastases with lung and/or bone metastasis from DTC were 75% (6/8) and it was difficult to cure these metastases at the same time. It is concluded that the postoperative treatment of 131I for brain metastases from DTC after undergoing thyroidectomy may improve clinical symptoms and life quality, reduce lesions, and prolong survival.

Primary hyperparathyroidism in a woman with multiple tumors: A case report

BACKGROUND Parathyroid adenoma(PTA)is known as an adenomatous hyperparathyroidism syndrome.At earlier times,the major symptoms of this disease included high blood calcium and low phosphorus.PTA is a benign neuroendocrine neoplasm.We have reviewed the literature and found that it is rare for patients with hyperparathyroidism to have benign tumors with multiple organs at the same time.This report describes a patient with a PTA and four nonfunctional adenomas.CASE SUMMARY We report a case of primary hyperparathyroidism in a 39-year-old woman with multiple organ tumors.The patient was admitted to hospital because of hypercalcemia.Laboratory,imaging,and histological examinations confirmed a left parathyroid neoplasm.Right thyroid adenoma was discovered during hospitalization.She had a medical history of uterine fibroids,right benign mammary gland tumor,and meningioma.The patient recovered after surgical and conservative treatments.CONCLUSION Primary hyperparathyroidism with multiple organ tumors is uncommon,and further studies should be conducted to determine if there is genetic heterogeneity.

多模态超声诊断甲状腺肿瘤

超声是诊断甲状腺疾病首选的影像学工具。基于常规超声的甲状腺影像报告和数据系统的建立在甲状腺肿瘤诊断中发挥着举足轻重的作用。近年来,弹性成像、超微血流成像、超声造影及人工智能等新技术广泛应用于甲状腺疾病超声诊断。多模态超声技术的应用大幅度提升了甲状腺恶性肿瘤的诊断准确度,为甲状腺癌患者个体化诊疗方案的制订提供了理论依据。

早期甲状腺乳头状癌血清代谢组学特征及其与淋巴结转移的关系

目的对比分析T1级甲状腺乳头状癌(PTC)与结节性甲状腺肿(nodular goiter,NG)的代谢组学特征,以及代谢产物与PTC患者淋巴结转移的关系。方法收集2020年1月~2021年12月于民航总医院耳鼻咽喉头颈外科行甲状腺切除术的60例T1级PTC患者和30例NG患者的血清样本。根据有无淋巴结转移,将PTC组分为有淋巴结转移(N+组)和无淋巴结转移(N-组)。使用超高效液相色谱-质谱(UPLC-Q-Exactive-MS)联用平台,分别对N+组与N-组、PTC组与NG组的血清代谢物进行对比分析,使用SIMCA-P 14.1软件进行主成分分析(principal component analysis,PCA)、偏最小二乘判别分析(partial least squares discrimination analysis,PLS-DA)、正交偏最小二乘判别分析(orthogonal partial least squares discriminant analysis,OPLS-DA)并进行建模,结合FDR校正的Mann-Whitney-Wilcoxon检验结果和代谢物在进行对比的两组中的差异倍数等来筛选潜在小分子代谢标志物,并通过二元逻辑回归分析建立联合诊断模型。结果N+组和N-组之间不存在明显差异代谢物。PTC患者与NG患者之间有7个差异性代谢物,相关的5条代谢通路分别为磷酸戊糖途径、戊糖和葡萄糖醛酸相互转化、糖酵解/糖异生、果糖和甘露糖代谢和脂肪酸生物合成。受试者工作特征(ROC)曲线下面积(AUC)>0.9的差异性代谢物为D-甘油醛3-磷酸,另有N-十一烷酰基甘氨酸、尿酸及三碘甲状腺原氨酸葡萄糖醛酸三种代谢物的AUC>0.8。结论PTC与NG患者主要在糖代谢和脂质代谢上有区别,D-甘油醛3-磷酸可以在N-十一烷酰基甘氨酸、尿酸及三碘甲状腺原氨酸葡萄糖醛酸的辅助下,结合影像学检查结果区分PTC与NG患者。同时,N+组和N-组的对比中未发现明显差异血清代谢物,是否存在淋巴结转移不会对T1级PTC患者的血清代谢物产生影响。

多模态超声联合细针抽吸活组织检查对直径≤5 mm甲状腺微小癌诊断分析

目的 分析多模态超声联合细针抽吸活组织检查(fine needle aspiration, FNA)对直径≤5 mm甲状腺微小癌(thyroid microcarcinoma, TMC)的诊断准确性。方法 回顾性分析2019年9月-2021年3月行多模态超声(二维超声、超声造影、超声弹性成像)联合FNA检查,且经手术病理证实为直径≤5 mm甲状腺微小结节120例(结节132个)的临床资料,分析多模态超声和FNA及联合检测与病理诊断结果的一致性,并采用受试者工作特征(ROC)曲线分析单项和联合检测的诊断价值。结果 132个直径≤5 mm甲状腺微小结节经术后病理结果分析,良性结节36个,TMC 96个。与病理结果比较,二维超声诊断符合率为85.60%(113/132),Kappa值0.646;超声造影诊断符合率为90.15%(119/132),Kappa值0.758;超声弹性成像诊断符合率为90.15%(119/132),Kappa值0.754;多模态超声诊断符合率为90.91%(120/132),Kappa值0.771;FNA诊断符合率为92.42%(122/132),Kappa值0.806;多模态超声联合FNA诊断符合率为94.70%(125/132),Kappa值0.860。ROC曲线分析结果显示,多模态超声与FNA单项诊断曲线下面积比较无差异(P>0.05);多模态超声与FNA联合诊断TMC的曲线下面积大于单项诊断(P<0.05)。结论 多模态超声和FNA对直径≤5 mm TMC均具有较好的临床诊断价值,二者联合更能提高临床诊断准确率。

高频超声联合超微血流成像技术在甲状腺乳头状癌颈部淋巴结转移中的诊断价值

【目的】探讨高频超声联合超微血流成像在甲状腺乳头状癌颈部淋巴结转移中的诊断价值。【方法】回顾性分析2020年1月至2023年6月在本院接受甲状腺乳头状癌切除术和颈部淋巴结清扫术治疗的60例患者的临床资料,术前均行高频超声、超微血流成像技术检查,比较高频超声联合超微血流成像检查与单纯高频超声及超微血流成像诊断转移性淋巴结的准确率。【结果】60例患者共计90个颈部淋巴结发生转移,65个淋巴结发生颈中央区转移,25个淋巴结发生颈侧区转移。高频超声和超微血流成像联合检查诊断颈部淋巴结转移的准确率显著高于高频超声检查和超微血流成像检查(P<0.05)。高频超声检查显示,44例甲状腺乳头状癌患者病灶内部或周边呈短棒状、点状血流信号,5例患者病灶内部呈分支状血流信号。超微血流成像技术检查显示,40例患者病灶内部或周边呈短棒状、点状血流信号,14例患者病灶内呈分支状血流信号。【结论】高频超声联合超微血流成像技术诊断甲状腺乳头状癌颈部淋巴结转移患者的价值高,值得临床借鉴。

多模态超声在甲状腺乳头状癌颈部淋巴结转移诊断中的临床应用价值

【目的】探讨多模态超声在甲状腺乳头状癌(PTC)颈部淋巴结转移诊断中的临床应用价值。【方法】回顾性分析2021年8月至2023年7月本院收治的90例PTC伴颈部淋巴结肿大患者的临床资料,所有入选者均进行二维超声(two dimensional ultrasound,DUS)、超声造影(contrast-enhanced ultrasound,CUES)、弹性超声成像技术(elastic ultrasound imaging technology,UE)检查。以病理结果为参考标准,分析DUS、CUES、UE单项检查与联合检查诊断PTC颈部淋巴结转移的灵敏度、特异度及准确度。分析PTC伴颈部淋巴结转移与未转移患者超声特征。【结果】90例PTC伴颈部淋巴结肿大患者病理结果显示,55例(61.11%)患者伴有颈部淋巴结转移,35例(38.89%)患者未出现颈部淋巴结转移。DUS、CUES、UE联合检查诊断PTC伴颈部淋巴转移的准确度为92.22%(83/90),明显高于DUS(73.33%)、CUES(80.00%)、UE(81.11%)单一检查,差异有统计学意义(P<0.05)。联合诊断灵敏度、特异度与CUES未见明显差异,但均高于DUS、UE单项检查,差异有统计学意义(P<0.05)。转移组患者血供模式、病灶组织所在区域、灌注均匀度、弹性评分、边缘规则及微钙化情况与未转移组比较,差异有统计学意义(P<0.05)。【结论】PTC颈部淋巴结转移临床诊断中应用多模态超声检查具有较高的诊断效能,临床需重视血供模式为周边血流型、病灶位于颈上部及中部、边缘不规则、微钙化等超声特征的病灶,以提高诊断准确性。

经腋窝入路腔镜手术治疗单侧甲状腺乳头状癌的疗效分析

目的分析经腋窝入路腔镜手术与传统开放式手术治疗单侧甲状腺乳头状癌的临床疗效。方法选取2020—2022年于内蒙古自治区人民医院甲状腺乳腺疝外科行手术治疗的108例单侧甲状腺癌患者为研究对象,其中42例行经腋窝入路腔镜甲状腺癌根治术,设为腔镜组;66例行传统开放式甲状腺癌根治术,设为开放组。比较两组患者一般资料、围手术期指标、术后总引流量、术后住院时间、术后颈部疼痛VAS评分以及术后并发症发生情况。结果两组患者一般资料差异无统计学意义(P>0.05);肿瘤直径、术中出血量、中央区淋巴结清扫数目、术后住院时间差异均无统计学意义(P>0.05);两组患者疼痛评分差异无统计学意义(P>0.05);腔镜组手术时间长于开放组,差异具有统计学意义(P<0.05);腔镜组术后引流量多于开放组,差异具有统计学意义(P<0.05);腔镜组术后吞咽障碍指数低于开放组,差异具有统计学意义(P<0.05);两组患者均未出现声音嘶哑、饮水呛咳、手足麻木等术后并发症。结论经腋窝入路腔镜甲状腺手术治疗单侧乳头状癌是安全有效的,值得临床推广应用。

免充气锁骨下入路腔镜甲状腺全切除术治疗甲状腺乳头状癌的单中心回顾性研究

目的:探讨免充气锁骨下入路腔镜甲状腺全切除术治疗甲状腺乳头状癌的早期疗效。方法:回顾分析2022年12月至2023年12月行免充气锁骨下入路腔镜甲状腺全切除术联合中央区淋巴结清扫术及传统开放入路甲状腺全切除术联合中央区淋巴结清扫术患者的临床资料。结果:共纳入137例,其中腔镜组37例,开放组100例。腔镜组年龄小于开放组[(44.24±8.44)岁vs.(49.08±10.82)岁],手术时间长于开放组[(106.89±21.90)min vs.(79.88±21.76)min],术后引流量多于开放组[(107.62±31.16)mL vs.(82.04±31.68)mL],术后美容满意度高于开放组[3(2,3)分vs. 2(1,3)分],颈部不适感发生率低于开放组[7(18.9%) vs. 43(43.0%)],差异均有统计学意义(P<0.05)。两组患者性别、BMI、肿瘤直径、桥本甲状腺炎、T分期、术中出血量、中央区淋巴结清扫数量、中央区淋巴结阳性数量、术后引流管留置时间、术后甲状腺球蛋白水平差异无统计学意义(P>0.05);两组暂时性及永久性甲状旁腺功能减退、暂时性及永久性喉返神经损伤、血肿、发生率差异亦无统计学意义(P>0.05),两组均未发生淋巴漏、切口感染、气管损伤、食管损伤。结论:免充气锁骨下入路腔镜甲状腺全切除术联合中央区淋巴结清扫术治疗甲状腺乳头状癌安全、有效,美容效果及术后颈部舒适度优于传统开放甲状腺全切除术。

甲状腺微小乳头状癌与非微小癌超声造影特征比较

目的:对比分析甲状腺微小乳头状癌(PTC)与非微小癌超声造影特征差异。方法:回顾性分析2021年9月-2023年3月我院经手术或穿刺病理确诊的PTC患者96例(共101枚结节),按照肿瘤最大直径分成PTC组(最大直径≤10 mm)和非微小癌组(最大直径>10 mm),比较两组结节超声造影增强程度、增强方式、增强均匀性,分析两组超声造影定量参数的差异。结果:不同大小的PTC超声造影增强程度、增强方式、增强均匀性差异均存在统计学意义(P<0.05),PTC组向心性增强、等增强较非微小癌组多见,非微小癌组偏心性、弥漫性增强、低增强及高增强较PTC组多见。PTC组均匀性增强多见,非微小癌组不均匀性增强多见。两组超声造影定量参数上升时间(RT)、平均渡越时间(mTT)、下降时间(FT)差异有统计学意义(P<0.05),PTC组的RT、mTT、FT均高于非微小癌组,两组的达峰时间(TTP)、峰值强度(PE)、流入相比率(WiR)、流出相比率(WoR)、流入相灌注指数(WiPI)、流入相曲线下面积(WiAUC)、流出相曲线下面积(WoAUC)、流入相和流出相曲线下面积(WiWoAUC)差异无统计学意义。结论:PTC超声造影表现多以向心性、不均匀低增强为主,不同大小PTC具有不同的超声造影表现,临床诊断中需加以考虑。

1例甲状腺滑膜肉瘤多模态超声表现

患者男,68岁,体检发现甲状腺结节1月余,无明显自觉不适;既往无特殊病史。查体:于甲状腺左叶触及直径3cm肿物,表面较光滑,无触痛及压痛,可随吞咽上下活动,无搏动,未闻及杂音。实验室检查:甲状腺激素、甲状旁腺素、降钙素及癌胚抗原均未见异常。