ObjectiveTo investigate the expressions of Snail and N-cadherin protein in thyroid papillary carcinoma (PTC) tissues and cell lines, and then discuss the clinical value of Snail and N-cadherin expressions. MethodsImmunohis-tochemical SP technique was performed to detect the expressions of Snail and N-cadherin protein in 60 cases of PTC, and the relation between the expression of Snail or N-cadherin and clinicopathologic indicators was analyzed. Western blot was used to investigate the constitutive and inducible expressions of Snail and N-cadherin protein. Results①The positive rates of Snail and N-cadherin protein expressions were 85.0% (51/60) and 78.3% (47/60) respectively in the PTC tissues of 60 patients with PTC, which were significantly higher than those (0, 0, respectively) in the corresponding normal tissues adjacent to the cancer (P < 0.01).②The positive rates of Snail and N-cadherin protein expressions in the PTC with lymph node metastasis were significantly higher than those in the PTC without lymph node metastasis (P < 0.01), which were not related with the gender, age, tumor size of the patients (P > 0.01).③There was a positive correlation between Snail and N-cadherin protein positive expression (rs=0.721, P < 0.001).④The constitutive and inducible expressions of Snail and N-cadherin in the PTC tissues and cell lines further were identified by Western blot. ConclusionsSnail and N-cadherin could constitutively express in PTC, which might play important roles in the development and metastasis of PTC. Snail and N-cadherin might be used as effective indicators.
ObjectiveTo explore the value of fluorescence tracer technique in sentinel lymph node (SLN) orientation of cN0 papillary thyroid cancer. MethodsThe total clinical data of 40 cT1-3N0M0 thyroid cancer patients admitted from January 2015 to January 2016 in our hospital were collected, and the SLN with indocyanine green (ICG) as fluorescent trace agent were observed and detected, and the effect of ICG detecting SLN and the guide role of SLNB on the dissection of the central area of neck lymph nodes by intraoperative frozen biopsy pathology and postoperative paraffin pathology were analyzed. ResultsA total of 40 thyroid cancer patients were treated by SLNB and then conducted by the dissection of the central area of neck lymph nodes, and 37 cases detected SLN, so the detection rate was 92.5% (37/40). And a total of 98 SLNs were detected, 1-5 for each case, average of 2.65/case. Intraoperative frozen pathological detected 28 cases of patients with metastases in SLN, and 9 patients without metastasis, including 1 case with postoperative pathology detecting micrometastasis in SLN and other 8 cases without metastasis in the central area of neck lymph nodes. Three cases who were not detected the SLN showed no metastases in final postoperative paraffin pathology. The SLNB of ICG fluorescent tracer was with a sensitivity of 96.6% (28/29), false-negative rate of 3.45% (1/29). ConclusionThe fluorescent tracer technique can guide the dissection of the central of neck lymph node of cN0 thyroid cancer patients accurately with a high detection rate and advantages of high sensitivity in detecting the SLN of thyroid cancer.
Objective To explore the manifestations and features of multi-slice spiral CT （MSCT） in the diagnosisof papillary thyroid carcinoma （PTC）. Methods Preoperative MSCT data of 35 cases of PTC proved by operation and pathology in our hospital form May. to Jun. in 2013 were observed retrospectively， to analyze the manifestations and characteristics of MSCT for it. Results Of 35 patients with PTC， MSCT totally showed 48 lesions， 68.6% （24/35） of patients with single lesion， 31.4% （11/35） of patients with 2-3 lesions， and 62.9% （22/35） of patients with lymph node metastasis. Of the 48 lesions， 29.2% （14/48） of lesions located in the left lobe， 70.8% （34/48） of lesions located in the right lobe；the lesions’ maximum diameter were 0.4-5.8cm， with the average maximum diameter of 1.3cm. There were 39.6% （19/48） of lesions with uneven density， 25.0% （12/48） of lesions with irregular shape， 47.9% （23/48） of lesions with blurred edges， 18.8% （9/48） of lesions had papillary enhanced tumor nodules， 10.4% （5/48） of lesions had peritumoral incomplete enhanced ring sign， 22.9% （11/48） of lesions invaded surrounding tissue or organs. There were 35.4% （17/48） of lesions had calcification， in which 76.4% （13/17） of lesions were fine granular calcification， 11.8% （2/17） of lesions were mixed calcification， and 11.8% （2/17） of lesions were coarse calcification. Conclusion MSCT manifestations of PTC have certain characteristics， which can provide imaging basis for clinical treatment options.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.
Objective To investigate the expression of c-met in tall cell variant of papillary thyroid carcinoma, and to compare it with other types of thyroid carcinoma and benign thyroid tissue. Methods The expressions of c-met in 60 cases of thyroid specimens were tested by immunohistochemical staining. Results The levels of expressed c-met in tall cell variant specimens were significantly higher than those in other types of papillary thyroid carcinoma and benign thyroid tissue. c-met expressions were significantly different in the following pairs of types: tall cell variant vs common papillary carcinoma of thyroid (P=0.000 1), tall cell variant vs follicular variant papillary thyroid carcinoma (P=0.000 1), and tall cell variant vs benign thyroid tissue (P=0.000 1). In addition, for all types of papillary carcinomas evaluated, c-met expression was significantly higher in specimens with extracapsular spread (P=0.010 0) and skeletal muscle invasion (P=0.020 0). Conclusion The high expression of c-met is a significant marker for tall cell variant papillary carcinoma of thyroid and its invasive behavior. This finding may explain the unusually aggressive behavior of this tumor and suggest a role for c-met in the early identification of patients with tall cell variant thyroid carcinoma.
Objective To detect the expression of KiSS-1 protein in papillary thyroid carcinoma, and to analyze its significance. Methods Paraffin-embedded specimens of 32 patients with thyroid papillary carcinoma and its adjacent cancer tissues were included in this study. Then the expression of KiSS-1 protein was detected by munohistochemistry and its relationship with clinical pathological features was analyzed. Results KiSS-1 protein mainly expressed in the cell membrane and cytoplasm. The expression of KiSS-1 protein was positive in adjacent tissues, but decreased or absent in cancer tissues in 32 patients. In the latter, there were 11 cases with positive expression (34.4%) and 21 cases with negative expression (65.6%), and the difference was statistically significant (χ2=31.256, Plt;0.001). The average value of KiSS-1 protein expression represented by absorbance (A) value (119.595 2) in cancer tissues was higher than that in adjacent tissues (174.805 0), t=34.429, Plt;0.001. The expression of KiSS-1 protein in cancer tissues was not related to patient gender (P=0.618) and age (P=0.061), but except TNM staging (P=0.034). The expression rate of KiSS-1 protein in cancer tissues with lymph node metastasis (4/4, 100%) was significantly higher than that without lymph node metastasis (7/28, 25.0%)， P=0.003. Conclusion The expression of KiSS-1 protein is decreased or absent in papillary thyroid carcinoma, which may be involved in tumorigenesis, invasion, and metastasis.
ObjectiveTo identify the risk factors of central lymph nodal (CLN) metastasis in papillary thyroid carcinoma (PTC) and indicate central neck dissection. MethodsFifty cases were analyzed retrospectively. The BRAFV600E gene mutation was analyzed by sequencing and expression of VEGF-C was analyzed by using immunohistochemically. The clinicopathologic and molecular marker factors relating to CLN metastasis were analyzed. ResultsThe BRAFV600E gene mutation was found in 30 of 50 (60.0%) patients of PTC. Univariate analysis showed that BRAFV600E gene mutation of PTC patients was significantly correlated with high expression of VEGF-C (87.5% vs. 34.6%,P=0.000), not with clinicopathologic factors. High expression of VEGF-C was significantly correlated with CLN metastasis in PTC (87.5% vs. 57.7%, P=0.019). Multivariate analysis showed that invasion of the surrounding tissues (P=0.009,OR=9.082,95% CI:1.748-47.185) and the high expression of VEGF-C (P=0.009,OR=9.082,95% CI:1.748-47.185) were independent risk factors for the presence of CLN metastases. Conclusions①The BRAFV600E gene mutation for PTC patients is significantly correlated with high expression of VEGF-C, not with CLN metastasis in PTC. ②High expression of VEGF-C is significantly correlated with CLN metastasis in PTC. ③Tumor extrathyroidal extension, especially invasion of the surrounding tissues is significantly correlated with CLN metastasis in PTC.
Objective To assess the applied significance of carbon nanoparticles in central compartment lymph node dissection in treatment of cN0 papillary thyroid carcinoma. Methods Sixty-eight patients with cN0 papillary thyroid carcinoma who were treated in Tongji Hospital of Tongji Medical College from May. to Oct. in 2012 were randomly allocated to the control group （n=32） and the carbon nanoparticles trace group （tracer group， n=36）， receiving non-carbon nanoparticles trace and carbon nanoparticles trace respectively. All patients were received total resection of thyroid plus the affected side and （or） contralateral side central compartment lymph node dissection. The lymph node-related indexes（including number of dissected lymph node at Ⅵarea and lymph node metastasis rate at Ⅵarea） and operative indexs （including operation time， blood loss， drainage time， complication， and hospital stay） were collected and compared between the 2 groups. Results There were 205 and 324 dissected lymph node at central compartment in control group and tracer group respectively. The results of postoperative pathology showed that the number of lymph node in central compartment of the tracer group was much more than those of control group （8.99±2.24 vs. 6.41±1.56， P＜0.001）. The metastasis rate of central compartment lymph node were 40.6% （13/32） in control group and 47.2% （17/36） in tracer group， but there was no significant difference between the 2 groups （P=0.762）. But in medial area of laryngeal recurrent nerve， the metastasis rate in the tracer group （38.9%， 14/36） was much higher than those of control group （12.5%， 4/32）， P=0.029. There were no significant differences in the operation time， blood loss， drainage time， hospital stay， and complication incidence such as bleeding， temporary hypocalcemia， and injury of superior laryngeal nerve between 2 groups （P＞0.05）. All the patients in 2 groups had followed-up for 6 months without death， recurrence， and metastasis.Conclusions The lymphatic tracer technique of carbon nanoparticles may improve the number of dissected lymph nodes in central region of cN0 papillary thyroid carcinoma， without increasing （or prolonging） operation time， intraoperative blood loss， and postoperative hospital stay， and can accurately represent the metastasis of lymph node， thus to make the staging of the tumor accurately and guide postoperative treatment.
ObjectiveTo evaluate the risk factors for central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC) of cN0 staging. MethodsClinical data of 94 patients with cN0 PTC in Guangdong General Hospital who underwent thyroidectomy with prophylactic central node dissection (pCND) from March to July in 2014 were collected to analyze the risk factors of CLNM by using univariate and multivariate analysis methods. ResultsCLNM was found in 43 patients (45.7%). Multivariate analysis results showed that, the CLNM rate of patients with age < 45 years, tumor located in front of lobe by ultrasound, diameter of tumor > 2 cm, capsular invasion, and total number of central lymph node dissected > 3 were significantly higher (P < 0.05). ConclusionAge < 45 years, tumor located in front of lobe by ultrasound, and diameter of tumor > 2 cm are the risk factors of CLNM in patients with cN0 PTC, pCND should be performed for patients with some of the above risk factors.
Objective To discuss the resection extent of primary surgery for papillary thyroid carcinoma （PTC） based on the analysis of the remaining thyroid gland residue and lymph nodes metastasis. Methods The clinical data of 163 patients with PTC received reoperation from January 2009 to September 2011 in our hospital were analyzed retrospectively. Results There were 24 males and 139 females in these patients. The age was 10-75 years old with （38.22±14.57） years old. Among 131 patients received residual thyroid thyroidectomy，88 patients were below 45 years old，and the cancer residual rate was 60.23% （53/88）；the others were over 45 years old，and the cancer residual rate was 76.74% （33/43），which was no significant difference （P?=?0.062）.The lymph nodes metastasis rate was 77.14% （81/105） in the patients below 45 years old and 81.13%?（43/53） in the patients over 45 years old among 158 patients received cervical lymph nodes dissection，which was no significant difference （P?=?0.958）.The cancer residual rate was 74.36%?（58/78），53.66%?（22/41），50.00%?（6/12），and 0 （0/32） in the patients with the tissue less than one lobe resection，lateral lobe （isthmus） resection，lateral lobe plus opposite side subtotal resection，total or subtotal resection，respectively. The total cancer residual rate was 65.65% （86/131） and the bilateral cancer residual rate was 52.76%?（86/163） after reoperation.79.75%?（130/163） of the patients didn’t received lymph nodes dissection in the primary surgery. The lymph nodes metastasis rate was 71.21%?（94/132） and 80.58% （83/103） in the reoperation patients received central region lymph nodes dissection and cervical lateral lymph nodes dissection, respectively. Conclusions Multifocus is an obvious character of PTC. Patients over 45 years old have more opportunities of tumor residual than that of the youngers （below 45 years old），but the result was no statistic value. For the most patients with PTC，a smaller resection extent suggests a larger risk for cancer residual，and total thyroidectomy or subtotal thyroidectomy leads to the least possibility for the risk. Cervical lymph node is a major type for its metastasis. Proper lymph nodes dissection is an essential way to reduce recurrence and reoperation. The Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer （2009） could be a best choice for therapy of PTC. And it is proposed to take central region lymph nodes dissection during primary surgery.