Objective:To investigate the detection rate and sonographic characteristics of color Doppler ultrasound in the diagnosis of papillary thyroid microcarcinoma(PTMC).Methods:A retrospective analysis was conducted on 50 c...Objective:To investigate the detection rate and sonographic characteristics of color Doppler ultrasound in the diagnosis of papillary thyroid microcarcinoma(PTMC).Methods:A retrospective analysis was conducted on 50 cases of PTMC confirmed by postoperative pathology from January 2020 to December 2024,all of which underwent preoperative color Doppler ultrasound examination.The detection rate was calculated,and the two-dimensional ultrasound characteristics and CDFI manifestations were analyzed.Results:Among the 50 cases of PTMC confirmed by pathology,the detection rate of color Doppler ultrasound was 88.00%,and the diagnostic accuracy rate was 96.00%.Two-dimensional ultrasound characteristics:The mean lesion size was(6.83±1.51)mm;42 cases(84.00%)had irregular shapes;45 cases(90.00%)had unclear boundaries;46 cases(92.00%)had hypoechoic lesions;38 cases(76.00%)exhibited microcalcifications;and 40 cases(80.00%)had an aspect ratio≥1.CDFI characteristics:The highest proportion was grade Ⅱ,with 23 cases(46.00%);39 cases(78.00%)had an RI≥0.7,and the average RI value was(0.75±0.06).Conclusion:Color Doppler ultrasound demonstrates a high detection rate for PTMC,with typical features including hypoechogenicity,irregular shape,microcalcifications,and high RI,making it the preferred imaging modality for early clinical diagnosis of PTMC.展开更多
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 bi...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.展开更多
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 ...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,展开更多
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 t...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.展开更多
Objective: The aim of our study was to evaluate the pathological features of posterior echo attenuation of papillary thyroid microcarcinoma (PTMC) and cystic degeneration of cervical lymph node metastasis. Methods: We...Objective: The aim of our study was to evaluate the pathological features of posterior echo attenuation of papillary thyroid microcarcinoma (PTMC) and cystic degeneration of cervical lymph node metastasis. Methods: We retrospectively evaluated the ultrasound results from 36 cases of PTMC with 20 nodules of cystic degeneration of cervical lymph node metastasis and correlated the results with the histopathologic findings. Results: The preliminary study indicated certain correlation between histopathologic findings and ultrasound results of posterior echo attenuation of papillary thyroid microcarcinoma and cystic degeneration of cervical lymph node metastasis. Conclusion: Posterior echo attenuation detected by ultrasound was associated with fibrous structures in PTMC nodules, while cystic degeneration and papillary changes of cervical lymph node metastasis in PTMC showed liquefactive necrosis, degenerative changes and enlarged follicular of nodular structures.展开更多
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 PT...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.展开更多
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 w...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.展开更多
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 assessme...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.展开更多
Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed wel...Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach （BABA）, compared with conventional open procedure in papillary thyroid microcarcinoma. Methods： One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People＇s Liberation Army （PLA） were randomly assigned to robotic group or conventional open approach group （17 = 50 in each group）. The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale （VAS）, postoperative hospital stay time, complications, and numerical scoring system （NSS, used to assess cosmetic effect） were analyzed. Results： The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group （118.8± 16.5 min vs. 90.7± 10.3 min, P 〈 0.05）. The study showed significant differences between the two groups in terms of the VASs （2.1 ± 1.0 vs. 3.8 ±~ 1.2, P 〈 0.05） and NSS （8.9 ± 0.8 vs. 4.8 ± 1.7, P 〈 0.05）. The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant （all P 〉 0.05）. Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. Conclusions： Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.展开更多
Background Minimally invasive video-assisted thyroidectomy （MIVAT） has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open ...Background Minimally invasive video-assisted thyroidectomy （MIVAT） has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open thyroidectomy （CT） for papillary thyroid microcarcinoma （PTMC）. Methods Thirty-one patients were treated with MIVAT and 37 with CT. Their pathological characteristics, surgical complications, 5-year postoperative thyroglobulin （TG） and ultrasonic results were followed up. Results All the patients took levothyroxine for suppressing thyroid stimulating hormone （TSH） after surgery, and were followed up with measurement of serum TG and neck ultrasonography at intervals of 6 or 12 months. There was no statistically significant difference between the CT and MIVAT groups for sex ratio, operation time, positive lymph nodes, complications and prognosis, but the MIVAT group had better cosmetic results. Conclusions MIVAT did not differ significantly from CT for PTMC after 5 years follow-up, but it did have better cosmetic results. MIVAT is a safe and valid surgical technique for selected cases.展开更多
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 intrathyro...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.展开更多
Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and rest...Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and restraints of molecular testing must be integrated into how physicians use and explain molecular testing to patients. Molecular tests can help rule in cancer for indeterminate thyroid nodules with very specific mutations for thyroid cancer, such as BRAF and RET/PTC, and can help reduce the rates of completion thyroidectomies in this era of de-escalation of the management of thyroid disease. The positive predictive value (PPV) of malignant cytology (Bethesda VI) is 98%;and even though molecular testing improves specificity and PPV, it falls short of this ideal for other mutations. We present a detailed evaluation of the current state of molecular testing and their clinical relevance in the setting of diagnostic utility and their impact on surgical decision-making. By recapitulating the clinical impact of these tests and some of the related drawbacks, we hope to provide adequate up to date information of the appropriate utilization of these tools in the management of indeterminate or suspicious thyroid nodules and highlight future directions on their utilization for the management of thyroid cancer.展开更多
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, inclu...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.展开更多
文摘Objective:To investigate the detection rate and sonographic characteristics of color Doppler ultrasound in the diagnosis of papillary thyroid microcarcinoma(PTMC).Methods:A retrospective analysis was conducted on 50 cases of PTMC confirmed by postoperative pathology from January 2020 to December 2024,all of which underwent preoperative color Doppler ultrasound examination.The detection rate was calculated,and the two-dimensional ultrasound characteristics and CDFI manifestations were analyzed.Results:Among the 50 cases of PTMC confirmed by pathology,the detection rate of color Doppler ultrasound was 88.00%,and the diagnostic accuracy rate was 96.00%.Two-dimensional ultrasound characteristics:The mean lesion size was(6.83±1.51)mm;42 cases(84.00%)had irregular shapes;45 cases(90.00%)had unclear boundaries;46 cases(92.00%)had hypoechoic lesions;38 cases(76.00%)exhibited microcalcifications;and 40 cases(80.00%)had an aspect ratio≥1.CDFI characteristics:The highest proportion was grade Ⅱ,with 23 cases(46.00%);39 cases(78.00%)had an RI≥0.7,and the average RI value was(0.75±0.06).Conclusion:Color Doppler ultrasound demonstrates a high detection rate for PTMC,with typical features including hypoechogenicity,irregular shape,microcalcifications,and high RI,making it the preferred imaging modality for early clinical diagnosis of PTMC.
文摘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.
文摘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,
文摘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.
文摘Objective: The aim of our study was to evaluate the pathological features of posterior echo attenuation of papillary thyroid microcarcinoma (PTMC) and cystic degeneration of cervical lymph node metastasis. Methods: We retrospectively evaluated the ultrasound results from 36 cases of PTMC with 20 nodules of cystic degeneration of cervical lymph node metastasis and correlated the results with the histopathologic findings. Results: The preliminary study indicated certain correlation between histopathologic findings and ultrasound results of posterior echo attenuation of papillary thyroid microcarcinoma and cystic degeneration of cervical lymph node metastasis. Conclusion: Posterior echo attenuation detected by ultrasound was associated with fibrous structures in PTMC nodules, while cystic degeneration and papillary changes of cervical lymph node metastasis in PTMC showed liquefactive necrosis, degenerative changes and enlarged follicular of nodular structures.
基金Supported by the Joint Funds of the Zhejiang Provincial Natural Science Foundation of China,No.LBY21H030001the Science and Technology Planning Project of Zhejiang Province,No.2020KY708.
文摘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.
基金Support by Minhang District Natural Science Research Project,No.2013MHZ003
文摘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.
基金Supported by a grant from the Science and Technology Plan Projects of Lanzhou(No.2017-4-75)
文摘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.
文摘Background： A large proportion of the patients with papillary thyroid microcarcinoma are young women. Therefore, minimally invasive endoscopic thyroidectomy with central neck dissection （CND） emerged and showed well-accepted results with improved cosmetic outcome, accelerated healing, and comforting the patients. This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach （BABA）, compared with conventional open procedure in papillary thyroid microcarcinoma. Methods： One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People＇s Liberation Army （PLA） were randomly assigned to robotic group or conventional open approach group （17 = 50 in each group）. The total operative time, estimated intraoperative blood loss, numbers of lymph node removed, visual analog scale （VAS）, postoperative hospital stay time, complications, and numerical scoring system （NSS, used to assess cosmetic effect） were analyzed. Results： The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group. There were no conversion from the robotic surgeries to open or endoscopic surgery. The subclinical central lymph node metastasis rate was 35%. The mean operative time of the robotic group was longer than that of the conventional open approach group （118.8± 16.5 min vs. 90.7± 10.3 min, P 〈 0.05）. The study showed significant differences between the two groups in terms of the VASs （2.1 ± 1.0 vs. 3.8 ±~ 1.2, P 〈 0.05） and NSS （8.9 ± 0.8 vs. 4.8 ± 1.7, P 〈 0.05）. The differences between the two groups in the estimated intraoperative blood loss, postoperative hospital stay time, numbers of lymph node removed, postoperative thyroglobulin levels, and complications were not statistically significant （all P 〉 0.05）. Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups. Postoperative cosmetic results were very satisfactory in the robotic group. Conclusions： Robotic total thyroidectomy with CND via BABA is safe and effective for Chinese patients with papillary thyroid microcarcinoma who worry about the neck scars.
文摘Background Minimally invasive video-assisted thyroidectomy （MIVAT） has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open thyroidectomy （CT） for papillary thyroid microcarcinoma （PTMC）. Methods Thirty-one patients were treated with MIVAT and 37 with CT. Their pathological characteristics, surgical complications, 5-year postoperative thyroglobulin （TG） and ultrasonic results were followed up. Results All the patients took levothyroxine for suppressing thyroid stimulating hormone （TSH） after surgery, and were followed up with measurement of serum TG and neck ultrasonography at intervals of 6 or 12 months. There was no statistically significant difference between the CT and MIVAT groups for sex ratio, operation time, positive lymph nodes, complications and prognosis, but the MIVAT group had better cosmetic results. Conclusions MIVAT did not differ significantly from CT for PTMC after 5 years follow-up, but it did have better cosmetic results. MIVAT is a safe and valid surgical technique for selected cases.
文摘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.
文摘Molecular testing in thyroid nodules and thyroid cancer is rapidly evolving;care must be used when incorporating molecular testing for thyroid nodules into clinical practice. A clear appreciation of the goals and restraints of molecular testing must be integrated into how physicians use and explain molecular testing to patients. Molecular tests can help rule in cancer for indeterminate thyroid nodules with very specific mutations for thyroid cancer, such as BRAF and RET/PTC, and can help reduce the rates of completion thyroidectomies in this era of de-escalation of the management of thyroid disease. The positive predictive value (PPV) of malignant cytology (Bethesda VI) is 98%;and even though molecular testing improves specificity and PPV, it falls short of this ideal for other mutations. We present a detailed evaluation of the current state of molecular testing and their clinical relevance in the setting of diagnostic utility and their impact on surgical decision-making. By recapitulating the clinical impact of these tests and some of the related drawbacks, we hope to provide adequate up to date information of the appropriate utilization of these tools in the management of indeterminate or suspicious thyroid nodules and highlight future directions on their utilization for the management of thyroid cancer.
文摘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.
