【摘要】 目的 探讨弹性成像在甲状腺微小癌诊断中的应用价值。 方法 回顾性分析从2007年12月-2008年4月间经病理证实的10例甲状腺微小癌患者共11个病灶的超声表现。 结果 彩色多普勒超声诊断甲状腺微小癌8例8个病灶，利用弹性成像技术诊断10例10灶。传统彩色多普勒超声对甲状腺微小癌的诊断率为72.7%；利用弹性成像技术对甲状腺微小癌的诊断率为90.9%。 结论 弹性成像技术对于甲状腺微小癌是对彩色多普勒超声检查的有益的补充，能够显著提高超声对甲状腺微小癌诊断的准确性。【Abstract】 Objective To evaluate the application of US-elastography in diagnosis of thyroid microcacinoma. Methods The images of color ultrasound and ultrasound elastography from 11 lesions of 10 patients with thyroid micro-carcinoma diagnosed via histopathology between December 2007 and April 2008 were retrospectively analyzed. Results Eight patients with eight lesions were found by colour ultrasound and 10 patients with 10 lesions were observed by ultrasound elastography. The diagnosis accurate rate of ultrasonography was about 72.7% and of ultrasound elastography was about 90.0%. Conclusion US-Elastography is a beneficial addition in diagnosis of thyroid microcacinoma by colour ultrasound. It can remarkably develop the accurate rate of the diagnosis of the disease.
Objective To explore the expression of chemokine receptor CCR7 in thyroid papillary microcarcinoma tissues and the relationship with clinicopathological features. Methods The CCR7 expressions in 31 cases of thyroid papillary microcarcinoma, 34 cases of thyroid papillary carcinoma which diameter＞1cm, 34 cases of nodular goiter, and 12 cases of thyroid papillary microcarcinoma contralateral normal thyroid tissues were detected by using immunohistochemistry S-P method. Results The expression positive rates of CCR7 in thyroid papillary microcarcinoma and papillary thyroid carcinoma which diameter＞ 1cm were both 100%, the difference had not statistically significant （P＞0.05）. In nodular goiter and normal thyroid tissues, the expression positive rate of CCR7 was 64.7% and 33.3%, respectively, and compared with thyroid papillary microcarcinoma, the difference had statistically significant （P＜0.05）. There were not relations between the expression of CCR7 and patient’s gender, age, capsule invasion, and lymph node metastasis （P＞0.05）. Conclusions The CCR7 in thyroid papillary microcarcinoma and thyroid papillary carcinoma which diameter＞ 1cm are both high expressions, and have the same bionomics, both prone to cervical lymph node meta-stasis, and the radical neck dissection （central area） are both need to take.
目的探讨结节性甲状腺肿合并甲状腺微小癌的临床特征、诊断、治疗原则及预后。方法回顾分析2003年1月至2010年2月期间在我科手术治疗的34例结节性甲状腺肿合并甲状腺微小癌患者的临床资料。结果 病理诊断乳头状癌33例，滤泡状癌1例。行患侧叶全切除术+峡部切除术+对侧叶次全切除术+患侧中央区淋巴结清扫术3例，1例加行患侧改良性颈部淋巴结清扫术; 患侧叶全切除术+峡部切除术+对侧叶次全切除术22例; 患侧叶全切除术+峡部切除术1例; 甲状腺全切除术8例。2例患者出现术后低钙血症，1周后恢复正常，无其他手术相关并发症发生。随访3个月至5年(平均20.2个月)，无一例复发或死亡。结论 甲状腺多发结节有恶性的可能，B超有助于诊断。手术方法多为患侧叶全切除术+峡部切除术+对侧叶次全切除术，预后较好。
ObjectiveTo investigate the relationship of concomitant BRAFV600E gene mutation with the predictive factors of papillay thyroid microcarcinoma(PTMC). MethodsBy fluorescence quantitative PCR method to detect BRAFV600E gene mutation of PTMC of 86 cases, and to detect the relationship with clinical pathological features of PTMC by single factor and multi-factor logistic regression analysis. ResultsThe morbidity of BRAFV600E gene mutation was 65.1%(56/86). By univariate analysis, BRAFV600E gene mutation status showed a related trend with lymph node metastasis(P=0.057). The multivariate analysis showwd that lymph node metastasis was correlated with BRAF V600E gene mutation(P < 0.05). When the diameter of tumor > 5 mm and≤10mm, BRAFV600E gene mutation was no statistically significantly related to central lymph node metastasis(P > 0.05). When BRAFV600E gene mutations was negative in patients with tumor diameter≤5 mm, no lymph node metastasis sample appeared. ConclusionsThe presence of BRAFV600E gene mutation is an independent predictive factor for central lymph node metastasis. When PTC with preoperative BRAFV600E gene mutation positive, the central neck dissection should be routine performed. There should be re-examined the necessity of preventative central lymph node disection when the tumor diameter is 5 mm or less with the patients which mutation negative.
ObjectiveTo study the expressions of BRAF gene in papillary thyroid microcarcinoma (PTMC) and papillary thyroid carcinoma (PTC) >1 cm in diameter, and the invasiveness of PTMC and PTC. MethodsThe data of 275 patients with PTC received surgical treatment and with BRAF gene mutation results in West China Hospital of Sichuan University from 2011 September to 2013 September were retrospectively analyzed. According to the size of tumors, the patients were divided into three groups, was the diameter <1 cm group, 1 cm< diameter≤2 cm group, and diameter >2 cm group,respectively. The ratio of BRAF gene mutation, and the degree of risk of extrathyroidal invasion and lymph node metastasis were compared. ResultsUnivariate analysis showed that tumor size was not related with the age, gender, and BRAF gene mutation rate (P>0.05), while the tumor size was related with the extrathyroidal invasion and lymph node metastasis (P<0.05), and the ratio of BRAF gene mutation was related with the extrathyroidal invasion and lymph node metastasis (P<0.05). Multivariate analysis showed that tumor size was associated with extrathyroidal extension (P=0.009) and lymph node metastasis (P=0.000). ConclusionsBRAF gene mutation can increase the extrathyroidal invasion and lymph node metastasis risk of PTC, and it is no significantly correlated with tumor size of PTC. The invasiveness of PTC increases with the increased of tumor size, but the PTMC of BRAF gene mutation positive is still require positive treatment.
Objective To discuss the relationship between thyroid stimulating hormone (TSH) and clinicopathologic features of the papillary thyroid microcarcinoma (PTMC) patients. Methods The thyroid nodules of 806 cases retrospectively that were for the first time hospitalized to our department in recent 5 years were collected, among them, postoperative pathological examination confirmed the diagnosis of PTMC in 403 cases, 403 cases of benign thyroid lesions, the history data of selected cases that meet the criterion of selection were retrospectively analyzed. TSH and anti thyroid globulin antibody (TGAb) levels between the 2 groups and the prevalence of ratio of PTMC in different TSH levels were compared. Univariate and multivariate analysis were performed to determine the risk factors of PTMC. Results The differences of preoperative TSH levels between the two groups was statistical significance (Z=–6.233,P=0.001), gender composition no statistical significance in two groups (χ2=3.246,P=0.072), and age was statistically significant (Z=–5.855,P=0.001). The constitution of ethnics of two groups was different (χ2=38.961,P=0.001). Logistic regression analysis display that age and TSH level were the independent risk factors of PTMC (age:OR=0.914,P=0.027; TSH:OR=4.662,P=0.008). Conclusions The level of serum TSH in PTMC patients is higher than in patients with benign thyroid nodules. TSH level is probably predictive of malignancy of PTMC.
Objective To summarize the progress of the application of ultrasound-guided thermal ablation for treatment of papillary thyroid microcarcinoma (PTMC). Methods The relevant literatures of thyroid nodules treated by ultrasound-guided thermal ablation were reviewed by adopting the methods of literature review. Results In conditions of grasping the therapeutic indication strictly and evaluating preoperative various aspects sufficiently, it reveals a certain feasibility and validity applying ultrasound-guided thermal ablation in the treatment of PTMC classified in the low-risk group. Conclutions Possessing the advantages of minimal invasive techniques, low-risks, beauty and rapidness, ultrasound-guided thermal ablation might be recommended as an alternative to a low-risk PTMC patient who is at high risk in general anaesthesia operation or intolerant to open operation.