Abstract:

对甲状腺乳头状癌（PTC）的患者是否行预防性的中央区淋巴结清扫（pCND）是存在争议的。相比于其他恶性肿瘤而言，PTC患者有较好的整体生存率，但由于淋巴结的转移而导致局部复发也是治疗的一个难点。与颈侧区淋巴结转移不同，中央区淋巴结转移在术前评估中不易被发现，并且第1次 术后如中央区的病灶复发或残留可能需再次手术治疗，但是出现手术并发症的风险将增加。由于中央区淋巴结在位置上属于甲状腺切除术的区域内，所以行pCND可以减少复发的风险及再次手术的需要，但也需要衡量患者的风险及获益。笔者将通过长期的治疗效果来讨论pCND的优势及劣势，同时也将对pCND的合理性，单或双侧pCND的指征及常规行pCND和复发再手术的比较进行讨论。分子标志物在高危患者中的应用及患者术后生存质量的研究也有所提及。

Abstract:颈部淋巴结转移在分化型甲状腺癌（DTC）中十分常见。DTC患者整体长期生存率高于90％。尽管DTC具有良好的预后，但因淋巴结转移而造成局部复发者增加，将降低患者的生活质量，影响患者的预后。因此，对患者的关注从以整体存活率为重点转变为以最近提出的无复发生存率为重点。为了这一目标，适当的淋巴结清扫是非常重要的。这种手术策略将阻止疾病的复发，但有增加并发症的可能。传统上，对肿瘤患者的评估主要是基于术后生存率，但近来认识到，在癌症的诊断与管理过程中，可以对患者的生活质量的各个方面产生重大影响。癌症的治疗目的，不仅仅是提高生存率，也应该保证患者的生活质量，同时评估这些变化也变得十分重要。

Abstract:In recent years, the healthy disease-free viewpoint and right-protection awareness have been increasingly growing among Chinese population, so they put forward higher requirements for the diagnosis and treatment of their diseases. Despite doctors trying their best to meet the requirements of the patients, once the complications inevitably arise, the patients and their families may resort to legal action, even to violence in order to gain compensation. Under the current healthcare environment, doctors should strive to avoid the occurrence of medical disputes, for which the essential strategy not only depends on the accumulation of professional knowledge and improvement of technique of the doctors, but further relies on good doctor-patient communication. Here, the authors, based on the characteristics of thyroid diseases and surgery, related laws and regulations, relevant case examples, and their own clinical experience, summarize the issues on how to make a good communication before thyroid surgery, with the purpose of helping raise the doctor-patient trust and improve the current tense doctor-patient relationship.

Abstract:Objective: To investigate the relationship between Hashimoto’s thyroiditis (HT) and risk of papillary thyroid cancer (PTC), and its association with the prognosis of PTC patients. Methods: The data of 2 478 patients undergoing thyroid surgery in the first affiliated hospital of China Medical University between 2004 and 2012 were retrospectively analyzed. Of them, 676 were PTC patients, and 1 802 were benign thyroid nodular disease (BTND) patients. The incidence of concomitant HT, parameters for thyroid function tests and other possible influential factors of the two groups of patients were compared and analyzed. Results: Compared with BTND group, in PTC group, the rate of concomitant HT, level of thyroid stimulating hormone (TSH), and positive rate of thyroglobulin antibodies (TGAb) and thyroid peroxidase antibody (TPOAb) were significantly increased, but the free triiodothyronine (FT3) level was significantly increased (all P<0.05), while the sex ratio and free thyroxine (FT4) level showed no statistical difference (both P>0.05). After exclusion of the HT patients, both TGAb and TPOAb positive rates in PTC group were still higher than those in BTND group (both P<0.05), and in addition, the PTC ratio was elevated with the increase of TSH level in either the entire group of patients or HT patients only. In comparison between the BTND patients with and without HT, the former showed significantly reduced male ratio, significantly increased TSH level and significantly decreased FT3 and FT4 levels (all P<0.05). In comparison between the PTC patients with and without HT, the former showed significantly decreased male ratio and average age, and significantly increased TSH level, but reduced tumor size and TNM stage (all P<0.05). Multivariate analysis identified that concomitant HT, high TSH level, male sex and positive TGAb were independent risk factors for PTC (all P<0.05). Conclusion: HT is associated with an increased risk of PTC, which is probably associated with the increased TSH level induced by the hypothyroid status in HT. However, as an autoimmune disease, it may also be associated with a better prognosis of PTC patients.

Abstract:Objective: To assess the clinical application value of CD147 detection in thyroid nodules with nondiagnositic cytologic results from fine-needle-aspiration (FNA) biopsy. Methods: Patients with thyroid nodules admitted from October to December 2013 were selected, and their postoperative surgical specimens were used for FNA smear test. According to thyroid cytopathology results using the Bethesda reporting system, immunohistochemical staining for CD147 was conducted in 36 samples suspicious for malignancy; the CD147 positive cases were considered as malignant, and the results were compared with the postoperative pathological diagnosis of the paraffin sections. Results: Nineteen cases (52.78%) were considered benign and 17 cases were considered malignant by CD147 staining, while 16 and 20 cases were proven benign and malignant respectively by postoperative pathological examination. CD147 positive expression rate in malignant lesions was significantly higher than that in benign lesions (P<0.05). CD147 expression was associated with calcification of the thyroid nodules (CD147 positive rate was 89.47%) and lymph node metastasis (CD147 positive rate was 100%). The accuracy and sensitively of FNA plus CD147 immunochemical analysis for differential diagnosis of benign and malignant thyroid lesions was 91.67% and 85.0%, respectively. Conclusion: CD147 can be used as a molecular biological marker for thyroid cytopathologic diagnosis, and FNA biopsy combined with CD147 immunochemical analysis could improve the preoperative detection rate of thyroid cancer.

Abstract:Objective: To summarize the experience in diagnosis and treatment of nodular goiter with thyroid carcinoma. Methods: The clinical data of 185 patients with nodular goiter and concomitant thyroid carcinoma who underwent surgical treatment from January 2007 to December 2012, and their diagnoses were confirmed by pathological examination, were retrospectively analyzed. Results: During that period, among a total of 1 657 patients with nodular goiter who received surgical treatment, 185 cases (11.16%) had concomitant thyroid cancer, of whom, 158 cases (85.4%) were papillary carcinoma, 17 cases (9.2%) were follicular carcinoma, 9 cases (4.9%) were the mixed form, and one case (0.5%) was undifferentiated carcinoma. The incidence of calcification in patients with nodular goiter and concomitant thyroid cancer was significantly higher than that in those with simple nodular goiter (χ2=130.16, P=0.00), and the incidence of cancer in patients with microcalcifications (gravel-like calcifications) was significantly higher than that in those with macrocalcifications (χ2=91.49, P=0.00). All patients underwent intraoperative frozen section assessment (except 12 cases in whom the diagnosis was recently confirmed at another hospital), and then underwent different surgical procedures of varying scopes according to patients’ conditions, and all of them were prescribed lifelong thyroxine therapy after surgery. Conclusion: Well differentiated papillary carcinoma is the most frequent type of thyroid cancer with concomitant nodular goiter; aggressive surgical treatment should be performed for patients who have nodular goiters with calcification and especially with microcalcification; intraoperative fast pathological examination of the nodular goiter should be performed, as this is helpful in the selection of the appropriate surgical approach.

Abstract:

Objective: To investigate the clinicopathologic characteristics of primary hyperthyroidism with concomitant thyroid cancer. Methods: The clinical data of patients with primary hyperthyroidism and concomitant thyroid cancer treated in Department of Thyroid Surgery in the First Hospital of Jilin University from January 2010 to August 2013 were retrospectively analyzed, and were also compared with data in the literature. Results: A total of 85 patients with primary hyperthyroidism underwent surgical treatment, and 31 cases had concomitant thyroid cancer. The preoperative diagnostic rate by clinical findings and neck ultrasound examination was 80.6% (25/31). After control of the symptoms of hyperthyroidism and thyroid function recovery was assured by examinations, all the 31 patients underwent surgical treatment by different procedures according to the patient’s specific condition, and all of them were successfully discharged from the hospital after surgery. No iatrogenic permanent recurrent laryngeal nerve injury or hypoparathyroidism occurred. The postoperative pathology showed that one case was medullary carcinoma and all the other 30 cases were papillary thyroid carcinoma; 17 cases (54.8%) had capsular invasion, and 9 cases (29.10%) had lymph node metastasis in central compartment, but there was no statistical difference in any pathological parameter compared with that of thyroid cancer alone, which was reported in the literature. Conclusion: The incidence of primary hyperthyroidism with concomitant thyroid cancer shows an increasing trend, and the importance of neck ultrasound examination should be emphasized in early diagnosis of this condition. Timely surgical treatment with an appropriate procedure after diagnosis may offer favorable outcomes.

Abstract:Objective: To evaluate the feasibility and clinical value of endoscopic thyroidectomy for early-stage differentiated thyroid carcinoma (DTC). Methods: The clinical data of 75 patients with early-stage DTC treated between January 2010 and June 2013 were retrospectively analyzed. Of the patients, 15 cases received totally endoscopic thyroidectomy (endoscopic operation group) and 60 cases were subjected to traditional open surgery (traditional operation group). All patents underwent at least resection of the affected lobe and isthmus plus central compartment neck dissection. The main clinical variables and postoperative cosmetic results between the two groups were compared. Results: Totally endoscopic thyroidectomy was successfully completed in all of the 15 patients without open conversion or postoperative massive hemorrhage. The operative time in endoscopic operation group was somewhat longer than that in traditional operation group, but the difference did not reach a statistical significance (P=0.059); there were no cases of postoperative hypocalcemia or hoarseness in any of the groups, and the clinical variables that included intraoperative blood loss, postoperative drainage volume, length of hospital stay and number of resected lymph nodes from the central compartment between the two groups showed no statistical difference (all P>0.05). Patients in the two groups were followed up for 6 to 36 months; no recurrence was noted, and the scars in patients of endoscopic operation group were small and not conspicuous, which yielded obviously better cosmetic results compared with traditional operation group. Conclusion: Totally endoscopic thyroidectomy for early-stage DTC is safe and feasible, with excellent cosmetic effect.

Abstract:Objective: To analyze the clinical and pathological features of thyroid microcarcinoma and assess the value of total thyroidectomy in the treatment of this condition. Methods: The medical records of 128 patients with thyroid microcarcinoma confirmed by surgical and pathological findings from October 2009 to December 2012 were retrospectively analyzed. All patients underwent total thyroidectomy and some of them also received adjuvant 131I therapy. Results: Of the 128 patients, single focus of microcarcinoma was found in 87 cases (67.97%), and multiple foci of microcarcinoma were found in 41 cases of (32.03%). The diameters of lesions in patients with single focus of microcarcinoma were all larger than 0.3 cm and were able to be detected by preoperative ultrasound; among patients with multiple foci of microcarcinoma, all of the lesions in 25 cases (60.98%) were clearly identified by preoperative ultrasound, while in the other 16 cases (39.03%), preoperative ultrasound could detect those lesions that were larger than 0.3 cm and the other lesions were found by intraoperative frozen section or postoperative paraffin sections. The multiple lesions in 22 patients (53.66%) were confined to only one side of the thyroid gland and 19 cases (43.34%) involved both sides. Postoperative follow-up rate was 100%, and one patient developed cervical lymph node metastases. Conclusion: Better understanding of the clinical and pathological characteristics of thyroid microcarcinoma, along with extensive examination may avoid missed diagnosis; total thyroidectomy is of proven value in treatment of thyroid microcarcinoma.

Abstract:

Objective: To investigate the value of determination of the peripheral blood level of CD4+CD25+Foxp3+ regulatory T cells (Treg) in breast cancer patients. Methods: The percentage of CD4+CD25+Foxp3+Treg cells in CD4+ T cells in the peripheral blood from 74 breast cancer patients and 30 healthy controls were measured by flow cytometry. The relations of CD4+CD25+Foxp3+Treg cell level with the clinicopathologic factors and relevant immunohistochemical parameters of the breast cancer patients were analyzed. Results: The percentage of CD4+CD25+Foxp3+Treg cells in CD4+ T cells of breast cancer patients was higher than that of healthy controls [(9.15±2.24)% vs. (2.29%±1.36%)], and the difference had statistical significance (P<0.05). Statistical analyses showed that the peripheral blood level of CD4+CD25+Foxp3+Treg cells of breast cancer patients was significantly related to histological grade, lymph node metastasis, pTNM stage and expressions of HER-2, pS2 and nm23 (r=0.583, r=0.333, r=0.919, r=0.604, all P<0.05), and irrelevant to tumor size, pathological type and the expressions of estrogen receptor (ER), progesterone receptor (PR), p53 and Ki-67 (all P>0.05). Further correlation analyses demonstrated that CD4+CD25+Foxp3+Treg cell level was positively correlated with histological grade, number of lymph node metastasis, pTNM stage and Her-2 expression and negatively correlated with pS2 and nm23 expression (r=–0.229, r=-0.401, all P<0.05). Conclusion: The peripheral blood level of CD4+CD25+Foxp3+Treg cells is increased in breast cancer patients, which also is closely related to the progression and metastasis of breast cancer. So its determination may offer certain implications for evaluation of the prognosis and therapeutic effects of the patients.

Abstract:Objective: To investigate the relationship between estrogen receptor (ER) and epidermal growth factor receptor (EGFR), and its role and mechanism in tamoxifen (TAM) therapy resistance of breast cancer. Methods: Two types of cells namely the TAM therapy-sensitive (TAM-S) and -resistant (TAM-R) human breast cancer MCF-7 cells were used. In these two types of cells, immunoprecipitation (IP) was performed to detect the connection between ERα and EGFR, and the connection of c-Src to the two former receptors, and the phosphorylation level of c-Src was also determined by Western blot analysis. After treatment with c-Src inhibitor PP2, the connection between ERα and EGFR was examined again by IP method. Results: ERα and EGFR linked in a complex form in both types of cells, but the linkage level in TAM-R cells was significantly higher than that in TAM-S cells (P<0.05). c-Src linked in a complex form to either ERα or EGFR in both types of cells, and the phosphorylation level of c-Src in TAM-R cells was significantly higher than that in TAM-S cells (P<0.05). After the c-Src activity was inhibited by PP2, linkage level between ERα or EGFR was decreased in both types of cells, while the decreasing degree in TAM-R cells was significantly greater than that in TAM-S cells (P<0.05). Conclusion: There is a connection between ERα and EGFR, which may play an important role in TAM therapy resistance of breast cancer, and c-Src activation (phosphorylation) may be the crucial mechanism for their linkage.

Abstract:Objective: To observe the influence of interference of Yes-associated protein (YAP) gene expression on proliferation and apoptosis in breast cancer cells. Methods: Using a retrovirus-mediated method, breast cancer MCF-7 cells were transfected with YAP shRNA (experimental group) or negative control shRNA (control group), respectively. After that, the interference efficacy was evaluated via qRT-PCR and Western blot analysis, cell proliferative ability was determined by bromodeoxyuridine (BrdU) incorporation assay and MTT assay, and cell apoptosis was detected with flow cytometry and DAPI staining, respectively. Results: Interference efficacy determination showed that YAP mRNA expression level was significantly decreased (P<0.05), and YAP protein expression was also remarkably down-regulated in MCF-7 cells in experimental group compared with control group at 72 h after transfection. Cell proliferation assay showed that BrdU incorporation level and OD value in experimental group were significantly reduced compared with control group (both P<0.05), and the ratio of proliferation inhibition in experimental group at 24, 48, 72 h after transfection was 19.1%, 38.5% and 53.5%, respectively. Cell apoptosis analysis showed that the apoptosis rate and number of apoptotic cells in experimental group were significantly increased compared with control group (both P<0.05).Conclusion: Interference of YAP gene expression can effectively inhibit the proliferation and accelerate apoptosis in breast cancer cells, and YAP may probably a potential therapeutic target for breast cancer.

Abstract:Objective: To observe the expression of TK1, Ki-67 and p53 in breast cancer (BC) and their prognosis. Methods: Sixty patients with breast cancer admitted from March 2009 to May 2013 underwent radical mastectomy and their histological specimens were obtained. The expressions of TK1, Ki-67 and p53 in these breast cancer tissues and their adjacent tissues were examined by immunohistochemical staining, and in combination with the follow-up data, the relations of TK1, Ki-67 and p53 expression with the prognosis of the patients were analyzed. Results: The positive expression rates of TK1, Ki-67 and p53 in breast cancer tissues were all significantly higher than those in their adjacent tissues (all P<0.05). The expression intensities of TK1, Ki-67 and p53 markedly affected the 5-year survival rate of the patients, which all indicated that the higher the expression intensity, the lower the survival rate (all P<0.05). The positive expression rates of TK1, Ki-67 and p53 in patients with recurrence or metastasis within 5 years were significantly higher than those in patients without recurrence or metastasis. Conclusion: The expressions of TK1, Ki-67 and p53 are enhanced in breast cancer tissue, and their expression intensities are closely associated with unfavorable prognosis of the patients.

Abstract:Objective: To compare the efficacy of different surgical procedures in treatment of bilateral nodular goiter (NG) with concomitant Hashimoto’s thyroiditis (HT). Methods: The data of patients with bilateral NG and concomitant HT that were treated by surgery and confirmed by pathological examination from January 2006 to July 2013 were collected. According to the resection scope, the patients were divided into subtotal/partial thyroidectomy group, near total thyroidectomy group and total thyroidectomy group, and 30 cases for each group were selected. The pre-, intra- and postoperative clinical parameters among the 3 groups were compared. Results: The preoperative clinical data among the three groups were comparable (all P>0.05). The operative time in subtotal/partial thyroidectomy group was significantly shorter than that in other two groups (both P<0.05), while there were no statistical differences in terms of the intraoperative blood loss, length of total hospital stay, length of postoperative stay, drainage retention time and drainage volume among the 3 groups (all P>0.05). No massive postoperative hemorrhage, permanent hoarseness, or hypocalcemia occurred in any of the groups, and no statistical difference was noted in the incidence of transient hoarseness among the 3 group (P>0.05). The incidence of transient hypocalcemia in total thyroidectomy group was significantly higher than that in other two groups (both P<0.05), while the incidence of recurrence in subtotal/partial thyroidectomy group was significantly higher than that in the other two groups (both P<0.05). Conclusion: For NG with concomitant HT, subtotal/partial thyroidectomy has a shorter operative time but a higher recurrence rate, while total bilateral thyroidectomy has a higher incidence of temporary hypocalcemia.

Abstract:Objective: To investigate the efficacy and safety of the use of harmonic scalpel in open thyroid surgery. Methods: Using a prospective randomized controlled trial design, 210 patients from February 2010 to May 2012 were divided into harmonic scalpel group and electric scalpel group with 105 cases in each group, and underwent open thyroidectomy with harmonic scalpel and conventional electric scalpel, respectively. All operations were completed by the same surgical team with a wide experience in thyroid surgery. The operative time, intraoperative blood loss and postoperative drainage volume for the same type of surgery, and postoperative complications between the two groups were compared. Results: There was no significant difference in age, sex, tumor size or type of disease between the two groups (all P>0.05). The operative time, intraoperative blood loss and postoperative drainage volume for the same type of surgery in harmonic scalpel group were all reduced compared with electronic scalpel group, with all differences reached a statistical significance (all P<0.05). No statistical difference was noted in postoperative complications between the two groups (P>0.05). Conclusion: Harmonic scalpel combines hemostasis and sectioning in a single instrument, which simplifies the surgical procedure; use of harmonic scalpel in open thyroid surgery can shorten operative time and reduce intraoperative bleeding.

Abstract:Objective: To compare the surgical effects of modified Miccoli’s approach versus total endoscopic approach in treatment of benign thyroid nodules. Methods: Forty-eight patients with benign thyroid nodules underwent thyroid adenoma resection, partial thyroidectomy, subtotal thyroidectomy, or unilateral thyroid lobectomy with modified Miccoli’s approach (modified Miccoli’s group, 24 cases) or total endoscopic approach (total endoscopic group, 24 cases). The operative time, intraoperative blood loss, postoperative pain scores, postoperative drainage volume, score for satisfaction with the incision, length of hospital stay, hospitalization costs and incidence of postoperative complications between the two groups were compared. Results: The parameters that included operative time, intraoperative blood loss, postoperative pain scores, postoperative drainage volume in modified Miccoli’s group were all significantly superior to those in total endoscopic group (all P<0.05), but the score for satisfaction with the incision in total endoscopic group was higher than that in modified Miccoli’s group (P<0.05). There was no statistical difference in terms of length of hospital stay, hospitalization costs or incidence of postoperative complications between the two groups (all P>0.05). Conclusion: The modified Miccoli’s approach has distinct advantage in treatment of benign thyroid nodules and can be regarded as a preference, while the total endoscopic approach is suitable for those with high cosmetic expectations.

Abstract:Objective: To compare the influence of exposure and non-exposure of recurrent laryngeal nerve (RLN) during thyroid surgery on the incidence of postoperative RLN injury. Methods: The randomized controlled trials (RCTs) comparing RLN exposure and RLN non-exposure during thyroid surgery were searched from several national and international databases. After screen for inclusion, data extraction, and quality assessment, the incidence of temporary and permanent postoperative RLN injury of the two procedures were compared by Meta-analysis. Results: Seven RCTs were finally included, with a total of 2 074 patients, of whom, 1 015 cases underwent thyroid surgery with RLN exposure (exposure group) and 1 059 cases without RLN exposure (non-exposure group). Meta-analysis results showed that either the incidence of temporary or permanent postoperative RLN injury in exposure group was lower than that in non-exposure group (OR=0.19, 95% CI=0.11–0.34; OR=0.14, 95% CI=0.06–0.34), and the differences had statistical significance (both P<0.05). Conclusion: Routine RLN exposure in thyroid surgery can effectively reduce the incidence of postoperative RLN damage. However, because no other clinical variables were compared in this study, the pros and cons of the two procedures need further verification with a large sample and high-quality RCTs.

Abstract:Objective: To investigate the alterations in thyroid function in different aged patients after unilateral thyroid lobectomy for benign thyroid tumor and the necessity of postoperative hormone replacement therapy (HRT). Methods: One-hundred and twenty patients with benign thyroid tumor undergoing unilateral thyroid lobectomy were divided according to their ages, into young group (less than or equal to 30 years, 23 cases), middle-aged group (greater than 30 to less than 60 years, 69 cases) and elderly group (greater than 60 years, 28 cases). The levels of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) in each group of patients were measured before operation and at 1 week, 1 month, 3 and 6 months, 1 year and 2 years after operation, respectively. Results: In young group, FT3 level was significantly decreased at postoperative week 1 and month 1 (P<0.05), but showed no statistical difference (P>0.05) at all later time points compared with preoperative level; FT4 level had no statistical difference at any postoperative time point compared with preoperative level (P>0.05); TSH level was significantly increased at postoperative week 1, month 1 and 3 (P<0.05) but showed no statistical difference at all later time points compared with preoperative level (P>0.05). In middle-aged group, either level of FT3, FT4 or TSH had no statistical difference at any postoperative time point compared with their preoperative levels (P>0.05). In elderly group, FT3 level was significantly decreased at postoperative week 1, month 1 and 3 (P<0.05), but showed no statistical difference (P>0.05) at all later time points compared with preoperative level; FT4 level was significantly decreased at postoperative month 1, 3 and 6 (P<0.05), but showed no statistical difference (P>0.05) at all other time points compared with preoperative level; TSH level was significantly increased at postoperative week 1, month 1, 3 and 6 (P<0.05) but showed no statistical difference at the later time points compared with preoperative level (P>0.05). No clinical hypothyroidism symptoms were noted in any of the 3 groups of patients. Conclusion: The recovery process of thyroid function varies among patients of different ages after hemithyroidectomy for benign thyroid tumor. HRT is unnecessary for middle-aged patients due to their strong compensatory ability, while a 6-month HRT for young patients due to a relatively large demand for thyroid hormones, and a 1-year HRT for elderly patients due to poor compensatory ability, are justified after operation.

Abstract:

Objective: To investigate the value of ultrasound detection of calcifications in differential diagnosis of benign and malignant thyroid nodules. Methods: The ultrasonographic data and clinicopathologic observations of 4 0 1 1 patients with thyroid disease undergoing surgical treatment from January 2005 to January 2010 were reviewed. The relations of whether or not calcification was present and different calcification patterns with benign and malignant thyroid nodules were analyzed, and the malignancy rate between single calcified nodule and multiple calcified nodules, and among calcified nodules of different ages groups were compared. Results: The malignancy rate in thyroid nodules with calcifications was significantly higher than that in those without calcification; in nodules with microcalcifications was signi?cantly higher than that with non-calci?cation; in single calcified or microcalcified nodule was significantly higher than in multiple calcified nodules; in calcified nodules in patients below 45 years old was significantly higher than that in those in patients greater than or equal to 45 years old, and all the difference had statistical significance (all P<0.05). For diagnosis of thyroid cancer, the sensitivity of calcification, microcalcification, macrocalcification and rim-like calcification was 80.42%, 51.65%, 26.52% and 2.25%, and their specificity was 67.53%, 93.19%, 76.79% and 97.55%, respectively. In the 39 patients with calcification in cervical lymph nodes, 37 cases were papillary thyroid carcinoma with lymph node metastases. Conclusion: Calcification and microcalcification in thyroid nodules has great importance in diagnosis of thyroid cancer. Single calcified nodule, microcalcified nodule, calcified nodules in patients younger than 45 years old, and calcification in lymph nodes have higher malignancy rate.

Abstract:Objective: To investigate the risk factors for non-sentinel lymph node (NSLN) metastasis in breast cancer patients with positive sentinel lymph node biopsy (SLNB) results. Methods: The clinical data of 138 breast cancer patients with positive SLNB results admitted from July 2009 to October 2013 at the affiliated tumor hospital of Xinjiang Medical University were collected. The relations of the clinicopathologic factors with NSLN metastasis were determined by univariate and multivariate Logistic regression analysis. Results: Univariate analysis showed that primary tumor diameter, histological grade, rate of sentinel lymph node metastases, maximal diameter of the sentinel lymph node metastases and vessel invasion were related to NSLN metastasis (all P<0.05); Logistic regression analysis identified that primary tumor diameter (OR=2.263, P=0.005), rate of sentinel lymph node metastases (OR=1.919, P=0.002), maximal diameter of the sentinel lymph node metastases (OR=8.479, P=0.000) and vessel invasion (OR=4.518, P=0.029) were independent risk factors for NSLN metastasis. Conclusion: Primary tumor diameter, rate of sentinel lymph node metastases, maximal diameter of the sentinel lymph node metastases, and vessel invasion can be used as independent variables to predict NSLN metastasis in breast cancer patients.

Abstract:

Objective: To investigate the clinicopathologic characteristics of breast cancer in women under 35 years of age. Methods: The clinical and pathological data of 85 young women (under 35 years of age) with breast cancer (observational group) admitted from 2005 to 2010 were retrospectively analyzed, and were compared with those from 164 middle-aged and elderly women with breast cancer (control group), who were admitted during the same period and randomly selected. Results: In the 85 young breast cancer women in observational group, there were no specific clinical symptoms, the misdiagnosis rate was 45.88%, average age was (30.27±2.41) years and average disease course was (11.51±1.56) months. Compared with control group, observational group showed larger tumor size, more advanced clinical stage, and poorer differentiation in histological grade (all P<0.05), but no statistical difference in constitution of the pathological types (P>0.05). In addition, the expression levels of estrogen receptor (ER) and progesterone receptor (PR) were lower but c-erbB-2 protein expression level was higher in the breast cancer tissues in observational group than those in control group (all P<0.05), and both rate and number of axillary lymph node metastasis in observational group were higher than those in control group (both P<0.05). Conclusion: Breast cancer in young women has distinct clinicopathologic characteristics and molecular biological features. Early diagnosis and treatment is the effective way to improve the survival rate in these patients.

Abstract:

Objective: To assess application value of bilateral water-dripping bipolar coagulation in hepatic lobectomy. Methods: The clinical data of 145 patients undergoing hepatic lobectomy in the first affiliated hospital of Chongqing Medical University between April 2011 and August 2013 were retrospectively analyzed. Of the patients, 93 cases underwent liver resection with bilateral water-dripping bipolar coagulation (observational group), and 52 cases received radiofrequency ablation (RFA)-assisted liver resection (control group). The clinical results of the two groups of patients were compared. Results: The preoperative data between the two groups were comparable, and all patients successfully received hepatic lobectomy. In observational group compared with control group, the operative time was prolonged, but the surgery-related cost and overall incidence of postoperative complications were significantly reduced (all P<0.05). There was no statistical difference between the two groups in terms of rate of first hepatic portal occlusion, intraoperative blood loss, transfusion rate, function recovery or length of postoperative hospital stay (all P>0.05). Conclusion: Hepatic lobectomy using bilateral water-dripping bipolar coagulation has the advantages of decreased postoperative complications and surgery-related cost, so it is recommended for use.

Abstract:Mutation in V-raf murine sarcoma viral oncogene homolog B1 (BRAF) gene is the most common genetic event in thyroid cancer, particularly in papillary thyroid cancer (PTC). Recent investigations indicate that BRAF V600E gene mutation is closely related to the occurrence and development of PTC. Further, as an effective risk-predicting molecular marker for PTC, it can help surgeons make personalized treatment plan for PTC patients. Here, the authors present the recent progress involving the relationship between PTC and BRAF gene.

Abstract:Breast cancer is a common malignant tumor in China. Its prevalence is increasing and the patients are getting younger, and thus it is a great threat to the health of women. With the rapid development of translational medicine, the concept of integrated therapy of breast cancer is gradually accepted by the public, among which, endocrine therapy has attracted enormous attention, due to its potent efficacy and low toxicity. In this paper, the authors overview the recent research progress in endocrine therapy of breast cancer involving ovarian function suppression, anti-estrogen drugs, progesterone, testosterone, aromatase inhibitors, luteinizing hormone and luteinizing hormone releasing hormone analogs and so on.