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.
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.
Objective To investigate the expression level and methylation level of micro RNA-34b（miR-34b） gene in papillary thyroid carcinoma （PTC）， and to analyze the relationship between methylation and clinicopathological characters of PTC. Methods PTC tissues and tumor adjacent tissues were collected from 25 patients with PTC who underwent operation in Huai’an First People’s Hospital of Nanjing Medical University from Sep. 2008 to Oct. 2010. Expression of miR-34b gene and level of methylation in gene promoter were detected by real time PCR and methylation-specific PCR in the 2 kinds of tissues， respectively. Results The expression value of miR-34b mRNA in PTC tissues was 0.85±0.05， which was significantly lower than those of tumor adjacent tissues （1.62±0.09）， P=0.030. There were methylation in 18 （72%，18/25） PTC tissues， and 10 （40%，10/25） in tumor adjacent tissues， and the ratio of methylation was higher in PTC tissues （P=0.021）. In PTC tissues， methylation was not related to age， gender， tumor size， TNM stage， and invasion of the capsule （P＞0.05）， but was related to lymph node metastasis （P＜0.05）. Ratio of methylation in patients with lymph node metastasis was significantly higher than those of patients with no lymph node metastasis. Conclusion Methylation of miR-34b gene promoter is one of the reasons for inactivation of PTC， and it may be related to the development and metastasis of PTC， which needs to be further investigated.
Objective To summarize the relationship between IgG4 and IgG4 related thyroid diseases. Methods Domestic and international publications involving the pathological features of IgG4-related thyroid diseases and relationship with IgG4 were retrieved and reviewed. Results IgG4-related disease was a newly recognized class of chronic and systemic lymphocytes disease， which may be solitary or involving multiple body organs， as well as thyroid. The expression of IgG4 was found in leisons of Hashimoto thyroiditis， Riedel thyroiditis， and papillary thyroid carcinoma. Conclusions IgG4-related thyroid disease is a new concept of thyroiditis. The knowledge of this new disease will provide appropriate treatment for patients with thyroiditis.
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.
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.
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 study the expressions and clinical significance of matrix metalloproteinases-2 (MMP-2) and vascular endothelial growth factor-C (VEGF-C) in patients with papillary thyroid carcinoma (PTC). Methods SP immunohistochemical technique was used to detect the expressions of MMP-2 and VEGF-C in 78 cases of PTC and 18 cases of thyroid benign tumors.Results The positive expression rates of MMP-2 and VEGF-C in PTC （80.77%, 75.64%） were significantly higher than those of the thyroid benign tumor （11.11%, 22.22%）, P＜0.05. The expressions of MMP-2 and VEGF-C were correlated to the degree of infiltration and lymph node metastasis in PTC: In those which infiltrated to or over the thyroid capsular, or had clinical neck lymph node metastasis, the positive expression rates were significantly higher than those in the other cases which had confined invasion of thyroid capsular or non-clinical metastasis of neck lymph node (P＜0.05). And during the follow-up of 41 patients who didn’t have clinical neck lymph node metastasis before operation, the positive expression rates of those who had clinical neck lymph node metastasis were significantly higher than those in the other patients who didn’t have neck lymph node metastasis (P＜0.05). There was significantly positive correlation between the expressions of MMP-2 and VEGF-C in PTC （Gamma=0.846， P＜0.05）. Conclusions MMP-2 and VEGF-C may be used to distinguish malignant and benign thyroid tumor; The expressions of MMP-2 and VEGF-C are correlated with the degree of infiltration and neck lymph node metastasis in PTC; Combined detection of MMP-2 and VEGF-C will be more accurate to predict condition of lymph node metastasis.
ObjectiveTo analyze the relevant factors of levelⅡlymph node metastasis in papillary thyroid carci-noma. MethodsThe clinicopathologic data of 83 patients from November 2011 to March 2014 were analyzed retrospec-tively. All the primary tumors were papillary thyroid carcinoma located in unilateral lobe with ipsilateral lateral neck lymph node metastasis. The relationship of gender, age, microcarcinoma, superior pole involved by carcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis was analyzed. The calculated data were analyzed with Chi-Square test and there was significant difference when P < 0.05. ResultsThe rate of lymph node metastasis at levelⅡ, Ⅲ, Ⅳ, Ⅴ, Ⅵwas 51.8% (43/83), 78.3% (65/83), 71.7% (59/83), 4.8% (4/56), and 79.5% (66/83), respectively. There was no significant relationship of gender, age, microcarcinoma, integrated tumor capsule, or extranodal invasion to levelⅡlymph node metastasis (P > 0.05). The rate of lymph node metastasis at levelⅡwas significantly higher when superior pole involved by carcinoma (P < 0.05). ConclusionAmong the patients with papillary thyroid carcinoma, when superior pole involved by carcinoma the patient should be underwent selective neck dissection, the proper extent of dissection including levelⅡshould be performed.
ObjectiveTo evaluate the frequency of BRAFV600E mutation and the association between BRAFV600Emutation and clinicopathologic characteristics of papillary thyroid carcinoma (PTC) in Chinese population by Meta-analysis. MethodsThe relevant published studies before January 2014 were reviewed according to the defined selection criteria using the PubMed,Embase,VIP,China Biology Medicine Database,Wanfang and China Knowledge Resource Integrated Database. The effect sizes of outcome parameters were estimated by odds ratio (OR) or weighted mean difference with a 95% confidence interval (CI). The quality of the included trials was assessed and Meta-analyses were conducted by RevMan 5.1 software. ResultsThe study included 46 studies with a total of 5 831 patients. The prevalence of BRAFV600E mutation ranged from 25% to 83%,with an overall prevalence of 54.6%. The clinicopathologic characteristics of 5 542 patients were analyzed. There were statistical significances in association between BRAFV600E mutation and the presence of classical type [OR=2.30,95%CI (1.32,4.01),P=0.003],follicular type [OR=0.44,95%CI (0.23,0.86),P=0.02],extrathyroidal extension [OR=2.18,95%CI (1.83,2.59),P<0.00001],multifocality [OR=1.31,95%CI (1.07,1.60),P=0.009],lymphocytic thyroiditis [OR=0.31,95%CI (0.23,0.42),P<0.00001],lymph node metastasis [OR=1.95,95%CI (1.40,2.72),P<0.000 1],advanced TNM stage [OR=2.41,95%CI (2.01,2.88),P<0.00001] and recurrence [OR=3.22,95%CI (2.04,5.09),P<0.00001],but the correlation of BRAFV600E mutation was not significant with gender,mean age,mean tumor size,age being ≥45 years,tumor size being ≥10 mm,tall cell type,and distant metastases (P>0.05). ConclusionIn Chinese patients,PTC with BRAFV600E mutation has more aggressive clinicopathologic characteristics than that without BRAFV600E mutation. The BRAFV600E mutation may be used as an important prognostic marker for patients with PTC.