ObjectiveTo investigate the condition of neck lymph node metastasis and related factors in thyroiditis coexisting thyroid cancer, and make clear the indication of neck lymph node dissection. MethodsA retrospective cohort study was conducted with the clinical data of 147 patients with thyroiditis coexisting thyroid cancer who underwent radical resection of thyroid cancer (total thyroidectomy or subtotal thyroidectomy) and neck lymph node dissection, including age, gender, tumor size, number of focuses, and lymph node metastasis. Results Among 147 patients, 65 patients with neck lymph node metastasis (44.22%), central cervical lymph node metastasis rate was 36.05% （53/147）， which was higher than that of lateral lymph node metastasis rate (20.41%, 30/147), Plt;0.05. Neck lymph node metastasis rate was correlated with patient’s gender and tumor size （Plt;0.05）, while it was not correlated with patient’s age and number of focuses (Pgt;0.05). ConclusionCentral neck lymph node metastasis rate is higher in patients with thyroiditis coexisting thyroid cancer, then routine prophylactic central neck lymph node dissection is significant. Patient’s gender and tumor size are correlated with neck lymph node metastasis. When tumor is larger or in male, ipsilateral lymph node dissection should be considered to done.
Objective To investigate the lymph node micrometastasis and its clinicopathologic features on 5-year disease free survival rate for patients with pT1—3N0 gastric cancer. Methods One hundred and twenty patients with stage pT1—3N0 gastric tumors were included, and 2 106 lymph nodes were harvested and examined in all the specimens. There were 9－28 lymph nodes with average 18 lymph nodes from each patient. All the lymph nodes were negative by HE staining. The CK20 expression of lymph nodes was tested by immunohistochemistry. The relationships between clinicopathologic features or CK positive expression and 5-year disease free survival were analyzed. Results The positive expression rate of CK20 was 9.07% (191/2 106) in lymph nodes and 26.67% (32/120) in patients with pT1—3N0 gastric cancer by immunohistochemistry. Eleven cases were with micriometastasis, 21 cases were isolated tumor cells (ITC). The average postoperative follow-up was 66.35 (range 24—121) months. Five-year disease free survival rates were 87.4%, 78.3%, and 40.9% for the lymph node negative, ITC, and micrometastasis groups, respectively. Five-year disease free survival rate in the micrometastasis group was lower than that in the lymph node negative group (P=0.000) and ITC group (P=0.046). However, there was no significant difference between the lymph node negative group and ITC group （P=0.253）. Multivariate analysis identified tumor diameter (P=0.011), depth of tumor invasion (P=0.043), and lymphatic vessel invasion (P=0.002) were related with CK20 positive expression. There was no significant relationship between the pathologic parameters and the 5-year disease free survival rates. Lymph node micrometastasis of gastric cancer was detected in 11 patients who should belong to stage pN1(Mi), the restage rate was 9.17%. While the lymph node negative (88 patients) and ITC (21 patients) were recorded pN0(i-) and pN0(i+), respectively, and were not recommended restage (stage pN0). Conclusion Patients with stage pT1—3N0 gastric cancer and micrometastasis in lymph node are with high-risk and low 5-year disease free survival rate, for whom adjuvant therapies may be justified and effective.
Objective To explore the expression of matrix metalloproteinase （MMP）-2 in patients with papillary thyroid cancer （PTC） recurrence or residuum and its value of clinical application. Methods The serums from 68 patients with thyroid disease underwent operation and 15 health examinations under stomachs empty from March 2009 to December2009 in this hospital were gathered. Sixty-eight patients with thyroid disease were divided into PTC with lymph node metastasis （LNM） group （n=19），PTC recurrence or residuum with LNM group （n=17），PTC without LNM group （n=10），and benign thyroid disease group （n=22） according to the postoperative pathological findings，15 health examinations as control group. The expression of MMP-2 of serum sample was detected by ELISA method. The difference of the expression of MMP-2 in each group was analyzed. Results The expressions of MMP-2 in the PTC recurrence or residuum with LNM group，PTC with LNM group，PTC without LNM group， benign thyroid disease group，and the control group were （1 724.00±762.24） ng/ml，（1 329.16±776.59） ng/ml，（1 489.61±546.53） ng/ml，（1 264.87±817.27） ng/ml，and （608.43±88.63） ng/ml，respectively. The expressions of MMP-2 in the PTC with LNM group and PTC recurrence or residuum with LNM group were significantly higher than those in the benign thyroid disease group （P＜0.05） and the control group （P＜0.05），respectively，which in the PTC without LNM group was significantly higher than that in the control group （P＜0.05）. There was no significant difference of MMP-2 expression of serum between the benign thyroid disease group and the control group （P＞0.05），which were no significant difference among the other threemalignant disease groups （P＞0.05）. The MMP-2 positive expression rates were 79%，76%，80%，41%，and 20% in the PTC with LNM，PTC recurrence or residue with LNM group，PTC without LNM group，benign thyroid disease group，and control group，respectively. The MMP-2 positive expressions rates of serums were not significantly different among three malignant disease groups （P＞0.05），but which were significantly higher than those of the benign thyroid disease group （P＜0.01） and control group （P＜0.01），respectively. Conclusions The MMP-2 level of serum can be used as an index to judge preoperative thyroid nodules，which can not be use to determine whether PTC metastasis or not.
Objective To investigate the expression of cerb B2 and CathepsinD in gastric carcinoma and its correlation with the biological behavior of gastric carcinoma (GC). MethodsThe expression was studied by immunohistochemical technique. The expression of cerb B2 and CathepsinD were analyzed with their relation to histologic types, depth of invasion, growth pattern, lymph node metastasis and prognosis of gastric carcinoma. ResultsThirtynine of the 102 gastric carcinoma specimens (38.24%) were positive for cerb B2 and correlated with depth of invasion (P＜0.05) and lymph node metastasis (P＜0.05); eightythree of the 102 gastric carcinoma specimens (81.37%) were positive for CathepsinD and correlated with depth of invasion (P＜0.05), growth pattern (P＜0.05), lymph node metastasis (P＜0.05) and blood vessels cancer embolus (P＜0.05). Prognosis of patients with gastric carcinoma with positive expression of cerb B2 or CathepsinD was poor. The 5year survival rate was significantly lower in gastric carcinoma patients with positive expression of cerb B2 or CathepsinD. Conclusion cerb B2 and CathepsinD are highly related to growth, invasion, metastasis and prognosis of gastric carcinoma.
Objective To explore the value of multidetector row helical CT （MDCT） in the diagnosis of lymph node metastasis in adenocarcinoma of esophaogastric junction （AEG）， and to study the pattern of lymph node metastasis of it. Methods The MDCT images of 60 patients with AEG who underwent operation in our hospital from Jan. 2011to Oct. 2012 were collected， in order to explore the value of MDCT in the diagnosis of lymph node metastasis in AEG， and to study the pattern of lymph node metastasis of it. Results With diameter upper 8 mm and the difference of the mean value of enhanced degree upper 70 Hu as the standard of lymph node metastasis， the Kappa value （0.819 and 0.718），sensitivity （83.1% and 91.8%）， and specificity （78.9% and 83.5%） were all optimal. The lymph node metastasis rate was significantly higher in serosa invasion group than those of non-invasion group （P＜0.05）. The metastatic area of lymphnodes mainly concentrated around cardia （No. 7， 8， and 9 group）， lesser curvature of the stomach， celiac axis， and hepato-gastric ligament （No. 10， 11， 12， and 14 group） with the metastasis rate of 83.8% and 82.3%， respectively. Conclusion MDCT is useful to confirm the features， location， and rules of lymph node metastasis in patients with AEG， which is helpful in accurately cleaning the lymph nodes.
ObjectiveTo investigate the value of diffusion weighted imaging (DWI) combined with three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma. MethodsFrom July 2009 to March 2011, DWI examination was performed in 37 patients with hilar cholangiocarcinoma, which was compared with 3D-VIBE sequences. The morphological characteristics and distribution were analyzed for metastatic and nonmetastatic lymph nodes. Signal intensity (SI) was measured on DWI images and apparent diffusion coefficient (ADC) was calculated for each lymph node. The SI of lymph nodes (SILN） and liver (SIliver) were also measured and the ratio of SI was calculated. The ADC and the ratio of SI were compared between metastatic and nonmetastatic lymph nodes. ResultsThere were fifty-nine groups of lymph nodes in 37 patients with hilar cholangiocarcinoma, fifty-one groups were revealed in both DWI and 3D-VIBE sequences, and eight groups were only demonstrated in one sequence (P=0.070). The short diameters were (1.05±0.42) cm and (0.78±0.22) cm on 3D-VIBE images for metastatic and nonmetastatic lymph nodes, respectively (P=0.030). The ADC value in metastatic lymph nodes was (1.64±0.3)×10-3 mm2/s, which was significantly lower than that in nonmetastatic lymph nodes 〔(2.28±0.79)×10-3 mm2/s〕 on DWI images (P=0.033). There were no significant differences in SILN/SIliver between metastatic and nonmetastatic lymph nodes on images of portal venous phase and 3 min delayed contrast-enhanced phase. ConclusionsDifferences of ADC and short diameter can provide valuable information to differentiate metastatic lymph nodes with nonmetastatic lymph nodes. When combined with 3D-VIBE sequence, DWI is more effective in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma.
Objective To study the expression of CD133 mRNA in peripheral blood mononuclear cells （PBMCs） of patients with gastric adenocarcinoma （GC） before operation or after operation and its clinical significance. To learn the relationship of CD133 expressions in PBMCs to primary lesion of GC. Methods Fifty patients with GC，10 patients with gastric ulcer （GU）， and 10 healthy volunteers were registered in this research. Expressions of CD133 mRNA in PBMCs and in primary lesion of GC by semi-quantitative RT-PCR and expression of CD133 protein in primary lesion of GC by immunohistochemical staining were detected. Correlations of CD133 mRNA expression with clinicopathologic parameters and postoperative survival rate were analyzed. Relation between CD133 mRNA level and CD133 protein expression or lymphatic metastasis were assessed too. Results The brightness scale value （ABSV） of CD133 mRNA in PBMCs of the patients with GC before operation （0.270±0.163） was higher than that in the healthy volunteers （0.029±0.060） or in the patients with GU （0.059±0.099） （P=0.000）. The ABSV of CD133 mRNA in the PBMCs of patients with GC before operation was related to poor cell differentiation （P=0.002）， lymph vessel invasion （P=0.028），deeper tumor invasion （P=0.041），later lymph node metastasis stage （P=0.010），later TNM stage （P=0.006），and positive expression of CD133 protein in the primary lesion （P=0.011）. Relative analysis revealed that the ABSV of CD133 mRNA in the PBMCs of patients with GC before operation was related positively to metastatic lymphatic nodes ratio （rs=0.422，P=0.002），metastatic lymph node number （rs=0.398，P=0.004），and ABSV of CD133 mRNA in the primary lesion of GC （rs=0.337，P=0.017）. The ABSV of CD133 mRNA in the PBMCs of patients with GC after operation obtained from blood sample at 1 week after curative resection was higher than that in the patients before operation （P=0.021）. Patients suffered from deeper invasion inclined to have a higher ABSV of CD133 mRNA after surgery （P=0.039）. Higher expression of CD133 mRNA in patients after operation demonstrated a much poorer survival rate （P=0.013）. Conclusions Higher expressive level of CD133 mRNA in GC before operation is associated to poor cell differentiation，lymph vessel invasion，deeper invasion，higher lymph node metastasis，later TNM stage，and positive expression of CD133 protein. It is also related positively to metastatic lymphatic nodes ratio，metastatic lymph node number，and ABSV of CD133 mRNA in primary lesion of GC. The level of CD133 mRNA in PBMCs of patients with GC is higher after operation as compared with before operation，which demonstrates deeper invasion and poorer survival.
Objective
To explore the effect of carbon nanoparticles dyeing on axillary lymph node dissection in modified radical mastectomy for breast cancer.
Methods
Eighty-eight patients with breast cancer who received modified radical mastectomy in Mianyang Central Hospital between Mar. 2012 and May. 2013 were recruited in the study, and they were equally divided into areola group and peripheral tumor group. After induction of anesthesia before operation, carbon nanoparticles were injected around the areolar in the areola group, and carbon nanoparticles were injected around the tumor in the peripheral tumor group. The number of dissected lymph nodes(be dyed or not be dyed), metastatic lymph nodes, and black dyed lymph nodes, as well as value of operation related indexes were recorded and compared.
Results
In the areola group, lymph nodes were detected in 1 453, in which 1 396 lymph nodes were stained black(96.1%); the average number of dissected lymph nodes were 33.0±7.1 per case; and 19 patients (43.2%, in total of 220 metastatic lymph nodes) of them were suffered from lymph node metastasis with the average number of metastatic lymph nodes of 5±2 per case. in addition, in the areola group, operative time were(122.1±10.2) min, blood loss were(83.8±10.1) mL, postoperative hospital stay were(7±1) d, and postoperative complications occurred in 3 patients. In the peripheral tumor group, lymph nodes were detected in 909, in which 594 lymph nodes were stained black (65.3%); the average number of dissected lymph nodes were 20.7±3.2 per case; 20 patients (45.5%, in total of 88 metastatic lymph nodes) of them were suffered from lymph nodes metastasis, with the average number of metastatic lymph nodes of 2±1 per case. In addition, in the peripheral tumor group, operative time were (121.6±11.4) min, blood loss were (84.2±11.3) mL, postoperative hospital stay were (7±2) d, postoperative complications occurred in 3 patients. The black staining rate of lymph nodes, the number of lymph nodes retrieved, and the number of metastatic lymph nodes in areola group were significantly higher than those of peripheral tumor group(P < 0.01). Operative time, blood loss, postoperative hospital stay, and postoperative complication rate did not significantly differ between the 2 groups (P > 0.05).
Conclusion
The dyeing effect of carbon nanoparticles suspension, which was injected at areola area after induction of anesthesia, is better than that of injected around the tumor, without increasing the incidence of complication.
Abstract： Surgery is an effective therapy for non-small cell lung cancer (NSCLC). The standard operation includes lobectomy and systematic dissection of lymph nodes. However, postoperative tumor recurrence is common even among incipient patients due to incomplete dissection of lymph nodes and micrometastasis of lymph nodes. Injecting a carbon nanoparticles suspension is a new technique aimed at preventing this recurrence. The carbon nanoparticles carry lymph node tracers that help surgeons locate lymph nodes in order to clean them thoroughly. The tracers also target the lymph nodes for chemotherapy, thus killing residual tumor cells intraoperatively to avoid postoperative cancer recurrence. Carbon nanoparticles suspension injection is already widely and successfully used in surgery for gastrointestinal and mammary gland tumors, and is being tested for effectiveness in NSCLC patients. Some studies have indicated that carbon nanoparticles suspension injection is effective in NSCLC patients and improves their prognoses. We reviewed the features, application methods, and clinical applications of studies of carbon nanoparticles suspension injection for NSCLC.
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.
