Objective
To investigate the optimal diagnosis and treatment strategy of occult carcinoma of the thyroid (OCT) with neck lymph node metastasis as the first symptom.
Method
In order to discuss the optimal diagnosis and treatment strategy of OCT with neck lymph node metastasis as the first symptom, we collected 35 cases and analyzed their characteristics, diagnostic methods, operative schemes, metastasis situation, and death situation.
Results
Of the 35 cases, 28 cases went to hospital because of swollen lymph nodes, and other 7 cases were discovered by color Doppler ultrasound in medical examination. Thyroid nodules were found by color Doppler ultrasound in 32 cases, 3 cases were found no thyroid nodule. Lymph node of 23 cases were determined by ultrasound-guided fine-needle aspiration biopsy (US-FNAB), and 16 cases (69.56%) were diagnosed as metastasis of thyroid carcinoma or suspicious metastasis by US-FNAB. Thyroid biopsy were done in 21 cases, and 11 cases (52.38%) were diagnosed as thyroid carcinoma or suspicious thyroid carcinoma by fine needle aspiration biopsy. Of the 35 cases, 19 cases were performed total thyroidectomy and functional neck lymph node dissection, 11 cases were performed resection of unilateral thyroid and isthmus and regional neck lymph node dissection, 5 cases were performed nonstandard operations. All cases were followed up for 3–10 years after operation, and the median time was 7-year. During follow up period, 10 cases suffered from reccurrence. Among them, 3 cases reoccurred in the nonstandard operation group, 5 cases reoccurred in resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, 3 cases reoccurred in total thyroidectomy and functional neck lymph node dissection group. There were 3 cases died. Among them, there was 1 case in each group of nonstandard operation group, resection of unilateral thyroid and isthmus and regional neck lymph node dissection group, and total thyroidectomy and functional neck lymph node dissection group. The recurrence rate of total thyroidectomy and functional neck lymph node dissection group was markedly lower than those of resection of unilateral thyroid and isthmus and regional neck dissection group (χ2=4.751,P<0.05) and nonstandard operation group (χ2=5.874,P<0.05). While there was no significance difference of the recurrence rate between the resection of unilateral thyroid and isthmus and regional neck dissection group and nonstandard operation group (χ2=0.291,P>0.05). There was no significance difference in the mortality among the three groups (P>0.05).
Conclusion
US-FNAB and intraoperation rapid frozen pathological section are important methods for diagnosis of OCT with neck lymph node metastasis as the first symptom, and standard operation is an principal treatment method for it.
ObjectiveTo explore the significance of thyroglobulin in the evaluation of lymph node metastasis during the treatment and follow-up of differentiated thyroid carcinoma.MethodThe literatures about thyroid globulin evaluation of lymph node metastasis of differentiated thyroid carcinoma were collected through online database and summarized.ResultsThe determination of thyroglobulin played an important role in the perioperative evaluation of lymph node metastasis in patients with differentiated thyroid carcinoma, the guidance of postoperative radiotherapy for metastasis, and the monitoring of recurrence and metastasis, and thyroglobulin combined with imaging examination could improve its evaluation efficiency.ConclusionsThyroglobulin is an important marker for the evaluation of lymph node metastasis in the treatment and follow-up of differentiated thyroid carcinoma. Combination between thyroglobulin and imaging examination or other laboratory indicators to comprehensively explore its diagnostic threshold is a new idea, that can improve its value in the evaluation of lymph node metastasis.
ObjectiveTo explore the relationship between Beclin 1 level and lymph node metastasis in patients with non-small cell lung cancer.MethodA total of 204 surgical specimens of patients with non-small cell lung cancer from September 2011 to September 2016 were collected in our hospital. There were 116 males and 88 females . Beclin 1 levels were detected by Western blotting. There were 116 males and 88 females at average age of 55.3±11.2 years. The patients were divided into three groups including a group N0 (no lymph node metastasis), a group N1(intralobar and interlobar lymph node metastases, and no mediastinal lymph node metastasis), and a group N2 (mediastinal lymph node metastasis). The differences of Beclin 1 levels in tumor tissues and lymph nodes of patients with N0, N1 and N2 were statistically analyzed.ResultsAmong 204 patients of lung cancer, 36 patients were squamous cell carcinoma and 168 patients were adenocarcinoma. The levels of Beclin 1 in tumor tissues of N0, N1 and N2 groups decreased gradually with a statistical difference (P<0.05). In the three groups, the levels of Beclin 1 in the lung hilum and intrapulmonary lymph nodes (N1 Beclin 1) of N1 and N2 groups were less than that of N0 group with a statistical difference (P<0.01). In the three groups, the level of Beclin 1 in the mediastinal lymph nodes (N2 Beclin 1) of N2 group was less than that of the N0 and N1 groups with a statistical difference (P<0.01). In the N1 group, the level of N1 Beclin 1 was less than that of N2 group (P<0.01). In the N2 group, though the level of N1 Beclin 1 was less than N2 Beclin 1, there was no statistical difference (P>0.05). ConclusionBeclin 1 level can be used as a reference index to judge the benign and malignant lung masses, and lymph node Beclin 1 level can be used as an important reference index to help determine whether there is lymph node metastasis in lung cancer.
Objective To investigate the efficacy of fine needle aspiration-thyroglobulin (FNA-Tg) with colloidal gold immunochromatographic assay (CGICA) on the assessment of lymph node metastasis during surgery in papillary thyroid carcinoma (PTC) patients. Methods Seventy-eight patients with PTC who underwent surgery in the Department of Thyroid Surgery of West China Hospital of Sichuan University from August to December 2019 were selected as the research objects, 289 neck lymph node specimens cleaned during the operation were prepared into eluent after lymph node FNA within 10 minutes in vitro, and then the FNA-Tg level was detected rapidly and quantitatively by CGICA. The specimen of washout fluid was labeled and sent to the laboratory for FNA-Tg detection by Roche electrochemiluminescence immunoassay. The lymph nodes in the whole group were divided into central region group and lateral cervical region group according to their location. According to the long diameter of lymph nodes, they were divided into <5 mm group, 5–10 mm group and >10 mm group. With postoperative pathological report as the gold standard, the receiver operating characteristic (ROC) curve of the whole group of data subjects was drawn, and the area under curve (AUC) was compared to calculate the best cut-off value of FNA-Tg in diagnosing PTC lymph node metastasis. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of FNA-Tg CGICA method and Roche method in the whole group and different subgroups were compared. The data of 55 lymph nodes detected by FNA-Tg CGICA method and rapid frozen pathology were collected, and the diagnostic efficacy indexes of CGICA method and rapid frozen pathology in the diagnosis of lymph node metastasis were compared. Results The ROC curves AUC of FNA-Tg detected by CGICA method and Roche method was 0.850 and 0.883, respectively, the difference was not statistically significant (Z=1.011, P>0.05). The sensitivity was 77.7% and 79.6% respectively (χ2=0.05, P>0.05), specificity was 84.9% and 93.5% respectively (χ2=7.50, P<0.05). Using McNemar test, there was no significant difference in the diagnostic results between the CGICA method and Roche method of FNA-Tg in the whole group (P>0.05). The diagnostic efficacy of FNA-Tg CGICA method was better in the lateral cervical region group than that in the central region group, and the diagnostic efficacy of the group with the long diameter of lymph nodes >10 mm was better than those of the groups with the long diameter of lymph nodes <5 mm and 5–10 mm. There was no significant difference in diagnostic results between FNA-Tg CGICA method and rapid frozen pathology (P>0.05). Conclusions The FNA-Tg CGICA method has high value in diagnosing PTC cervical lymph node metastasis, and has the characteristics of rapidity and convenience. The diagnostic efficiency is similar to that of Roche method.
ObjectiveTo study the correlation of lymph node metastasis and recurrence with body mass index (BMI) and estrogen receptor (ER) in papillary thyroid carcinoma (PTC).MethodThe relevant literatures were retrieved in the past six years through the CNKI, VIP, Wanfang, CBM, PubMed, Medline, Embase, Cochrane Library, etc. databases for meta-analysis of relationship of lymph node metastasis and recurrence of PTC with BMI or ER and its subtypes.ResultsThe meta-analysis showed that the lymph node metastasis of PTC was associated with the BMI and ERα [OR=1.27, 95% CI (1.12, 1.42), P<0.000 1; OR=2.68, 95% CI (1.86, 3.86), P<0.000 01, respectively ], and which not associated with the ER and ERβ [OR=0.87, 95% CI (0.56, 1.35), P=0.53; OR=1.22, 95% CI (0.78,1.89), P=0.39, respectively ]. The ERα was associated with the PTC recurrence [OR=1.87, 95% CI (1.04, 3.35), P=0.04 ], but the BMI was not the risk factor for the recurrence of PTC [OR=1.187 1, 95% CI (0.930 0, 1.515 3), P=0.17 ].ConclusionsAlthough BMI was not found to be associated with PTC recurrence, high BMI promotes PTC metastasis, so lymph node dissection in obese patients should be more careful and comprehensive. Positive ERα increases risk of lymph node metastasis and recurrence of PTC, which can be used as a negative factor in evaluating prognosis of PTC and provide a new idea for endocrine therapy of PTC.
ObjectiveTo investigate the correlation between expression of stromal interaction molecule 1 (STIM1) and tumor malignant degree or lymph node metastasis in patients with gastric cancer. MethodsA total of 83 patients with gastric cancer treated in the Affiliated Hospital of Southwest Medical University and Sichuan Mianyang 404 Hospital from October 2018 to April 2021 were collected. The expression of STIM1 protein in the gastric cancer tissues and the corresponding adjacent normal gastric tissues was detected by immunohistochemistry method. Meanwhile the correlation between the expression of STIM1 protein and clinicopathologic features or postoperative lymph node status of the patients with gastric cancer was analyzed. ResultsThe positive rate of STIM1 protein expression in the gastric cancer tissues was 95.2% (79/83), including 62 (74.7%) patients with high expression (STIM1 scoring 5–7) and 21 (25.3%) patients with low expression (STIM1 scoring 2–4), which in the corresponding adjacent normal gastric tissues was 41.0% (34/83), the difference was statistically significant (χ2=58.078, P<0.001). The expression of STIM1 protein was not related to gender, age, and tumor size of the patients with gastric cancer (P>0.05), while the proportions of the patients with high expression of STIM1 protein in the gastric cancer patients with low/undifferentiated tumor, T3+T4 of infiltration depth, TNM stage Ⅲ, and lymph node metastasis were higher than those with high/medium differentiation (χ2=11.052, P=0.001), T1+T2 of infiltration depth (χ2=24.720, P<0.001), TNM stage Ⅰ+Ⅱ (χ2=9.980, P=0.002), and non-lymph node metastasis (χ2=6.097, P=0.014). The expression intensity of STIM1 protein was positively correlated with the number of lymph node metastasis (r=0.552, Z=–3.098, P=0.002) and the rate of lymph node metastasis (r=0.561, Z=–6.387, P<0.001). ConclusionsPositive rate of STIM1 protein expression in gastric cancer tissues is relatively high. STIM1 protein expression in gastric cancer tissue is closely related to tumor malignancy and lymph node metastasis, so it might play an important role in progression of gastric cancer.
ObjectiveTo explore the risk factors of lymph node metastasis (LNM) in patients with early gastric cancer (EGC), and try to establish a risk prediction model for LNM of EGC.MethodsThe clinicopathologic data of EGC patients who underwent radical gastrectomy and lymph node dissection from January 1, 2015 to December 31, 2019 in this hospital were retrospectively analyzed. Univariate analysis and logistic regression analysis were used to determine the risk factors for LNM of EGC, and the risk prediction model for LNM of EGC was established based on the multivariate results.ResultsA total of 311 cases of EGC were included in this study, and 60 (19.3%) cases had LNM. Univariate and multivariate analysis showed that age (younger), depth of tumor invasion (submucosa), vascular invasion, and undifferentiated carcinoma were the risk factors for LNM of EGC (P<0.05). The optimal threshold for predicting LNM of EGC was 0.158 (area under the receiver operating characteristic curve was 0.864), the sensitivity was 80.0%, and the specificity was 79.3%.ConclusionsFrom results of this study, risk factors for LNM of EGC have age, depth of invasion, vascular invasion, and differentiation degree. Risk prediction model for LNM of EGC established on this results has high sensitivity and specificity, which could provide some references for treatment strategy of EGC.
Objective
To investigate the relationship between clinical features and lymph node metastasis in lung adenocarcinoma patients with T1 stage.
Methods
We retrospectively analyzed the clinical data of 253 T1-stage lung adenocarcinoma patients (92 males and 161 females at an average age of 59.45±9.36 years), who received lobectomy and systemic lymph node dissection in the Second Affiliated Hospital of Harbin Medical University from October 2013 to February 2016.
Results
Lymph node metastasis was negative in 182 patients (71.9%) and positive in 71 (28.1%). Poor differentiation (OR=6.988, P=0.001), moderate differentiation (OR=3.589, P=0.008), micropapillary type (OR=24.000, P<0.001), solid type (OR=5.080, P=0.048), pleural invasion (OR=2.347, P=0.024), age≤53.5 years (OR=2.594, P=0.020) were independent risk factors for lymph node metastasis. In addition, in the tumor with diameter≥1.55 cm (OR=0.615, P=0.183), although the cut-off value of 1.55 cm had no significant difference, it still suggested that tumor diameter was an important risk factor of lymph node metastasis.
Conclusion
In lung adenocarcinoma with T1 stage, the large tumor diameter, the low degree of differentiation, the high ratio of consolidation, and the micropapillary or solid pathological subtypes are more prone to have lymph node metastasis.
ObjectiveTo investigate the risk factors of cervical lymph node metastasis of papillary thyroid microcarcinoma (PTMC) with clinical lymph node metastasis negative (cN0).MethodThe clinicopathologic data of patients with cN0 PTMC who underwent at least one lobectomy plus central lymph node dissection in this hospital from January 2013 to December 2018 were retrospectively collected and the risk factors of lymph node metastasis were analyzed.ResultsA total of 1 821 patients with cN0 PTMC were enrolled in this study. The results of postoperative pathology showed there were 837 (46.0%) cases with lymph node metastasis, in which of 805 (44.2%) cases with central lymph node metastasis; 252 (33.1%) had lateral lymph node metastasis among 761 patients underwent lateral lymph node dissection. The results of univariate analysis showed that male, age <55 years old, tumor diameter ≥5 mm, bilateral cancer, capsule invasion, and multiple foci were associated with lymph node metastasis of cN0 PTMC (P<0.05). Further binary logistic regression multivariate analysis results showed that these factors (except multiple foci) were the independent risk factors of lymph node metastasis of cN0 PTMC (P<0.05). While the results found that the risk of lateral lymph node metastasis was increased with the increasing of the number of central lymph node metastasis in patients with cN0 PTMC (P<0.05).ConclusionsCervical lymph node metastasis of cN0 PTMC is related to many factors, and central lymph node metastasis indicates a higher risk of lateral lymph node metastasis. For patients with risk factors, preventive central lymph node dissection should be given at the first surgery and decided whether to perform lateral lymph node dissection according to the intraoperative situation.
ObjectiveTo explore the clinical pattern of intrapulmonary lymph node metastasis and the significance of No.13 and No.14 lymph nodes biopsy in patients with non-small cell lung cancer (NSCLC).MethodsThe clinical data of 234 patients with primary peripheral NSCLC who underwent systemic dissection of intrathoracic lymph nodes and intrapulmonary lymph nodes in the First Affiliated Hospital of Chongqing Medical University between 2013 and 2015 were retrospectively analyzed. There were 159 males and 75 females, aged 36-89 (61.35±8.57) years. Statistical analysis was performed accordingly on hilar (No.10), interlobar (No.11), lobar (No.12) and segmental (No.13 and 14) sites of the samples of N1 lymph nodes after surgery.ResultsA total of 3 019 lymph nodes of No.10-14 were dissected in 234 patients (12.9 per patient). The 263 lymph nodes were positive with a rate of 8.71% (263/3 019) and lymph node metastasisa occured in 99 patients with a rate of 42.31% (99/234), among whom there were 40 patients of N1 metastasis, 48 of N1+N2 metastasis and 11 of N2 skipping metastasis. Routine pathological examination demonstrated No.13 and No.14 lymph nodes metastasis in 16 patients with a rate of 6.84% (16/234). In 886 dissected lymph nodes of No.13 and No.14, 86 lymph nodes showed metastasis with a rate of 9.71% (86/886). Of the patients with swelling hilar and mediastinal lymph nodes reported by preoperative CT scan, only 56.32% of them were confirmed with lymph node metastasis by postoperative histopathology; while 34.01% of the patients with normal size lymph nodes had lymph node metastasis.ConclusionIn the surgical treatment of NSCLC, it is necessary to detect the metastasis of No. 13 and 14 lymph nodes and non-tumor parabronchial lymph nodes, which is helpful to obtain accurate postoperative TNM staging and is of great significance for guiding postoperative treatment. Preoperative CT is not a reliable method to judge lymph node metastasis, particularly for intrapulmonary lymph node metastasis.
