ObjectiveTo summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.
ObjectiveTo explore the influence of sentinel lymph node (SLN) status on the prognosis of elderly breast cancer patients ≥70 years old, and to screen patients who may be exempted from sentinel lymph node biopsy (SLNB), so as to guide clinical individualized treatment for such patients. MethodsA retrospective analysis was made on 270 breast cancer patients aged ≥70 years old who underwent SLNB in the Affiliated Hospital of Southwest Medical University from 2012 to 2021. The clinicopathological characteristics of the total cases were compared according to the status of SLN. Kaplan-Meier method was used to draw the survival curve, and the influence of SLN status on the overall survival (OS) time, local recurrence (LR) and distant metastasis (DM) of patients were analyzed, and used log-rank to compare between groups. At the same time, the patients with hormone receptor (HR) positive were analyzed by subgroup. The differences between groups were compared by single factor χ2 test, and multivariate Cox regression model was used to analyze and determine the factors affecting OS, LR and DM of patients. ResultsThe age of 270 patients ranged from 70 to 95 years, with a median age of 74 years. One hundred and sixty-nine (62.6%) patients’ tumor were T2 stage. Invasive ductal carcinoma accounted for 83.0%, histological gradeⅡ accounted for 74.4%, estrogen receptor positive accounted for 78.1%, progesterone receptor positive accounted for 71.9%, and human epidermal growth factor receptor 2 negative accounted for 83.3%. The number of SLNs obtained by SLNB were 1-9, and the median was 3. SLN was negative in 202 cases (74.8%) and positive in 68 cases (25.2%). Thirty-five patients (13.0%) received axillary lymph node dissection. There was no significant difference in LR between the SLN positive group and the SLN negative group (P>0.05), but the SLN negative group had fewer occurrences of DM (P=0.001) and longer OS time (P=0.009) compared to the SLN positive group. The results of univariate and multivariate analysis suggest that the older the patient, the shorter the OS time and the greater the risk of DM. Analysis of HR positive subgroups showed that SLN status did not affect patient survival and prognosis, but age was still associated with poor OS time and DM. ConclusionsFor patients with invasive ductal carcinoma of breast in T1-T2 stage, HR positive, clinical axillary lymph nodes negative, and age ≥70 years old, SLNB may be exempted. According to the patient’s performance or tumor biological characteristics, patients who need systemic adjuvant chemotherapy may still consider SLNB.
ObjectiveTo explore the factors associated with non-sentinel lymph node (NSLN) metastasis in early breast cancer patients with 1-2 positive sentinel lymph nodes (SLN), seeking the basis for exempting some SLN-positive patients from axillary lymph node dissection. MethodsA total of 299 early breast cancer patients who were diagnosed with positive sentinel lymph node (SLN) biopsy and underwent axillary lymph node dissection at the Affiliated Hospital of Southwest Medical University from January 2019 to April 2023 were selected. Univariate analysis was performed on the clinical and pathological data of patients, and multivariate logistic regression analysis was conducted to identify factors related to axillary non-sentinel lymph node (NSLN) metastasis of patients with SLN positive in early breast cancer. GraphPad Prim 9.0 was used to draw receiver operating characteristic (ROC) curve, and the area under curve (AUC) of ROC was calculated to quantify the predictive value of risk factors. ResultsAmong the 299 breast cancer patients with 1-2 SLN positive, 101 cases (33.78%) were NSLN positive and 198 cases (66.22%) were NSLN negative. Univariate analysis showed that the number of positive SLN, clinical T staging and lymphovascular invasion were related to the metastasis of NSLN (P<0.001). Multivariate logistic regression analysis indicated that having 2 positive SLN [OR=3.601, 95%CI (2.005, 6.470), P<0.001], clinical T2 staging [OR=4.681, 95%CI (2.633, 8.323), P<0.001], and presence lymphovascular invasion [OR=3.781, 95%CI (2.124, 6.730), P<0.001] were risk factors affecting axillary NSLN metastasis. The AUCs of the three risk factors were 0.623 3, 0.702 7 and 0.682 5, respectively, and the AUCs all were greater than 0.6, suggesting that the three risk factors had good predictive ability for NSLN metastasis. ConclusionThe number of positive SLN, clinical T staging, and lymphovascular invasion are related factors affecting NSLN metastasis in early breast cancer patients with positive SLN, and these factors have guiding significance for whether to exempt axillary lymph node dissection.
Objective To investigate the diagnostic value of strain elastography (SE) and virtual touch tissue image quantification (VTIQ) technique in determining the nature of cervical lymph nodes in patients with lung cancer. Methods A total of 124 patients with lung cancer combined with cervical lymph node enlargement were selected for this study. All patients underwent routine ultrasound examination, using SE to detect lymph nodes and scored them, and using VTIQ technique fro measurement of lymph node shear wave velocity (SWV). Pathological results were taken as gold standards. Non-metastatic lymph nodes were included in the benign group, while metastatic lymph nodes were included in the malignant group. Receiver operating characteristic (ROC) curve was generated. The optimal cutoff value of SWV was determined for predicting metastatic lymph nodes, the area under curve (AUC) of SE and VTIQ technique was compared, and the diagnostic efficacy of SE and VTIQ technique for benign and malignant lymph nodes was analyzed. Results Among the 124 patients, 28 cases of benign lymph nodes had an SE score of 2 - 3, and 59 cases of malignant lymph nodes had an SE score of 4 - 5. The accuracy, sensitivity, and specificity of SE were 70.2%, 75.6%, and 60.9%, respectively. The maximum, minimum, median, and mean values of SWV in the malignant lymph nodes were significantly higher than those in the benign lymph nodes in VTIQ technique testing (P<0.05). Based on the ROC curve analysis, the mean value of SWV had the highest diagnostic efficiency, and its cutoff value of 3.18 m/s was used as the diagnostic criterion for predicting malignant lymph nodes. The accuracy, sensitivity, and specificity of the VTIQ technique in diagnosing malignant lymph nodes were 85.5%, 92.3%, and 73.9%, respectively. The AUC of SE and VTIQ technique were 0.713 and 0.896, respectively, indicating higher diagnostic value of VTIQ technique. Conclusions Both SE and VTIQ technique have high accuracy in determining the nature of cervical lymph nodes in lung cancer patients. Compared with SE, VTIQ technique showed superior diagnostic performance, and SWVmean has the best diagnostic performance. It can provide a new non-invasive examination method for evaluating the nature of cervical lymph nodes in lung cancer patients in clinical practice.
Objective To explore regularity of lymph node metastasis and analyze its relation between lymph node metastasis and histological features and its immunohistochemical markers of gastric cancer, and to provide evidence for selection of reasonable operation. Method The clinical data of 160 patients with gastric cancer who underwent D2, D3 or D3+ from August 2013 to May 2016 in the Second Hospital of Lanzhou University were retrospectively studied, and the relation between the lymph node metastasis and the pathological features and the immunohistochemical markers in the different location of gastric cancer was analyzed. Results ① The rate of lymph node metastasis in the early gastric cancer was significantly lower than that in the advanced gastric cancer (P<0.05), which in the T4 stage was significantly higher than that in the T1–T3 stages (P<0.05), in the poorly differentiated gastric cancer was significantly higher than that in the well differentiated gastric cancer (P<0.05), or in the Borrmann type Ⅲ+Ⅳ (infiltrative type) was significantly higher than that in the Borrmann type Ⅰ+Ⅱ (topical type,P<0.05), but which wasn’t associated with the gender, tumor location, or tumor diameter (P>0.05). ② The lymph node metastasis occurred mainly in the first and the second stations for the well differentiated gastric cardia cancer, which not only occurred in the first and the second stations, but also occurred in the No.13 lymph node for the poorly differentiated gastric cardia cancer; which occurred mainly in the first and the second stations and occasionally occurred in the No.12 lymph node for the well differentiated gastric body cancer, which not only occurred in the first and the second stations, but also occurred in the No.12, No.13 and No.14 lymph nodes for the poorly differentiated gastric body cancer; which occurred in the No.11, No.12 and No.13 lymph nodes for the part of well differentiated gastric antrum cancer, which even occurred in the No.15 and No.16 lymph nodes for the part of poorly differentiated gastric antrum cancer. ③ The expression positive rates of the TopoⅡα, Villin, Ki-67, CK-8, and CK-18 proteins in the poorly differentiated gastric cancer were significantly higher than those in the well differentiated gastric cancer (P<0.05), which of the P-gp, GST-π, and c-erbB-2 proteins in the poorly differentiated gastric cancer were significantly lower than those in the well differentiated gastric cancer (P<0.05). The expression positive rates of the TopoⅡα, P-gp, Villin, Ki-67, CK-8, and CK-18 proteins in the gastric cancer with lymph node metastasis were significantly higher than those in the gastric cancer without lymph node metastasis (P<0.05), whereas there were no relation between the expression positive rates of the GST-π and c-erbB-2 proteins and the lymph node metastasis of gastric cancer (P>0.05). ④ The different location of gastric cancer wasn’t associated with the gender, gross type, clinical stage, T stage, degree of differentiation, Borrmann type, or tumor diameter. Conclusions In advanced gastric cancer, depth of tumor invasion reached T4, poor degree of differentiation, and Borrmann infiltration type of gastric cancer, lymph node metastasis rates are higher. For gastric cardia cancer patients with well differentiation, standard D2 should be performed, D2+No.13 should be performed for poor differentiation. For gastric body cancer patients with well differentiation, D2+No.12 should be performed, D3 should be performed for poor differentiation. For gastric antrum cancer patients with differentiation degree or not, D3 should be performed, selective dissection of No.15 or No.16 lymph node should be performed for poor differentiation. Combined detection of TopoⅡα, Villin, Ki-67, CK-8, CK-18, P-gp, GST-π, and c-erbB-2 immunohistochemical markers might be helpful to improve accuracy of lymph node metastasis and evaluate degree of malignancy and prognosis of patients with gastric cancer.
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 systematically evaluate the effectiveness and safety of minimally invasive video-assisted thyroidectomy (MIVAT) and conventional open thyroidectomy (COT) in treatment of thyroid carcinoma without lymph node metastasis. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), WanFang, CBM, VIP and CNKI were searched to collect the randomized controlled trails (RCTs) and non-RCTs about MIVAT and COT in treatment of thyroid carcinoma without lymph node metastasis. The retrieval time was from inception to October 2015. The studies were screened according to the inclusion and exclusion criterias, and the data was extracted and the quality of studies was evaluated by 2 reviewers independently. Then the Meta-analysis was conducted by using RevMan 5.2 software. Results A total of 13 non-RCTs involving 3 083 cases were included. The results of Meta-analysis showed that: compared with COT group, operative time of MIVAT group was longer (MD=31.36, 95% CI: 27.68-35.03, P<0.05), hospital stay (MD=-0.16, 95% CI: -0.28--0.04, P=0.01) and length of scar (MD=-1.51, 95% CI: -1.63--1.39, P<0.05) of MIVAT group were shorter, but there was no significant difference in the incidences of transient hypocalcemia (OR=1.29, 95% CI: 0.93-1.78, P=0.13), transient laryngeal nerve palsy (OR=1.42, 95% CI: 0.93-2.17, P=0.11), hemotoma (OR=1.21, 95% CI: 0.64-2.29, P=0.56), recurrence (OR=0.61, 95% CI: 0.28-1.33, P=0.22), number of retrieved central lymph nodes (MD=-0.10, 95% CI: -0.98-0.78, P=0.82), and the size of tumors (MD=-0.02, 95% CI: -0.06-0.02, P=0.39) between the 2 groups. Conclusion MIVAT is safe and feasible in treatment of thyroid carcinoma without lymph node metastasis when its indications are strictly controlled.
ObjectiveTo investigate the risk factors for central lymph node metastasis (CLNM) in patients with clinically negative lymph node (cN0 stage) papillary thyroid carcinoma (PTC).MethodsThe clinicopathological data of 250 patients with cN0 PTC who underwent thyroidectomy and central lymph node dissection (CLND) in Department of General Surgery of Xuzhou Central Hospital from June 2016 to June 2019 were retrospectively analyzed. The influencing factors of CLNM in patients with cN0 PTC were analyzed by univariate analysis and binary logistic regression, and then R software was used to establish a nomogram prediction model, receiver operating characteristic curve was used to evaluate the differentiation degree of the model, and Bootstrap method was used for internal verification to evaluate the calibration degree of the model.ResultsCLNM occurred in 147 of 250 patients with cN0 PTC, with an incidence of 58.8%. Univariate analysis showed that multifocal, bilateral, tumor diameter, and age were correlated with CLNM (P<0.01). The results of binary logistic regression analysis showed that multifocal, bilateral tumors, age≥45 years old, and tumor diameter>1 cm were independent risk factors for CLNM in patients with cN0 PTC (P<0.05). The area under the curve (AUC) of the nomogram prediction model established on this basis was 0.738, and the calibration prediction curve in the calibration diagram fitted well with the ideal curve.ConclusionsCLNM is more likely to occur in PTC. The nomogram model constructed in this study can be used as an auxiliary means to predict CLNM in clinical practice.
Objctive To explore the effect of positive lymph nodes ratio (LNR) on prognosis of patients with non-small cell lung cancer (NSCLC). Methods Clinical data of 432 NSCLC patients undergoing radical surgery for lung cancer and systemic lymph node dissection in our hospital from January 2010-2013 were retrospectively analyzed. There were 316 males and 116 females with age of 39-84 (57.59±9.16) years. Among 432 patients, 229 (53.0%) were classified as N0 based on pathological staging of lymph nodes, 104 (24.1%) as N1 and 99 (22.9%) as N2. Kaplan-Meier curve and COX multi-factor regression model were used to evaluate the correlation between the clinical data and patients' survival. Results Five lymph nodes on average (range, 1-52) were removed in each patient. Kaplan-Meier survival curves showed that the higher the staging of positive lymph nodes was, the shorter the patients' overall survival and disease-free survival were (P<0.001). Survival analysis showed that the LNR was closely associated with disease-free survival and overall survival (P<0.001). COX multivariate analysis revealed that the LNR staging was an independent risk factor of prognosis of NSCLC. Conclusion LNR is an independent prognostic factor of NSCLC, and can be used to improve lymph node staging in standards for NSCLC staging in the future.
Objective To investigate the expression and clinical significance of Notch-1 protein in papillary thyroid carcinoma (PTC) tissues and cervical lymph node metastases. Methods Immunohistochemical method was used to detect the expression of Notch-1 protein in 69 cases of PTC tissues, along with tumor adjacent tissues and 34 cases of metastatic lymph node tissues, and to analyze its role in PTC and metastatic lymph node tissue. Results Compared with PTC tissues or cervical lymph node metastases and tumor adjacent tissues, the positive rates of expression of Notch-1 protein in PTC tissues or cervical lymph node metastases were significantly lower than that in cancer adjacent tissues (P＜0.05). The expression of Notch-1 protein was correlated with the tumor size and capsule invasion of patients with PTC. Conclusions Notch-1 protein expression is decreased in PTC tissues and metastatic lymph node tissues, suggesting that the Notch-1 protein may play an important role in the development, invasion and metastasis of PTC. There is no significant difference in the positive rates of Notch-1 protein expression in PTC tissues and metastatic lymph node tissues, it's suggested that the malignant degree of cancer cells in lymph node metastasis is not significantly increased, and the biological behavior remained relatively stable.