Objective To discuss the relationship between thyroid stimulating hormone (TSH) and clinicopathologic features of the papillary thyroid microcarcinoma (PTMC) patients. Methods The thyroid nodules of 806 cases retrospectively that were for the first time hospitalized to our department in recent 5 years were collected, among them, postoperative pathological examination confirmed the diagnosis of PTMC in 403 cases, 403 cases of benign thyroid lesions, the history data of selected cases that meet the criterion of selection were retrospectively analyzed. TSH and anti thyroid globulin antibody (TGAb) levels between the 2 groups and the prevalence of ratio of PTMC in different TSH levels were compared. Univariate and multivariate analysis were performed to determine the risk factors of PTMC. Results The differences of preoperative TSH levels between the two groups was statistical significance (Z=–6.233,P=0.001), gender composition no statistical significance in two groups (χ2=3.246,P=0.072), and age was statistically significant (Z=–5.855,P=0.001). The constitution of ethnics of two groups was different (χ2=38.961,P=0.001). Logistic regression analysis display that age and TSH level were the independent risk factors of PTMC (age:OR=0.914,P=0.027; TSH:OR=4.662,P=0.008). Conclusions The level of serum TSH in PTMC patients is higher than in patients with benign thyroid nodules. TSH level is probably predictive of malignancy of PTMC.
ObjectiveTo investigate the effect of lymph node dissection in central region on the prognosis of cN0 papillary thyroid microcarcinoma (PTMC).MethodsAccording to the inclusion and exclusion criteria, 300 patients with cN0 PTMC underwent operation in the Second Department of General Surgery of Zhongshan People’s Hospital from January 1, 2007 to May 31, 2016 were retrospectively collected, then who were divided into the central lymph node non-dissection (147 cases) and dissection (153 cases) groups according to whether central lymph node dissection or not. The differences in the incidence of postoperative complications, recurrence rate, and metastasis rate between the two groups were analyzed. The risk factors of central lymph node metastasis of cN0 PTMC were analyzed.ResultsAll patients had no postoperative lymphatic leakage and death. Fifty-nine (38.6%) cases had the lymph node metastasis in the patients with central lymph node dissection. The patients were followed up for (83.0±20.7) months and (79.5±26.2) months (t=1.283, P=0.203) of the non-dissection group (147 cases) and dissection group (153 cases), respectively. During the follow-up period, there was no distant metastasis such as bone metastasis and lung metastasis in both groups; 5 cases recurred in the non-dissection group, 1 case recurred in the dissection group, and there was no significant difference in the recurrence rate between the two groups (χ2=3.008, P=0.089). There was no permanent complications between the two groups. There was no significant difference in the disease-free survival curve (χ2=2.565, P=0.109) between the two groups. The incidence of capsule invasion (P=0.026), calcification (P<0.001), hoarseness (P=0.013), numbness of limbs (P<0.001) in the dissection group were significantly higher than those in the non-dissection group. The results of multivariate analysis showed that the multifocal (OR=24.57, P<0.001), tumor diameter >5 mm (OR=5.46, P=0.019), and capsule invasion (OR=9.42, P=0.002) were the independent risk factors for the lymph node metastasis in the central region.ConclusionsFrom the results of the study, thyroidectomy alone is safe for cN0 PTMC, but the changes of lymph nodes in the central region still need more long-term follow-up. cN0 PTMC patients with tumor diameter >5 mm, multifocal, and capsule invasion are more likely to have lymph node metastasis in the central region. Comprehensive evaluation can be made according to the patient’s condition, and individualized and precise treatment can be carried out.
ObjectiveTo explore the best timing of thyroid stimulating hormone (TSH) inhibition therapy by analyzing the trend of TSH level changes after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma (PTMC).MethodsThe clinical data of patients with low-risk PTMC who underwent unilateral thyroid lobectomy in the Dongfeng Hospital Affiliated to Hubei Medical College from September 2016 to December 2018 were retrospectively analyzed. The TSH of all patients were measured before operation and in month 1, 3, and 6 after operation, respectively, and the change trend was analyzed.ResultsAccording to the inclusion and exclusion criteria, a total of 271 patients with low-risk PTMC were included in this study. The TSH level in month 1 after operation was higher than that of before operation [(2.93±1.09) mU/L versus (2.05±0.76) mU/L, t=19.9, P<0.001]. Among the 129 patients with TSHlevel ≤2.0 mU/L before operation, 56.6% (73/129) of them still had the TSH level ≤2.0 mU/L in month 1 after operation, 45.0% (58/129) in month 3 after operation and 39.5% (51/129) in month 6 after operation.ConclusionsTSH level of patient with low-risk PTMC is increased after lobectomy, so individualized TSH inhibition treatment should be formulated. For patients with TSH level>2.0 mU/L before operation, oral levothyroxine sodium tablets should be taken immediately after operation. For patients with preoperative TSH level ≤2.0 mU/L, TSH level should be dynamically monitored, and whether and when to start oral TSH inhibition therapy should be decided according to results of TSH level.
ObjectiveTo investigate the role of intraoperative frozen section pathology in central lymph node metastasis of papillary thyroid microcarcinoma (PTMC), and to analyze the risk factors of central lymph node metastasis.MethodsClinical data of 481 patients diagnosed with PTMC from January 2015 to June 2019 in our hospital were included. The consistency of frozen pathological results of intraoperative prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes with postoperative paraffin pathological results, as well as the relationship between the numbers of intraoperative lymph nodes sent for examination and postoperative pathological results were analyzed. Then the Kappa value were calculated respectively. Furthermore, univariate and multivariate analysis were used to analyze the factors affecting central lymph node metastasis.ResultsCentral lymph node metastasis was found in 207 patients with PTMC (43.0%). Of the 207 patients, 192 patients were examined by frozen section, with 139 patients had positive results. The Kappa value of prelaryngeal lymph nodes, paratracheal lymph nodes, pretracheal lymph nodes, and central lymph nodes were 0.300, 0.643, 0.560, and 0.755, respectively (P<0.001). Simultaneous intraoperative examination of three anatomic lymph nodes in the central region has a high accuracy in evaluating whether there was lymph node metastasis. The consistency test between intraoperative frozen and postoperative paraffin pathological results showed that when the number of lymph nodes was less than 5, the Kappa value was 0.690 (P<0.001), and when more than or equal to 5, the Kappa value was 0.816 (P<0.001). The results of logistic regression showed that, maximum value of tumor diameter, tumor number, and thyroid capsule involvement were risk factors for central region lymph node metastasis in PTMC (P<0.05).ConclusionsCentral region lymph node metastasis in PTMC was common. Prelaryngeal lymph nodes, pretracheal lymph nodes, and paratracheal lymph nodes should be selected for frozen pathological examination during the operation, which could effectively indicate whether the central lymph nodes were involved. And combined with the risk factors of lymph node metastasis, such as maximum value of tumor diameter, number of tumors, and thyroid capsule involvement, a more accurate individualized operation plan can be designed for patients.
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 summarize the latest research progress in active surveillance of low-risk papillary thyroid microcarcinoma at home and abroad, and provide some reference for future clinical work. MethodRetrieved and reviewed relevant literatures about prospective studies on active surveillance of papillary thyroid microcarcinoma.ResultsIn recent years, the incidence of papillary thyroid microcarcinoma had increased sharply, but most of the biological activities were inert, tumor-specific mortality was very low, and only a few had progressed. For patients with papillary thyroid microcarcinoma, surgery was a safe and effective treatment method, but due to changes in the epidemiological characteristics of the disease, people were reconsidering whether there was overtreatment in patients without high-risk characteristics. Expert consensus and guidelines no matter at home or abroad mentioned that active monitoring can be considered as an alternative to surgery. For suitable patients, active monitoring might be a better choice.ConclusionsActive surveillance for low-risk papillary thyroid microcarcinoma is basically considered to be a safe and feasible treatment option, but large numbers of clinical trials are still needed to provide evidence for the conversion of conventional clinical treatment models. In the future, by more accurately assessing the tumor progression of patients with low-risk papillary thyroid microcarcinoma, active surveillance is promising to alternate surgical treatments.
Objective To summarize the latest research progress on the relationship between cN0 multifocal papillary thyroid microcarcinoma (PTMC) and central lymph node metastasis (CLNM) at home and abroad, so as to provide a reference for surgeons to balance the benefits and risks of surgery and select the best treatment plan. Method The latest studies on the relationship between CLNM and tumor characteristics of cN0 multifocal PTMC (including number of tumor foci, total tumor diameter, primary tumor diameter, total tumor surface area, etc.) were reviewed. Results Current domestic and international guidelines differ on whether cN0 PTMC should be used to prevent central lymph node dissection (pCLND). Proponents believe that pCLND could reduce the recurrence rate of disease and facilitate postoperative risk stratification and management under the premise of technical support. Opponents argue that it was not clear whether pCLND actually improves the prognosis of PTMC patients, but postoperative complications do correlate with pCLND. In order to guide the application of pCLND in the surgical treatment of cN0 PTMC, a large number of studies had reported the risk factors of CLNM in PTMC in recent years, among which multifocal was considered to be a very important risk factor for CLNM. In order to further understand the internal relationship between multifocal PTMC and CLNM, scholars at home and abroad quantified the feature of multifocal PTMC into various parameters, and studied the relationship between them and CLNM in multiple dimensions. It was found that total tumor diameter (TTD) > 1 cm, increased tumor number, total tumor surface area (TSA) >3.14 cm2, diameter ratio (TDR) < 0.56, tumor volume > 90 mm3 and bilateral multifocal PTMC might be the risk factors for increased CLNM risk in patients with cN0 multifocal PTMC. Conclusion These screened parameters are initially considered to be effective tools for predicting the risk of CLNM in multifocal PTMC. Multiple risk parameters coexist, especially in patients with multifocal PTMC characterized by bilateral intralar multifocal PTMC, who are expected to benefit more from pCLND. However, a large number of clinical studies are still needed to provide reliable evidence-based evidence for clinical diagnosis and treatment. In the future, by combining these valuable parameters, a scoring system can be constructed to predict the disease status of multifocal PTMC more accurately and identify patients with necessary pCLND, which will be of great significance for the appropriate treatment of PTMC.
ObjectiveTo explore the value of active surveillance (AS) with ultrasound for papillary thyroid microcarcinoma (PTMC) tumor growth.MethodsA retrospective collection of 196 patients who underwent ultrasound-guided fine-needle aspiration biopsy at West China Hospital of Sichuan University from January 2014 to December 2018 were pathologically diagnosed as PTMC, and no cervical lymph node metastasis was found on ultrasound, and AS was performed. According to the change of the maximum diameter of the nodule, the patients were divided into the maximum diameter increase group, the maximum diameter stable group and the maximum diameter reduction group. According to the nodule volume change, the patients were divided into the volume increase group, the volume stable group and the volume reduction group. The differences in the patients’ gender, age, with Hashimoto’s thyroiditis, follow-up time, tumor size, boundary, shape, echo, aspect ratio, calcifications, multifocality, bilateral involvement, other nodule, surrounding tissues and cervical lymph nodes among the different groups were analyzed in order to clarify the related factors of tumor growth.ResultsOne hundred and ninety-six patients had ultrasound AS time ranging from 6 to 79 months with the median (quartile) time were 16.0 (10.0, 30.0) months. One hundred and seventeen patients (59.7%) were in AS for 6 to 63 months with the median (quartile) time were 13.0. (8.0, 22.0), surgical treatments were performed after termination of AS. Forty-five patients (23.0%) continued to perform AS, 34 patients (17.3%) did not continue to perform AS in West China Hospital of Sichuan University. There was no significant reduction in the maximum diameter and volume of the nodules in all cases. Among them, 9 cases (4.6%) had an increase in the maximum diameter of the nodules, and 187 cases (95.4%) had a stable maximum diameter. Forty cases (20.4%) had an increase in the volume of the nodules, and 156 cases (79.6%) had a stable volume of the nodules. Comparison of the maximum diameter change of nodules between the two groups, there was a significant difference in the age of patients (P<0.05). Comparison of the maximum volume change between the two groups, there were significant differences in age, follow-up time and initial nodule volume (P<0.05). Logistic regression analysis showed that younger age was an independent risk factor for PTMC nodule growth [OR＝0.638, 95%CI (0.601, 0.675), P＝0.015].ConclusionsYounger age is a risk factor for PTMC tumor growth. We should adopt a more active monitoring program for younger patients. The increase of PTMC tumor volume can be more easily monitored than the increase of its maximum diameter, so it can be used as an indicator to predict nodule growth at an earlier stage in AS.