目的 建立基于反传（BP）神经网络技术的甲状腺癌诊断模型，并评估该模型的临床应用价值。方法 回顾性分析2010年1月至2011年8月期间南京市鼓楼医院收治的甲状腺癌患者103例及甲状腺良性病变患者51例，提取其超声图像的9个特征，循建模规则，建立基于BP神经网络技术的甲状腺癌诊断模型，依此模型对2011年9月至2011年12月期间收治的根据超声图像特征疑为甲状腺癌的42例患者进行术前诊断，其结果与术后病理诊断结果（术后病理诊断为甲状腺癌32例，甲状腺良性病变10例）进行对比研究。结果 甲状腺癌诊断模型对建模样本的诊断准确率为95.45%（147/154）；术前样本的诊断准确率为90.48%（38/42）；所有样本的诊断准确率为94.39% （185/196）。结论 从本组有限的病例结果初步得出，基于BP神经网络技术的甲状腺癌诊断模型具有较高的可行性及可靠性，可望成为一种全新的甲状腺癌辅助诊断方法。
Objective To explore the diagnosis and relapse factors of thyroid cancer. Methods Two hundreds fifty-six cases of thyroid cancer approved by surgery and pathology from 1999 to 2006 were analyzed retrospectively. Results Two hundred and thirty-five cases were approved papillary thyroid carcinoma (91.8%)，11 cases were follicular thyroid carcinoma (4.3%)， 7 cases were medullary thyroid carcinoma (2.7%)， 3 cases were anaplastic thyroid cancer (1.2%). All patients underwent surgery. The operation procedures included thyroidectomy and lymph nodes dissection in central zone of affecting side and subtotal thyroidectomy of contralateral side. Total or subtotal thyroidectomy of both sides and the dissection in unilateral or bilateral Ⅵ region lymph nodes or functional cervical lymph nodes dessection plus contralateral side Ⅵ region lymph nodes dissection in multi-focal cancer and double leaf gland cancer. Functional cervical lymph nodes dessection if existing lymph nodes metastasis or thyroid cancer invading anterior cervical muscle. Two hundreds twentyeight cases were followed up with complete clinical information about (6.5±1.3) years (3-9 years). Six cases died during follow-up because of relapse or metastasis.Conclusions Imaging evaluation is the main method for diagnosis of thyroid cancer. Needle biopsy is reliable and accurate for diagnosis of thyroid tumor. Diameter of tumor is related with cervical lymph node metastasis. Patho-type and stage of tumor, local invasion extent, lymph node metastasis and operation procedure are related with the relapse closely.
ObjectiveTo understand the follow-up needs of postoperative patients with thyroid cancer and analyze its influencing factors, so as to provide a reference for the establishment of a follow-up management system for patients with thyroid cancer.MethodsConvenience sampling was used to conduct a questionnaire survey on the follow-up need, recovery, anxiety, and stress of patients after thyroid cancer surgery in 2 tertiary A hospitals from March to April in 2020. The self-designed follow-up needs questionnaire, the Quality of Recovery Questionnaire 15 (QoR-15), the Generalized Anxiety Disorder-7 (GAD-7), and the Perceived Stress Scale (PSS-4) were scored. The higher score, the higher need, the better recovery, and the more serious anxiety and stress.ResultsIn this study, 382 questionnaires were distributed, which of 351 were returned and of 349 were valid, the valid callback rate was 99.4% (349/351). ① Follow-up needs. Follow-up form: Online platform was the preferred follow-up method (72.2%), the most patients hoped that the follow-up would be conducted by a doctor (82.5%) and hoped to start the follow-up at 1 month after the operation (67.6%) and in the afternoon (50.7%), the duration of each follow-up was 10–15 min (47.3%), and accepted the follow-up frequency of 1 times per month (41.3%) and the lifetime follow-up (69.9%). Needs degree of follow-up contents: There were 13 follow-up items requiring more than 80% of patients. The top 5 items with the higher follow-up needs score were the question on test results, returning visit guidance, knowledges of metastasis and recurrence, medication guidance, and issuance of inspection orders, and their scores were 4.78±0.47, 4.70±0.51, 4.70±0.57, 4.65±0.59, 4.57±0.64, respectively. The results of multiple linear regression analysis were found that the age (young), marital status (unmarried), medical payment method (with medical insurance), and postoperative interval (<1 month) were closely related to the follow-up needs score (P<0.05). ② Recovery, anxiety, and stress statuses: The total QoR-15 score of patients was 79.87±29.95, which was positively correlated with the total score of follow-up needs (72.93±8.52, r=0.131, P=0.014). No significant correlation was found between the total score of GAD-7 (4.77±3.59) or PSS-4 (6.51±3.10) and the total score of follow-up needs (r=0.068, P=0.207; r=0.008, P=0.881).ConclusionsYoung, unmarried, medically insured, and early postoperative patients with thyroid cancer have higher follow-up needs. Patients with better recovery after surgery have a higher follow-up needs. Medical staff should pay attention to follow-up services after discharge, rationally arrange content, frequency, and time period of follow-up according to follow-up needs of patients, so as to improve quality of medical services.
Objective To sum up experiences in diagnosis and treatment for thyroid malignancy. Methods Clinical records of 8 patients diagnosed as Hashimoto’s disease associated with thyroid malignancy by histologic examination at our hospital from Jan. 1998 to Dec. 1998 were analyzed. Results There were 1 male and 7 females with average age of 37.6 years. The incidence of Hashimoto’s disease associated with thyroid cancer and malignant lymphoma were 7.7% and 2.6%, respectively. No operative mortality and complication was found. Conclusion Hashimoto’s disease is not uncommon. The combined thyroid cancer is small with papillary carcinoma predominance and the prognosis is good. If it is complicated with malignant lymphoma, the thyroid is rapidly enlarged with pain and dyspnea.
Objective The expression of CD15 antigen and oncoprotein bcl-2 in thyroid cancer were examined in order to study the correlation between them. Methods The expression of CD15 and bcl-2 in 50 thyroid cancers, 20 adjacent noncancerous portion, 45 adenoma and 10 normal thyroid tissue were respectively investigated by microwave-LSAB immunohistochemical technique. Results The positive rate of CD15 and bcl-2 in thyroid cancer was 68.0% and 46.0% respectively, which was significantly higher than that in adenoma or adjacent noncancerous (Ｐ＜0.05). The percentage of CD15 and bcl2 positive expression were found to be significantly correlated with the tumor metastasis (Ｐ＜0.05), but not correlated with histological feature. Expression of CD15 was significantly correlated with bcl-2.Conclusion Expression of CD15 and bcl-2 can be regarded as a parameter to evaluate tumor metastasis and prognosis of thyroid cancer.
ObjectiveTo summarize the research progress of sentinel lymph node biopsy (SLNB) in the surgery of thyroid carcinoma in recent years. MethodsLiteratures about the recent studies on categories of SLNB and the neck lymph node dissection conducted by SLNB in the surgery of thyroid carcinoma were reviewed following the results searched from PubMed and CNKI data base. ResultsSLNB has a high detection rate and it is of great significance to detect the occult metastatic lymph nodes and guide the neck lymph node dissection during operation. ConclusionThe SLNB, with its high accuracy rate on the detection of occult metastatic lymph nodes, guides neck lymph node dissection during operation in order that it can maximize the benefits of patients.
手术是治疗分化型甲状腺癌的重要手段和有效方法，已在我国各级医院广泛开展。但由于对疾病认识的不足和技术条件的限制，分化型甲状腺癌的外科治疗在不同地区、不同医疗机构和不同医生之间存在着很大的差异，其治疗结果也迥然不同。尽管目前对分化型甲状腺癌的外科治疗还存在一些不同的观点和尚需进一步研究和探讨的问题，但在很多方面已逐渐达成共识，治疗方案也逐渐趋于规范化，现就以下几个方面浅谈加强分化型甲状腺癌的规范化治疗，旨在提高分化型甲状腺癌的诊治水平……