Expression and clinical significance of Shh/Gli-1 in papillary thyroid carcinoma.

The Sonic Hedgehog (Shh) pathway affects cancer initiation, progression, and metastasis, but its role in papillary thyroid carcinoma (PTC) remains elusive. To characterize expression and clinical significance of Shh and the transcription factor Gli-1-the key elements of the Shh pathway in PTC tissues-we immunohistochemically examined Shh/Gli-1 expression in PTC tissues from 142 patients, along with adjacent non-cancerous tissues as controls. We reviewed 142 patients' clinical characteristics and analyzed their relationship with expression of Shh/Gli-1. Shh and Gli-1 were expressed in 64.1 % (91/142) and 47.9 % (68/142) in PTC tissues, respectively, compared with 16.9 % (24/142) and 9.2 % (13/142) of adjacent non-cancerous tissues. Gli-1 expression was significantly associated with patients' ages (P < 0.05) and lymph node metastasis (P < 0.01). Increased Shh and Gli-1 expression was significantly associated with tumor-node-metastasis (TNM) stage (P < 0.01). Shh and Gli-1 were expressed in 79.2 and 60.4 %, respectively, of PTC tumors larger than 10 mm. Shh was significantly associated with tumor size (P < 0.01). Shh and Gli-1 were expressed in 72.5 and 65.2 %, respectively, of patients with lymph node metastasis. Overall, we found increased expression of the main initiator Shh and transcription factor Gli-1 in Shh pathway in PTC tissues. The expression of Shh/Gli-1 was significantly associated with tumor size, clinical staging, and lymph node metastasis, indicating that aberrant activation of the Shh pathway is important to PTC occurrence and progression. Potentially, Shh/Gli-1 could be a diagnostic indicator and a marker of therapeutic response.

Applicability of rapid intraoperative parathyroid hormone assay through fine needle aspiration to identify parathyroid tissue in thyroid surgery.

Hypoparathyroidism is a frequent and serious complication of thyroid surgery. Identification and preservation of the parathyroid glands are key factors in managing hypoparathyroidism. The aim of the present study was to investigate the efficacy of rapid intraoperative parathyroid hormone (rIO-PTH) assay levels through fine needle aspiration (FNA) in identifying parathyroids as a parameter in thyroid surgery. rIO-PTH assay through FNA and frozen section examination were performed on 194 suspected parathyroids anatomical structures from 50 consecutive patients undergoing thyroidectomy (rIO-PTH group). The association between the rIO-PTH values and histological results were analyzed. Clinical effects were compared between the rIO-PTH and control groups from 50 patients undergoing a similar standard surgery. rIO-PTH levels from 93/194 aspirated anatomical structures certified as parathyroid tissues by histological analysis were demonstrated to have a mean of 3,369 pg/ml (range, 145.2-5,000 pg/ml). These values were significantly increased compared with the mean value of 25.7 pg/ml from non-parathyroids tissues significantly (P<0.001). The mean number of 3.76 on the recognized parathyroids was obtained by naked eye measurements combined with rIO-PTH assay through FNA, was significantly higher than compared with only naked eye measurements (P<0.05). Postoperative permanent or transient hypoparathyroidism was not detected in the rIO-PTH groups. The difference between the postoperative serum calcium level and blood PTH values of rIO-PTH and control groups was not statistically significant (P>0.05). The value of rIO-PTH assay through FNA demonstrated that it is a good parameter for differentiating parathyroids and non-parathyroids tissues. The technique is a highly reliable, quick, simple and non-invasive method with a short learning curve in thyroid surgery, which is particularly valuable for inexperienced surgeons. This method may replace frozen section examination, which relies on a surgeon's personal experience on the basis of topographic or morphologic criteria for recognizing parathyroids.