ABSTRACT
Abstract Lateral Lymph Node Metastasis (LLNM) is common in Papillary Thyroid Carcinoma (PTC) and is associated with a poor prognosis. LLNM without central lymph node metastasis as skip metastasis is not common. We aimed to investigate clinicopathologic and sonographic risk factors for skip metastasis in PTC patients, and to establish a nomogram for predicting the possibility of skip metastasis in order to determine the therapeutic strategy. We retrospectively reviewed the data of 1037 PTC patients who underwent surgery from 2016 to 2020 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic and preoperative sonographic risk factors of skip metastasis. A nomogram including the risk factors for predicting skip metastasis was further developed and validated. The incidence of skip metastasis was 10.7%. The univariate and multivariate analyses suggested that gender (p = 0.001), tumor location (p = 0.000), extrathyroidal extension (p = 0.000), and calcification (p = 0.000) were independent risk factors. For papillary thyroid microcarcinoma, tumor location (p = 0.000) and calcification (p = 0.001) were independent risk factors. A nomogram according to the clinicopathologic and sonographic predictors was developed. The receiver operating characteristic curve indicated that AUC was 0.824 and had an excellent consistency. The calibration plot analysis showed a good performance and clinical utility of the model. Decision curve analysis revealed it was clinically useful. A nomogram for predicting the probability of skip metastasis was developed, which exhibited a favorable predictive value and consistency. For the female PTC patient, tumor located at the upper pole is more likely to have skip metastasis. Surgeons and sonographers should pay close attention to the patients who have the risk factors. Evidence level: This article's evidence level is 3. Level 3 evidence is derived from nonrandomized, controlled clinical trials. In this study, patients who receive an intervention are compared to a control group. Authors may detect a statistically significant and clinically relevant outcome.
ABSTRACT
Abstract Introduction The treatment of papillary thyroid microcarcinoma remains controversial. Central lymph node metastasis is common in papillary thyroid microcarcinoma and it is an important consideration in treatment strategy selection. Objective The aim of this study was to investigate clinicopathologic risk factors and thyroid nodule sonographic characteristics for central lymph node metastasis in papillary thyroid microcarcinoma. Methods We retrospectively reviewed the data of 599 papillary thyroid microcarcinoma patients who underwent surgery from 2005 to 2017 at a single institution. Univariate and multivariate analyses were used to identify the clinicopathologic factors and preoperative sonographic features of central lymph node metastasis. A receiver-operating characteristic, ROC curve analysis, was performed to identify the efficacy of ultrasonographic features in predicting central lymph node metastasis. A nomogram based on the risk factors was established to predict central lymph node metastasis. Results The incidence of central lymph node metastasis was 22.4%. The univariate and multivariate analyses suggested that gender, age, multifocality, extrathyroidal invasion, and lateral lymph node metastasis were independent risk factors for central lymph node metastasis. The univariate and multivariate analyses revealed that nodular shape, margin, and calcification were independently associated with central lymph node metastasis. The ROC curve analysis revealed that the combination of shape, margin and calcification had excellent accuracy in predicting central lymph node metastasis. The nomogram was developed based on the identified risk factors for predicting central lymph node metastasis, and the calibration plot analysis indicated the good performance and clinical utility of the nomogram. Conclusions Central lymph node metastasis is associated with male gender, younger age (<5 years), extrathyroidal invasion, multifocality and lateral lymph node metastasis in papillary thyroid microcarcinoma patients. The ultrasongraphic features, such as irregular shape, ill-defined margin and calcification, may improve the efficacy of predicting central lymph node metastasis. Surgeons and radiologists should pay close attention to the patients who have these risk factors. The nomogram may help guide surgical decision making in papillary thyroid microcarcinoma.
Resumo Introdução O tratamento do microcarcinoma papilífero de tireoide permanece controverso. A metástase em linfonodos centrais é comum e é uma consideração importante na seleção da estratégia de tratamento. Objetivo Investigar os fatores de risco clínico-patológicos e as características ultrassonográficas de nódulos tireoidianos para metástase em linfonodos centrais em microcarcinoma papilífero de tireoide. Método Foram analisados retrospectivamente os dados de 599 pacientes com microcarcinoma papilífero de tireoide submetidos à cirurgia de 2005 a 2017 em uma única instituição. Análises univariadas e multivariadas foram usadas para identificar os fatores clínico-patológicos e as características ultrassonográficas pré-operatórias das metástases em linfonodos centrais. Uma análise de curva ROC (receiver-operating characteristic) foi feita para identificar a eficácia das características ultrassonográficas na previsão dessas metástases. Um nomograma baseado nos fatores de risco foi estabelecido para prever a metástase em linfonodos centrais. Resultados A incidência de metástase em linfonodos centrais foi de 22,4%. As análises univariadas e multivariadas sugeriram que sexo, idade, multifocalidade, invasão extratireoidiana e metástase em linfonodos laterais eram fatores de risco independentes para a metástase em linfonodos centrais. As análises univariadas e multivariadas revelaram que o formato nodular, a margem e a calcificação estavam independentemente associadas à metástase em linfonodos centrais. A análise da curva ROC mostrou que a combinação do formato, margem e calcificação apresentou excelente precisão na previsão dessas metástases. O nomograma foi desenvolvido com base nos fatores de risco identificados para predizer a metástase em linfonodos centrais e a análise do gráfico de calibração indicou o bom desempenho e a utilidade clínica do nomograma. Conclusões Em pacientes com microcarcinoma papilífero de tireoide, metástase em linfonodos centrais está associado ao sexo masculino, menor idade ( < 45 anos), invasão extratireoidiana, multifocalidade e presença de metástase em linfonodos laterais. As características ultrassonográficas, como formato irregular, margem mal definida e calcificação, podem melhorar a eficácia da previsão de metástase em linfonodos centrais. Cirurgiões e radiologistas devem ficar mais atentos aos pacientes que apresentam esses fatores de risco. O nomograma pode ajudar a orientar a tomada de decisão cirúrgica para o microcarcinoma papilífero de tireoide.
ABSTRACT
Objective To develop a quality evaluation indicator system of midwifery care in line with the modern service concept in Shanghai area under the background of over-medicalization trend of midwifery services, and to guide the improvement direction of midwifery quality. Methods Guided by the evidence-based framework of midwifery quality and indicator selection principles, the indicators for evaluating midwifery quality were preliminarily selected by literature review and theoretical analysis. Two rounds of Delphi survey among 53 experts from Shanghai were conducted to decide the final quality evaluation indicator system of midwifery care. Analytic hierarchy process ( AHP) and the importance′ sum average method were adopted to calculate weights coefficients of the indicators. Results 45 indicators for evaluating midwifery quality were preliminarily selected. The response rate of two rounds of Delphi survey were 76% and 100% , the authority coefficients were 0.90 and 0.89, expert opinion coordinate coefficients were 0.190 and 0.257, respectively. The final version of the indicator system consists of 11 structure quality indicators, 13 process quality indicators and 19 outcome quality indicators. The weight values of the three first-level indicators were 0.195 8, 0.310 8 and 0.493 4 respectively. The weight values of the 43 second-level indicators ranged from 0. 016 1 to 0. 028 6. Conclusions The quality evaluation indicator system of midwifery care developed fits evidence-based midwifery philosophy. It provides a scientific tool for midwifery quality evaluation in Shanghai, which can guide the improvement of midwifery quality.
ABSTRACT
Objective To develop an indicator system for evaluating midwifery quality. Methods Guided by the latest evidence-based framework of midwifery quality,based on indicator selection principle,the indicator system for evaluating midwifery quality was preliminarily developed by literature review,expert meeting,theoretical analysis and expert consultation,for further validation through large-scale Delphi method. Results The indicator pool for mid-wifery quality evaluation was identified by literature review,including indicator name and definition of special indi-cator. The indicator system was finalized through comprehensive analysis and selection,and consisted of 45 indica-tors. The expert consultation questionnaire response rate was 100%,the rate of experts who provided written sug-gestions was 81.3%,the authority coefficient was 0.92,the coefficients of variation of indicators ranged from 0 to 0.29. Conclusion The preliminarily developed indicator system for midwifery quality evaluation guided by the lat-est evidence-based framework of midwifery quality was scientific,oriented and accessible,which could be further ex-amined through large-scale Delphi method.
ABSTRACT
OBJECTIVE@#To investigate the rule of lymphatic formation and the relationship between lymphatic formation and clinical pathological factors in supraglottic carcinoma.@*METHOD@#Immunohistochemistry method and automatic image analysis technique were applied to observe the lymphatic quantity and state in central carcinoma tissue, join tissue and normal larynx mucosa of supraglottic carcinoma. Analyze the rule and the correlation between lymphatic formation and T stage, differentiation, lymph metastasis.@*RESULT@#The lumen-lymphatic formation was not seen in central carcinoma tissue. There are little lymphatic in normal larynx mucosa whereas many lymphatic formation in join area. The lymphatic density in join tissue is correlated with T stage, differentiation and lymph metastasis: T(1-2) lower than T(3-4) and the difference is significant (P<0.01); The difference between high and middle differentiation is insignificant (P=0.212); High-middle differentiation lower than low differentiation and the difference is significant; No lower than N+ and the difference is significant (P<0.01).@*CONCLUSION@#In join area, there are lymphatic formation both in carcinoma area and para-tumor area. Tumor cell can go to lymph nodes via this pathway. This conclusion provides theoretical basis for clinical utility of the anti-tumor medicines which inhibitable lymphatic formation. It can help surgeons forecast prognosis and select more effective treatment method to observe join lymphatic vessel quantity.