Carbon nanoparticles facilitate lymph nodes dissection and parathyroid glands identification in reoperation of papillary thyroid cancer.

The aim of the study was to investigate whether carbon nanoparticles (CNs) can improve the dissection of lymph nodes and protect parathyroid glands (PGs) during reoperation for patients with papillary thyroid carcinoma (PTC).PTC patients who previously underwent thyroidectomy and later received reoperation between January 2009 and January 2016 were retrospectively recruited. We compared the patients who had CN suspension injected into the residual thyroid gland with a control group of patients who did not have the injection. The primary endpoints were the number of lymph nodes dissected, the number of PGs identified and reimplanted, and the rate of postoperative hypoparathyroidism.CN suspension injection was conducted in 55 of 174 patients. The total number of lymph nodes and metastatic lymph nodes dissected between the 2 groups were not different (22.8 ±â€Š13.7 vs 21.0 ±â€Š13.3, P = .481 and 5.5 ±â€Š3.8 vs 4.8 ±â€Š4.0, P = .695). The number of central lymph nodes and metastatic central lymph nodes in the CN group was significantly higher than those dissected in the control group (8.7 ±â€Š6.9 vs 6.2 ±â€Š5.2, P = .037 and 2.7 ±â€Š1.9 vs 2.1 ±â€Š1.6, P = .012). More PGs were identified (2.42 ±â€Š1.15 vs 1.58 ±â€Š1.12, P = .001) and fewer were reimplanted (48 vs 90, P = .040) in the CN group. Patients who had CN suspension injection had a lower rate of transient hypoparathyroidism (14/55 vs 50/119, P = .043) but no significant difference in the rate of permanent hypoparathyroidism (1/55 vs 9/119, P = .173).CN suspension injection improves dissection of central lymph nodes and identification of PG in PTC patients undergoing reoperation and lowers the rate of postoperative transient hypoparathyroidism.

[The Risk Factors of Contralateral Central Lymph Node Metastasis in Solitary Thyroid Papillary Micro-carcinoma].

OBJECTIVE: To explore the possible risk factors of contralateral central lymph node metastasis (CLNM) in solitary thyroid papillary micro-carcinoma (PTMC). METHODS: Clinicopathologic data of 318 patients with confirmed solitary PTMC by final histological who underwent bilateral centeral lymph node dissection (CLND) from April 2012 to May 2015 in our hospital were retrospectively reviewed. Univariate Χ2 test and multivariate logistic regression analysis were used to determine the risk factors of contralateral CLNM in solitary PTMC. RESULTS: The incidence of ipsilateral CLNM and contralateral CLNM in solitary PTMC patients were 40.57% (129/318), 9.75% (31/318), respectively. Univariate analyses revealed that contralateral CLNM had a correlation with tumor located in lower pole, capsular invasionand underlying ipsilateral CLNM (P < 0.05), and had a correlation with underlying nodular goiter (P < 0.05). Multivariate logistic regression analysis showed that tumor located in lower pole and ipsilateral CLNM were independent risk factors for contralateral CLNM (P < 0.05). CONCLUSIONS: Solitary PTMC patients had a low tendency to contralateral CLNM, it shouldn't undergo contralateral CLND commonly, if the tumor located in lower pole or combine withipsilateral CLNM, it should be consider to undergo bilateral CLND.

Prediction of nonrecurrent laryngeal nerve before thyroid surgery--experience with 1825 cases.

BACKGROUND: Nonrecurrent laryngeal nerve (NRLN) is a rare anatomic anomaly, which often co-occurs with aberrant right subclavian artery (ARSA). With this large case series, we present our experience of predicting the presence of NRLN by the means of chest X-ray film, thoracic computed tomography (CT), and ultrasonography. MATERIALS AND METHODS: A prospective, nonrandomized study has been carried out. A total of 1825 patients with various thyroid disorders scheduled for surgery were recruited between January 2006 and July 2012. All patients underwent preoperative chest X-ray examination. Those suspected with ARSA further underwent thoracic CT scan. Unsuspected patients who had NRLN revealed by surgery were analyzed with ultrasonography postoperatively. RESULTS: A total of 41 patients (2.25%) were suspected to have ARSA by X-ray, of those 19 (46.3%) were confirmed by thoracic CT and proven to have NRLN upon subsequent surgery. No NRLN injury was inflicted. For the remaining 22 cases, CT scan suggested a normal right subclavian artery and none had NRLN upon surgery. For the 1784 unsuspected patients, 4 (0.22%) were discovered to have NRLN upon surgery, of those one was injured. For the 19 predicted NRLN, the time used for identifying the nerve was significantly shorter than the four cases with unsuspected NRLN (t = -15.978; P = 0.000). After the operation, all these unsuspected NRLN were confirmed to have ARSA by ultrasonography. CONCLUSIONS: Patients scheduled for thyroid surgery should be screened for ARSA upon routine chest X-ray and thyroid ultrasonography before surgery. Detection of ARSA can accurately predict the existence of NRLN; hence prevent NRLN injury during subsequent surgery.

[Clinical research strategy for cN0 thyroid papillary carcinoma central lymph node dissection].

OBJECTIVE: To discuss the pattern of central lymph node metastasis of cN0 single thyroid papillary carcinoma and provide clinical evidence-supported proof for central lymph node dissection. METHODS: The performed thyroidectomy and bilateral central lymph node dissection for 150 patients with cN0 single papillary thyroid carcinoma. The bilateral central lymph nodes were divided into 4 parts: the cornu inferius cartilaginis thyroideae region of ipsilateral central area, the lower part of ipsilateral central area, the cornu inferius cartilaginis thyroideae region of contralateral central area, the lower part of contralateral central area on the baseline of 1 cm below the cornu inferius cartilaginis thyroideae. We analyzed the differences and influencing factors of lymph node metastasis in these 4 parts. RESULTS: The lymph node metastasis rate in lower part of ipsilateral central area was the highest (56.7%), followed by the lower part of contralateral central area (28.0%), the cornu inferius cartilaginis thyroideae region of ipsilateral central area (17.3%), and the cornu inferius cartilaginis thyroideae region of contralateral central area (0). In the logistic analysis of multiple factors, invaded thyroid capsule was an independent factor for lymph node metastasis in both the cornu inferius cartilaginis thyroideae region of ipsilateral central area (ß = 0.1835, χ(2) = 0.3102, P < 0.05) and lower part of contralateral area (ß = 0.3166, χ(2) = 1.4640, P < 0.05). The patients' age ≥ 45 years (ß = 0.5737, χ(2) = 6.5923) and invaded thyroid capsule (ß = 0.4258, χ(2) = 3.4735) were independent factors for lower part of ipsilateral central area (both P < 0.05). CONCLUSION: The cornu inferius cartilaginis thyroideae region of contralateral central area of cN0 single PTC patients could not be cleared routinely.

[Predictors of level V lymphatic metastasis in papillary thyroid carcinoma].

OBJECTIVE: To study the predictors of level V metastasis in papillary thyroid carcinoma (PTC). METHODS: The clinic data of 122 patients with PTC who underwent therapeutic lateral neck dissection between March 2004 and November 2010 was analyzed retrospectively. There were 31 male and 91 female patients. The median age at diagnosis was 38.5 years (ranging from 8 to 87 years). All the patients had undergone unilateral or bilateral lymph node dissection (II-VI or I-VI). Univariate analysis and multivariate analysis were performed using χ(2) test and binary Logistic regression test, respectively. RESULT: The level V metastases was significantly associated with capsular invasion, extrathyroidal extension, preoperative distant metastasis, the size of primary, ipsilateral level IV lymph node metastasis and simultaneous metastases to ipsilateral level II, III and IV (χ(2) = 4.223 - 13.748, P < 0.05). Age, sex, tumor-multifocal, pTNM, central lymph node metastases ipsilateral level II lymph node metastases and ipsilateral level III lymph node metastases were not found to be associated with level V metastases (χ(2) = 0.882 - 3.167, P > 0.05). In multivariate analysis, extrathyroidal extension (OR = 8.32, 95%CI: 2.44 - 28.3, P = 0.001) and simultaneous metastases to ipsilateral level II, III and IV (OR = 7.81, 95%CI: 2.11 - 28.8, P = 0.002) were independent predictors of level V metastasis. CONCLUSIONS: Extrathyroidal extension, simultaneous metastases to ipsilateral level II, III and IV are risk factors for level V lymph nodes metastases in PTC. Dissection of level V lymph nodes should be considered for PTC patients with extrathyroidal extension and simultaneous metastases to ipsilateral level II, III and IV.

[Related factors of central lymph node metastasis in papillary thyroid carcinoma].

OBJECTIVE: To study the related factors of central lymph node (CLN) metastasis in papillary thyroid carcinoma (PTC),the indications and the extent of central neck dissection (CND). METHODS: A total of 153 cases treated between Jan. 2009 and Dec. 2010 was analysed retrospectively. Of the cases 28 males and 125 cases females, with a mean age of (44 ± 14) years. T1, T2, and T3 diseases accounted for 51, 10 and 81 cases, respectively; I, II, III and IV diseases for 88, 3, 26 and 36 cases, respectively. Multifocal tumors were found in 63 cases. The related clinicopathologic factors were analyzed, including sex, age, tumor size, extrathyroidal extension, and multifocal tumor. RESULTS: All the cases had total/near total thyroidectomy and CND, of them 64 cases had unilateral neck dissection and 18 cases had bilateral neck dissection. CLN metastases existed in 68.6% (105/153) cases, 37.2% (57/153) for unilateral and 31.4% (48/153) for bilateral respectively. The rates of CLN metastasis were 86.6% (71/82) in cN1 cases and 47.9% (34/71) cN0 cases, respectively,and the rates of bilateral CLN metastases were 45.1% (37/82) in cN1 cases and 15.5% (11/71) in cN0 cases. Multivariate analysis showed that extrathyroidal extension (P = 0.002, OR = 3.502) was an independent risk factor for CLN metastasis and that lateral neck lymph node metastasis (P = 0.028, OR = 3.080), surrounding tissue invasion (P = 0.014, OR = 3.113), and maximum tumor diameter greater than 1 cm (P = 0.012, OR = 3.732) were independent risk factors for bilateral CLN metastases. CONCLUSIONS: It is indicated that ipsilateral CND should be obligatory for PTC. Intraoperative frozen section examination should be routine. Bilateral CND should be conducted when ipsilateral CLN metastases accompanied by one of following issues such as more invasive tumor (surrounding tissue invasion, T3 or T4 disease), maximum tumor diameter greater than 1 cm, and lateral neck lymph node metastasis.

[Cultivation and characterization of tumor spheres generated from human colorectal cancer cell lines].

OBJECTIVE: To study on the cultivation method for tumor spheres from colorectal cancer cell lines and identify whether resulting Colo205 spheroid cells display cancer stem cell characteristics. METHODS: Lovo, Colo205 and SW480 cells were seeded in serum free medium (SFM) with EGF and bFGF. Flow cytometry analysis, cell invasion assay and xenograft experiment were applied to examine the cell surface marker expression pattern, cell invasive ability and in vivo tumorigenicity of both Colo205 spheres and parental cells. CD44 expression of tumor spheroid cells was also analyzed after cultured with serum supplemented medium by flow cytometry. CD44, Musashi-1 and Oct4 mRNA were detected in these two cells by RT-PCR. RESULTS: Tumor spheres could be generated from three colorectal cancer cell lines in SFM. The formation and proliferation of tumor spheres were benefited from fresh SFM, cell dissociation reagent Accutase and the floating status of cancer cells. The overwhelming majority of spheroid cells were CD44+ cells. But CD44+ cells were gradually decreased when spheres cultured with serum supplemented medium. Colo205 spheres have higher Musashi-1 and Oct4 mRNA expression, tumor-initiating capability and invasive ability compared with those of parental cells. CONCLUSION: Tumor spheres in which enrich cancer stem cells can be generated and matained from colorectal cancer cell lines in SFM on floating-culture condition.

[An investigation of BRAF mutation in papillary thyroid carcinoma and its clinical value].

OBJECTIVE: To study the relationship between BRAF mutation and clinicopathological features in papillary thyroid carcinoma (PTC). METHODS: Fresh samples were examined for the presence of BRAF mutations in 43 patients with PTC and 20 patients with non-PTC thyroid disease and 40 normal thyroid tissues by polymerase chain reaction (PCR) and direct sequencing. The relationship between BRAF mutation and clinicopathological features was studied. RESULTS: BRAF mutation was detected in 39.5% (17/43) of PTC samples, in 0 of non-PTC thyroid disease samples and normal thyroid tissues. Significant association was seen between BRAF mutation and both extrathyroidal invasion and cervical lymph node metastasis (P<0.05, P<0.05). There was no significant relationship between BRAF mutation and gender, age at the time of diagnosis, tumor size and distant metastasis. CONCLUSION: BRAF mutation is associated with extrathyroidal invasion and lymph node metastasis. It may increase the ability of invasion and metastasis of PTC and have influence on prognosis.

Sequential defunctionalization followed by thyroxine supplementation as preoperative preparation of hyperthyroid patients undergoing thyroidectomy.

BACKGROUND: Preparing hyperthyroid patients for thyroid surgery with a combination of antithyroid drugs and thyroxine has long been controversial because this combination usually results in only partial inhibition of thyroid function. We therefore used large doses of antithyroid drugs to completely inhibit the synthesis of thyroxine and render the thyroid gland defunctionalized. We then administered physiologic doses of thyroxine to inhibit thyroid-stimulating hormone secretion. We have named this treatment "sequential thyroid defunctionalization followed by thyroxine supplementation." METHODS: Four hundred and seventy-one hyperthyroid patients seen at our hospital were divided into experimental and control groups. The control group was treated preoperatively with antithyroid drugs and iodine preparation. The experimental group was further divided into four subgroups and treated with "sequential thyroid defunctionalization followed by thyroxine supplementation". Each of the four subgroups received different doses of antithyroid drugs and thyroxine for differing time periods. Thyroid function was assessed at each stage of treatment, as were operative blood loss volumes and postoperative complications. RESULTS: Compared to the control group, the four experimental groups showed less thyroid congestion and surface varices at surgery. Patients in subgroup A also had thyroid glands that were almost histologically normal. The mean operative blood loss volume of the experimental group was less than that of the control group (326 +/- 163) ml in the control group; (196 +/- 57) ml in subgroup A; (230 +/- 71) ml in subgroup B; (240 +/- 80) ml in subgroup C; and (312 +/- 97) ml in subgroup D). The postoperative complication rate of the experimental group was 8.64% (21/243) whereas that of the control group was 17.54% (40/228). CONCLUSIONS: Sequential thyroid defunctionalization followed by thyroxine supplementation is effective in reducing the bleeding volume and postoperative complication rate in selected hyperthyroid patients undergoing thyroidectomy.

Endoscopic thyroidectomy: an evidence-based research on feasibility, safety and clinical effectiveness.

BACKGROUND: The feasibility and safety of endoscopic thyroidectomy were evaluated by an approach of systematic review of published studies in the past decade. METHODS: A database searching was performed on MEDLINE, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials. Both comparative and non-comparative studies about endoscopic thyroidectomy were selected and analyzed. For the comparative studies, RevMan 4.2 was used for statistical analysis; and for the non-comparative studies, data analysis was performed by SPSS 13.0. RESULTS: Seven comparative studies involving 367 patients (video-assisted thyroidectomy (VAT), 174 patients; conventional thyroidectomy (CT), 193 patients) were included in VAT-CT group. Age, gender, operative types, and pathological diagnosis were similar. Compared with CT, the mean operative time for VAT was significantly longer (VAT, 80.0 minutes; CT, 61.9 minutes, P < 0.01), but the postoperative hospital stay was shorter (VAT, 1.7 days; CT, 2.5 days, P < 0.01). The complication rate for VAT was 6.9%, while that for CT was 9.3% (P = 0.35). Three studies analyzed the postoperative pain and cosmetic evaluation, and indicated that the VAT group was superior to the CT group, but there was no significant difference after a meta-analysis. Three comparative studies involving 273 patients (totally endoscopic thyroidectomy (TET), 145 patients; CT, 128 patients) were included in TET-CT group and the results generally resembled that of VAT-CT group. There were 18 and 14 non-comparative studies reporting the results of VAT and TET, respectively. The mean operative time for VAT was 76.8 minutes compared with 135.8 minutes for TET. The postoperative hospital stay was 1.8 and 3.8 days for VAT and TET respectively. The rates of conversion to open surgery for VAT and TET were similar (VAT, 2.8%; TET, 3.9%, P = 0.105). The complication rate for VAT was 8.6%, while that for TET was 3.5% (P < 0.01). CONCLUSIONS: The feasibility and safety of endoscopic thyroidectomy were initially verified and accepted, and it should be considered as a valid option, offering some advantages to patients in terms of cosmetic results and postoperative distress.

[Safety of routine exposure of recurrent laryngeal nerve in thyroid surgery].

OBJECTIVE: To explore the safe approach to routine exposure of the recurrent laryngeal nerve in thyroid surgery. METHODS: A total of 1974 sides of laryngeal nerves were exposed in 1458 thyroid surgeries, which included six right side non-recurrent laryngeal nerves. Ninety seven percent (1915 sides of the laryngeal nerves) were exposed through inferior thyroid artery way. The rest were exposed through nerve entrance way (38 sides, 1.9%) or isthmus-to-tracheoesophageal groove way (21 sides, 1.1%). RESULTS: Permanent injury of recurrent laryngeal nerves occurred in seven cases, which comprised 0.5% of the total surgeries. Transient injury of recurrent laryngeal nerves occurred in 24 cases, which comprised 1.6% of the total surgeries. CONCLUSION: Routine exposure of recurrent laryngeal nerve in thyroid surgery is safe. The exposure should be started from the inferior thyroid artery and be ended at the nerve entrance into laryngeal.

[Study on thyroid defunctionalization method for the preoperative preparation of hyperthyroid operation].

OBJECTIVE: To set up and publicize the thyroid defunctionalization method for the preoperative preparation of hyperthyroid operation. METHODS: 476 hyperthyroid patients admitted in our hospital from March 1990 to February 2005 were studied by groups. They were divided randomly into a test group (244 patients), in which "preoperative preparation method of sequential thyroid defunctionalization" was applied to hyperthyroid patients, and based on the different drug dosages and treating terms used, further 4 subgroups (A, B, C and D) were divided to observe the treatment efficiency; And a control group (232 patients), in which antithyroid drugs and iodine preparation were applied preoperatively to cases. Thyroid functions in every stage of treatment were tested by radioimmunoassays (RIA), and operative bleeding volumes and postoperative complications were observed. RESULTS: Compared to the control group, the thyroid congestion and surface varices were alleviated in the test groups, in which the thyroid tissue of subgroup A most closed to euthyroidism histologically. The mean operative bleeding volume of test group was less than that of the control group. The bleeding volumes were (324.76 +/- 163.26) mL for the control group, (195.74 +/- 57.07) mL for the subgroup A, (230.00 +/- 70.81) mL for the subgroup B, (240.47 +/- 80.29) mL for the subgroup C and (314.75 +/- 96.46) mL for the subgroup D. There was no significant difference between the control group and subgroup D, but compared with the subgroup A, B, and C, there was the significant difference between control and treated subgroup (P < 0.05). The postoperative complication rate of the test group was 8.61% (21/244), while that of the control group was 17.24 (40/232). There was statistic difference between two groups (P < 0.005). CONCLUSION: The key to "preoperative preparation method of sequential thyroid defunctionalization" is as follows: the synthesis of thyroxin should be fully inhibited to thyroid defunctionalized; sufficient exogenous thyroxin should be supplemented; the term of thyroid function compensation should be long enough. The "preoperative preparation method of sequential thyroid defunctionalization" can decrease perioperational complications effectively and operation risks.