| Part Ⅰ Ultrasound-guided fine needle aspiration biopsy and cytological evaluation for thyroid micronodulesObjective:This part aimed to evaluate the value of ultrasound-guided fine needle aspiration biopsy(US-FNAB)and cytological evaluation in the diagnosis of thyroid micronodules.Methods and Materials:A total of 1100 patients with 1100 thyroid nodules who underwent ultrasound-guided FNAB and cytological evaluation in our hospital were retrospectively reviewed.Patients were divided into>1.0 cm group and ≤1.0cm group according to the maximum diameter of the thyroid nodules.Ultrasound findings and cytological results of the patients were analyzed and compared.Results:Ultrasound findings:For all 1100 nodules,547 cases were highly suspected as malignancy,cytology positive were 474(86.7%);358 cases were moderately suspected as malignancy,cytology positive were 62(17.3%);175 cases were lowly suspected as malignancy,cytology positivewere 42(24%);19 cases were extremely lowly suspected as malignancy,cytology positive were 1(5.3%);and 1 case was benign,cytology positive was 0(0%).In>1.0 cm group,129 cases were highly suspected as malignancy,cytology positive were 116(89.9%);104 cases were moderately suspected as malignancy,cytology positive were 12(11.5%);77 cases were lowly suspected as malignancy,cytology positive were 13(16.9%);11 cases were extremely lowly suspected as malignancy,cytology positive was 0(0%);and 1 case was benign,cytology positive was 0(0%).In ≤ 1.0cm group,418 cases were highly suspected as malignancy,cytology positive were 358(85.6%);254 cases were moderately suspected as malignancy,cytology positive were 50(19.7%);98 cases were lowly suspected as malignancy,cytology positive were 29(29.6%);8 cases were extremely lowly suspected as malignancy,cytology positive was 1(12.5%);and 1 case was benign,cytology positive was 0(0%).Cytological results:In 1100 nodules,there were 453 papillary carcinomas,126 suspected papillary carcinomas,26 follicular tumors,6 suspected follicular tumors,7 atypical lesions of unknown significance,289 nodular goiters,13 colloid and 175 chronic lymphoid thyroiditis,and 5 samples could not be diagnosed or had poor preparation.The sensitivity and specificity of US-FNAB in the diagnosis of thyroid nodules were 86.007%and 81.9%,respectively.The sensitivity and specificity of US-FNAB in>1.0cm and ≤1.0cm groups were 92.8%vs 92.3%and 82.4%vs 81.7%,respectively.Conclusion:For thyroid nodules which ultrasound highly suspected asmalignancy,US-FNAB and cytological evaluation are effective methods to confirm the nature of the nodules.Part II Role of B-raf expression in thyroid papillary microcarcinoma with lymph node metastasis after ultrasound-guided fine needle aspiration biopsyObjective:This part aimed to investigate the relationship of B-rafV600E&B-rafRNA expression inpapillary thyroid microcarcinoma(PTMC)with lymph node metastasis.Methods and Materials:A total of 116 patients with 116 cases of PTMC were divided into metastasis group(58 cases)and non-metastasis group(58 cases).B-rafV600E mutation was detected and B-rafmRNA expression was measured by RT-PCR.Results:A total of 116 nodules were sampled in 116 patients,the mean maximum diameter was 0.62±0.24cm(range:0.24-1.00 cm).The mean maximum diameter was0.78±0.19cm(range:0.511.00cm)in metastasis group while in non-metastasis group was 0.47±0.38cm(range:0.24-1.00cm).There were 18 males and 40 females with the mean age of 47.6±6.9 years and 20 males and 38 females with the mean age of 48.3±7.8 years in metastasis and non-metastasis groups,respectively.B-rafinRNA expression was significant higher in metastasis group than in non-metastasis group with statistical significant(P<0.05);the frequency of B-rafV600E mutation was significant higher in metastasis group than in non-metastasis group with statistical significant(P<0.05).In B-rafV600E mutation group,the size of PTMC was significant larger than that in non-B-rafV600E mutation group(P<0.05);more patients with PTMC in B-rafV600E mutation group were diagnosed with lymph node metastasis(P<0.05).In our study,distal metastasis was identified in only 6 patients,5 inB-rafV600E mutation group and 1 in non-B-rafV600E mutation group.It seems that B-rafV600E mutation was related to the distal metastasis of PTMC,but significant difference was not observed due to small sample.No significance were found in age,gender and number of lesions between B-rafV600E mutation group and non-B-rafV600E mutation group(P<0.05).Conclusion:B-rafV600E and B-rafinRNA mutation were closely related to the lymph node metastasis of PTMC.Part III Ultrasound-guided percutaneous laser ablation in the treatment for papillary thyroid microcarcinomaObjective:Ultrasound-guided percutaneous laser ablation(UG-PCLA)was performed in 138 PTMC patients.The feasibility,safety and efficacy were evaluated.Methods and Material:Patients who were diagnosed with PTMC by ultrasound-guided fine needle aspiration biopsy and cytological evaluation between January 2015 and December 2016 in our hospital were recruited,and UG-PCLA was performed in 138 patients with 138 lesions based onpersonal preference.Careful explanation of the procedure of UG-PCLA was offered and informed consent was obtained before surgery.Pre-operative routine examinations,ultrasound examination,contrast-enhanced ultrasonography and Virtual touch tissue quantification(VTQ)were performed,intra-operative treatment and complications were recorded,and post-operative contrast-enhanced ultrasonography was done to evaluate the effect of the surgery.After surgery,follow-up including the detection of thyroid function,ablation volume,contrast-enhanced ultrasonography,VTQ,post-operative complications,post-operative cytological examination after FNAB of ablation region,recurrence and metastasis were performed.Results:Pre-operative ultrasonography:138 lesionswere showed as solid hypoechoic,the mean maximum diameter was 0.52±0.23cm(range:0.37-1.00cm),big calcified foci were found in 17 lesions,spotty calcified foci in 71 lesions,and 40 lesions had no calcified foci.Contrast-enhanced ultrasonography showed uniform enhancement in 33 lesions,and uneven enhancement in 105 lesions.VTQ imaging showed the mean SWV was 3.01 ± 1.12m/s(range:1.87-9.00m/s).Intra-operative observations:UG-PCLA was performed successfully in all patients.Immediate ultrasonography evaluation after treatment showed the ablation region completely covered the original lesions.Contrast-enhanced ultrasonography showed no enhancement in the ablation region.Observation of symptoms:pain was found in 52 patients,in whom 12 developed severe pain and were gradually reduced after supplemental anesthesia with 2%lidocaine;intraoperativehoarse was noted in 23 patients while spontaneous disappeared in 4-5 h after treatment without any administration;hemorrhage was not observed in ultrasound images in all patients.Post-operative follow-up:pain was noted in 42 patients 1 h after surgery,but was tolerable with no specific treatment;3 patients developed mild pain 1 day after surgery,but none had pain 1 week after surgery;hoarse was found in 23 patients 1 h after surgery with no specific treatment,and disappeared 1 day after surgery;hemorrhage was not observed in ultrasound images 1 h after surgery.Thyroid function:T3,T4,FT3 and FT4 increased,TSH reduced,and TPO-Ab and TG-Ab remained unchanged at 1 h,1 day and 1 week after surgery;T3,T4,FT3 and FT4 at 1 month after surgery were lower than those at 1 h,1 day and 1 week after surgery,but TSH increased at 1 month,compared to that before surgery,the differences were not significant(P>0.05).Ablation region:1 day after surgery,the mean ablation volume was 543.84±213.67mm3(range:248.29-1734.45mm3);the ablation volume remained unchanged at 1 week after surgery;but the ablation volume reduced in 1 month;the ablation volume further reduced in 3 months after surgery;the ablation volume in 6 months and 12 months was comparable to 3 months.Contrast-enhanced ultrasonography:no enhancement was not observed in the ablation region at 1 h,1 day and 1 week after surgery,partial enhancement was noted in the ablation region of 41 cases at 1 month after surgery;enhancement was found in the ablation region of 87 patients at 3 months after surgery;enhancement was observed in the ablation region of 127 patients at 6 months after surgery,and only 2 patients had no enhancement at 12 months after surgery.VTQ imaging:SWV was 4.19±2.34m/s in 1 day,4.87±3.22m/s in 1 week,3.52±1.74m/s in 1 month,3.22±1.88m/s in 3 months,3.35±2.04m/s in 6 months and 3.31±2.17m/s in 12 months after surgery.Cytological examination after FNAB of ablation region:tumor cells were not observed in the central ablation region,carbonization was noted in the ablation region immediate,in 1 day,1 week and 1 month after surgery;blood cells and epithelial cells were noted in the ablation region in 6 months and 12 months after surgery,but carbonization was not observed.Conclusion:UG-PCLA is a feasible,safe and effective strategy for PTMC and may be employed as one of regimens in the clinical treatment of PTMC. |
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