Research On Clinicopathological Features And Related CK19 Expression Of Malignant Thyroid Nodules

Objective:1.To improve the diagnosis and surgical treatment of patients with thyroid nodule;2.To assese the diagnostic value of immunohistochemical staining of CK19 on thyroid nodule tissues at differentiating between benign and malignant thyroid nodules;Methods:1.Clinical and pathological characters of 2844 cases with thyroid nodule which underwent operation in Tianjin Medical University General Hospital during 1999-2008 were retrospectively analyzed to improve the accuriety of differentiat diagnose of benign and malignant thyroid nodule,and to improve the treatment.2.The expression of CK19 were examined immunohistochemically in 40 cases of nodular goiter and 40 cases of papillay thyroid carcinoma.Results:1.2226(78.27%) cases were diagnosed as nodular goiter,300(10.55%) as thyroid malignant tumor,258(86.0%) cases as papillary thyroid carcinoma of thyroid. The ratio of benign to malignant is 8.48:1 and male to female is 1:3.38.Malignant thyroid nodules from benign lesions combined accounted for 34.33%(103/300),the combined 85 cases of nodular goiter,nodular goiter with malignant transformation rate of 3.68%(85/2311).2.The average age of malignant cases is signifcantly younger than that of benign cases(P＜0.05).Follicular thyroid cancer was the minimum age (34.43 years) in malignant cases,papillary carcinoma(44.47 years),medullary carcinoma(47.4 years) and undifferentiated carcinoma(56.87 years) followed by increased,those groups were significant differences(p＜0.05).3.1 year incidence of malignant nodules surgery rate(43%) higher than benign nodules(34.63%).From 2000 to 2008,the course is less than 1 year of operation the number of cases(142→390) and surgical cases each year a number of malignant nodules(25→56) gradually increased,a positive correlation(p＜0.05).However,no correlation between the proportion of that(70.65%→70.40%,12.44%→10.11%).4.The major reason of treatment is finding of neck masses,malignancy group were significantly more than the benign group in emergence of preoperative hoarseness,cough,neck lymph nodes, hyperthyroidism,abnormal thyroid antibodies,the second surgery(P＜0.05).5.The reoperation rate of malignant thyroid nodules is significantly higher than that of benign nodules.6.in malignant group the number of nodules,the ratio of solid nodules,the number of enlarged lymphonodes are significantly higher than that in benign gruop,differentiated thyroid cancer is less than 4cm in size-based,accounting for 39.22%(91/232),and other malignant nodules greater than 4cm in diameter significantly larger number of cases,the two groups was statistically differences (P＜0.05).7.Differentiated thyroid cancer were more in the middle size(2cm-4cm between),and malignant nodules larger more than.8.Unilateral lobectomy plus isthmusectomy is the major procedure in malignant nodules cases(25%),and the rest from more to less for Unilateral lobectomy,local mass excision,the entire thyroid gland or near-total resection,subtotal lobectomy,glandular leaves some or subtotal, etc.2003 for the sector,compared before and after 5 years less than the affected gland excision leaf,Unilateral lobectomy plus isthmusectomy and near total or total thyroidectomys were have significant difference(p＜0.05).9.The positive rate of CK19 histoimmunochemical detection in malignant thyroid was significantly higher than that of benign ones(P＜0.01).Conclusions:1.Surgical treatment of t malignant nodules cases accounted for 10.55 percent,more women than men(1:3.38),in the majority of papillary carcinoma.More than half of the malignant transformation from benign disease,Malignant transformation rate of nodular goiter was 3.68 percent.2.High incidence of follicular thyroid cancer in 20 to 40 years old,papillary carcinoma and medullary carcinoma of the high incidence of age group 30 to 50 years old,the other of the high incidence of thyroid malignancy in the age of 60 years old.3.Although the main manifestations of malignant nodules as found in the neck tumor,but which is often accompanied by hoarseness,cough,neck lymph nodes,hyperthyroidism,abnormal thyroid antibodies etc.Ultrasonography indicate single,solid mass is also risk factors.Thus treatment of malignant nodules was significantly higher than that of benign nodules.4.Data in this group prompted the incidence of thyroid nodules may increase,but it did not increase the proportion of malignant.5.Malignant nodules higher reoperation rate showed that preoperative diagnosis of the disease is still difficult.6.Thyroid ultrasonography with high specificity and diagnostic accuracy,should be as routine examination.ECT, MIBI,thyroid function,antibody measurement diagnostic examination of thyroid nodules in the application of more and more.Intraoperative frozen examination of the diagnostic value is the highest,but the role of MIBI to be further assessed.7.For malignant thyroid nodules,Unilateral lobectomy plus isthmusectomy is the most used technique,"not less than lobectomy gland"More and more used in the treatment of malignant thyroid nodules.8.CK19 is a very valuable indicator in the diagnosis of pathological of papillary thyroid carcinoma and is a good marker in distinguishing papillary thyroid carcinoma and papillary hyperplasia.